�鶹Ů��

Urging people to sign up for coverage under the Affordable Care Act, President Obama said last week that while premiums might be rising, most consumers need not worry. “Premiums going up,” he said, “don’t necessarily translate into higher premiums for people who are getting tax credits.” ... But left unmentioned in the pitch to consumers are what economists and health policy experts describe as possible reasons to be concerned about rising premiums. (Pear, 10/30)

Republicans are jumping on the news that ObamaCare premiums will rise nationwide to push a GOP alternative. In the GOP weekly address, Rep. John Ratcliffe (Texas), bemoaned the news that premiums on the most common ObamaCare plan will rise nationwide, by an average of more than 20 percent. ... Republicans have jumped on the mounting headlines of rising ObamaCare prices and fewer insurers on the marketplace. (Rupert, 10/29)

Tuesday is a big day for ObamaCare.Officials are kicking off a sign-up season that is critical for the health of the law. The enrollment period for 2017 coverage stretches from Nov. 1 to Jan. 31. The administration is looking to boost the sign-up numbers by bringing in more young and healthy people. That would help ease insurer concerns about the stability of the law, amid attention on spiking premiums and insurers dropping out of the market. (Sullivan, 10/31)

Having health insurance is vital for 21-year-old Mercedes Nimmer, who takes several expensive prescription drugs to manage multiple sclerosis. So Nimmer was thrilled to get health insurance last year through the Affordable Care Act’s marketplace and qualify for a federal subsidy to substantially lower her cost. Yet, the government assistance still left her with a $33 monthly premium, a hefty amount for Nimmer, who makes $11,000 a year as a part-time supply clerk. (Galewitz, 10/31)

Insurers selling plans on the federally run exchange in Tennessee next year are cutting off the commissions they paid brokers for selling their products — leaving brokers short on income and wondering how to handle open enrollment, which begins Tuesday. Cigna and Humana decided not to pay individual commissions — paid per member per month they pay a premium — after BlueCross BlueShield of Tennessee pulled its on- and off-exchange plans in three major metro areas for 2017. Aetna, which is selling plans off exchange across the state, also informed brokers it would not be paying individual commissions in Tennessee. (Fletcher, 10/28)

Saint Thomas Health and Cigna have reached an agreement that will put the not-for-profit health system in some 2017 health insurance plans sold on the Obamacare exchange. Saint Thomas Health was excluded from networks in individual health plans sold on the exchange after UnitedHealthcare decided to leave the state and BlueCross BlueShield of Tennessee exited the greater Nashville market. The two remaining carriers, Cigna and Humana contracted with TriStar Health, leaving Saint Thomas Health, Nashville General Hospital at Meharry and Vanderbilt University Medical Center out of plans sold on the exchange. (Fletcher, 10/28)

Starting on Tuesday, nearly 90,000 New Hampshire residents will have the opportunity to shop around for a better deal on health insurance, and others are expected to sign up for the first time, in the fourth open enrollment period under the Affordable Care Act, aka Obamacare...By November of 2014, four more companies jumped into the online marketplace, bringing to five the number of companies offering coverage in 2015 and in 2016. But that number is about to drop to four in 2017, as Community Health Options, a Maine-based insurance cooperative (meaning its owners are technically the policy-holders), has pulled out of New Hampshire after experiencing heavy losses. (Solomon, 10/29)

Whether or not Missourians feel sticker shock when shopping for insurance coverage on HealthCare.gov this fall will depend on their income and where they live. On average, premiums are increasing in almost every county in Missouri for 2017 coverage, and they’re climbing nationwide too. About 87 percent of Missourians who purchased plans through HealthCare.gov last year received some sort of financial assistance because of their income, according to data from the U.S. Department of Health and Human Services. And that’s the angle federal health officials keep pushing as critics say the price increases mean the Affordable Care Act is faltering. (Liss, 10/30)

Central Texans will find higher premiums and fewer insurers in the Affordable Care Act health insurance exchange when open enrollment for 2017 starts Tuesday. The second-lowest premium for midlevel insurance on the federal exchange for a 27-year-old — the measure the federal government has used to compare premiums — will increase by 16 percent in Travis, Williamson, Hays and Bastrop counties, according to information from the exchange. In Texas, premiums on average will increase by 18 percent. (Chang, 10/28)

