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The Trump administration came into office looking to dismantle Barack Obama's health care law, but the Affordable Care Act survived. Now the administration is on the hook to deliver a smooth ending to sign-up season, with a crush of customers expected this week. For millions of eligible consumers time runs out on Friday. (Alonso-Zaldivar, 12/11)

If you need to sign up for health insurance for 2018, you have until next Friday to purchase an individual marketplace plan through Obamacare. With a shorter enrollment period and other changes, the number of participants is expected to fall short of last year’s numbers. (Candisky, 12/8)  

With one week left to sign up for health insurance through the federal marketplace, the number of people enrolling in New Hampshire is roughly equal to last year, although it is unclear what the final tally will be because the enrollment period has been shortened. Most New Hampshire residents have until Friday to buy health insurance through the Health Insurance Marketplace. That deadline comes much earlier than in past years when open enrollment continued through the start of January. (Brooks, 12/10)

Open enrollment for health care under former President Barack Obama's health care law ends Dec. 15, and while current Texas enrollment numbers are up from this time last year, new restrictions under the Trump administration may mean more uninsured Texans. (Allbright, 12/11)

Meanwhile, Americans are struggling with high premiums —

Margaret Leatherwood has eight choices for health insurance next year but no good options. The cheapest individual coverage available in her market would eat up nearly a quarter of the income her husband brings home from the oilfields. The Bryson, Texas, couple makes too much to qualify for Affordable Care Act tax credits that help people buy coverage. But they don't make enough to comfortably afford insurance on their own, even though Paul Leatherwood works seven days a week. (Murphy, 12/10)

An increasing number of Iowans who face steep health insurance bills are looking at an alternative: faith-based “health sharing ministries,” in which religious Americans help each other pay medical bills. The arrangements aren’t exactly insurance, but they count as coverage under the federal Affordable Care Act. That means people who join the cost-sharing ministries don’t have to pay a federal penalty for going uninsured. (Leys, 12/8)

As rates skyrocket, and uncertainty over the health law threatens to push premiums even higher, consumers who buy their own coverage and earn too much to qualify for financial aid are bearing the brunt of price increases. ... And rates could spike even higher if Congress and the president repeal the individual mandate that requires eligible Americans to buy health insurance or pay a fine. (Chang, 12/10)

With Congress seemingly on the brink of repealing the Affordable Care Act’s centerpiece requirement that most people get insurance or pay a penalty, Democrats are warning such a move would be disastrous, and Republicans are anticipating a sweeping symbolic victory. Senate Republicans included a measure to repeal the mandate in their recently passed tax overhaul; the House didn’t, leaving GOP leaders to hammer out a final agreement for the compromise bill they hope to pass by year’s end. President Donald Trump on Friday night threw his weight behind the push to strike the mandate, promising a crowd in Pensacola, Fla., that it would soon be gone. (Radnofsky and Armour, 12/10)

In other news —

Sen. Lisa Murkowski (R-Alaska) is pushing back on Democratic attacks that she is undercutting ObamaCare, saying opponents are simply using “scare tactics.” In a question-and-answer video posted on her YouTube page, Murkowski defended her vote for tax reform this month. Murkowski backed a bill that includes language repealing ObamaCare’s individual mandate. (Sullivan, 12/8)

Kaiser Health News: Sen. Collins’ Strategy To Stabilize Insurance Market Raises Doubts Among Analysts
Sen. Susan Collins (R-Maine), whose vote was pivotal in pushing the GOP tax bill forward last week, thought she had a deal to bolster health care protections in exchange for her support. But it’s now far from clear that her strategy to shore up part of the Affordable Care Act will prevail or that her deal would produce the results she anticipates. (Rovner, 12/11)

A tax overhaul bill being hammered into its final form by Senate and House Republicans is all but certain to cut tax credits designed to encourage development of “orphan drugs” meant to treat rare diseases afflicting limited numbers of patients. Since 1983, a federal law has allowed fledgling companies to write off 50% of the cost of human clinical studies to develop drugs aimed at small markets of patients who wouldn’t otherwise have access to drugs specifically designed for their ailments. The law was designed to address crippling diseases afflicting a few thousand, or fewer, adults and children. (Burton, 12/8)

