�鶹Ů��

Largely as a note to myself. Amid all the discussions of how Obamacare is doing, it’s easy to lose sight of an obvious question: how’s it doing compared with expectations? You may have heard that fewer people have signed up on the exchanges then predicted; but did you hear about the smaller number of employers dropping coverage, or the unexpectedly strong growth in Medicaid despite red-state rejection? (Paul Krugman, 3/31)

Judging from all the cheering going on among Obamacare enthusiasts–including the usual suspects such as Paul Krugman as well as the president himself–you would think Obamacare had bent the cost curve. This should not be a surprise given that President Obama pointed out 6 years ago, “Every single good idea to bend the cost curve and start actually reducing health care costs [is] in this bill.” If the law failed to bend the cost curve, there surely would be a lot of ‘splainin’ to do. (Chris Conover, 3/31)

History may quibble, but this death-spiral began with Barack Obama’s health-care summit at Blair House on Feb. 25, 2010. For a day, Republicans gave detailed policy critiques of the proposed Affordable Care Act. When it was over, the Democrats, including Mr. Obama, said they had heard nothing new. That meeting was the last good-faith event in the Obama presidency. Barack Obama killed politics in Washington that day because he had no use for it, and has said so many times. The Democrats survived the Obama desert by going to ground. But frustrated Republicans outside Congress eventually started tearing each other apart. (Daniel Henninger, 3/30)

What, exactly, was the Supreme Court doing on Tuesday with its bizarre, lengthy, highly unusual order to the parties in a major case involving religious freedom and contraception? The optimistic answer is, trying to clean up a mess of its own making. ... At oral arguments on Mar. 23, the justices struggled to find less restrictive means that would satisfy the groups’ complaints while ensuring that women would continue getting contraceptive coverage, as the Affordable Care Act requires. ... The court’s strange order illustrates the mess it has waded into by essentially handing over interpretations of federal law to religious objectors. (Jesse Wegman, 3/31)

Before Obamacare, health insurance companies routinely refused to sell policies directly to patients who had illnesses like AIDS, hepatitis C or heart disease. It should be no surprise to anyone, then, that once the Affordable Care Act required insurers to offer insurance to sick people, a lot more sick people signed up. That is the basic conclusion of a new report on health insurance customers from the Blue Cross and Blue Shield Association analyzing health insurance for 4.7 million Americans in 27 states and the District of Columbia. (Margot Sanger-Katz, 3/31)

Bernie Sanders is worrying millionaires, billionaires and now drug patent holders.Sanders and 11 other members of Congress sent a letter on Monday supporting an earlier petition to the National Institutes of Health (NIH) asking the agency to hold a hearing on exercising its so-called "march-in rights" on the prostate cancer drug Xtandi. A 1980 law lets federal agencies force companies to license patents to other manufacturers in the interest of public health or safety, or if an invention is not available to the public on "reasonable terms." In this case, the idea is to reduce Xtandi's price by breaking a patent-protected monopoly. (Max Nisen, 3/31)

Step therapy protocols are becoming more and more common and affect patients with diseases from epilepsy, to mental illness, cancer, HIV/AIDS and those with autoimmune diseases, among others. I have been living with arthritis for more than 30 years. My husband, Gary, was diagnosed with multiple sclerosis eight years ago. Both of our diseases have forced us to fight our insurance companies to have access to the medications our doctors have prescribed. This is because of a cost-saving mechanism employed by insurance companies known as step therapy. (Kim Kitowski, 3/31)

Buying long-term care insurance isn't an easy decision. It's an increasingly pricey product that requires you to look way down the road, to the possibility of shelling out big bucks for a nursing home or some other form of assisted living. The last thing you want to worry about is having your insurer pull a fast one on you after you sign up for coverage. But that's what Prudential has done, making a sneaky change to policyholders' long-term care coverage. (David Lazarus, 4/1)

In a blatant act of malice and ignorance, the N.C. General Assembly and Governor Pat McCrory have set the state of North Carolina back decades. As physicians and health care providers who care for members of the LGBT community, we find this legislation deplorable and truly irresponsible. House Bill 2 was drafted to discriminate against the transgender community – human beings whose sex assigned to them at birth and their gender identity do not conform to societal expectations. Every human being has a gender identity and a sexual orientation. Every human being is equal and should have equal protection under the law. This is not just our position as medical and mental health providers, it is the truth and constitutionally and ethically correct. (Clayton A. Alfonso, 3/31)

[I]t’s no wonder that legislators in states across the country, including New Hampshire, have looked skeptically at the Food and Drug Administration. The FDA, after all, is the agency responsible for screening medicines for potential drawbacks before bringing them to doctors and patients. These legislators have introduced so-called “right to try” legislation, which is advertised as allowing patients to gain easier access to experimental drugs still in development. (3/31)

Antibiotics meant for humans have no place on the farm. When they are fed routinely to chickens, pigs and cows -- to help them grow or fend off infections -- germs in animals can easily become resistant, and ultimately threaten people, too. It's a threat long recognized by Europe, the U.S. and Canada, where the use of antibiotics to promote growth in livestock has already or will soon be banned. Unfortunately, this progress is endangered by the ongoing, even expanding, antibiotics free-for-all taking place in countries where agriculture is less regulated. (3/31)

In recent years, the United States has seen increasing efforts to reduce inappropriate use of medical treatments and tests. Perhaps the most visible has been the Choosing Wisely campaign, in which medical societies have identified many tests, medications, and treatments that are used inappropriately. The result is recommendations advising against using these interventions or suggesting that they be considered more carefully and discussed with patients. The success of such efforts, however, may be limited by the tendency of human beings to overestimate the effects of their actions. Psychologists call this phenomenon, which is based on our tendency to infer causality where none exists, the “illusion of control.”1 In medicine, it may be called the “therapeutic illusion” (a label first applied in 1978 to “the unjustified enthusiasm for treatment on the part of both patients and doctors”2). When physicians believe that their actions or tools are more effective than they actually are, the results can be unnecessary and costly care. Therefore, I think that efforts to promote more rational decision making will need to address this illusion directly. (David Casarett, 3/31)

“There are many viruses that have similar characteristics to dengue, yellow fever, and Zika that have the potential to emerge. We don’t know why Zika emerged now. But we know how to develop surveillance systems that will allow us to pick these viruses up if they start to move as Zika has.” This starting point was outlined by tropical medicine expert Duane Gubler at a World Health Organization (WHO) meeting in Geneva in early March. Gubler has spent his career studying tropical infectious diseases with an emphasis on dengue virus (DENV), a flavivirus closely related to Zika virus (ZIKV).1 His introductory presentation at the international meeting about the ZIKV challenge emphasized the complexity of the flavivirus–host relationship and the inevitability, thanks to urbanization and globalization, of emergence and spread of viruses that were previously confined to small, remote geographic areas. (Charlotte J. Haug, Marle Paule Kleny and Bernadette Murgue, 3/30)