The nation’s ever-controversial health care law suffered a black eye last week after the federal government announced that next year’s premiums for those who depend on the Affordable Care Act would increase by an average of 22 percent. But the blow won’t be as painful for most of the 1.4 million Californians who get their health coverage through Covered California, the state’s health insurance exchange: The average 2017 premium increase will be 13.2 percent after two years of modest increases. (Seipel, 10/30)

Numbers released early last week show rate increases for Obamacare on the New Hampshire marketplace are lower than the national average of 22 percent. The Granite State has the second-lowest increase in the country for the "benchmark" silver plan used to compare all states - a policy for a 27-year-old male. That premium increased 2 percent between 2016 and 2017, with the monthly premium for the "benchmark" increasing from $215 a month in 2016 to $219 a month next year. But if you compare all of the individual plans offered by New Hampshire's two largest insurers, the average increase is 11.1 percent for Harvard-Pilgrim and 13.9 percent for Anthem. Abmetter and Minuteman Health also offer plans in New Hampshire. (Solomon, 10/29)

Florida won't be immune from the increases that made national headlines this week. Premiums for plans offered on and off the Affordable Care Act exchanges will rise by an average of 19 percent statewide, according to the Florida Office of Insurance Regulation. Still, advocates insist the plans will be economical. A study released by the U.S. Department of Health and Human Services found 84 percent of Florida consumers will be able to purchase a plan with monthly premiums of $100 or less. (McGrory, 10/28)

Arizona was shaping up to be one of the more unlikely battlegrounds of the 2016 campaign when a political bombshell appeared to explode last week: The Obama administration revealed that the cost of midlevel plans on the Affordable Care Act’s health insurance marketplace here would increase next year by 116 percent on average. Senator John McCain, running for re-election against the headwind of Donald J. Trump, took the bad news as a gift, highlighting it in a new television ad that begins, “When you open up your health insurance bill and find your premiums are doubling, remember that McCain strongly opposes Obamacare.” (Goodnough, 10/29)

Healthcare leaders apparently don't think much of Donald Trump. A quarter of 100 prominent healthcare executives gave money to Trump's opponent, Democrat Hillary Clinton. The rest have not donated to either Clinton or Trump, according to a Modern Healthcare analysis of federal election records. Not a single one financially backed Trump, even though many of them have a history of donating to conservative politicians and causes. (Herman and Muchmore, 10/29)

ObamaCare appears to have lost its potency on the campaign trail. Senate Republican candidates have featured the healthcare law in just 12 percent of their ads this year, according to data by Wesleyan University. That’s about half as many anti-ObamaCare ads by Republicans from the same period in 2014. It's an even sharper shift from the elections in 2010 and 2012, when Republicans campaigned aggressively on the healthcare law and wiped away the Democratic majorities in Congress. Leading up to the GOP’s 2010 wave election, ObamaCare made up a full one-third of advertising, according to the Wesleyan data. (Ferris, 10/31)

This is the third in a series of videos about campaign health proposals that “sound like a good idea.” This one explores why a Republican suggestion to establish a new federal high-risk insurance pool may not be such a good idea after all. (Rovner and Ying, 10/31)

The U.S. health care industry has been hit with 22 major computer breaches since mid-2015 that have resulted in the loss of millions of patient records, says SecurityScorecard, a New York City firm that offers cybersecurity ratings and monitoring. Nearly two-thirds of the 27 largest hospitals in the United States are slow to install security patches to overcome cyber vulnerabilities, the company said in a report released Thursday. It was only one of two surveys released this week on the health care system and cybercrime. A second report, released by Intel Security’s McAfee Labs unit, underscored that stolen medical records are less valuable than stolen records from banks – but still valuable. (Johnson, 10/28)

Healthcare systems, practices and medical schools are deploying an array of tactics to help physicians cope with the unique stress of modern medicine. Some programs offer regular moments of reflection, connection with other doctors or other sources of catharsis. (Whitman, 10/29)