Anne Hammer is one of millions of elderly Americans who could face a substantial tax hike in 2018 depending on the final negotiations over the Republican tax bill. In her retirement community in Chestertown, Md., it’s the big topic of conversation. Hammer is 71. Like many seniors, her medical bills are piling up. There are doctor visits, insurance premiums, drugs, a colonoscopy, a heart scan, an unexpected trip to the emergency room that lasted three days, ongoing monitoring for breast and ovarian cancer that run in her family and the costs of medical staff at her retirement community. Her out-of-pocket medical expenses vary, but she estimates they are about $20,000 a year. (Long, 12/10)

A progressive activist who identified himself as diagnosed with Lou Gehrig's Disease (ALS) confronted Sen. Jeff Flake (R-Ariz.) on an airplane this week over Flake's vote on the GOP tax-reform bill. Activist Ady Barkan, a staffer at the Center for Popular Democracy, questioned Flake on Thursday after the Arizona Republican voted in favor of the GOP tax-reform bill that passed the Senate in a late-night session last week. Videos of the 11-minute conversation were posted on Twitter. (Bowden, 12/8)

Republicans must resolve the differences between the House and Senate versions of their tax overhaul bill before they can pass a final version. Both versions include substantial overall tax cuts for individuals and businesses, but the details vary, resulting in different outcomes for different groups. (Andrews and Parlapiano, 12/8)

In the coming days, a small group of Republicans will meet in Washington to try to settle a simple question: Should their revised tax bill eliminate a deduction for medical expenses and take away thousands of dollars each year from many people who are sick and, often, old? The two competing tax bills that will form the basis of an attempt at compromise over the coming weeks, one from the House of Representatives and one from the Senate, answer the question differently. The Senate bill would keep a deduction for medical expenses intact. The House bill would kill it off entirely. The more money that people had to spend this year, the more they would lose next year if the House prevails and the deduction disappears. (Lieber, 12/8)

And in other tax news —

A fight over ObamaCare is spilling into Congress’s December agenda, threatening lawmakers’ ability to keep the government open. President Trump signed stopgap legislation Friday aimed at averting a shutdown and keeping the government funded through Dec. 22. The bill allows lawmakers to focus on the next — and seemingly more difficult — negotiating period. (Weixel, 12/9)

ObamaCare's "Cadillac tax" has emerged as a sticking point in bipartisan negotiations over delaying certain health-care taxes before the end of the year. Democrats are pushing to delay the “Cadillac tax” on high-cost health plans, which is despised by unions, but Republicans are pushing back and have resisted including the Cadillac tax in the package, sources say. (Sullivan, 12/10)

Nearly 100 House Democrats are urging congressional leaders to pass a bipartisan extension of the Children’s Health Insurance Program (CHIP). In a letter sent Friday, 99 House Democrats urged leaders of the House and Senate to reject the House-passed CHIP extension and instead work on a bipartisan solution. (Weixel, 12/8)

Attorney General Jeff Landry’s office is raising “concerns” that Louisiana’s governor cannot legally sidestep lawmakers to enter into $15.4 billion in Medicaid contracts through an emergency process. Sixteen Republican state senators asked Landry to determine if Gov. John Bel Edwards can use emergency provisions to keep five managed-care companies operating services for 1.5 million Medicaid patients. The guidance issued to lawmakers by the GOP attorney general suggests that if the Democratic governor’s administration continues services by invoking the emergency statute, the contracts could be subject to legal dispute. (Deslatte, 12/11)

[Assistant Attorney General John Morris] said Edwards, a Democrat, and the Louisiana Department of Health do not have the authority to extend five contracts with private companies for 23 months, as the governor wants, if lawmakers on the Legislature's budget committees won't vote for them. The contract extensions have won the approval of the Senate Finance Committee, but the House Appropriations Committee voted down the arrangements twice in November. (O'Donoghue, 12/10)

The agency that runs Texas’ Medicaid program owes the federal government about $1 million dollars for making payments to cover health care services for dozens of people who weren’t alive. The Texas Health and Human Services Commission pays managed care organizations a fixed rate to provide medically necessary services to Medicaid recipients. (Rice, 12/9)

The policy, known as the Hospital Readmissions Reduction Program, created financial penalties for hospitals whose readmissions exceed the national average for patients suffering from heart failure, heart attacks, and pneumonia. In recent years it has been expanded to include other conditions. Its aim was to encourage hospitals to deliver stepped-up care to severely ill patients even after they leave the hospital, in the hope of preventing return visits that result in more anguish for patients and skyrocketing costs for everyone else. (Ross, 12/11)

