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If it's brave to state the obvious -- and in Washington, it often is -- then Paul Ryan may be the most courageous man in Congress. "If we want to save the country, then we need a mandate from the people," the Republican leader said in a speech Thursday at the Library of Congress. "And if we want a mandate, then we need to offer ideas. And if we want to offer ideas, then we need to actually have ideas." ... Ryan's ambition is the right one. He promised "a tax code that rewards good work instead of good connections," an overhaul of federal poverty programs, even an actual Republican plan to replace Obamacare (better six years late than never, as the saying goes). (12/3)

Republicans would like Americans to believe they’ve come up with a kindlier, gentler way to repeal the Affordable Care Act. They haven’t. The Senate on Thursday approved a GOP bill that would eliminate key elements of President Barack Obama’s signature domestic policy achievement, wiping out the coverage expansion that has produced a historic decline in the number of uninsured Americans. ... Thursday’s vote was a first for the full Senate -- and that’s important, even though Obama has already said he’d veto the proposal. It’s a reminder that Republicans remain committed to repeal, even though it hasn’t figured prominently in the presidential campaign, and that they have lined up the necessary votes should one of their own become president in 2017. (Jonathan Cohn, 12/3)

The Affordable Care Act (ACA) is performing worse than expected when it became law: plans are less attractive, enrollment is lower, premium increases are higher, and risk pools are sicker. The Senate is now considering a reconciliation bill that contains several significant policy changes to the ACA, including repealing its new taxes like the individual and employer mandates as well as much of its new spending. One important change is to end the ACA’s elevated federal reimbursement rate for state Medicaid spending for generally able-bodied, working-age adults. (Brian Blase, 12/3)

The Justice Department last month asked the Supreme Court to review a preliminary injunction blocking the Obama administration from implementing the president’s immigration executive order, which would defer deportations for up to five million undocumented immigrants. When President Obama announced his executive action, he acknowledged in his televised speech the concern that such immigrants “would take our jobs” and “stick it to the middle class.” He assured us that this is “not what these steps would do.” But he didn’t consider how this new edict would interact with his other legal inventions, namely ObamaCare. (Andy Puzder, 12/3)

Abortion is an issue that divides Americans along fundamental principles. Opponents of the Supreme Court's Roe v. Wade decision, and of the millions of abortions it has made legal, have every right to denounce that decision in passionate language. But when political leaders falsely equate fetal tissue research -- a morally and scientifically complex effort to advance medical discovery -- with the commercial sale of baby parts, they do nothing to support public debate. We don't know what specifically inspired the gruesome shooting at a Planned Parenthood clinic in Colorado Springs last week. But the setting should surprise no one. (12/2)

The first death threats came at 3 a.m. It was November 1973 and I had just started performing abortions at a small nonprofit clinic in Colorado. ... I started sleeping with a rifle by my bed. I expected to be shot as I walked out the door in the morning or as I came home at night. ... Why do I continue doing abortions? Because it matters.The women need my help. ... Performing safe abortions in a humane, dignified, and caring atmosphere matters for the health and safety of the women. It matters for the health of their families. It matters for the health of our society. (Warren Hern, 12/4)

“The single most effective way to combat the heroin epidemic is renewing bipartisan Medicaid Expansion now,” argues Senate Minority Leader Jeff Woodburn. New Hampshire Democrats echo this talking point, cynically exploiting the drug crisis plaguing the state to get more Medicaid money out of Washington. In truth, the expanded Medicaid program that sunsets 13 months from now has almost nothing to do with the drug problem. (12/3)

A few weeks ago, with very little warning, my skin burst into a mysterious full-body rash. Also, I quit my job. My two new conditions — persistent, inexplicable hives and unemployment — did not seem to be related, but they fit together like a hand in glove. What better time to suffer from a mysterious medical condition than when you have nothing better to do than search Google? I consulted the available literature: WebMD (see a doctor); Mayo Clinic (see a doctor); a passionate, 2,000 post message-board thread filled with fellow sufferers (avoid chemtrails). I decided to see a doctor. So far as I knew, I was insured: I'd signed up online for COBRA, the government program that allows the recently jobless to remain temporarily on their former employers' health plan. For around $400 a month, I could see any doctor in the United Healthcare Choice network. (Max Read, 12/3)

The concept of Medicare negotiating drug prices directly with manufacturers has been raised throughout 2015 by the Senate and the president, but never more vocally than over the last month by presidential candidates Hillary Clinton and Sen. Bernie Sanders (I-Vt.) .... Late last month, President Obama's nominee for Food and Drug Administration (FDA) commissioner, Dr. Robert Califf, was questioned by members of the Senate Committee on Health, Education, Labor and Pensions (HELP) on a variety of issues, including tackling rising prescription drug prices and the right of Medicare to negotiate [prices]. ... While Califf stressed pricing to be largely outside of the FDA's purview, there's no doubt that the FDA is falling short in several actionable areas within its purview and patients are suffering. (Joseph Gulfo, 12/4)