Pediatrician Karen Rhea said she found it “gut-wrenching” to see young people in psychiatric crisis: a teen who overdosed, the one with mental illness who landed in jail, the high school senior who tried to kill herself by crashing her car. With a population of about 20,000 then, Franklin, Tenn., where she practiced, had no child and adolescent psychiatrists, so Rhea spent long hours searching for inpatient care, phoning judges, looking for mental-health specialists in Nashville 20 miles away. ... And limited access to mental health care has far-reaching consequences. The longer that psychiatric illness or family dysfunction goes on, the more difficult it is for the child to succeed, Rhea said. Untreated problems can lead to difficulties in school, and that, she said, hurts self-esteem, limits social skills, hinders relationships and creates the view in a family that the child is badly behaved instead of having an illness. (Vander Schaaff, 10/30)

Acknowledging that “there is more work to be done” to ensure that patients with mental illness and addiction do not face discrimination in their health care, a presidential task force made a series of recommendations Friday including $9.3 million in funding to improve enforcement of the federal parity law. The long-awaited report is the product of a task force President Barack Obama announced in March during a speech about the opioid epidemic. (Gold, 10/31)

Enthusiasm for precision medicine, from the White House down to everyday physicians, is at an all-time high. But serious problems with the databases used to interpret patients’ genetic profiles can lead to “inappropriate treatment” with “devastating consequences,” researchers at the Mayo Clinic warned on Monday. Their report describes the cases of some two dozen people who had heart defibrillators surgically implanted but, it turns out, never needed them. The individuals were family members who underwent genetic testing after a young relative died of a heart syndrome. Test results indicated that they carried a mutation in a heart-related gene — and the database that the testing company used indicated it caused a potentially fatal disorder. (Begley, 10/31)

The research group behind an effort to synthesize a human genome this week released more information about its plans, including a draft white paper with a timeline of how the research might go. It’s the latest step in the ambitious project, originally named “Human Genome Project-Write,” which came to light after a May meeting to discuss the building of large genomes from off-the-shelf parts. Within a year, the international group will select one small-scale research project to kick off the effort, and start a “major effort to engage with representative members of the public,” according to the draft road map. By year five, it will “shift into high gear” and start tackling the creation of entire genomes — maybe human or maybe not, depending on feedback. (Swetlitz, 10/28)

Just about every day, genetic counselor Shawn Fayer heads to the maternity ward at Brigham and Women's Hospital in Boston and tries to convince new parents to give him a blood sample. Fayer is offering gene sequencing for newborns. It gives parents a tantalizing look at their baby's genetic information. (Harris, 10/31)

But whether the trade group should be hawking it at an assembly of the nation’s dietitians — as it did here at a conference this month — has become a point of contention.The event in question is the annual Food and Nutrition Conference and Expo, and it is a veritable feast of food-related promotion. But the event is also made possible by vast sums of money from companies and trade groups, in some cases reinforcing the perception that “Big Food” brands are corrupting the guidance provided to millions of Americans every year. Over the years, the group hosting the event, the Academy of Nutrition and Dietetics, has exacerbated those concerns. (Kaplan, 10/31)

If you’ve inhaled so many “fun size” Halloween candies that you feel like you could die, scientists have some good news: That is extremely unlikely. Of all the ways to go, overdosing on candy might not seem so bad. But death by candy is actually pretty hard to pull off. (Kaplan, 10/31)

A complication of measles that kills children years after they have been infected is more common than previously thought, according to disturbing data released Friday. ... The complication is a neurological disorder that can lie dormant for years and then is 100 percent fatal. Researchers don't know what causes the virus to reactivate, and there is no cure once it does. The only way to prevent the disorder is by vaccinating everyone possible against measles. (Sun, 10/28)

The body’s immune T cells fight off foreign invaders, but in patients with cancer and chronic diseases, they get tired from that constant battle. And it’s not just the body’s natural T cells that get exhausted. Engineered cells known as CAR-T cells — which aim to home in on and attack tumor cells — can get worn out, too. Now, scientists have a clearer picture of what’s happening inside those tired T cells. We talked to researcher Dr. Nick Haining of the Dana-Farber Cancer Institute about the work, published this week in Science. (Thielking, 10/28)

A majority of U.S. middle and high schoolers say that e-cigarettes are less harmful than traditional cigarettes and that such products as smokeless tobacco and cigars fall somewhere in between, according to national surveys. They’re not necessarily wrong, but that comes with caveats, experts say. (10/28)