Hospitals and health plans are increasingly investing in consumer-oriented services to remain competitive as patients and members shop more for their care. Most healthcare executives currently focus at least part of their strategic plan on consumerism, and they expect that will only continue to grow in the years ahead, according to respondents to Modern Healthcare's most recent CEO Power Panel survey. (Castellucci, 12/9)

Kaiser Health News: In Era Of Increased Competition, Hospitals Fret Over Ratings
For two years, Saint Anthony Hospital here has celebrated its top-rated “A” grade from the national Leapfrog Group that evaluates hospital safety records. But this fall, when executives opened a preview of their score, they got an unwelcome surprise: a “C.” Hospitals take their ratings seriously, despite hospital industry experts’ skepticism about their scientific methodology and studies showing that scores may not have a huge influence on patient behavior. In a highly competitive market, no one wants to be a “C”-rated safety hospital any more than a “C”-rated restaurant for cleanliness. (Gold, 12/11)

Two major hospital systems are in talks about a possible merger that would create the largest U.S. owner of hospitals, as a series of deals shape up to further consolidate control of the health-care landscape. Ascension and Providence St. Joseph Health, both nonprofits, are talking about combining, according to people familiar with the discussions. A deal would create an entity of unprecedented reach, with 191 hospitals in 27 states and annual revenue of $44.8 billion, based on the most recent fiscal year. That would dethrone the nation’s largest pure hospital operator, HCA Healthcare Inc., which owns 177 hospitals and ended 2016 with $41.5 billion in revenue. (Evans and Wilde Mathews, 12/10)

Ascension Health and Providence St. Joseph Health are in talks to merge and create the nation's largest hospital chain, the Wall Street Journal reported on Sunday. A merger between St. Louis-based Ascension and Providence out of Renton, Washington would give the combined not-for-profit entity 191 hospitals in 27 states and annual revenue of $44.8 billion. The deal would put the merged company ahead of HCA, which has 177 hospitals and reported $41.5 billion in 2016, according to Modern Healthcare data. (12/10)

Ascension is in talks to combine with Providence St. Joseph Health, another nonprofit system, in a merger that would create a combined health system with 191 hospitals in 27 states and annual revenue of $44.8 billion, the Wall Street Journal reported. ...The health system is now the second-largest in Wisconsin. (Hauer and Boulton, 12/10)

And in other hospital news —

A Catholic Health Initiatives and Dignity Health combination that would form a not-for-profit powerhouse exemplifies a traditional health system mega-merger under a newly popular two-pronged leadership approach. More than a year after announcing plans to align, CHI and Dignity late last week signed a definitive agreement to merge, potentially creating the nation's largest not-for-profit hospital company. The new health system would include 139 hospitals, more than 159,000 employees and 25,000 physicians and other advanced practice clinicians. (Kacik and Bannow, 12/9)

Mayo announced this summer that it would close its LeRoy clinic after key staffers left, though its pharmacy remains open. ... This scenario is playing out in towns across the state as Mayo closes or trims service at smaller clinics throughout its Minnesota health care network, leaving some Mayo patients concerned about getting to a doctor and questioning the clinic's commitment to the people in its service area. (Richert, 12/10)

The internet is great place to shop for plane tickets, laundry detergent, artisan jewelry and pretty much anything else you might ever want to buy. But a new report says there's one big exception — healthcare. If you expect the World Wide Web to help you figure out how much you'll need to pay to get your hip replaced, a painful joint isn't your only problem. And if you think Google can tell you the cheapest place to go for a cholesterol test, just type "reality check" into that rectangular search bar. (Kaplan, 12/8)

This month, the Minnesota Department of Human Services rolled out stringent opioid prescribing guidelines, including a plan to track doctors and warn or sanction those who are too liberal with prescriptions. ...While none of the guidelines outlaw opioids for chronic pain, they might have spooked some doctors into cutting prescriptions and persuaded health insurers to impose limits that can create havoc for patients already on high doses of the drugs. (Olson, 12/9)

