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The Democrats’ differences were focused largely on issues and policies, though there was far more engagement than some had predicted. The debate included discussions about climate change and renewable energy, college affordability, prescription drugs, terrorism and civil liberties, and the most serious threats to U.S. security in a world awash in conflicts. (Balz and Gearan, 10/13)

The Democrats’ first matchup proved to nearly be as rough-and-tumble as the previous Republican debates, though the candidates also found several areas of agreement. ... Each candidate had a chance to cite interest groups they had taken on when asked which enemies they are most proud of. Mrs. Clinton narrowed her list to health-insurance companies, drug companies, the Iranians and “probably the Republicans.” Mr. Sanders mentioned Wall Street and pharmaceutical companies. Mr. Webb mentioned an enemy soldier who wounded him but added with a smile that he was no longer around. (McCain Nelson, Meckler and Nicholas, 10/14)

President Barack Obama's landmark health care reform law -- one of the most contentious political issues of the past six years -- received all but no attention during the Democratic debate Tuesday tonight. But considering that all five Democrats on the stage were supporters of the Affordable Care Act, perhaps it's not surprising that CNN opted to raise issues more likely to provoke confrontation. (Young, 10/14)

Former Secretary of State Hillary Clinton was the only presidential candidate to utter the name of Planned Parenthood, the reproductive health provider that has faced unprecedented attacks on its funding this year, during the Democrats' first primary debate of the election Tuesday. (Lachman, 10/13)

Jeb Bush on Tuesday offered a detailed proposal to replace much of the Affordable Care Act with a more conservative health care plan that could lower individual insurance costs but would probably not protect as many people as President Obama’s initiative. (Pear and Flegenheimer, 10/13)

Bush's 10-page replacement plan is now the most detailed alternative being offered by any of the top-tier GOP candidates. It represents a stark contrast with Democratic front-runner Hillary Rodham Clinton, who has been campaigning on the health’s law historic expansion of health coverage while proposing new regulations to protect consumers from rising drug prices and runaway medical bills. (Levey, 10/13)

Jeb Bush unveiled his alternative to the Affordable Care Act on Tuesday, vowing to fully repeal President Barack Obama’s Washington-centric approach and shift to a system where states would have a freer hand to shape the health insurance market. (Cook, 10/13)

Republican presidential candidate Jeb Bush said he would scrap the national health insurance law known as Obamacare. Bush outlined his plan to replace it during a speech in New Hampshire Tuesday. Bush wants a system that protects people from worst-case scenarios rather than comprehensive coverage that includes services they may not want. He said insurance shouldn’t cover everything. (O'Connor, 10/13)

Mitch McConnell privately wants the White House to pay this price to enact a major budget deal: Significant changes to Social Security and Medicare in exchange for raising the debt ceiling and funding the government. Several people familiar with the high-stakes fiscal negotiations said the Senate majority leader's staff is trying to drive a hard bargain in the private talks with the White House and Democratic leaders. (Raju, 10/13)

U.S. Sen. Sherrod Brown stood in the corner of a Cleveland supermarket Tuesday and launched a broadside on the pharmaceutical industry. He argued prices for prescription drugs are out of control, and that the businesses responsible are offering scant justification for sudden increases. ... Brown made the appearance to push for a bill he is co-sponsoring -- The Medicare Prescription Drug Savings and Choice Act -- to lower drug costs by giving Medicare the power to negotiate prices on behalf of seniors. (Ross, 10/13)

If Kevin McCarthy was Plan A, and a very resistant Paul Ryan is Plan B, House Republicans don’t currently have a viable Plan C to become their next speaker. The half-dozen or so Republicans seriously looking at running believe they can unite the warring GOP Conference. But most or all of them would face a serious challenge wooing the several dozen hard-line conservatives who don’t have the numbers to get one of their own in the No. 1 spot but have demonstrated that, if they stick together, they can veto other candidates. (French, 10/13)