After skin disease, prostate cancer is the most common cancer among men in the United States, affecting 1 in 6. It also is the second-leading cause of death from cancer among men. Nearly 3 million men in the United States currently live with prostate cancer, with a new case occurring every 2.4 minutes and a death occurring every 19.1 minutes. ... Prostate cancer has no early warning signs. But a test that involves a digital rectal exam and a blood test can help identify cancer early on, when treatment is most effective, says Dr. Ronney Abaza, a urologic surgeon at OhioHealth. (Pyle, 10/30)

Co-founded by Jay Feinberg, who found himself in need of a donor 25 years ago, Gift of Life has facilitated more than 3,000 transplants since its inception in 1991. It has added 275,000 names to Bone Marrow Donors Worldwide, a database of 28 million donors ... [Robby] Holroyd says that being a donor is one of the most gratifying — and easiest — things he has ever done. (The procedure, which involves a machine draining blood from your arm, has much become much easier over the years.) (Rhodes, 10/28)

Nonprofit hospitals in New York have invested billions of dollars with secretive offshore financial firms, and some of the most complex deals involved high-stakes insurance coverage affecting doctors, health-care workers and patients. In addition to typical investments, some of the select 16 New York nonprofit hospitals used offshore insurance companies to cover medical malpractice and other liabilities with limited U.S. regulation, a USA Today Network investigation has found. One of the insurance deals involved Mount Sinai Hospital, according to federal tax filings in 2014, the most recent year available. (Robinson, 10/28)

Six months before Dignity Health and Catholic Health Initiatives announced they were in merger talks, the two hospital giants each dispatched small work teams to probe whether a deal was desirable. What they found were complementary geographic footprints, hefty debt burdens and several very successful markets dragged down by a smattering of challenging ones. (Barkholz, 10/29)

Children’s Hospital Colorado is getting a new helicopter outfitted specifically to meet the needs of child patients. The helicopter, which is expected to take flight early next year, will be based exclusively at the hospital in Aurora and will have more interior space than other medical helicopters in order to accommodate an incubator for newborn patients. The nurses and therapists based aboard it will have special expertise in and equipment for treating children. The helicopter will be operated by Flight For Life Colorado, the critical-care transport service of Centura Health. (Ingold, 10/28)

Federal regulators said 12 U.S. hospitals, including well-known medical centers in Los Angeles, Boston and New York, failed to promptly report patient deaths or injuries linked to medical devices. The Food and Drug Administration publicly disclosed the violations in inspection reports this week amid growing scrutiny of its ability to identify device-related dangers and protect patients from harm. (Terhune, 10/28)

Derry Medical Center, Southern New Hampshire Internal Medicine (SNHIM) and UnitedHealthcare have launched an accountable care program to help improve people's health and their satisfaction with their health care experience. Derry Medical Center and SNHIM will provide care under a value-based, patient-centric care model focused on keeping people healthy. The new accountable care program will dedicate resources to care coordination and make it easier to share important health information. Derry Medical Center and SNHIM serve more than 10,000 people eligible for Medicare. (10/29)

Eight children in Western Washington have been hospitalized this fall with acute neurologic illnesses, and health investigators are trying to determine if the children are suffering from an extremely rare syndrome that causes varying degrees of paralysis similar to polio. The children had a range of types and severity of symptoms, but all had a loss of strength or movement in one or more arms or legs. Doctors emphasized the syndrome is not contagious. (Long, 10/28)

The announcement earlier this year that Alta Bates Summit Medical Center would close its campus [in Berkeley, Calif.], possibly as early as 2018 but certainly by 2030, sent shock waves through the East Bay. Cities issued resolutions calling for the hospital to stay open, and “Save Our Hospital” signs popped up on lawns and in store windows. Coming just a year after Doctors Medical Center in San Pablo closed following a long struggle to stay solvent, Alta Bates’ plans to shutter has stoked fears that a large swath of the East Bay is turning into a health care desert that will result in delays in care for those facing life-threatening conditions and longer waits for inpatient procedures. (Ioffee, 10/30)

