�鶹Ů��

The Obama administration says it’ll send more than 10 million mailings to woo the uninsured for the final health care law sign-up season of President Barack Obama’s tenure. Add to that countless email messages to both prospective and returning customers — and ads on social media platforms such as Instagram and Facebook. (10/13)

The Obama administration is planning to use television ads and direct mail to boost participation in the Affordable Care Act’s exchanges in the coming open-enrollment period, but its timing will mean fighting for attention amid the noise of the election. The ads, which are partly focused on the affordability of coverage under the law, will run headlong into campaigns by opponents of the law who are using their own political ads to denounce it as a costly boondoggle. (Armour, 10/13)

The Obama administration is touting new outreach tactics that it says will help bring more young people into ObamaCare as a new signup period nears. Officials say they have learned lessons from the first three years of signups in order to hone their messages. Bringing a higher percentage of young and healthy people, or increasing the overall enrollment number, would help ease insurer concerns about a smaller and sicker group of enrollees than expected. (Sullivan, 10/13)

A new analysis projects that ObamaCare enrollment will be roughly flat or could even decline slightly next year. The analysis from Standard & Poor's projects that between 11.7 million and 13.3 million people will sign up for ObamaCare in the enrollment period that begins Nov. 1. That is compared to 12.7 million who signed up last year. That means that two years of growth in the marketplace will turn into a “significant slowdown” for 2017, the report says. (Sullivan, 10/13)

Enrollment in the Obamacare insurance marketplace is likely to stall or even decline for 2017 as higher premiums drive away people who aren’t eligible for government subsidies, according to S&P Global Ratings forecasts. ... This November will be the fourth open enrollment period for individuals to choose insurance plans under the Affordable Care Act, President Barack Obama’s signature health-care law. The “significant slowdown” predicted by S&P would be another setback for ACA’s government-run insurance markets, after big insurers pulled out of many states because of mounting losses. (Doherty, 10/13)

Cara Suzannah Latil is living proof that the Affordable Care Act works — but also of why a central piece of the law is in turmoil. Ms. Latil, 49, who works at a homeless shelter in Santa Fe, N.M., is one of millions of Americans who once found it difficult or impossible to get health insurance because they already had serious illnesses. Hepatitis C was ravaging her liver when she learned in 2014 that she also had breast cancer. Through the health care law, she was able to buy subsidized insurance that paid for all but $800 of her cancer surgery and radiation, she said, as well as tens of thousands of dollars’ worth of medications that cured her hepatitis. (Goodnough and Abelson, 10/14)

A growing number of people in Obamacare are finding out their health insurance plans will disappear from the program next year, forcing them to find new coverage even as options shrink and prices rise. At least 1.4 million people in 32 states will lose the Obamacare plan they have now, according to state officials contacted by Bloomberg. That’s largely caused by Aetna Inc., UnitedHealth Group Inc. and some state or regional insurers quitting the law’s markets for individual coverage. (Tracer, Darie and Doherty, 10/14)

Donald Trump had one response when asked about how he would replace ObamaCare at this week’s presidential debate: He’ll allow companies to sell insurance across state lines. The GOP’s decade-old talking point has gained momentum since the healthcare law passed six years ago. But Republicans rarely — if ever — acknowledge that the crux of what they want is already allowed under ObamaCare. For the last 10 months, states have been legally allowed to let insurers sell plans outside their borders. (Ferris, 10/13)

The incredible shrinking provider network is nothing new in marketplace plans. One way insurers have kept premiums in check on the individual market is by reducing the number of providers available in a plan’s network. Earlier this year, the federal government said that it would introduce a tool this fall to help consumers who are shopping on HealthCare.gov gauge how narrow a plan’s provider network is compared with others in the area. But most consumers who want that information will have to wait at least another year. (Andrews, 10/14)

Spending growth under the Medicaid program tapered nationally in fiscal year 2016 as the initial effects of the Affordable Care Act’s coverage expansion began to wear off, according to a Kaiser Family Foundation survey released Thursday. Total Medicaid spending by the federal and state governments grew at a rate of 10.5 percent in fiscal year 2015 as Obamacare led to a surge in enrollment. In fiscal year 2016, spending growth declined to just under 6 percent. Officials project that fiscal year 2017 spending will grow even more slowly, at a rate of 4.5 percent. (Pradhan, 10/13)