The latest attempt to help low-income Utahns get health insurance was dead on arrival Tuesday, as House Republicans dealt the proposal a crushing blow, sending state leaders back to the drawing board and leaving tens of thousands of people without hope for health care for the foreseeable future. Utah Access Plus, the latest plan aimed at expanding health-insurance coverage to an estimated 125,000 Utahns, received seven votes from the 63 GOP House Republicans in the three-hour closed-door meeting, House Speaker Greg Hughes, R-Draper, said Tuesday night. Hughes said it was concerns about the long-term sustainability of the Medicaid funding for the program, the potential for exploding costs and vocal opposition from medical providers who were called on to pay for part of the program that ultimately doomed Utah Access Plus in the House. (Gehrke, 10/13)

The latest version of Medicaid expansion, crafted by Gov. Gary Herbert and GOP legislative leaders, failed Tuesday to muster more than a handful of supporters among House Republicans and members of the Senate. ... That straw vote, along with a poll of both Republican and Democratic senators, leaves little hope of action on a plan to provide health care to some 95,000 low-income Utahns before the 2016 Legislature. The governor's spokeswoman, Aimee Edwards, said in a statement that Herbert "stands by" his plan for Medicaid expansion, known as Healthy Utah, that was defeated in the House last session. (Riley Roche, 10/13)

Florida still has nearly 2.8 million residents who lack health insurance, according to a new report, and 80 percent of them are uninsured for reasons that have nothing to do with Medicaid politics. Many qualify for subsidized plans under the Affordable Care Act but haven’t signed up, says the report released today by the Kaiser Family Foundation. Others have enough income to buy it on their own or through their employer, but don’t. (Gentry, 10/13)

The sky-high price hikes in medications from companies such as Turing Pharmaceuticals and Valeant Pharmaceuticals are far from anomalies in the pharmaceutical industry. About one-third of Americans have been hit by an unexpected price increase in their medications during the past year, according to a recent poll by Consumer Reports. On average, the price hike was $39 per prescription, although one out of 10 consumers said they faced higher out-of-pocket costs of at least $100. (Picchi, 10/13)

For the first time, a consortium of top U.S. cancer hospitals will provide patients with guidance about the cost of drugs used in their treatment, helping address a concern for many people undergoing a major medical event -- what the financial repercussions of their condition are. The information will supplement summaries the group has provided for 20 years on the effectiveness, side effects and evidence backing the therapies. The guidelines are being issued during a national conversation about the cost of drugs that has become a focus of Democratic presidential candidates and weighed on biotechnology stocks. (Cortez, 10/13)

In late June, Susan DeVore asked an auditorium filled with medical-industry executives if any would be willing to link the prices of the drugs and devices they sell to how well those products work. DeVore, whose company, Premier, helps 3,400 U.S. hospitals make purchasing decisions, recalls seeing about a half-dozen hands go up. “I think it’s a little bit scary for them,” she says. But it’s a question they should get used to hearing, she adds. “Health systems and physicians are more interested in it today than they’ve ever been.” (Tozzi, 10/12)

Early last year, drugmaker Mallinckrodt Plc spent $1.3 billion to buy a company that sold an injectable form of acetaminophen -- essentially Tylenol in a liquid solution. Within months, the new owner more than doubled the price of the drug, called Ofirmev. Revenue from the medication shot up, too, and hospitals searched for ways to absorb the costs ... In this case, hospitals were able to fight back by seeking other options, cutting into Mallinckrodt’s projected sales growth. In the fiscal third quarter, which ended in June, revenue from Ofirmev came in at $62 million. While that was a 17 percent increase from a year earlier, analysts had been estimating 37 percent growth on average, according to BMO Capital Markets. (Koons, 10/13)

As U.S. health insurers chart an unprecedented consolidation of the industry, hospitals are taking a fresh look at becoming insurers themselves to keep more of their patients' healthcare dollars in house. Among the country's largest insurers, Aetna Inc struck a deal to buy Humana Inc, while Anthem Inc agreed to acquire Cigna Corp. Both transactions are expected to draw months of scrutiny by U.S. antitrust regulators and Congress. (Kelly, 10/13)