Last year alone, nearly 2,700 children tested in Philadelphia had harmful levels of lead in their blood. Lead poisoning can cause irreversible damage, including lower IQ and cause lifelong learning and behavioral problems. Lead poisoning can be prevented, and cases have dropped sharply here and across the country. Yet Philadelphia continues to struggle to eradicate the problem, especially in the city's poorest neighborhoods. In some stubborn pockets of the city, as many as one out of five children under age 6 have high lead levels. (Laker, Ruderman and Purcell, 10/30)

Chesterfield County-based Venebio Group LLC thinks it can help with that epidemic by getting to the root of the problem: predicting who is most likely to die by an opioid prescription. The scientific consulting firm has developed a tool — the Venebio Opioid Advisor — that allows physicians to better understand the likelihood that their patient may overdose on an opioid prescription before they write it. That means that if patients are in need of a powerful, painkilling opioid, the physician could ensure they also have access to the overdose-reversing drug naloxone, for example. (Demeria, 10/30)

The first year of safe-sleep training sessions concluded on Saturday morning, part of a multiyear effort to spread the word that babies should sleep alone, on their backs and in a crib free of suffocation risks. The sessions, designed to train “safe-sleep ambassadors,” are open to anyone in the community and are held at Columbus Public Health on Parsons Avenue. In that way, health officials hope to cut down on one of the biggest causes of infant mortality in the county. On average, a baby dies every other week in Franklin County because of unsafe sleep practices, Gray-Medina said. (Feran, 10/30)

The former director of Dartmouth-Hitchcock's Norris Cotton Cancer Center says he was forced out after he questioned how $6 million raised for cancer research was spent. Dr. Mark Israel of Hanover, who headed the center for 14 years, filed the lawsuit Thursday in Grafton County Superior Court. He is suing Dartmouth-Hitchcock Medical Center, Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Health. He is asking the court to order Dartmouth-Hitchcock to return the $6 million to the center's philanthropic accounts, and to award him back wages, compensatory damages and/or restitution in excess of $2 million, as well as attorneys' fees and costs. (Grossmith, 10/29)

As communities across Kansas struggle to accommodate an influx of people with mental illness in their criminal justice systems, religious leaders are calling for a new approach in Lawrence. A group called Justice Matters, which represents 23 congregations, released a report this week titled “Restorative Justice at Home.” The report contains several recommendations to beef up Douglas County’s mental health treatment options as an alternative to a proposed expansion of the county jail. At a news conference Thursday, members of the group described the report as comprehensive reform that aims to shift the community from thinking about mental illness as a risk factor for criminal behavior to instead thinking about it as a medical condition like heart disease or cancer. (Marso, 10/28)

About 8,000 patients were prescribed opiates by Seattle Pain Centers this year, part of an estimated 25,000 seen at eight clinic sites since 2008. The sites closed days after state regulators suspended the medical license of former director Dr. Frank Li, saying he failed to properly monitor Medicaid patients, possibly contributing to at least 18 deaths since 2010. Li, who has denied the allegations, has not been charged with a crime. ... At a news conference Thursday, members of the group described the report as comprehensive reform that aims to shift the community from thinking about mental illness as a risk factor for criminal behavior to instead thinking about it as a medical condition like heart disease or cancer. (Aleccia, 10/30)

The Ohio Supreme Court this week put an end to a long legal battle between the Cleveland Clinic and a retired Air Force colonel when it ruled that a malpractice suit cannot be filed more than four years after an alleged injury. David Antoon, who had surgery at the Clinic in 2008, said the procedure to remove a cancerous prostate gland left him impotent and incontinent and was performed by doctors-in-training rather than the physician he thought would be his surgeon. The Clinic denies any wrongdoing related to the procedure and has also said that Antoon's injuries are well-known risks of his prostatectomy surgery and do not indicate anything was done incorrectly. (Zeltner, 10/28)

More than 300 people gathered Thursday night for an anti-abortion prayer vigil outside an abortion provider in central Phoenix as part of the 40 Days for Life cross-country bus tour. Phoenix is one of more than 125 cities in 50 states that will have been visited by the time the 40 Days for Life campaign, which started Sept. 28 in Washington, D.C., ends Nov. 6 in Falls Church, Virginia. (Frank, 10/28)