McKesson Corp.’s board failed to audit the company’s system to spot suspicious shipments of opioid-based painkillers even after agreeing to do so as part of a settlement, according to a summary of board minutes unsealed Friday in a shareholder lawsuit. The suit, filed in October, alleges that McKesson directors paid scant attention to oversight of opioid sales after a 2008 settlement centering on the company’s insufficient monitoring of such shipments. The directors also disclaimed any responsibility for the growing opioid epidemic, seeing it as a “matter of public policy to be addressed by the federal and state governments,” the investor said in another unsealed portion of the complaint. (Melin and Feeley, 12/8)

Chris Beekman, whose company sells the dietary supplement Opiate Detox Pro, does not understand what all the fuss is about. “If it works, it works,” Mr. Beekman, the owner of NutraCore Health Products, said in an interview. “If it doesn’t, it doesn’t.” His customers, addicts trying to shake a dependence on opioids, can always get their money back, he said. (Kaplan, 12/8)

The synthetic painkiller fentanyl has been the driving force behind the nation’s opioid epidemic, killing tens of thousands of Americans last year in overdoses. Now two states want to use the drug’s powerful properties for a new purpose: to execute prisoners on death row. As Nevada and Nebraska push for the country’s first fentanyl-assisted executions, doctors and death penalty opponents are fighting those plans. They have warned that such an untested use of fentanyl could lead to painful, botched executions, comparing the use of it and other new drugs proposed for lethal injection to human experimentation. (Wan and Berman, 12/9)

Kaiser Health News: Opioids After Surgery Left Her Addicted. Is That A Medical Error?
In April this year, Katie Herzog checked into a Boston teaching hospital for what turned out to be a nine-hour-long back surgery. The 68-year-old consulting firm president left the hospital with a prescription for Dilaudid, an opioid used to treat severe pain, and instructions to take two pills every four hours as needed. Herzog took close to the full dose for about two weeks. (Bebinger, 12/11)

Nearly six months after syringe services programs, known as needle exchanges, became legal in Virginia in an effort to curb surging rates of hepatitis C, the Department of Health has yet to receive a single application to launch one from any of the 55 eligible districts. (O'Connor, 12/11)  

Health officials are warning that the United States may have an unusually harsh flu season this year. But they stress that flu seasons are notoriously difficult to predict, and it's far too early to know for sure what may happen. The concern stems from several factors, including signs that the season started a few weeks earlier than usual. "When you have an early start with regional outbreaks, that is generally not a good sign," says Anthony Fauci, who directs the National Institute of Allergy and Infectious Diseases. "Sometimes that's the forerunner of a serious season." (Stein, 12/8)

The Arizona Department of Health Services has reported 1,143 cases of influenza, spanning all 15 counties, so far this flu season. One infant has died in Maricopa County. State data shows significantly more flu cases this year than at this time last year. (Del Rio, 12/8)

Flu numbers are rising in Wyoming, with the highest levels reported in the southwestern corner of the state. The Wyoming Department of Health’s Kim Deti said people should keep common-sense measures in mind to help slow or prevent spreading the flu. (Mullen, 12/8)

Two hundred and fifty-seven Ohioans have been hospitalized for the flu so far this season, above the five-year average for this period. But the Ohio Department of Health says it's not too late to get a vaccine to prevent the illness. (Segall, 12/8)

Georgia is one of seven states overall — most of them in the Southeast — that have reported “widespread’’ flu activity, according to a new CDC report, tracking the week ending Dec. 2. ...The Georgia Department of Public Health said Friday that there have been 47 influenza-associated hospitalizations in the eight-county metro Atlanta area so far this season. (Miller, 12/9)

If a new flu pandemic emerges, it may be easy to spot. The epidemic is most likely to appear in spring or summer, researchers have found — not in the midwinter depths of the flu season. Normally flu strikes in winter, when children are crowded into classrooms and the air is cold and dry — ideal for transmitting the influenza virus. But historically, that has not been true of the great flu epidemics. (McNeil, 12/8)

As recent years have seen great progress in treating cancer, the country’s second leading cause of death with almost 600,000 people dying from it last year, American researchers are struggling to keep the momentum. While they have developed more than 2,000 immunotherapy drugs, only five percent of patients are willing to test them. (Booker, 12/10)

Andrea Sutton, a mom in Firestone, Colo., was trying to put her 3-year-old son Daniel down for a nap, but he wasn't having it. It was January, too cold for him to burn off much energy outside, and he was restless. She read him some books to settle him down and then left him to fall asleep. She returned with her 4-year-old daughter a little while later to check on him. They found him hanging from the cord of the window blinds, wearing like a necklace the V-shaped strings above a wooden knob that lowers when the blinds go up. (Haelle, 12/11)

