�鶹Ů��

Republicans haven’t figured out how to kill the Affordable Care Act. But they are transforming it into a weaker, less efficient and more dysfunctional version of itself. ... The tax cut bill Senate Republicans passed earlier this month would eliminate the individual mandate, a key piece of the program’s architecture that requires people to get insurance or pay a penalty to the government. If final legislation includes the same provision, and if the legislation becomes law, then fewer people will have insurance and premiums will be higher, according to experts in and outside the government. (Jonathan Cohn, 12/10)

Collins said that she would vote for the recent Senate tax bill so long as Republicans leaders promised to pass other legislation — in the near future — that would reduce the bill’s knock-on damage to health care programs. ... Her colleagues assured her they would pass the bills she wanted — not immediately but soon after the tax bill had passed. ... Within days of the Senate vote on the tax bill, conservative House Republicans started saying that they didn’t care about her deal. She did not make it with them, and they do not feel bound by it as they negotiate the bill’s final language with the Senate. These House members, as Politico put it Friday, have decided to “thumb their nose” at Collins. (David Leonhardt, 12/10)

Confirming the warnings and worst fears of progressives, House Speaker Paul Ryan made it plain this week: the ultimate aim of Republican lawmakers -- and their number one priority in January -- is to shrink the Medicare program that provides health insurance to the elderly and disabled. ... That's code for resuming a decades-long fight against government-supported health care by conservatives, who fought bitterly against the creation of Medicare in 1965 and have been trying to cripple or kill the program ever since. (Errol Louis, 12/8)

The opioid epidemic should command focused attention even from our policy-averse president. It's America's worst drug crisis, especially severe in the working-class and rural communities that supported President Donald Trump. Its solution involves spending money, which supposedly doesn't faze Trump, and tougher actions against drug companies, which he's vowed to take. (Albert R. Hunt, 12/8)

The American epidemic of opioid abuse is finally getting the attention it warrants. While policy solutions continue to be inadequate, the decision by President Trump to declare a national opioid emergency has helped to increase discussion about the problem and how the country can solve it. But the conversation also needs to address a dangerous – and largely ignored – interconnected public health crisis wreaking havoc among young Americans. The problem is that more Americans than ever are injecting opioids and inadvertently infecting themselves with hepatitis C. Shared needles mean shared blood-borne infections – and that’s how the opioid crisis has created a new generation of hepatitis C patients. (Robert Greenwald, Ryan Clary, 12/7)

[T]his past week there were big headlines about a new study that linked contraceptive pills and other hormonal birth control to an increased risk of breast cancer. Some news articles stressed the risk of a commonly used medication. Others, like the one by Roni Caryn Rabin in The New York Times, carefully placed the numbers in context to explain that the absolute risk is very small. (Relative risk is the percentage change in one’s absolute risk as a result of some change in behavior.) I would go even further. This was a prospective cohort study, meaning it was an observational study that followed women over time and saw what happened to them naturally. The data set didn’t allow for adjusting for some factors that could also be associated with breast cancer .... The study found only an association, and not causal proof you might obtain from a randomized controlled trial. (Aaron E. Carroll, 12/10)

The problem is that while some individuals will have their lives saved by early cancer detection, if every person were to undergo screening, there would likely be no lives saved overall. It’s counterintuitive — but it’s what the evidence says. (Benjamin Mazer and John Mandrola, 12/8)

American consumers aren’t the only ones struggling with higher healthcare costs. CVS Health’s proposed $69-billion purchase of health insurer Aetna is driven in part by the companies’ efforts to get control over more of the costs they face, and to make their operations more efficient. The question for regulators, though, is whether the combination results in a company that uses its clout to help consumers or squeeze more dollars out of them. (12/11)

The architects of the slew of major healthcare deals announced in the past week offered a common rationale: The combinations will lower costs and improve care. Yet a closer examination of the deals suggests these hookups merely tinker around the edges of the major drivers of healthcare spending. And, for the two deals hatched on Wall Street, a good argument can be made that they are more motivated by the profits that come from financial engineering than the savings that can be derived from lowering the cost of care. (Merrill Goozner, 12/9)

As board chair of a community hospital, I am often confronted with the dozens of quality and safety measures that state and federal regulators use to score and pay us, and private organizations use to rate us. And as someone who works to improve the quality of care for older adults, I am struck by how much all these measures miss when it comes to what really matters for seniors. ... These ratings are often described as measuring quality and safety. In truth, they really measure only safety. And they are much more likely to focus on process than on outcomes. That’s not surprising because process is so much easier to track, especially for older adults. Falls can be counted. Happiness cannot. (Howard Gleckman, 12/6)

Hospitals and health plans are increasingly investing in consumer-oriented services to remain competitive as patients and members shop more for their care. Most healthcare executives currently focus at least part of their strategic plan on consumerism, and they expect that will only continue to grow in the years ahead, according to respondents to Modern Healthcare's most recent CEO Power Panel survey. (12/9)

The first day I worked as a doctor, I experienced the most intense sense of loss and failure of my entire career. And I began to learn a lesson that I've needed 30 years to fully appreciate. It is this: Even the most conscientious physician can never care as much as a family member whose beloved child or spouse or parent is dangerously ill. So if we are wise, we doctors and scientists will learn to tap that urgency born of their love to help our patients. (Isaac Kohane, 12/8)

The San Antonio City Council is considering raising the legal age to purchase tobacco products from 18 to 21. This proposal is flawed on many levels. It sends young people a troubling message about adulthood and the role of government, it will not serve the stated purpose of limiting tobacco use, and it will hurt San Antonio businesses. (Anwar Tahir, 12/10)