While national spending and enrollment for Medicaid continues to grow, it has slowed considerably following the 2014 implementation of the Medicaid expansion under the Affordable Care Act. That’s the finding of a new 50-state survey by the Kaiser Family Foundation. Medicaid, the state/national health program for low-income and disabled Americans, now covers nearly 73 million Americans and accounts for one in six dollars spent in the health care system after undergoing rapid growth when states expanded income eligibility for the program through the ACA. (Pugh, 10/13)

Virginia Gov. Terry McAuliffe, in an attempt to balance the state’s $1.5 billion budget shortfall, plans to eliminate planned pay raises for state employees and teachers and will ask the General Assembly to dip into the rainy-day fund to keep funding intact for education, public safety and Medicaid. “There will be no program cuts to public education, Medicaid for our families most in need, nor our core public safety services,” McAuliffe (D) said in a statement Thursday. (Sullivan, 10/13)

In 2013 Republican Gov. Sam Brownback put Medicaid under the management of three private insurance companies, promising managed care would improve services, cut waste and save enough money to end the lists for the kind of services Nick Fugate needs. But families of Kansans with developmental disability didn’t trust the companies to provide the complicated help their loved ones needed. They managed to get the federal government to delay the switchover, but in February 2014 federal officials gave their approval and the KanCare experiment began for them. More than two years later, many families say they’ve seen few signs of improvement, particularly in the waiting list. Not only is there still a waiting list, it has grown by a few hundred to about 3,500 people. Except in emergency situations, the average wait is seven years. (Smith, 10/13)

The Centers for Disease Control and Prevention on Thursday warned that contaminated medical devices used in open-heart surgeries could be to blame for a rash of infections in patients in the United States and Europe. Data published in the CDC’s Morbidity and Mortality Weekly Report indicate that at least 11 patients in the US were infected with bacteria from a heater-cooler device that maintains patients’ internal temperatures during surgery. Previous reports indicated that six people in Switzerland were infected, and dozens of Americans have come forward with symptoms. (Boodman, 10/13)

More than half a million patients who had open-heart surgery in the United States since 2012 could be at risk for a deadly bacterial infection linked to a device used during their operations, federal health officials said Thursday. Although rare, such infections may cause serious illness or death. The infection is particularly insidious because it is difficult to detect. Patients may not develop symptoms or signs for months after initial exposure. (Sun, 10/13)

[Bryson Mees-Hernandez's death] could be blamed on many factors, from his grandmother’s negligence to the failure of government and industry to find ways to prevent his death and so many others. The Associated Press and the USA TODAY Network set out to determine just how many others there have been. The findings: During the first six months of this year, minors died from accidental shootings — at their own hands, or at the hands of other children or adults — at a pace of one every other day, far more than limited federal statistics indicate. (Foley, Fenn and Penzenstadler, 10/14)

It's the kind of information you might expect from long-range government research: On average, one American child or teenager is killed or injured every day in an accidental shooting. The most common victims are ages 3 or 16. And the shootings happen most frequently in their own homes.Yet for the most part, such government research doesn't exist. (Paine, 10/14)

In Arizona, 19 children under 18 were involved in accidental shootings from Jan. 1, 2014, to June 30, 2016, according to an analysis by the Associated Press and the USA TODAY Network. Those shootings resulted in the deaths of three children and one adult. Another 14 children and one adult were injured.Nationally, at least 1,020 children under age 18 have been involved in accidental shootings during that time, according to the analysis. That translates to at least eight shootings by or involving a minor each week. (Jeong ,10/14)

Some of the most troubling images of the opioid crisis involve parents buying or using drugs with their children in tow. Now new research offers a glimpse into the addicted brain, finding that the drugs appear to blunt a person’s natural parenting instincts. Researchers at the Perelman School of Medicine at the University of Pennsylvania scanned the brains of 47 men and women before and after they underwent treatment for opioid dependence. (de la Cruz, 10/13)