Women who consume lots of sugar during pregnancy may increase the risk for asthma in their children, researchers report. Previous studies have suggested that poor diet and obesity are linked to the current increases in childhood asthma. This new study, in the Annals of the American Thoracic Society, implicates sugary drinks and fructose, or fruit sugar. (Bakalar, 12/8)

Jeannie Cox currently enjoys a flavor called Coffee & Cream when she vapes. She’s also fond of White Lotus, which tastes “kind of fruity.” She buys those nicotine-containing liquids, along with her other e-cigarette supplies, at Mountain Oak Vapors in Chattanooga, Tenn., where she lives. A retired secretary in her 70s, she’s often the oldest customer in the shop. Not that she cares. What matters is that after ignoring decades of doctors’ warnings and smoking two packs a day, she hasn’t lit up a conventional cigarette in four years and four months. (Span, 12/8)

It's a typical hectic morning at Michele Comisky's house in Vienna, Va., when she gets a knock on her front door. "Hi, how are you?" Comisky says as she greets Keisha Herbin Smith, a research assistant at Georgetown University. "Come on in." Comisky, 39, leads Herbin Smith into her kitchen. (Stein, 12/11)

Your brain may be the most miraculous thing about you. Think about it: Its processing power would put the most powerful computer to shame.It’s the control center for a dizzying number of physical tasks. And it makes you you — not bad for a big lump of grayish matter. So why not feed your brain by learning more about it? It’s easy, thanks to the Harvard Brain Tour, a virtual journey through brains’ innate capacities and the discoveries they’ve prompted throughout the century. (Blakemore, 12/10)

Yoga may hold a key to aging well, suggests a growing body of research into its potential benefits for body and mind — benefits that include reducing heart rate and blood pressure, relieving anxiety and depression, and easing back pain. One recent study even raised the possibility of positive changes in biological markers of aging and stress in people who do yoga. So it’s no surprise that the number of yoga practitioners in the United States has more than doubled to 36.7 million over the last decade, with health benefits the main reason people practice, according to the Yoga in America Study conducted last year on behalf of Yoga Journal and the Yoga Alliance. (Krucoff, 12/10)

During the holiday season, many of us feel pressure to find our loved ones the "perfect" gift. Why? Because gift-giving has long been considered a prime way to express love. However, recent research suggests that gestures don't need to be large or have a hefty price tag to feel meaningful. The study, published this summer in The Journal of Social and Personal Relationships, suggests that small acts of kindness, not grand overtures, make people feel most loved and supported. (Fraga, 12/9)

In 1997, when Japanese researchers accidentally discovered a gene variant that appeared to speed up aging in lab mice — which they stumbled upon while conducting an unrelated study on high blood pressure — they named it Klotho. ...[Dena] Dubal’s lab runs one of dozens of research initiatives under way at Bay Area universities, institutions and biotech firms — some funded by a new influx of venture capital — that show promise that modern medicine may be able to eradicate or prevent diseases for which aging is the biggest risk factor. (Ho, 12/8)

American adults who grew up without the Internet and once didn’t see the value in getting a smartphone or downloading dozens of apps are increasingly seeking out new technologies. ...But one major challenge: The employees creating the app are often a couple of generations distant from their user base. (Thadani, 12/8)

Many of Ron Fleming’s fellow soldiers have spent the last five decades trying to forget what they saw — and did — in Vietnam. But Fleming, now 74, has spent most of that time trying to hold onto it. He’s never been as proud as he was when he was 21. Fleming was a door gunner in the war, hanging out of a helicopter on a strap with a machine gun in his hands. He fought in the Tet Offensive of 1968, sometimes for 40 hours straight, firing 6,000 rounds a minute. But he never gave much thought to catching a bullet himself. (Dembosky, 12/11)

Hospitals across Southern California reported that high numbers of patients with breathing problems caused by this week's wildfires visited emergency rooms. Health officials in Ventura, Los Angeles and Santa Barbara counties warned of high pollution levels caused by smoke. The microscopic particles in smoke can penetrate deep into the lungs, creating a hazard for those who already have heart or lung problems such as asthma, emphysema or COPD. (Karlamangla, 12/8)