Retail health clinics found inside pharmacies and other stores should be used as backups to people’s regular doctors, says a large group of U.S. physicians. The recommendation is one of six included in a position paper from the American College of Physicians (ACP) that aims to build a framework for retail health clinics underscoring patient safety, communication and collaboration. (Seaman, 10/12)

The estimate of the unfunded future expenses of a trust that pays the health-care costs of more than 700,000 United Auto Workers retirees from three Detroit-area automakers widened by $16 billion last year as it changed accounting assumptions and adjusted for new projections of how long members will live. Prior to last year, the UAW Retiree Medical Benefits Trust had cut drug costs, added preventive care and restored benefits such as dental and vision while also increasing assets. Based on that success, the UAW had proposed a health-care pool for 295,000 active autoworkers in a new contract. The idea was downgraded to area of study after almost two thirds of the union’s members at Fiat Chrysler Automobiles NV rejected the labor deal with that provision. The vote came before the new financial results were released. (Green, 10/13)

Veteran workers at Fiat Chrysler could pay deductibles for the first time if the cost of their coverage triggers a politically sensitive tax that takes effect in 2018. In the "Explanation of Benefits" document in the proposed contract between the UAW and Fiat Chrysler is a letter from FCA health care executive Kathleen Neal to UAW Vice President Norwood Jewell. The two acknowledge in writing that the company and union discussed the "Cadillac tax" on high-cost health care plans that is a provision of the Affordable Care Act. (Gardner, 10/12)

Xerox will book a pre-tax charge of around $385 million in the third quarter, after the business services and copier company announced that it will not complete the implementation of new Medicaid payment systems for Montana and California. The Norwalk, Connecticut, company said Tuesday that it will still process Medicaid claims in those states using existing systems to avoid interrupting any services. (10/13)

Johnson & Johnson beat analysts’ estimates for third-quarter profit as a lower tax rate helped the world’s biggest maker of health-care products overcome slightly weaker-than-projected sales for key drugs such as Remicade. J&J has been investing heavily in building up its pharmaceutical business as other products, such as medical devices, face pressure to compete on price to retain customers. The company fell short in the third quarter on several of its top drugs. Arthritis treatment Remicade had revenue of $1.61 billion, compared with expectations for $1.68 billion of sales, while blood thinner Xarelto’s $461 million in sales missed the $468.5 million average projection. Psoriasis drug Stelara was an exception, bringing in $613 million, more than the $586.5 million average estimate. (Koons, 10/13)

St. Louis-based Centene, a Medicaid-focused health insurer, is looking for the deal to boost its presence in California and other western states, while allowing for $150 million a year in synergies in the second year after closing. Health Net shareholders will receive 0.622 shares of Centene and $28.25 in cash for each share held. (Minaya, 10/13)

GHO Capital Partners, a London-based investor in health-care assets, is buying specialist testing company DNA Diagnostics Center Inc. of the U.S. for 104 million euros ($118 million), according to a statement from the company. DDC, based in Fairfield, Ohio, makes DNA tests for paternity, immigration, veterinary and forensic cases, among others. GHO Capital plans to help the company, which employs 245 people, mostly based in the U.S., “grow enormously” in Europe, Mortimer said. No further details of the deal were disclosed. (Torsoli, 10/13)

Trying to quell the controversy over its use of fetal tissue, Planned Parenthood announced Tuesday that it would no longer accept reimbursement for the costs of providing the tissue for medical research. The move comes after months of attacks on the group, beginning with the release in July of undercover videos by anti-abortion groups. The videos seemed to show Planned Parenthood officials discussing the procurement of fetal tissue, which led to an unsuccessful Republican effort in Congress to end its federal financing. (Lewin, 10/13)

“Over the last two months, opponents of safe and legal abortion have turned patently false claims about our role in fetal tissue donation into fodder to advance their extreme political agenda,” Richards wrote in the letter, which was released Tuesday. The results of that campaign, she said, included “votes in the U.S. House of Representatives and Senate that would have blocked Planned Parenthood from receiving federal reimbursements for providing cancer screenings and other preventive care.” (LaGanga and Muskal, 10/13)