The Affordable Care Act required Medicaid, the joint state-federal health program for the poor, to start paying for all available substance abuse treatments in 2014, a provision seen as a boon for low-income people who previously were not covered for addiction treatment. But Medicaid coverage of the most widely used opioid addiction medication, buprenorphine, varies widely among states. Many doctors don’t want to treat Medicaid patients for addiction. And red tape can make it difficult for many Medicaid recipients with addictions to get effective treatment. (Vestal, 10/14)

In Howard, the resources for long-term treatment and recovery, part of a state-led fight against the epidemic, are only just catching up. Unlike neighboring jurisdictions, the county has no residential detox facility. Although the county has multiple treatment facilities, the county's only outpatient clinic for Medicaid and uninsured recipients who have substance-abuse disorders is closing at the end of the year after the grant that operates it expires. The clinic serves about 750 people per year. (Waseem, 10/13)

Women are less likely to die of breast cancer than they were a decade ago, but not all women are benefiting from that trend. White women saw more of a drop in death rates than black women — 1.9 percent a year from 2010 to 2014, compared to a 1.5 percent decrease for black women, according to a report published Thursday by the Centers for Disease Control and Prevention. (Shute, 10/13)

The breast cancer incidence rate among Hispanic women is 28 percent lower than for their non-Hispanic white counterparts. Yet breast cancer remains the leading cause of cancer death for Hispanic women, with an estimated, 2,800 deaths in 2015, according to the American Cancer Society. This may be due to the fact that breast cancer is less likely to be diagnosed at a local stage in Hispanics. Between 2008 and 2012, for example, 57 percent of breast cancers among Hispanic women were found while they were local, that is, still confined to the organ of origin, compared with 65 percent of breast cancers among non-Hispanic white women, the American Cancer Society reports. (Veciana-Suarez, 10/14)

Reducing testosterone levels with androgen deprivation therapy, or A.D.T., is a common treatment for prostate cancer. But a new study has found that it more than doubles the risk of dementia. (Bakalar, 10/13)

A large study has found that body mass index, waist circumference and diabetes are all associated with an increased risk for liver cancer. Liver cancer is the sixth most common cancer, and its incidence has tripled since the mid-1970s in the United States. (Bakalar, 10/14)

Florida announced a new Zika transmission zone on Thursday, saying that the virus had popped up in a mile-square patch of northern Miami and that five people had been infected. (Tavernise, 10/13)

At least five people have contracted Zika virus from mosquitoes in Miami’s Little River neighborhood, Florida Gov. Rick Scott announced on Thursday, identifying a one-square-mile zone where the disease is spreading — between Northwest 79th and 63rd Streets from Northwest 10th Avenue to North Miami Avenue. Scott’s office identified the area after the Florida Department of Health confirmed that two women and three men had contracted Zika there. Three of the people live in the one-square-mile area, and two either work there or recently visited, according to the governor’s announcement. (Chang and Smiley, 10/13)

Florida Gov. Rick Scott (R) is accusing federal health officials of holding up money to fight Zika as the state combats its latest outbreak of the virus.“ It has been two weeks since federal funding to fight Zika was approved by Congress and signed by President Obama. However, Florida has not yet received a dime,” Scott said in a statement Thursday. “We don’t need bureaucratic timelines — we need funding now,” Scott said. Scott said his state needs the money even faster than expected after the Florida health department confirmed another outbreak of the Zika virus in Miami-Dade County on Thursday. (Ferris, 10/13)

Recognizing the prevalence of the problem, doctors and nurses across the country are now pushing an ambitious campaign to change practices in intensive care units to reduce cases of “ICU delirium” — a sudden and intense confusion that can include hallucinations, delusions, and paranoia. Anywhere from a third to more than 80 percent of ICU patients suffer from delirium during their hospital stay. And one-quarter of all ICU patients suffer from post-traumatic stress disorder once they leave, a rate that’s comparable to PTSD diagnoses among combat veterans and rape victims. Patients with ICU delirium are less likely to survive and more likely to suffer long-term cognitive damage if they do. (McFarling, 10/14)

