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The most important challenge is to attract more young (and generally healthy) people to the marketplace. Then, the risk to insurers would be spread more widely, making it less expensive to cover people with greater medical costs. People age 25 to 34 remain twice as likely to be uninsured as those age 45 to 64. More young people could be attracted with more generous subsidies, lower caps on deductibles, or a stiffer penalty for going uninsured. (Currently, that penalty is $695 a year or more.) In many cases, it would help to better inform people that they’re eligible for financial help. (10/26)

President Barack Obama said last week that problems in the marketplaces are “growing pains.” Critics on the right have said the ACA is in a “death spiral.” There is a lot to say about this year’s premium increases and no lack of people saying things. What has not been said, however, is that the key moment for the marketplaces is not the start of this open-enrollment season on Nov. 1 or this round of premium increases but next spring and summer, when state regulators begin to see proposed premiums for next year’s open-enrollment season and we learn whether the marketplaces have stabilized. (Drew Altman, 10/26)

More than 177 million Americans receive health care benefits through employers and the favorable tax treatment of these benefits in the U.S. tax code helps protect employees and their dependents from the current uncertainties of the Affordable Care Act exchanges. Despite employer-sponsored care’s important role, modifying the tax treatment of employer-provided health benefits has long been a goal of some policymakers and health economists on both sides of the political aisle. (Mark Wilson, 10/26)

This week, the White House finally admitted what had become obvious for months: premiums within the Affordable Care Act (ACA) exchanges will skyrocket in 2017. Unfortunately, neither the administration nor its intended successor Hillary Clinton demonstrated a grip on the failures that have driven the markets to collapse, or the need for a clear change in direction. Instead, both argued for Band-Aids that will make matters even worse. (Edward Morrissey, 10/27)

As a private practice doctor, I usually try to steer clear of discussing politics with my patients. It’s simply too divisive of a topic, and in order to be effective at my job, I have to build bonds of trust with the people I’m treating. But this rule is getting harder and harder to follow – especially when my patients are the ones who bring political issues up. In recent months, I’ve seen an outpouring of frustration from the men and women who come through my practice’s front doors. (Fritz Butehorn, 10/26)

Obamacare customers and supporters received bad news Monday: Insurers are raising premiums for popular plans on the Obamacare exchanges by an average of 25 percent. As with most everything involving the Affordable Care Act, however, the news was met with a bit of misinformation – and a lot of political spin. Let’s cut through that with five things you should know about the premium hikes. (10/26)

Obamacare has succeeded in expanding health-insurance coverage, but the mechanisms the law created to moderate costs and improve affordability simply aren’t working. Increasing federal subsidies for health insurance masks the problem and add to the national debt. Congress and the next president should make fixing this failing program a priority. (10/27)

President Barack Obama took stock of his health care legacy in JAMA this summer. Reflecting on the Affordable Care Act (ACA), the president enumerated evidence to support what he termed “significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care.” Both President Obama and commentators in accompanying Editorials, however, acknowledged that much work remained to be done. To that end, and anticipating the presidential transition following the November election, US National Academy of Medicine (NAM) President Victor Dzau, MD, earlier this year convened 19 working groups to frame a health policy agenda that might gain bipartisan support. (C. David Naylor, 10/25)

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” For too many individuals living in the United States, this state remains well out of reach. Despite spending relatively more on health than any other country and ranking among the wealthiest of nations, the United States is far from the healthiest. Although life expectancy at birth has been gradually increasing, the United States ranks 43rd worldwide on this key measure, with residents demonstrating poorer health (compared with other high-income countries) at each life stage. Furthermore, between the top and bottom 1% of income distribution, life expectancy (at age 40 years) differs about 15 years for men and 10 for women, with further disparities by geography, race/ethnicity, and other dimensions. (Howard K. Koh, 10/25)

Recently, the Monitor’s Ella Nilsen described the plight of Dartmouth-Hitchcock, which was forced to announce the layoff of dozens of employees, in part to make up for losses on the drugs it used. The situation is the same at Concord Hospital, where per-patient drug spending increases by nearly 25 percent per year, and at Franklin and Laconia regional hospitals, where spending on pharmaceuticals has increased by $1 million per month. Nationally, the situation is just as bad. About one in five Americans with one or more prescriptions can’t afford to fill them on schedule. Americans pay far more than citizens of other nations, not because they use more health care or drugs but because they pay so much for them. (10/27)

Growing up, I didn’t know what was wrong with my mother. I was 25, maybe 26, when I learned she had a lobotomy. I am still trying to make sense of it. My mother had two brain tumors. The first one, in July 1945, was operated on in Oklahoma City and she survived, her bright mind intact. The second one, in November 1953, occurred when she was pregnant with me. Shortly after I was born, my mother flew from San Diego, where we lived, to Oklahoma City. This time there was trouble during surgery, and to staunch the trouble they took both her frontal lobes. (Mona Gable, 10/27)

Sitting in an empty park in the suburbs of New Delhi, India, Rachana (a pseudonym) told me the real story about her work in the sex trade. While shocking, it wasn’t nearly as horrific as the story the organization she worked for urged her to tell when speaking to national media and foreign donors. I’ve learned since then that the prompting she received isn’t unheard of — a famous non-governmental organization (NGO) that helped women who were rescued from sex trafficking in Cambodia was caught in fabrications that resulted in its subsequent closing. ... Exaggerating stories or overselling the impact of an NGO to potential donors isn’t corruption. But it is disappointing at best, and dishonest at worst. The challenges of working in marginalized communities deserve attention and thoughtful improvement, not false appearances of success. (Abraar Karan, 10/26)