Fetal tissue has been provided by affiliates in California and Washington state; the Washington affiliates haven’t taken money while the California ones have, she said. The Oregon affiliate has provided placental tissue in exchange for reimbursement. The group didn’t disclose how much money it will forgo with its policy change. (Armour, 10/13)

Republicans in control of Congress have responded to the undercover videos by launching several investigations of Planned Parenthood, along with efforts to cut off the organization's federal funding. Most of that funding is reimbursement for Medicaid patients receiving cancer screenings, contraception and other non-abortion services. (10/13)

In Washington, the saga has led to the threat of a shutdown, the resignation of House Speaker John Boehner and now a House Republican conference without a leader. Planned Parenthood allies had quietly suggested that the organization could end the political uproar by refusing to accept legally allowed payments for the cost of procuring and handling tissue. Laguens on Tuesday said that the decision was the result of thorough analysis. (Haberkorn, 10/13)

Representative Jason Chaffetz, chairman of the oversight committee, said the policy change was a good move but that Planned Parenthood's spending and federal support remained in question. Planned Parenthood receives about $500 million annually in federal funds, largely in Medicaid reimbursements. (Trott, 10/13)

The organization has been under fire since a Southern California group, the Center for Medical Progress, released covertly recorded videos this summer it said showed Planned Parenthood officials seeking to make money from the sale of tissue from aborted fetuses to medical researchers. The controversy initiated a series of hearings led by Republicans in Congress and a call to end federal funding to Planned Parenthood. (Colliver, 10/13)

In the first large, controlled study of Bayer AG’s sterility device Essure, researchers found that women who have had it implanted were 10 times as likely to need new operations as women who got standard sterility surgery. Women have spoken of debilitating pain and allergic reactions to the Essure implants, including at a Food and Drug Administration workshop last month. Some 750,000 or more women world-wide have gotten the Essure implants, but it has been difficult to assess the scope of the problem until this study. (Burton, 10/13)

Caught in the crossfire of the legal dispute is the Alzheimer’s Disease Collaborative Study, a $100 million-plus research effort to test new drugs, formed between the University of California, San Diego and the National Institute on Aging, a federal agency, and partly funded by corporate grants from companies like Eli Lilly & Co. Neither the companies nor the NIH are named as defendants. (Wang and Loftus, 10/14)

With about five weeks to go before California Attorney General Kamala Harris must decide on a proposed deal between the struggling Daughters of Charity Health System and BlueMountain Capital Management, a consulting firm hired by the state is again recommending that approval be granted only if the hedge fund continues to operate most of the hospitals as acute-care medical facilities for at least a decade. (Seipel, 10/13)

Crozer-Keystone Health System has reached a preliminary deal to be acquired by Prospect Medical Holdings Inc., a for-profit firm that owns 13 hospitals in California, Texas, and Rhode Island, Crozer officials said Monday. Crozer, which owns five hospitals in Delaware County with about 600 beds, has struggled financially. It announced a year ago that it was exploring strategic options. (Brubaker, 10/13)

Two Broward County hospital districts are in a legal dispute about which one of them should be allowed to offer an adult kidney-transplant program, according to documents filed in the state Division of Administrative Hearings. The North Broward Hospital District, which is known as Broward Health, filed a legal challenge after the state Agency for Health Care Administration denied its application for what is known as a "certificate of need" to operate a kidney-transplant program. (10/13)

A settlement has been reached in the legal tug-of-war over the Barbara Ann Karmanos Cancer Institute that pitted the Detroit Medical Center against Flint-based McLaren Health Care. The confidential settlement, announced Monday, concludes a 2013 lawsuit concerning a merger and marketing partnership between Karmanos and McLaren that DMC sought to scuttle. The merger was controversial because Karmanos had an exclusivity compact with DMC. However, Karmanos and McLaren claimed that DMC did not live up to its end of the agreement because it didn't attract enough cancer patients from Detroit's suburbs to treat at Karmanos. (Reindl, 10/12)

