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A polar ice sheet lodged itself atop the entrance to Hell this afternoon, as the House of Representatives passed, by an overwhelming bipartisan margin of 392-37, a fix to the Medicare formula for reimbursing doctors, putting Congress on the brink of ending a saga that has been marked by punts and short term fixes for well over a decade. ... Don't expect it to last. (Greg Sargent, 3/26)

How was such a deal possible in an otherwise polarized and seemingly deadlocked Congress? Granted, the Senate has yet to act, but the strong bipartisan vote and support from the president will make it hard for the Senate to block enactment. Given the rarity of the House vote, I suspect we’ll soon see a spattering of headlines declaring a thaw in Congress’s deep legislative freeze, and pointing to potential new agreements on the horizon. Perhaps. But closer inspection of deal-making on the doc fix points to a set of special circumstances that likely made a bargain possible. (Sarah Binder, 3/26)

Medicare’s physician payment formula—the “sustainable growth rate” (SGR) in Washington speak—is another central-planning failure that puts bureaucrats and lobbyists ahead of patients and doctors. There is broad, bipartisan consensus that reform is desperately needed. However, the only thing worse than the SGR’s annual circus is repealing the SGR without solving the much bigger problems in Medicare. Unfortunately, the deal finalized in the House this week largely ignores those overarching problems and threatens to leave the next generation further in debt. (Sen. Ben Sasse, R-Neb., 3/26)

Some of those changes aim to make Medicare more solvent by reducing the growth of program spending, a conservative goal, but it would achieve this by liberal means: prohibiting the sale of certain types of insurance policies. ... The issue involves Medigap supplemental insurance, which pays for beneficiary cost-sharing (deductibles, co-payments, and co-insurance) not covered by the traditional Medicare program. The most popular Medigap policies cover the Medicare Part B deductible, along with other forms of cost-sharing. Studies have shown that these types of policies—which allow seniors to visit medical providers without any out-of-pocket costs—encourage beneficiaries to over-consume care, raising taxpayer spending on Medicare. (Chris Jacobs, 3/26)

Here’s why it’s hard for the U.S. government to keep its costs down: Seniors and the very poor are entitled by law to almost half its money. Congress can trim other expenses, and automatic budget cuts and the cessation of two U.S. wars have slowed spending growth. But Social Security, Medicare and Medicaid are exempt from budget wrangling and are growing: from $1.7 trillion, or 48 percent of the fiscal 2014 budget to an estimated $3.2 trillion, or 53 percent of the U.S. budget, by 2024. (Toluse Olorunnipa and Roger Runningen, 3/26)

Even as politicians and pundits continue to debate the merits of the Affordable Care Act (ACA), it is time to look beyond it to the next phase of US health care reform. Although many physicians contributed to the development and implementation of the ACA, the forces that have steered it so far have been primarily governmental. Leaders from within health care should now more firmly take the tiller. ... The challenge now is to follow through on such structural changes and ensure that they actually lead to improvement for patients and families. (Donald M. Berwick, Derek Feeley and Saranya Loehrer, 3/27)

All of a sudden, Gov. Sam Brownback is consumed with compassion for the more than 5,000 disabled Kansans who are pleading for services. This is new. Brownback didn’t give a rip about people with developmental and physical disabilities when he rammed through his massive tax cuts, which benefited wealthy Kansans and rendered the state unable to meet its most basic obligations. (Barbara Shelly, 3/26)

“Of all the things that could kill more than 10 million people around the world,” writes philanthropist Bill Gates in the New England Journal of Medicine, “the most likely is an epidemic stemming from either natural causes or bioterrorism.” Beginning with this blunt and clinical assessment, we are given a detailed picture of the specter that haunts Gates’s nightmares: the emergence of a highly infectious virus that would spawn global panic, overwhelm the supply of medical commodities, set off a desperate technological race against death, reduce global wealth by trillions of dollars and fill millions of graves. (Michael Gerson, 3/26)

On November 20, 2014, President Barack Obama announced his intention to grant millions of undocumented immigrants a reprieve from the threat of deportation, along with the possibility of legal employment in the United States. ... The population affected by the policy is one that currently experiences major disparities in health care coverage and access. Immigrants are far more likely than native-born residents to be uninsured .... Although the President's policy does not explicitly address health care, it will most likely increase access to insurance among covered immigrants and members of their family through a variety of direct and indirect means. (Benjamin D. Sommers and Wendy E. Parmet, 3/26)

In his 2015 State of the Union address, President Barack Obama announced a new Precision Medicine Initiative (PMI), a national investment in research on approaches to disease treatment and prevention that take into account individual variability in each person's genes, environment, and lifestyle. ... But scientific progress alone won't guarantee that the public reaps the full benefits of precision medicine — an achievement that, as [Francis] Collins and [Harold] Varmus note, “will also require advancing the nation's regulatory frameworks.” Nowhere are such advances more important than in the regulation of genomic testing. (Eric S. Lander, 3/26)

If a state allows parents to obtain religious exemptions from vaccination requirements for school entry, can it temporarily exclude unvaccinated children from school during an outbreak of a vaccine-preventable illness without violating the family's constitutional rights? If parents refuse to vaccinate their children, what can physicians legally and ethically do to protect other patients in their practice from exposure to vaccine-preventable illnesses? ... Both questions invoke the legal and moral authority to use a classic public health measure known as social distancing to attempt to mitigate the spread of an infectious disease. ... Governments and physicians employing social distancing policies must give careful and systematic attention to the ethical and legal issues. (Y. Tony Yang and Ross D. Silverman, 3/25)