Those who have declared war on the white coat come mainly from the infection control community. They argue that the coats, with their long, loose-fitting sleeves, are prone to be germ magnets... Several studies, including research by the World Health Organization (WHO), as well as by infectious disease experts in the United States, Britain and Israel, show that pathogens are easily transferred from surfaces to fabric, and from fabric to skin. Studies have also confirmed that many of the microorganisms detected on white coats are antibiotic-resistant. (Ridderbusch, 10/13)

Scientists may have found a way for patients with HIV to keep the virus in check without having to take powerful drugs every day for the rest of their lives. A clinical trial in monkeys found that by augmenting the standard HIV treatment with an antibody developed in the lab, the animals were able to enter a state of sustained remission, according to a report in Friday’s edition of the journal Science. (Healy, 10/13)

But for many of us, lifestyle changes are enough to bring cholesterol down. Doctors almost always recommend exercising and not smoking, along with eating less saturated and trans fat. And losing weight — as little as 5 to 10 pounds — can have a big impact on cholesterol. But there's another step you can take that may surprise you: Eat less sugar. (Maher, 10/13)

The hottest trend in health care these days may be “integrative medicine,” which claims to blend the best ideas from alternative medicine and conventional practice. But there is vast disagreement on what the best ideas are. And it’s not clear who will decide. (Gentry, 10/13)

After the federal government invested more than $30 billion, most hospitals and physicians now have electronic health record systems. Yet some software vendors who sell these things are tucking hidden fees — some small, some big — into the contracts, making it hard to deliver on the promise to share patient data. So the Department of Health and Human Services has released a sort of ‘how to negotiate’ guide to help doctors and hospitals sidestep contractual minefields and not get tripped up by the fine print. (Gorenstein, 10/12)

There seems to be no shortage of websites that aim to identify the top doctors and hospitals for patients. But a local nonprofit is throwing its resources behind a new site that allows St. Louis area consumers to compare area physicians and hospitals. ChooseWellSTL.org, which launches Friday, was developed by the Midwest Health Initiative, a new regional health improvement collaborative, with the goal of helping consumers see how area health care providers measure up. (Liss, 10/14)

Denver Health sent 250,000 appointment reminders and 2,000 well child check reminders to patients via text message over the past three years. Patients who got texts made it to their appointments 73 percent of the time, compared to a 66 percent attendance rate for those who didn’t, the historic safety-net hospital and community healthcare provider said. Now, a federal grant will allow Denver Health to expand its texting capabilities and tie those messages directly into patients’ electronic health records. (Rusch, 10/13)

For the first time, scientists have helped a paralyzed man experience the sense of touch in his mind-controlled robotic arm. For the cutting-edge experiment, a collaboration between the University of Pittsburgh and the University of Pittsburgh Medical Center, electrodes smaller than a grain of sand were implanted in the sensory cortex of the man's brain. The electrodes received signals from a robot arm. When a researcher pressed the fingers of the prosthesis, the man felt the pressure in the fingers of his paralyzed right hand, effectively bypassing his damaged spinal cord. (10/13)

Twelve years ago, a car wreck took away Nathan Copeland's ability to control his hands or sense what his fingers were touching. A few months ago, researchers at the University of Pittsburgh and the University of Pittsburgh Medical Center gave Copeland a new way to reach out and feel the world around him. It's a mind-controlled robotic arm that has pressure sensors in each fingertip that send signals directly to Copeland's brain. (Hamilton, 10/13)

A surgeon at Saint Vincent Hospital unnecessarily removed a patient’s kidney because he relied on the test results of another patient with the same name, according to public health inspectors who found serious safety lapses at the hospital. The federal Centers for Medicare & Medicaid Services threatened to terminate Saint Vincent from the Medicare program on Dec. 12 if the Worcester hospital does not put in place improvements, according to a letter last month from the agency to hospital chief executive Steven MacLauchlan. (Kowalczyk, 10/14)

