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According to an old bit of folk wisdom, if one person says you are drunk, you can wave him off. If two people tell you, go home. When UnitedHealth Group announced a few months back that it was going to stop selling individual health insurance in most Obamacare exchanges, informed observers were not alarmed. They noted that nearly all exchange customers still had at least two, and most had three or more, insurers competing for their business. (Henry J. Aaron, 8/19)

Since I last wrote about it, Aetna’s withdrawal from the Obamacare exchanges has ginned up even more drama. Jeff Young and Jonathan Cohn of the Huffington Post published a letter in which Aetna told the Justice Department that it would reduce its exchange participation unless Justice allowed the merger with Humana to go through. This has naturally triggered a firestorm of accusations about “extortion” and renewed calls for a public option that can protect people against the threat of insurance-less insurance exchanges. (Megan McArdle, 8/19)

This Greg Ip column presents one of the best summaries I have seen of problems with the Affordable Care Act stemming from its major, popular feature: prohibiting insurers from discriminating in enrollment or premiums based on an individual’s pre-existing health conditions. The 2010 health-care law, Mr. Ip writes, is suffering the same slow “unraveling” of the health insurance market it was designed to fix: attracting disproportionate numbers of older, sicker patients, whose health-care costs drive up premiums, which in turn prompts younger, healthier customers to drop the insurance (even with subsidies) or to opt out of enrolling (and choosing to pay a modest “tax” penalty). (Robert Litan, 8/21)

One of the biggest factors fueling the angst over drug prices in the U.S. is that some older medicines that should be sold cheaply as generics are still priced very high, often owing to a dwindling number of generic competitors and the rising cost of producing these drugs. Bernie Sanders and Hillary Clinton like to blame generic-company mergers and greedy drugmakers. But a closer look reveals that a series of regulatory policy blunders is at fault. (Scott Gottlieb, 8/19)

This column is a mea culpa. In this week's issue of Modern Healthcare, we highlight the leaders whom our readers and the editorial staff consider the most influential people in healthcare. We go through a form of crowd-sourcing to determine who gets on the list. It begins by asking readers to nominate candidates. Over 9,000 suggested one or more names this year. (Merrill Goozner, 8/20)

We’ve known for decades, of course, that the retirement of the huge baby-boom generation — coupled with low birthrates — would make the United States an older society. Similarly, we’ve known that this would squeeze the federal budget. Social Security and Medicare spending would grow rapidly, intensifying pressures to cut other programs, raise taxes or accept large budget deficits. All this has come to pass. But the study goes a giant step further, claiming that the very fact that the United States is an aging society weakens economic growth. “The fraction of the United States population age 60 or over will increase by 21 percent between 2010 and 2020,” says the study. This aging shaves 1.2 percentage points off the economy’s present annual growth rate, the study estimates. (Robert J. Samuelson, 8/21)

Oregon and California attracted national notice this year as battlegrounds in the struggle for accessible contraceptive care. New laws in both states allow pharmacists to prescribe hormonal birth control to women directly. Yet the fight for increased access to contraception isn’t being fought on the West Coast alone; it’s also taking place on computer and smartphone screens all over the country. A handful of companies and nonprofits have developed websites and phone apps allowing women in most states to obtain a prescription for oral contraception from a physician without visiting a doctor’s office, either by answering a series of online questions or talking to a clinician via video or online call. (8/21)

McDonald’s plan to get children active by providing them with fitness trackers ended almost as quickly as it started. The fast-food company replaced the toys in its Happy Meals with pedometers, but soon scrapped the devices after “limited” reports surfaced that they could irritate children’s skin. (Steven Overly, 8/20)

For someone who talks big about job creation, Gov. Terry Branstad is doing a stellar job of jeopardizing the solvency of some Iowa employers. Four months after implementation of his plan to privatize Medicaid administration, the carnage is in full swing. Stories of small employers not being paid by managed care companies are being reported across the state. (8/20)

Mercy Medical Center has tentative plans to build an 11-story hospital tower and two parking garages as part of a campus overhaul in Des Moines. With an expected cost of $500 million, it would be one of the most expensive real estate projects in central Iowa, behind data centers for Microsoft and Facebook. (8/21)

I'm willing to bet most people know someone who has been treated for breast cancer and is now cancer free. Most can also probably name someone who died of the disease. That's the way people regard breast cancer: either you're cured or you die. But about 30 percent of breast cancer patients live with a different reality. (Julie Klasky, 8/21)

A federal appeals court gave medical marijuana advocates what seemed like a big win last week with a unanimous ruling that the federal government may not prosecute people who grow and distribute medicinal cannabis if they comply with state laws. The decision affirms a mandate from Congress, which barred the U.S. Department of Justice in 2014 and 2015 from bringing cases against legitimate pot shops in states that have medical marijuana laws. It makes clear that if operators are meticulously following the rules, they shouldn’t have to worry about the feds coming after them. (8/22)

Ms. Fogarty holds dental therapy license No. 2 from the state of Minnesota, which in 2009 became the first state to recognize these midlevel professionals. Dental therapists are not massaging patients’ teeth and gums; they are specialists with years of training. At the University of Minnesota, getting a dual bachelor’s in dental hygiene and master’s in dental therapy requires 32 months of dedicated course work, taking the same classes as dental students who stay for the full program. After passing a state exam, dental therapists are authorized to clean teeth and fill cavities, though they cannot do orthodontic or reconstructive work. (Eric Boehm, 8/19)

After interviewing several residents at Boston teaching hospitals (their names are changed or omitted to protect their privacy) and reviewing the research, I'm starting to understand the scale of mental health disorders in residency and why this problem seems to be growing worse. Residency’s long hours, trauma, sleeplessness and social isolation inevitably erode our healthy coping mechanisms. At the same time, there is a powerful culture of fear, stigma and lack of self-care that prevents residents from seeking help. The resources that are in place in residency programs are simply not adequate. (Elisabeth Poorman, 8/19)

Not long ago, a good friend of mine said something revealing to me: “I don’t think of you as disabled,” she confessed. I knew exactly what she meant; I didn’t think of myself as disabled until a few decades ago, either, even though my two arms have been pretty significantly asymmetrical and different from most everybody else’s my whole life. (Rosemarie Garland-Thomson, 8/19)

Many contemporary feminists consider abortion to be an integral part of women's rights. As such, they are unaware that the same women who fought for the right to vote also fought for the rights of the unborn to be born and for their mothers to be supported. It's important to understand the suffragists' adamant opposition to abortion as we continue the fight for equal rights today. (Marilyn Kopp, 8/21)