A week of major wind-whipped fires across Southern California has caused significant air pollution and health problems. The air quality is worst in and around fires burning from Ventura County to San Diego County, but the smoke has traveled to places not threatened by the flames. And with the Santa Ana winds dying down, officials say the smoke could stick around for a while. (Karlamangla and Vives, 12/9)

Climate change-focused research published in the journal Environmental Research Letters a year ago concluded smoke could send 30 more people to hospitals across the West each year during the late 2040s than was the case 40 years earlier as smoke waves become more frequent and severe, mostly in the late summer and early fall. ...Impacts could be heavy in parts of central Colorado and Washington — and in Southern California. (Upton and Wheeling, 12/9)

Fenway Community Health Center permitted a doctor accused of sexually harassing and bullying employees to continue working there for four years after the first serious complaint was filed in 2013, according to interviews with current and former employees and documents reviewed by the Globe. (Healy and Pfeiffer, 12/8)

The chief executive of Fenway Community Health Center resigned Sunday, under pressure from the board of directors, employees, and donors over his handling of complaints that a prominent doctor had allegedly sexually harassed and bullied staff members there for years. (Healy and Pfeiffer, 12/10)

Two years ago, Texas threatened to shut down Timberlawn psychiatric hospital over severe safety problems that investigators said put patients in jeopardy. Instead, the state decided to let the Dallas hospital stay open but to monitor it more closely. Yet on the state’s watch, Timberlawn has had many of the same problems — and at least one new one, according to interviews and inspection records obtained by The Dallas Morning News. (Mervosh and Ambrose, 12/10)

Partners HealthCare, the state’s largest health system, recovered from the worst financial loss in its history to record a profit this year after a turnaround in its insurance business, Neighborhood Health Plan. In the 2016 fiscal year, Partners lost $108 million on operations, driven almost entirely by losses at Neighborhood, a Medicaid insurer that Partners acquired in 2012. (Dayal McCluskey, 12/8)

Clover Health, an insurance startup propelled by Silicon Valley money, is losing one of its two founders. The setback comes about six months after an investment that valued the company at more than $1 billion. Kris Gale told employees last month that he’s stepping away from his role as chief technology officer but will remain an adviser. He didn’t detail a reason for his departure, which he said would be official at the end of January. “Getting to this point took a lot out of me, and because of that, I can better serve Clover as an adviser going forward,” he wrote in a message to staff reviewed by Bloomberg. (Huet, 12/8)

Nationally, fewer than 10 percent of the nation’s physicians practice in a rural area — even though such areas hold 20 percent of the U.S. population. In Colorado, there are 13 counties — all rural — that do not have a hospital, including two without even a clinic. Two counties, including Crowley, don’t have a single doctor. As a result, rural Coloradans face greater barriers to receive care. Ratios of patients to providers are higher in rural areas than in urban. A Colorado Health Institute survey from earlier this year found that rural Colorado counties have the longest wait times for patients trying to see a general-practice doctor or a specialist. (Ingold, 12/10)

Three months after Hurricane Harvey struck the shores of Texas, some local environmental groups say they are in the dark about the safety of federal Superfund sites damaged during the storm. (Regan, 12/10)

Republicans haven’t figured out how to kill the Affordable Care Act. But they are transforming it into a weaker, less efficient and more dysfunctional version of itself. ... The tax cut bill Senate Republicans passed earlier this month would eliminate the individual mandate, a key piece of the program’s architecture that requires people to get insurance or pay a penalty to the government. If final legislation includes the same provision, and if the legislation becomes law, then fewer people will have insurance and premiums will be higher, according to experts in and outside the government. (Jonathan Cohn, 12/10)

Collins said that she would vote for the recent Senate tax bill so long as Republicans leaders promised to pass other legislation — in the near future — that would reduce the bill’s knock-on damage to health care programs. ... Her colleagues assured her they would pass the bills she wanted — not immediately but soon after the tax bill had passed. ... Within days of the Senate vote on the tax bill, conservative House Republicans started saying that they didn’t care about her deal. She did not make it with them, and they do not feel bound by it as they negotiate the bill’s final language with the Senate. These House members, as Politico put it Friday, have decided to “thumb their nose” at Collins. (David Leonhardt, 12/10)