Five major hospitals are challenging a proposal by the Florida Department of Health that would revamp the approval of new trauma centers — the latest chapter in years of legal wrangling about the state's trauma system. Tampa General Hospital, St. Joseph's Hospital in Tampa, Bayfront Health in St. Petersburg, UF Health Jacksonville and Lee Memorial Hospital in Fort Myers filed the challenges last week in the state Division of Administrative Hearings. They contend that the Department of Health is overstepping its legal authority in the proposal, which would change criteria that have limited the numbers of trauma centers allowed in each of 19 areas of the state. (10/13)

After three nights in the hospital following a fall, 73-year-old Gail Rubin learned she would need rehab in a skilled nursing facility before she could go back to her Havertown home. Twenty-five days later, Rubin left rehab walloped with out-of-pocket expenses totaling more than $9,000 and a hard lesson in the high cost of Medicare's complicated rules. Saturday marks the start of the annual open enrollment period, in which Medicare beneficiaries are urged to study their plan options. It's a good time to assess how your health status, or what your plan covers, may have changed. (Wood, 10/14)

Nurses at five Allina Health hospitals in Minnesota have approved a contract to return to work. A majority of rank-and-file members of the Minnesota Nurses Association on Thursday voted to ratify the tentative agreement reached earlier in the week. Both the union and Allina Health say the nurses will return to work Sunday morning. (10/13)

Nurses approved a contract Thursday to return to work at five Allina Health hospitals in the Twin Cities, concluding a contentious, nine-month negotiation in which they voted down four prior contract proposals and went on two strikes for a combined 44 days. While similar to a contract offer the nurses rejected Oct. 3, the latest offer provided enough new financial incentives and guarantees about health benefits to earn nurses’ support — though not without some hand-wringing. (Olson, 10/14)

Members of the Minnesota Nurses Association voted Thursday to approve the latest proposed contract with Allina Health. Approval of the contract — unanimously supported by union leaders — puts an end to an open-ended strike at five Twin Cities hospitals that began on Labor Day. The union announced the approval late Thursday night after polls closed at 8:30 p.m. and votes were tallied. (Cooney, 10/13)

Massachusetts’ health insurance market has an income inequality problem, according to a report from Attorney General Maura Healey’s office, whose findings mirror national studies. The analysis found that more health care dollars are spent on higher-income communities than on lower-income communities — even though the latter tend to have greater medical needs. Healey’s office called this a “distressing” trend that has persisted for years. (Dayal McCluskey, 10/13)

North Carolina's largest healthcare system is fighting back against a lawsuit by the U.S. Justice Department that alleges the system imposed anti-competitive contract requirements on insurers, saying a federal appeals court has completely rejected the government's arguments. Carolinas HealthCare System urged a North Carolina federal judge on Wednesday to toss out Justice Department's suit after the U.S. Court of Appeals for the 2nd Circuit rejected the government's arguments against similar contract arrangements in a case involving American Express. (Teicert, 10/13)

Henry [Lloyd] is one of three minors who now have approval to participate in Connecticut’s medical marijuana program. Two other minors have applications pending. Another, whose application was approved, died. To qualify, children or teens must have one of six conditions – cerebral palsy, cystic fibrosis, severe epilepsy, a terminal illness requiring end-of-life care, or irreversible spinal cord injury with objective neurological indication of intractable spasticity. (Levin Becker, 10/13)

Partners HealthCare and Boston Medical Center are joining a sweeping national effort to gather medical data on at least 1 million people and use it to better understand how disease works. They are among several health care organizations across the country that will participate in the national Precision Medicine Initiative, federal officials said Thursday. Precision medicine is an emerging approach in which a patient’s medical treatments are based on his or her genes, lifestyle, and other factors. (Dayal McCluskey, 10/13)

The number of unfilled nursing jobs has climbed since 2013, and the state is expected to add about 10,000 new registered nurse positions by the end of this year. Despite that demand, some of the region's state colleges and the University of Central Florida — all with well-regarded nursing programs — routinely turn away qualified applicants because they cannot afford to expand their programs. UCF's College of Nursing, for example, this year rejected more than half of the 306 students who applied and met admission requirements, enrolling 126 of them in the nursing program on its main Orlando campus. (Postal, 10/13)