The coming months could make the difference in whether or not New Jersey becomes a national leader in how healthcare is delivered to Medicaid recipients. But if it’s going to happen, according to advocates and experts, the state government and the health insurance industry are going to have to pull together. And they’re going to have to set a smart pace. By July, the state’s three Medicaid Accountable Care Organizations must have a plan in place for how they will share the savings that could result from their efforts to better coordinate the healthcare of residents in high-poverty areas of Camden, Newark, and Trenton. (Kitchenman, 10/13)

A new report shows that growing Medicaid spending is responsible for much of the growth in the Virginia state budget. A report by the Joint Legislative Audit and Review Commission issued Tuesday showed that Medicaid spending rose by 75 percent from fiscal 2006 to 2016. That accounted for 25 percent of the state budget’s total growth from $32 billion to $47 billion during that time. (10/13)

[House Speaker William J.] Howell also took aim at Medicaid spending, which increased by almost $3.5 billion over 10 years, or 74 percent, and accounted for 23 percent of budget growth. General fund spending on the federal-state program rose 79 percent, accounting for 54 percent of new spending. (Martz, 10/13)

Over the past year, Kansas has changed its state employee health plan so employees shoulder more of the cost burden while the cash-strapped state pays less. State officials say the changes correct imbalances within the plan and shore up a reserve fund for the future. (Marso, 10/13)

A new California law will require daycare workers to have vaccinations for measles and whooping cough by next year. The law was approved this week by Gov. Jerry Brown nearly a year after California's worst measles outbreak in 24 years began at Disneyland, infecting more than 130 California residents and more than two dozen other people who resided out of state. (LIn II and Xia, 10/13)

California ends its legislative season having enacted some of the country's most aggressive social policies: Laws requiring student vaccinations, granting terminally ill people the right to take life-ending medications, and mandating equal pay for women were among dozens approved. The range of sweeping new laws in the most populous state reflects legislators' desire to set a national trend on progressive social and environmental issues while sidestepping more thorny economic matters. (10/13)

Fetal tissue used for scientific research tops the list of topics Lt. Gov. Dan Patrick has asked Texas senators on the Health and Human Services Committee to study before the Legislature reconvenes in 2017. (Walters, 10/13)

Nneka Campbell spent the third anniversary of her daughter's death at a hearing at the Florida Department of Health in Tallahassee -- to honor, she said, the memory of 10-month-old Amelia, who died of complications following heart surgery at St. Mary's Medical Center in West Palm Beach. Amelia was one of nine infants who died after heart surgery at St Mary's over four years, a death toll that drew national attention when CNN reported it in early June. At the time, St. Mary's and the state contested CNN's allegations. But in August, the hospital shuttered its pediatric cardiology unit; its chief executive resigned. (Menzel, 10/13)

A woman who has HIV can pursue a lawsuit stemming from the alleged disclosure of her diagnosis by an employee of a primary-care clinic, a state appeals court ruled Monday. The 1st District Court of Appeal overturned part of a decision by a Duval County circuit judge who dismissed the lawsuit, which was filed by a woman identified in the ruling only as Jane Doe. A physician for Baptist Primary Care Inc., in 2006 diagnosed the woman as having HIV and began treatment. (10/13)

Now that California has legalized aid in dying, advocacy groups are planning statewide education campaigns so doctors know what to do when patients ask for lethal medication to end their lives. One of the first stops for doctors new to the practice is a doctor-to-doctor toll-free helpline. It's staffed by physicians from states where the practice is legal, who have experience writing prescriptions for lethal medication. (Dembosky, 10/13)

The gym at Riverside Correctional Facility in Philadelphia is through the metal detector, two heavy doors and down the hall. There’s a basketball court like one you’d see at any high school, except there’s a corrections officer on guard near the three-point line. Sixteen stationary bikes are set up in a half circle in the corner. On bike number two, Lakiesha Montgomery, 32, from Philadelphia, is peddling fast and singing along to the Nicki Minaj’s song "Fly.” (English, 10/14)

The NPR/ProPublica investigation into worker's compensation continues with a look at an emerging trend: employers opting out of worker's comp altogether. (Berkes, 10/14)