A clinical trial conducted at a Virginia hospital indicates that hospital-acquired infections can be reduced by using copper-infused linens and hard surfaces developed by a Richmond-based company. Sentara Leigh Hospital in Norfolk recently published the results of a 10-month clinical trial in which copper-infused linens and hard surfaces developed by Cupron Inc. were used in a wing of the hospital with 124 patient rooms. The areas where the copper-infused materials were used showed an 83 percent reduction in the bacteria C-difficile and a 78 percent overall reduction in “a host” of drug-resistant organisms including MRSA, Sentara said. (Reid Blackwell, 10/28)

The Contra Costa Mosquito and Vector Control office has identified a group of mosquitoes on Bethel Island that have tested positive for the West Nile virus. The group of mosquitoes bearing the virus were identified on Stone Road, between Sea Drift Drive and Slough Place, on Oct. 24. The announcement comes two months after mosquitoes bearing the West Nile virus were identified in the same location on Bethel Island. (Davis, 10/28)

An independent mental-health center that has served the Des Moines area for 47 years plans to join the state’s largest hospital and clinic system. Eyerly Ball Community Mental Health Services has signed a letter of intent to affiliate with the UnityPoint Health system, leaders of both organizations announced Friday. The planned move comes amid a national wave of independent clinics and medical practices joining large health systems. (Leys, 10/28)

Rejecting arguments that the records must be kept secret, a federal magistrate has ordered the Florida Department of Corrections to give a decade's worth of documents about drugs used in the state's lethal-injection procedure to lawyers representing seven Arizona Death Row inmates. Lawyers for the Arizona inmates and the First Amendment Coalition of Arizona in June filed a subpoena seeking years of records related to Florida's three-drug lethal injection protocol, including the types of drugs purchased, the strengths and amounts of the drugs, the expiration dates of the drugs and the names of suppliers. (10/28)

Doctors making house calls is a long-gone tradition that went away in the 1960s, but is slowly making a return as our population grows grayer. A 2012 Medicare pilot program called Independence at Home incentivized doctors to make house calls on frail elders in return for a share of the savings. In its first year, 8,400 patients treated at home nationwide saved Medicare more than $25 million - or $3,070 per patient. Legislation was filed by Massachusetts Sen. Ed Markey last summer to expand the program and make it permanent. (Grosky, 10/29)

During the 2015-16 flu season, nearly 4,000 Ohioans were hospitalized for the flu, and many more more missed school and work while suffering from milder forms of the illness. That's why the Ohio Department of Health (ODH) and Centers for Disease Control and Prevention  (CDC) are urging flu shots this fall for anyone six months old and older. After all, this is the official start of the flu season in Ohio. (Washington, 10/28)

Can private insurers cover Medicaid patients without going broke? That’s the pressing question raised by last week’s news that Neighborhood Health Plan will stop enrolling Medicaid customers until it can sort out its money-losing contracts with hospitals and other providers. The answer is far from clear. (Dayal McCluskey, 10/20)

A federally required fix in the way Medicaid managed-care companies are taxed could hit Ohio and Greater Cleveland particularly hard if state law isn't adjusted wisely to accord with the new federal mandate. The mandate requires affected states either to broaden or eliminate the Medicaid managed-care sales tax. (10/30)

I appreciate the effort by Tim Keck, acting secretary of the Kansas Department for Aging and Disability Services, to put a positive spin on the state’s attempt to improve the lives of Kansans with disabilities, but his recent commentary was inaccurate (“Safety net for disabled strong and improving,” Oct. 24 Opinion). The safety net for Kansans with disabilities is not strong. It is actually deteriorating to the point where drastic action will be required if changes are not made. (Tim Cunningham, 10/31)

The 25 percent increase in Obamacare premiums for 2017 announced on October 24 is eye-popping. That is five times the increase that workers are likely to see in the cost of health benefits offered by employers. Politically, this is a disaster. However, the jump in premiums is overdue. Insurers in the exchange market have found that the cost of providing coverage is much higher than they initially projected. We expect insurers to offer coverage to everyone, regardless of their health condition. That’s good social policy, but it is expensive. (Joseph Antos, 10/31)

