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"If The Washington Post wants to say that our ideas are bold, I accept that,” Sen. Bernie Sanders (I-Vt.) said Thursday in response to a critical editorial we ran about him. “We’ve got to create an economy that works for the middle class. And whether The Washington Post likes it or not, that’s what I intend to do.” In fact, we would love that — and we were heartened that Mr. Sanders chose to engage with our editorial. Yet our disagreements with Mr. Sanders are not as he portrayed them; they do not concern the problems he chooses to address or the boldness with which he proposes to address them. What concerns us is not that Mr. Sanders’s program to tackle these issues is “radical,” as he put it, but that it is not very well thought out. We are far from the only ones, for example, to point out that his health-care plan rests on unbelievable assumptions about how much he could slash health-care costs without affecting the care ordinary Americans receive. (1/28)

A week ago I worried about the Sanders health plan; it looked as if he was low-balling costs in an effort to obscure how hard making such a plan would be, and how many currently well-insured people would end up being losers. ... Now Kenneth Thorpe, a health policy expert (and a long-term supporter of health reform who believes that single payer would be a good thing if politically feasible) has tried to crunch the numbers, and it really doesn’t look good. Thorpe estimates that the plan would actually require about twice as much new revenue as Sanders claims. (Paul Krugman, 1/28)

For a moment during Thursday's GOP debate, it looked like a leading Republican presidential candidate might actually explain how he intends to replace Obamacare. And then -- poof -- the moment passed. It happened when Fox News host and moderator Bret Baier asked Sen. Ted Cruz (R-Texas) about the Affordable Care Act -- and decided to press Cruz on what he intended to do about people now getting health insurance because of the law. ... Truth is, Republicans don’t have a better alternative to the health care law. All of their plans result in far fewer people having insurance, or the people with insurance having much weaker coverage -- because making coverage available to all, at affordable prices, requires a combination of spending, taxes and regulation that Republicans can’t abide. (Jonathan Cohn, 1/28)

The two fundamental objectives behind Obamacare — universal coverage and cost containment — have not been reached. We have, however, spent a boatload of money and raised taxes for many. Around 5 million people got booted off of their insurance plan, many of whom therefore could not keep their doctors. Like so much else of the social welfare state, the problem is not that Obamacare accomplished nothing. It is that it accomplished far less, at far higher cost, and with far less personal choice than might otherwise have been available. (Jennifer Rubin, 1/28)

Every single Democrat in the Iowa Senate —a majority of the chamber’s members — signed a letter sent to President Barack Obama this week asking for help. Stop Gov. Terry Branstad from privatizing management of our state’s Medicaid program, they urged. Deny his request for federal permission to proceed. (1/29)

Senate Democrats have submitted a letter to President Obama and other federal officials about our concerns over Governor Branstad’s unilateral decision to privatize Iowa’s Medicaid program. We appreciate the decision by federal officials in December to delay implementation of Medicaid privatization until at least March 1. ... But Iowa still isn’t ready. Since the delay by the Centers for Medicare and Medicaid Services (CMS) more than 40 days ago, we have seen no evidence that the Iowa Medicaid Enterprise and the out-of-state companies picked to help privatize Medicaid have taken the steps necessary to ensure the health and well being of more than 560,000 Iowans. (State Sen. Dick Dearden, 1/29)

Nearly five years after a group of homeless veterans sued the U.S. Department of Veterans Affairs for allegedly misusing its sprawling property in West L.A., the department has finally approved a draft master plan that will focus the campus more sharply on the people it was intended to serve. The plan still has to undergo environmental and historic preservation reviews before it can become final. Nevertheless, its clear aim is to turn the campus from a place mainly used for dispensing medical care into an inviting locale designed not just for vets' medical care, but also for their social, recreational, counseling and housing needs. (1/29)

Public health is responsible for extraordinary achievements over the past century, such as remarkable gains in life expectancy and substantial decreases in infectious disease mortality, and could make similar critical contributions to health in this century. Public health should be ascendant, but ample evidence suggests that it is on the defensive today, underappreciated, and underfunded. Government actions to improve the health of populations are widely suspect, as illustrated by the controversies involving efforts to curb soda container sizes in New York City, state and federal efforts to limit reproductive health rights, and global efforts to address climate change. (Sandro Galea and George J. Annas, 1/28)

New York University obstetrician and gynecologist Taraneh Shirazian has been seeing some very worried women — those with pregnancies who have traveled through Latin America and the Caribbean in the last few months. As the scale of Zika virus outbreak becomes apparent, they are terrified that their unborn children may have been affected. She struggles to know what to tell them about the risk they may face. The data is simply not available. What is clear, however, is that the Americas appear to be facing a health crisis on a scale and potential complexity that could be compared to West Africa’s 2014 Ebola outbreak. (Peter Apps, 1/28)

Vice President Joe Biden's yearlong push to cure cancer by marshaling the resources of the federal government will no doubt involve every kind of cancer study and devote much effort to bringing new investment -- public and private -- to the work. In one critical corner of cancer research, however, a lot of progress could be made with little new spending, if Biden would help clear a few obstacles. This is the effort to learn more about which of the so- called variant genes in human DNA cause cancers to start growing. Knowing this, medical scientists could better tell who is at risk and how to prevent and treat the disease. Today, researchers know only a fraction of those variant genes because they lack access to crucial genetic data. Biden could help them get the information they need. (1/28)

In recent decades, the United States has seen a dramatic increase in opioid prescribing for chronic pain. That growth has been associated with increasing misuse of prescription opioids and has led to increases in deaths due to unintentional opioid overdose and in the number of people seeking treatment for opioid-misuse disorders. There’s probably 100% agreement that we, as a profession and society, have become overly opioid-centric in our management of chronic pain. Far more controversial are the role of long-term opioid therapy in managing chronic pain and the best strategy for ending the epidemic of prescription-opioid misuse. (Daniel P. Alford, 1/28)

This newspaper’s advice in July was to not draw conclusions until everyone learned more about the secretly recorded videos of Planned Parenthood medical officials discussing fetal-tissue handling practices. Unfortunately, too many politicians couldn’t help themselves and jumped at the chance to demonize the women’s health provider. But facts are increasingly getting in the way, most recently this week, when a Harris County grand jury cleared Planned Parenthood of any wrongdoing and instead returned indictments against two anti-abortion activists involved in producing the sting tapes. (1/28)

The federal government’s dietary guidelines have changed little since first being issued in 1980. A revised set of recommendations released this month includes a new cap on added sugar, but this is unlikely to end the guidelines’ failure for 35 years to check the rise of obesity and diabetes. The problem, simply put, is a reliance on weak science. (Steven E. Nissen and Nina Teicholz, 1/28)

A recurring question facing medical education is the value of the fourth year of medical school. Some observers have called for eliminating this final year of study altogether. Others, particularly residency program directors, have raised concerns that medical students aren’t being adequately trained for entering residency. ... If the fourth year is potentially expendable, why isn’t it being used to meet the needs and desires of medical students, residents, and residency programs? Surely, a year is sufficient time to address these curricular goals. Unfortunately, meeting these needs is more challenging than one might expect, at least in part because the process of preparing for and applying to residency programs has become overly burdensome. (Eva M. Aagaard and Mona Abaza, 1/28)