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As the principal source of health insurance for the poor, the dominant payer for long-term services and supports, the most important source of health care financing during public health crises, and the largest source of funding for the health care safety net, Medicaid occupies a central place in U.S. health policy. Medicaid will inevitably continue to evolve as the population ages, population health needs change, poverty persists, and rates of coverage by employer-sponsored insurance continue to decline, especially among workers at smaller, low-wage firms. (Sara Rosenbaum, 10/13)

Last week, Bill Clinton called the Affordable Care Act, “the craziest thing in the world” as it is creating expensive, unaffordable health care for those who earn too much to be on Medicaid, small business and individuals who earn too much to obtain government subsidies. He later walked back his criticism saying the ACA helped insure many who were uninsured. (Wayne Oliver, 10/13)

Over the summer, the National Institute of Mental Health got its first new director in 13 years. As Joshua Gordon settles into the top job at NIMH, one of his primary tasks should be to respond to the widespread perception that the agency — the world’s largest funder of mental-health research, with an annual budget of approximately $1.5 billion — has lost sight of its most fundamental mission: finding ways to ease the burden of mental illness for those affected by it today. (Roberto Lewis-Fernandez, 10/13)

In my work on the intensive treatment unit of a psychiatric hospital, I see many patients whose lives collide with the criminal justice system. Some are admitted to my care because they’re seeking respite. Others are admitted — often brought in by police — because the community seeks respite from them. (Christine Montross, 10/13)

In 1985, when internist Jim O’Connell, cofounder of the Boston Health Care for the Homeless Program,1 began doing outreach to homeless people, one of the toughest questions he faced was whether to commit someone to the hospital for involuntary psychiatric treatment. States vary in their criteria for involuntary commitment: some permit consideration of psychiatric need, whereas others allow such infringement of civil liberties only if one is believed to pose an immediate physical danger to self or others. Nevertheless, the application of legal criteria to the unique circumstances of someone’s life requires subjective interpretation. So despite 30 years of navigating this tension between liberty and need, O’Connell remains conflicted about when commitment is appropriate. “I’ve never found a comfort zone,” he explained to me. “I’ve only had experiences that are bad and experiences that are good.” (Debra Malina, 10/13)

Everybody knows the Affordable Care Act has been a massive, expensive failure, with prices and spending spiraling out of control. We heard this on Wednesday, from Minnesota’s Democratic Gov. Mark Dayton: “The reality is the Affordable Care Act is no longer affordable.” ... It’s true that nobody’s ever seen (or, at least, not in a good long while) numbers like this for health care — because, in fact, the price increases have been so small. (Catherine Rampell, 10/13)

More than 57 million older and disabled Americans rely on Medicare for their health insurance, with millions more joining their ranks every year. Since its launch in 1965, Medicare has evolved from no-frills coverage to a complex suite of health insurance products that many people neither understand nor use to their fullest advantage. Part D drug plans did not even exist until 2006. More than 40 million people now have these private insurance plans. Likewise, Medicare Advantage plans are only about a decade old but have become the most popular choice of new Medicare enrollees and are now used by nearly 20 million people. (Philip Moeller, 10/13)

On July 7, 2016, in our Minneapolis community, Philando Castile was shot and killed by a police officer in the presence of his girlfriend and her 4-year-old daughter. Acknowledging the role of racism in Castile’s death, Minnesota Governor Mark Dayton asked rhetorically, “Would this have happened if those passengers [and] the driver were white? I don’t think it would have.” Such incidents are tragic — and disturbingly common. Indeed, in recent weeks, our country has witnessed the well-publicized deaths of at least three more black men at the hands of police: Terence Crutcher, Keith Scott, and Alfred Olango. (Rachel R. Hardeman, Eduardo M. Medina and Katy B. Kozhimannil, 10/12)

Relatively little attention was paid last year when President Obama called for creation of a database containing the DNA of a million volunteers as part of moves toward “precision medicine,” or tailoring healthcare to people’s individual needs. But to many in the healthcare field, Obama’s embrace of a national repository of genetic information was seen as a turning point in advancing use of “big data” to reduce medical costs and improve people’s well-being by anticipating disorders before they become serious problems. (David Lazarus, 10/14)

Intellectually, we all know that there are no guarantees of good outcomes, in surgery or in life. But emotionally, most of us expect perfection -- both of others and of ourselves. Physicians have a particularly hard time accepting our fallibility. Robert Helmreich studied the culture of medicine and aviation and found that “both stress the need for perfection… and a deep sense of personal invulnerability.” So when something goes wrong, we are uniquely unprepared for the emotional fallout. (Jo Shapiro, 10/13)

There’s a good reason that Proposition 52 – the Medi-Cal Funding and Accountability Act – enjoys such diverse support from labor, business and health care groups and from both sides of the political aisle. It promises to continue access to vital health care for more than 13.5 million Californians, or one in every three of the state’s residents. (Duane Dauner, 10/13)

E-cigarettes have become the rage among teens and young adults, and the ENDS business has mushroomed into a billion-dollar enterprise, ready to take over from the traditional tobacco industry.But are e-cigarettes safe? Although there's some debate among health experts, data about the harmful effects of e-cigarettes is emerging slowly. It appears that all the damage from tobacco cigarettes that we have been trying to prevent will now be reproduced by e-cigarette smoking. (Ravindra Nathan, 10/13)

For those who will benefit from slimming down, my five minutes of counseling are no match for the toxic culture of weight loss, a culture so desperate that people spend billions of dollars on supplements that may contain speed. In fact, there is no evidence that even an hour or two of this kind of advice helps patients lose any weight, according to Dr. David Grossman, vice chair of the United States Preventive Services Task Force. (Elisabeth Poorman, 10/14)

A 2004 study found Fresno had the highest rate of IV drug use in the country – more than New York or Miami – and nearly three times the national average. Last year, just after the deputy police chief was caught trafficking in opiates in a federal sting, the district attorney announced that Fresno’s drug problem was getting worse, with heroin available at every high school. The secondary impacts of widespread IV drug use are reflected in high rates of HIV, AIDS and a current syphilis outbreak. Lesser known is the problem of abscesses, which for IV drug users are a slow-motion car crash. Once users start injecting drugs, abscesses can become part of their lives, with sometimes fatal consequences if they’re not treated promptly. (Lisa Maronelli, 10/12)