On Monday, Donald Trump presented Americans with a puzzle of a sentence: “All of my employees are having a tremendous problem with Obamacare.” At first it seemed like Trump might be admitting to something illegal. Employers have to provide health insurance. The candidate seemed, to some, to be implying that his employees were buying their own insurance (“with Obamacare”) and having tremendous problems. But later that day, on Fox News, Trump said something equally confusing: “Well, I don’t use much Obamacare, I must be honest with you …” Together these sentences raised the possibility that the candidate believes Obamacare is a product or service. And so maybe, like so many Americans, Trump isn’t clear on what Obamacare is. (James Hamblin, 10/30)

We’ve heard a lot of rhetoric in the past few days about the recent announcement of premium increases for the Affordable Care Act marketplaces. Like clockwork, the ACA repeal machine has sprung back into action to argue, as it has for the past six years, that the law will collapse any day now. (Thomas Huelskoetter, 10/31)

Figuring out how Obamacare is faring has always been hard. It’s been hard because many Republicans are rooting for the law to fail and try to make any flaw sound existential. And it’s been hard because we in the media haven’t always done a good job covering the law. We tend to sensationalize its problems, rather than distinguishing between routine ones and truly worrisome ones. (David Leonhardt, 10/28)

Here’s a little diversion to pass the time as you endure Washington’s policy debates. Listen for phrases like “All we have to do” or “We need just a small tweak” or “There’s a really simple fix.” Then watch to see what happens. Whatever that person is proposing will prove to be really, really costly -- politically or fiscally or both...All we have to do to fix American health care is to pay our providers and suppliers low European prices instead of high American ones. All we need to do to make Republican tax plans work is to get economic growth up to 4 percent. All that was needed to make Iraq a better place was for America to depose Saddam Hussein and for Iraqis create a liberal democracy. There is always a devil in the details behind those innocuous “all” statements, and he has his pitchfork ready. (Megan McArdle, 10/28)

According to the Department of Health and Human Services, premiums for a mid-level plan under the Affordable Care Act will go up by an average of 25 percent in the 39 states served by HealthCare.gov. That's more than three times the 7.5 percent hike this year.In Arizona, meanwhile, a 27 year old buying the second lowest “silver plan” will see premiums soar by 116 percent. If that 27 year old makes $35,000 a year, he’ll pay nearly 10 percent of his gross income for insurance even with an Obamacare subsidy... No worries, though. The Obama administration says most of those 27 year olds will get generous taxpayer-supplied subsidies to cut the cost. (Laurie Roberts, 10/28)

In July analyst Paul Westra of the brokerage firm Stifel Nicolaus warned of a looming “restaurant recession,” noting that it might be the first sign of a more widespread U.S. recession in 2017. He said this in a bearish report that downgraded 11 restaurant stocks. ... A September survey by the research firm Civic Science found that more Americans are spending less on dining out. The No. 1 reason was, not surprisingly, a worsening of their personal finances. Yet the one factor that “jumped off the screen” was increased health-care costs. (Andy Puzder, 10/30)

Healthcare pricing concerns are making a late run for relevance as the presidential campaign heads down the homestretch. Unfortunately, too much attention is being paid to price hikes on the Obamacare exchanges, which affect only a thin sliver of the population. Too little attention is being paid to the main drivers of popular concern—high drug prices and employers' insistence on shifting more healthcare costs onto the backs of their employees. (Merrill Goozner, 10/29)

Destructive and persistent, the epidemic of opioid addiction is also deeply ironic: Unlike previous drug scourges in U.S. history, this one spread via perfectly legal channels. Millions of people were introduced to addictive pain-killing medications by doctors’ prescriptions, filled at pharmacies, ultimately supplied by pharmaceutical manufacturers. All of this went on in one of the most heavily regulated sectors of the U.S. economy — health care — which is supervised by a veritable army of officials working for dozens of agencies, state and federal. (10/30)

The alleged “Patient Zero” of the American AIDS epidemic — a French Canadian flight attendant named Gaétan Dugas, who died of AIDS in 1984 — was exonerated last week. Genetic sequencing of blood samples stored since the 1970s showed that the strain infecting him had circulated among gay men in New York for several years before he arrived here in 1974. Therefore, although he had hundreds of sexual partners in several cities, he did not introduce the virus to North America; he was a victim before he was a vector. (Donald G. McNeil, 10/29)