Under the steady gaze of a watercolor giraffe and tissue paper butterflies, a Flint pediatrician and mother of two last month forced the state of Michigan to snap to attention. But getting the state to concede the probability that Flint’s water is poisoning its children with lead — after months of assurances from both city and state officials that the water is safe — was far from easy. It required Dr. Mona Hanna-Attisha, 38, to sidestep bureaucracy. It meant awkward conversations and putting her hospital — city-owned Hurley Medical Center — smack-dab in a political minefield. (Erb, 10/12)

Jeb Bush's new health-care plan looks a lot like the plan Scott Walker embraced two months ago, which in turn looks a lot like the one Marco Rubio sketched in an op-ed article and the one touted by Senators Orrin Hatch and Richard Burr and Representative Fred Upton. That's a good thing. It means that Republicans are finally reaching a consensus on what to do about health policy that draws on the best conservative thinking on the subject. Bush (for whose campaign my wife works) is helping to ratify that consensus. (Ramesh Ponnuru, 10/13)

Today in New Hampshire, former Florida Gov. Jeb Bush unveiled his plan to repeal and replace Obamacare. In many ways, the plan reflects the mainstream of Republican wonk thinking on health care, and expresses similarities to an earlier plan proposed by Wisconsin Gov. Scott Walker. Like Walker’s plan—but in a different way—Bush’s plan seems likely to increase the deficit. ... All told, Bush’s plan to replace Obamacare is best seen as a work in progress. When it comes to the key fiscal questions of how to reform health care entitlements—Medicaid, Medicare, and tax subsidies—Bush’s plan isn’t fully fleshed out. But benchmarked by the standard of what other Republican candidates have put out, the level of detail is in the top tier. (Avik Roy, 10/13)

Obamacare is the latest example of how Washington makes health care and health coverage so extraordinarily expensive. Obamacare’s mandates and taxes force Americans to buy expensive products with benefits they don’t want and may never need. It also places a disproportionate share of the premium costs on the young and healthy. In addition to higher individual premiums, it costs small businesses more to comply with Obamacare’s myriad new rules than it does to insure a worker. As a result of Obamacare, providers are not being held directly accountable to patients for the value of the care they deliver, and little information is available to consumers on prices and quality. (Jeb Bush, 10/12)

We have long argued that Jeb Bush’s big challenge would not be ideological, since he is a very conservative reformer. Despite his difficulties as a campaigner (which we have said would be the real test), his ideological preferences have been reinforced by a series of conservative policies — government reform (including shrinking government by attrition), tax reform (pro-growth, more fiscally responsible than some others), and now healthcare. (Jennifer Rubin, 10/13)

In the United States, every dollar you earn as wages is subject to taxes, but every dollar you get in health insurance is not. This system, which has been around since the 1940s, leads to some distortions in pay and health insurance. Companies may be more likely to give you a raise in the form of richer benefits than higher pay, because it’s a better value. And the federal government spends a lot more money, in the form of lost taxes, to help rich people buy health insurance than it does to help middle-income people. (Margot Sanger-Katz, 10/13)

The Affordable Care Act slapped a hefty tax on expensive employer-sponsored health plans in an effort to discourage companies from offering the most expansive forms of coverage while also raising money for new insurance subsidies. But the "Cadillac tax" is proving to be an idea that only an economist could love, as critics from the left and the right, from unions and corporate America, have stepped up to denounce it. In fact, Hillary Rodham Clinton and Republicans on the House Ways and Means Committee called for its repeal almost simultaneously last month. Yet the tax, which is slated to go into effect in 2018, may simply take the wrong approach to doing the right thing. (10/13)

By liberal and media acclamation, ObamaCare is a glorious success, the political opposition is fading and the entitlement state has gained another permanent annex. The reality, for anyone who cares to look, is different and suggests that ObamaCare is far more vulnerable than this conventional wisdom. As Exhibit A, note that participation on the federal and state insurance exchanges is badly trailing the original projections and declining over time. (10/13)