Confirming the warnings and worst fears of progressives, House Speaker Paul Ryan made it plain this week: the ultimate aim of Republican lawmakers -- and their number one priority in January -- is to shrink the Medicare program that provides health insurance to the elderly and disabled. ... That's code for resuming a decades-long fight against government-supported health care by conservatives, who fought bitterly against the creation of Medicare in 1965 and have been trying to cripple or kill the program ever since. (Errol Louis, 12/8)

The opioid epidemic should command focused attention even from our policy-averse president. It's America's worst drug crisis, especially severe in the working-class and rural communities that supported President Donald Trump. Its solution involves spending money, which supposedly doesn't faze Trump, and tougher actions against drug companies, which he's vowed to take. (Albert R. Hunt, 12/8)

The American epidemic of opioid abuse is finally getting the attention it warrants. While policy solutions continue to be inadequate, the decision by President Trump to declare a national opioid emergency has helped to increase discussion about the problem and how the country can solve it. But the conversation also needs to address a dangerous – and largely ignored – interconnected public health crisis wreaking havoc among young Americans. The problem is that more Americans than ever are injecting opioids and inadvertently infecting themselves with hepatitis C. Shared needles mean shared blood-borne infections – and that’s how the opioid crisis has created a new generation of hepatitis C patients. (Robert Greenwald, Ryan Clary, 12/7)

[T]his past week there were big headlines about a new study that linked contraceptive pills and other hormonal birth control to an increased risk of breast cancer. Some news articles stressed the risk of a commonly used medication. Others, like the one by Roni Caryn Rabin in The New York Times, carefully placed the numbers in context to explain that the absolute risk is very small. (Relative risk is the percentage change in one’s absolute risk as a result of some change in behavior.) I would go even further. This was a prospective cohort study, meaning it was an observational study that followed women over time and saw what happened to them naturally. The data set didn’t allow for adjusting for some factors that could also be associated with breast cancer .... The study found only an association, and not causal proof you might obtain from a randomized controlled trial. (Aaron E. Carroll, 12/10)

The problem is that while some individuals will have their lives saved by early cancer detection, if every person were to undergo screening, there would likely be no lives saved overall. It’s counterintuitive — but it’s what the evidence says. (Benjamin Mazer and John Mandrola, 12/8)

American consumers aren’t the only ones struggling with higher healthcare costs. CVS Health’s proposed $69-billion purchase of health insurer Aetna is driven in part by the companies’ efforts to get control over more of the costs they face, and to make their operations more efficient. The question for regulators, though, is whether the combination results in a company that uses its clout to help consumers or squeeze more dollars out of them. (12/11)

The architects of the slew of major healthcare deals announced in the past week offered a common rationale: The combinations will lower costs and improve care. Yet a closer examination of the deals suggests these hookups merely tinker around the edges of the major drivers of healthcare spending. And, for the two deals hatched on Wall Street, a good argument can be made that they are more motivated by the profits that come from financial engineering than the savings that can be derived from lowering the cost of care. (Merrill Goozner, 12/9)

As board chair of a community hospital, I am often confronted with the dozens of quality and safety measures that state and federal regulators use to score and pay us, and private organizations use to rate us. And as someone who works to improve the quality of care for older adults, I am struck by how much all these measures miss when it comes to what really matters for seniors. ... These ratings are often described as measuring quality and safety. In truth, they really measure only safety. And they are much more likely to focus on process than on outcomes. That’s not surprising because process is so much easier to track, especially for older adults. Falls can be counted. Happiness cannot. (Howard Gleckman, 12/6)

Hospitals and health plans are increasingly investing in consumer-oriented services to remain competitive as patients and members shop more for their care. Most healthcare executives currently focus at least part of their strategic plan on consumerism, and they expect that will only continue to grow in the years ahead, according to respondents to Modern Healthcare's most recent CEO Power Panel survey. (12/9)

The first day I worked as a doctor, I experienced the most intense sense of loss and failure of my entire career. And I began to learn a lesson that I've needed 30 years to fully appreciate. It is this: Even the most conscientious physician can never care as much as a family member whose beloved child or spouse or parent is dangerously ill. So if we are wise, we doctors and scientists will learn to tap that urgency born of their love to help our patients. (Isaac Kohane, 12/8)

The San Antonio City Council is considering raising the legal age to purchase tobacco products from 18 to 21. This proposal is flawed on many levels. It sends young people a troubling message about adulthood and the role of government, it will not serve the stated purpose of limiting tobacco use, and it will hurt San Antonio businesses. (Anwar Tahir, 12/10)