Thanks to some scientific sleuthing, that rap has been laid to rest. Patient Zero never existed. In fact, Dugas’ “zero” designation in popular culture was a solecism propagated in no small part by the author Randy Shilts in “And the Band Played On,” his book about the AIDS crisis. In fact, Dugas had been assigned the letter O, not a number, by a scientist at the Centers for Disease Control and Prevention (CDC). The letter denoted that Dugas was from “outside Southern California,” nothing more. (Mary Sanchez, 10/30)

Many primary care practitioners have been avoiding the battle against opioid addiction and opioid overdoses. But they shouldn’t. Embedded in their communities, primary care doctors and nurses are perfectly positioned to treat addiction and champion care for those struggling with the use of opioid pills or heroin. Our expertise is in getting to know our patients and providing longitudinal care for those with chronic conditions like heart disease and diabetes — and addiction. (Julian A. Mitton, 10/28)

A couple of weeks ago, the big insurance company Anthem decided that it wouldn’t pay for Exondys 51, a drug that already had been approved by the Food and Drug Administration to treat Duchenne muscular dystrophy. Anthem’s decision was controversial, because two other insurers had said they’d cover the treatment for their patients. But it was less controversial than it could have been for two reasons: The drug costs $300,000 a year, and the evidence that it works is almost laughably thin. To put it another way, Anthem’s decision undoubtedly infuriated advocates for DMD patients, but it may well have been the right call. (Michael Hiltzik, 10/28)

It’s that time of year when many people experience cold and sinus infections. Telling them part determines how each illnesses is treated. Each year, about 31 million people experience sinus infections, usually caused by bacteria growing in the sinuses, the bony cavities found behind the nose, eyes, brows, and cheekbones. Typically, a cold or allergy attack causes mucous membranes in the sinuses to swell and block the tiny openings into the sinuses, which interferes with their ability to drain. (Nathan Deckard, 10/28)

Presidents George W. Bush and Obama have warned that keeping nuclear missiles on hair-trigger alert is reckless. There have been multiple near-misses and near-launches — cases where confusion or computer glitches forced leaders to make decisions in just a few sweaty, terrifying minutes about whether to Release the Kraken. And yet, in a failure of imagination and leadership, nothing has been done. Control of this God-like power will soon be transferred to a new president. But do we really want to trust anyone with this situation? (Matt Bivens, 10/28)

There are so many times that we have to count on indirect methods to build evidence to make a diagnosis. For example, we count on an elevated white blood cell count to suggest infection or shadows on a chest X-ray to gauge the size of the cardiac silhouette. But we cannot differentiate between heart enlargement and fluid around the heart, and we read electrical impulses on an EKG and recognize a pattern that is suggestive of one diagnosis or another. This all changed with the addition of ultrasound. (Diane Gorgas, 10/30)

If a patient came to my clinic and asked if it’s OK to smoke marijuana, I would explain why it’s a poor decision for their health. However, on Nov. 8, I will vote yes on Question 4 to legalize recreational marijuana in Massachusetts. This is because I have seen a much more frightening public health crisis up close: the devastating effects of mass incarceration for drug offenses. Rising prison populations constitute a major threat to public health and I believe the costs of incarceration for patients and communities simply outweigh the dangers of marijuana. (Akshar Rambachan, 10/28)

There are a small but growing number of health systems around the country that are thinking “more like retailers” and establishing clear pricing strategies to compete for consumers who face rising out-of-pocket costs under high-deductible health plans, according to a new report from the PwC Health Research Institute. ... Some policymakers believe new laws and regulations are needed to prod healthcare providers to move more rapidly on price transparency. If more consumers were demanding upfront price information to facilitate comparison shopping, that might do the trick. But so far, to the bewilderment of many experts, they are not. (Harris Meyer, 10/27)

Kansans in the mental health community are coming together to preserve our state’s mental health safety net in the face of a $30 million budget shortfall. Many Kansans — more than 126,000 — live with a serious mental illness. As policymakers, advocates and providers work to maintain core services and contain costs, it is important to consider a strategy for those with mental illness to live longer, healthier lives: helping them quit smoking. (Kimber Richter, 10/30)

An annual report from the Centers for Disease Control and Prevention put St. Louis at the top spot in the nation last year for spreading two pernicious, sexually transmitted diseases — diseases that should be easily preventable if the city promoted better sex education, more disease testing and increased public awareness about the importance of condoms. (10/30)