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Trump's pitch to motivate insurers to compete against one another on price and quality of service sounds great in theory. In fact, all insurers already can sell plans in every state. There's a good reason why they don't. Insurance is regulated by the states, not the federal government. Each state writes its own minimum requirements for health coverage; for reserves and other solvency guarantees; for dispute settlements; and for how much plans can discriminate by charging older, sicker people more and younger, healthier people less. To sell plans in, say, Oklahoma, UnitedHealthcare, the U.S.'s largest health insurer, must follow Oklahoma's regulations. No single product would conform with Oklahoma's regulations and those of neighboring states. So UnitedHealthcare must tailor products for each. (Paula Dwyer, 11/10)

Day 1. That’s when President-elect Donald Trump says he expects Congress to send him a bill repealing Obamacare, which he says he’ll sign. And more than 20 million Americans will lose health coverage. “There’s no way to sugarcoat any of this,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “We’re about to throw 20 million people under a bus.” (David Lazarus, 11/10)

President-elect Donald Trump picked up the theme in his campaign, promising “on Day One of the Trump administration” to “ask Congress to immediately deliver a full repeal of Obamacare.” He pledged to supplant it with “something terrific.” This promise is about to come face-to-face with reality. Repealing many Obamacare provisions isn’t possible without the assent of congressional Democrats. Perhaps more important, dismantling key elements of the law risks leaving the U.S. healthcare system in chaos — certainly in worse shape than it was even before the Affordable Care Act was passed. (Michael Hiltzik, 11/10)

In the realm of public policy, a bit of economic thinking can go a long way. Obamacare is seemingly grinding to a [halt] as a result of being fundamentally at odds with basic economic principles. Today, real, acting human beings are much less the object of economics than are complex mathematical models, abstracted away from reality and setting aside the most central ideas of traditional political economy. And that’s unfortunate, because economics as the study of human beings, their wants, and their means of acquiring them has much to teach about health care policy in general and the failures of Obamacare in particular. (David S. D'Amato, 11/10)

In the next few months, the U.S. Department of Justice will square off with lawyers from Anthem and Cigna and then from Aetna and Humana, seeking to block these four giant health insurers from merging into two mega-health insurers. Though these court cases may seem a little less exciting than the Fall classic, many of the tools used to predict the result of the World Series can help observers see why the DOJ should prevail in these important consumer protection cases. (David Balto, 11/10)

Yesterday Americans woke up to news of a new president-elect: Donald J. Trump. The immediate question for those whose lives focus around lifting the health of individual Americans is, “What does this mean for health care in America?” At the heart of the answer is uncertainty. Trump is an “unknown unknown” when it comes to deep, thoughtful health policy. He has excelled in many fields, but at best he personally has only dabbled in the field of health care, which accounts for a fifth of our overall economy and affects literally every American. (Bill Frist, 11/10)

Vice President-elect Mike Pence has told evangelical leader James Dobson that the next administration will reverse President Barack Obama’s contraceptive mandate rules and transgender bathroom guidance -- both of which it can do without Congress. If Pence speaks for President-elect Donald Trump, both decisions would have major implications for cases now before the U.S. Supreme Court. In both cases, the effects of unilateral executive action are tricky, because liberal appellate decisions remain on the books, and because conservatives would like to see those decisions reversed. Trump doesn’t yet have an attorney general or a solicitor general, but his Department of Justice will soon have to figure out how to proceed. (Noah Feldman, 11/10)

As I’ve headed to work in recent days to see abortion patients in my office, I have felt bereft: All the premises of my life, work, education, and future were gone. Something very profound in the meaning of the America I know has been destroyed with the election of Donald J. Trump as president. (Warren M. Hern, 11/11)

In a past era, the work of the hospital physician was done primarily at the bedside or in the adjacent wet laboratory. Residents had the opportunity to witness the unfolding of diseases (for which we may now have cures) and to come to know their patients over the course of lengthy hospitalizations. The life was grueling and all-consuming — and those who took it up were almost invariably unmarried white men, with teaching hospitals actively discouraging marriage. Medicine was a fraternal order. Doctors’ lounges were central locations where community internists, specialists, and surgeons ate together, socialized, and “curbsided” each other for patient consultations. Charts were kept on paper and were often indecipherable. (David I. Rosenthal and Abraham Verghese, 11/10)

Does it seem like every time you turn on the TV these days, there seems to be only two kinds of advertising — political ads and ads from personal injury law firms? Not a day goes by that I don’t see one of these ads from personal injury law firms, which usually make scary claims about the dangers of a medicine or other product and urge people to sue. (Mary Gray, 11/11)

Care for people with multiple medical conditions accounts for the majority of U.S. health care spending. Some of the highest-cost patients have functional impairments and social needs that necessitate long-term services and supports, and there is much debate about designing higher-value, more patient-centered services for them. One approach from England entails the creation of “personal health budgets,” a model for self-directed support that may be worth considering in the United States. (Luke O’Shea and Andrew B. Bindman, 11/10)

On August 24, 2016, I mailed a letter and pocket card to 2.3 million doctors, nurses, dentists, and other clinicians asking them to help address America’s escalating opioid epidemic. It was the first time in the 145-year history of the Office of the Surgeon General that such a letter was issued specifically to medical professionals calling them to action. (Vivek H. Murthy, 11/9)