�鶹Ů��

Critics of the 2010 Affordable Care Act complain that it doesn't do much to control the healthcare costs that are becoming unsustainable for families and businesses. In fact, the law does many small things; the latest is the grant program announced last week to teach Medicare and Medicaid doctors new ways to offer higher-quality, better-coordinated, more cost-effective care. ... Part of the challenge is figuring out how doctors can prosper by delivering better care at lower cost. ... Such statistics won't be the ultimate measure of the program or of the act's other cost-control initiatives, however. It will be whether doctors fundamentally change the way they do business, so the savings continue after the federal dollars expire. (10/26)

There is one unmistakably good piece of news on the budget deficit this election season, but self-proclaimed deficit hawks in the Republican Party have no grounds to boast about it: Since 2010, the pace of health care spending has fallen dramatically and with it, projected deficits over the next decade and beyond. The slowdown is evident in all major health programs, including Medicare, Medicaid and subsidies to buy insurance under the Affordable Care Act. (10/26)

[Ohio Gov. John] Kasich is one of several Republican governors trying to do the same balancing act: opposing Obamacare while taking its Medicaid money. He pushed Ohio to participate in this expansion over the objections of many state Republicans. His remarks highlight the difficulty his party is having on Medicaid -- and point to a weakness that could hurt his chance at the presidential nomination. (Ramesh Ponnuru, 10/24)

It’s time to retire a Democratic establishment politician: Sen. Mark Warner, whose record of accomplishment at the Capitol is thin. His vote to support President Obama’s health care “reform” — a vote that was absolutely essential to its passage — has damaged the country by injecting federal power into our health system in hopes of modest gains purchased at exorbitant costs to our economy, our health and our freedom. This vote alone should disqualify Warner. (10/26)

[O]ne of the enduringly weird aspects of our current pundit discourse [is]: constant calls for a moderate, sensible path that supposedly lies between the extremes of the two parties, but is in fact exactly what Obama has been proposing. ... The Affordable Care Act subsidizes insurance premiums for lower-income workers, and pays for those subsidies in part by eliminating overpayments for Medicare Advantage. So conservatives are celebrating both ends of that deal, right? Oh, wait, death panels. (Paul Krugman, 10/24)

Doctors rarely talk about death. Mostly it's because we're in the business of trying to help people prolong their lives, which almost always makes death an unwelcome topic of discussion. Too often, death is seen as failure, though it shouldn't be. ... Even though my medical practice is mostly confined to the office now, I still confront death regularly. As a part of my practice, I decided to be more mindful about it by keeping a list of the patients I've cared for who have died. I call it my necrology. I started by keeping names in a small notebook. (John Henning Schumann, 10/25)

We learned about my husband's inoperable brain tumor from a nurse who doled out the news as though providing his cholesterol count. ... we readily agreed to the arduous treatment course the specialist suggested: six weeks of chemotherapy and radiation conducted concurrently. ... a doctor told us that 50% of the UCLA patients with his kind of tumor were alive after five years. We never thought about that other 50%, ... But amid the flurry of medical meetings, a friend introduced Mark to a doctor who had also been diagnosed with a brain tumor, though one considered less aggressive. Mark spoke with him. Oddly enough, this fellow had passed up certain treatments. Why? Because doctors don't die like the rest of us. Physicians often decline treatment in cases of terminal illness, (Nora Zamichow, 10/24).