State employee unions plan to ask a judge to block the privatization of group homes for people with intellectual or developmental disabilities, saying the layoffs caused by those changes violate Connecticut law and will eventually be blocked by the state labor board. If that happens, the unions say in their request for an injunction, clients would have their lives upended twice – first by having to go through a change in staff in state-run group homes where they have developed relationships with caregivers, and then again if the labor board orders the laid-off state employees to be reinstated. If the unions are successful, they could block a major component of Gov. Dannel P. Malloy’s plan to shrink the state workforce — a plan that already is lagging behind schedule. (Levin Becker and Phaneuf, 10/13)

Once again, government actions against a controversial for-profit company’s chain of group homes for the disabled may have come too late to protect a child. ProPublica has learned that Maryland had begun pulling about 30 children out of homes owned and managed by AdvoServ in August, but hadn’t yet relocated a teenage girl when she died a month later after being manually restrained by staff. Maryland’s Department of Human Resources had also stopped placing children in AdvoServ homes, following inspections that identified deficiencies in quality control, record-keeping, and conditions in residential and common areas. (Vogell, 10/13)

Quitting smoking can be hard to do, but it's a step that most cigarette smokers want to take, according to the Centers for Disease Control and Prevention. And despite its difficulty, many people succeed. In fact, the CDC reports that the number of former smokers has exceeded the number of current smokers since 2002. (Caldwell, 10/13)

[W]e calculated the current economic burden that is attributable to vaccine-preventable diseases among US adults. We estimated the total remaining economic burden at approximately $9 billion (plausibility range: $4.7–$15.2 billion) in a single year, 2015, from vaccine-preventable diseases related to ten vaccines recommended for adults ages nineteen and older. Unvaccinated individuals are responsible for almost 80 percent, or $7.1 billion, of the financial burden. (Ozawa et al., 10/12)

Many observers are calling for modification of Medicare’s Hospital Readmissions Reduction Program (HRRP) to relieve an unfair burden on safety-net hospitals, which serve low-income populations and consequently have relatively high readmission rates. To broaden the perspective on this issue, we addressed the fundamental question of whether the HRRP has been an effective tool for reducing thirty-day readmissions in safety-net hospitals. In the first three years of the program, these hospitals reduced readmissions for heart attack by 2.86 percentage points, heart failure by 2.78 percentage points, and pneumonia by 1.77 percentage points, and they also reduced the disparity between their readmission rates and those of other hospitals. (Carey and Lin, 10/4)

The sample included between 1200 and 1400 hospitals per fiscal year in 19 states with Medicaid expansion and between 2200 and 2400 hospitals per fiscal year in 25 states without Medicaid expansion .... Expansion of Medicaid was associated with a decline of $2.8 million ... in mean annual uncompensated care costs per hospital. Hospitals in states with Medicaid expansion experienced a $3.2 million increase ... in mean annual Medicaid revenue per hospital, relative to hospitals in states without Medicaid expansion. Medicaid expansion was also significantly associated with improved excess margins ... but not improved operating margins. (Blavin, 10/10)

This Visualizing Health Policy infographic examines state policies related to abortion and their intersection with clinical practice. Nine of 10 reported abortions in the United States are in the first trimester. Between 2003 and 2012, the abortion rate decreased 18% among women aged 15 to 44 years. Twenty-five states have laws that restrict insurance coverage of abortion in private plans. Twenty-seven states require women seeking abortion to wait 18 hours or more before obtaining an abortion, and several require women to be counseled on topics unsupported by medical consensus or evidence, such as abortion raising the risk of breast cancer. Many states have specific requirements for clinics and physicians who provide medication abortions. (Gomez et al., 10/11)

Avalere finds that consumers with a range of common health conditions could reduce their spending between $8,800 and $90,020 by purchasing insurance through the Affordable Care Act (ACA). Avalere examined the potential financial benefits for consumers with a range of ages, incomes, and family size who have diabetes, a broken leg, breast cancer, and stroke. The findings indicate that even after paying premiums, deductibles, and cost-sharing, these consumers could reduce their spending significantly by purchasing insurance compared to remaining uninsured. (10/13)

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)