Like most debates, this one touched on a wide range of topics. But when it focused on issues such as Social Security, Medicare and college tuition, it seemed to have settled on a new slogan: “Spend, baby, spend.” The indefatigable Vermont Sen. Bernie Sanders, of course, led the pack. He pushed his plans to increase Social Security benefits by an average of $65 per month, pay every dime of the cost of students attending public universities, and expand Medicare to make it available to anyone. But the others weren’t far behind. [Hillary] Clinton and former Maryland governor Martin O’Malley, the most plausible of the three lesser-known candidates, want to expand Social Security. Both would pour money into subsidizing tuition. And O’Malley has a sweeping health plan that makes Obamacare look tame. (10/14)

Former Secretary of State Hillary Clinton gave a textbook, factually correct defense of paid family leave and medical leave laws during Tuesday night's Democratic debate. CNN’s Dana Bash asked Clinton about the subject, pressing her on Republican Carly Fiorina’s claim that requiring corporations to provide paid leave will hurt businesses and the economy. Clinton responded that it was a strange claim for Fiorina to make, given that Fiorina comes from California -- a state that has had a paid leave law in effect for 10 years. And the California law has worked well, by nearly all accounts. (Jonathan Cohn, 10/13)

Before World War II, about 40 percent of all doctor-patient encounters were house calls. Today, the proportion has dwindled to less than 1 percent. The major reason, not surprisingly, is money: Traveling to patients’ homes is inefficient and almost never profitable for doctors or hospitals. But I believe that if we revived the house call, the overall savings to the health care system, not to mention the impact on patient care, would be enormous. (Sandeep Jauhar, 10/14)

Medicare's quirky funding formula also has created a hefty, inequitable increase in Part B premiums for about 30 percent of beneficiaries. Solving Medicare's long-term financial challenges will be hard enough without undermining the idea that the system is fundamentally fair. As it wrangles over debt ceilings, email servers and crumbling highways, Congress should fix this Medicare anomaly before 2016 rates kick in later this month. (10/13)

The Freedom Caucus’s demands from the next speaker, outlined in a questionnaire, include commitments to provide for the filibuster-proof repeal of Obamacare, require that any increase in the debt ceiling be coupled with entitlement reform and refuse to fund the government through temporary spending bills. Most alarming, they call on any prospective speaker to abide by the so-called Hastert rule against bringing legislation to the floor without support from a majority of the GOP caucus. This is a recipe for disaster in the form of government shutdowns and debt defaults. If I were Ryan, I would tell the Freedom Caucus to take its demands — and the speakership, for that matter — and shove them. (Ruth Marcus, 10/13)

You may have heard something about the new medical coding system that the Centers for Medicare and Medicaid Services has plunked down on the clipboards of hospitals and health-care providers as of Oct. 1. It’s called ICD-10, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. Also known as the bigger, hairier stepchild of ICD-9, a system that we in the medical world have used for many years without too much trouble. (R.J. Petrella, 10/13)

The Food and Drug Administration convened a panel of experts last month to examine the safety and effectiveness of a device for permanent birth control that has generated thousands of complaints from women who say they were harmed by it. The device, known as Essure, is implanted in a woman’s fallopian tubes to induce scar tissue formation to block the tubes and prevent eggs from being fertilized. ... All birth control measures carry risks and benefits. What women and doctors need to know is how this device compares with surgical procedures and intrauterine devices in preventing pregnancies and causing minimal harm. The F.D.A. needs to look hard for ways to get that information and should consider suspending sales of Essure until better data is available. (10/14)

The grim reaper is feeling bullish. Following success in California — the fifth state where doctors are now free to prescribe lethal doses of medication to terminally-ill or dying patients — so-called “right-to-die” activists have turned their eyes to Maryland, New York and beyond. “I think that this is a national wave,” Maryland Del. Shane E. Pendergrass, D-Howard, told The Washington Post. Pendergrass plans to sponsor “right-to-die” legislation in January. It’s a wave with the potential to sweep some of society’s most vulnerable — the elderly, the terminally ill and disabled — prematurely into the hereafter. (Kirsten Powers, 10/13)