In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

2. Podcast: 'What The Health?' We Have Numbers!

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Sarah Kliff of, Joanne Kenen of Politico and Alice Ollstein of Talking Points Memo discuss the first days of open enrollment for 2018 individual health insurance plans and whether the Democratic gains in Tuesday’s off-off-year elections will have any impact on health care policy in Washington, D.C. (11/10)

3. Political Cartoon: 'Signing Off?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Signing Off?'" by David Fitzsimmons, The Arizona Daily Star.

Here's today's health policy haiku:


Confused by choices…
So who ya gonna call? An
Insurance broker.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Health Law

4. After Navigators' Budget Slashed, Consumers Being Directed To Get Help From Private Brokers

But advocates worry that shifting from a nonprofit model to one where the agent stands to make a commission will ultimately hurt consumers. Meanwhile, a study finds that competition in the Affordable Care Act exchanges has gone down, Democrats seize on health care as a political weapon, and five states ask a judge to halt the rollback of the health law's birth control mandate.

The New York Times: Trump Administration Guiding Health Shoppers To Agents Paid By Insurers
After cutting funds for nonprofit groups that help people obtain health insurance under the Affordable Care Act, the Trump administration is encouraging the use of insurance agents and brokers who are often paid by insurers when they help people sign up. The administration said in a recent bulletin that it was “increasing partnerships” with insurance agents and viewed them as “important stakeholders” in the federal marketplace, where consumers are now shopping for insurance. But some health policy experts warned that a shift from nonprofit groups, which are supposed to provide impartial information, to brokers and agents, who may receive commissions for the plans they recommend, carries risks for consumers. (Pear, 11/11)

Kaiser Health News: Brokers Are Reluctant Players In A Most Challenging ACA Open-Enrollment Season
Lee Nathans, like insurance brokers in many states, expects to be crazy busy for the next several weeks, fielding calls from “people who are not going to be happy.” Open enrollment for Affordable Care Act coverage started Nov. 1, and the approximately 10 million people who buy their own health insurance are only now getting a look at what’s being offered. It’s daunting. “There will be a lot of people who will need to use a broker,” said Nathans, of Columbus, Ohio. (Appleby, 11/13)

The Hill: ObamaCare Insurer Competition Declining: Study
Insurer competition in the ObamaCare marketplaces is declining, but three-quarters of enrollees still have a choice of two or more insurers, according to a new analysis. The analysis from the Kaiser Family Foundation finds that the average number of insurers per state declined to 3.5 for 2018, down from 4.3 this year and 5.6 the year before. (Sullivan, 11/10)

The Hill: ObamaCare Becomes Political Weapon For Democrats
ObamaCare is emerging as a top issue for Democrats as they seek to gain control of Congress in next year's midterm elections. Just a year after worries about ObamaCare premiums were seen as a contributing factor in Hillary Clinton's loss, voter concerns about GOP attacks on the health-care law seem to be bolstering Democratic candidates. (Sullivan, 11/10)

The Hill: Five States Ask Judge To Halt Trump's Rollback Of Birth-Control Mandate
Five states are asking a federal judge to halt the implementation of the Trump administration's recent rollback of ObamaCare's birth-control mandate. The attorneys general in California, New York, Maryland, Delaware and Virginia filed the motion for a preliminary injunction Thursday night with the U.S. District Court for the Northern District of California. (Hellmann, 11/10)

5. Pace Of Health Law Enrollment For First Days Surged Over Last Year, But Will It Continue?

The high numbers even after the Trump administration slashed the outreach budget for sign-ups surprised experts.

The Hill: Record ObamaCare Sign-Up Drive
ObamaCare is entering its third week of open enrollment and supporters are watching to see if the fast pace of sign ups will continue. About 600,000 people signed up for ObamaCare plans in the first four days of enrollment, the Trump administration announced Thursday. About twice as many people signed up on the first day, Nov. 1, this year compared to last year. (Hellmann, 11/13)

Philadelphia Inquirer: Obamacare Signups Surging In Pa., N.J. And Nationally. Will It Last?
People around the Philadelphia region, like consumers around the country, are rushing to sign up for health insurance under the Affordable Care Act, also known as Obamacare, advocacy groups reported Friday. More than 600,000 people nationally selected insurance plans in the first week of the annual open enrollment period — a pace that could be double last year’s signups early on. Given that President Trump and congressional Republicans have spent the past year attacking and trying to dismantle President Barack Obama’s signature law, that is stunning many observers. (Sapatkin, 11/10)

Kaiser Health News: Podcast: ‘What The Health?’ We Have Numbers!
Democrats won some unexpectedly large victories in Tuesday’s off-off-year elections, putting health care squarely back on the political map. Meanwhile, enrollment was unexpectedly high in the insurance exchanges’ opening days, according to the Department of Health and Human Services. (11/10)


6. Trump Administration Chips Away At Initiatives That Base Payments On Quality Over Quantity

Experts have said that paying doctors for quality care instead of just the number of appointments they take would help rein in burgeoning medical costs. But the Trump administration wants to slow efforts to shift toward that model.

The New York Times: Trump Health Agency Challenges Consensus On Reducing Costs
For several decades, a consensus has grown that reining in the United States’ $3.2 trillion annual medical bill begins with changing the way doctors are paid: Instead of compensating them for every appointment, service and procedure, they should be paid based on the quality of their care. The Obama administration used the authority of the Affordable Care Act to aggressively advance this idea, but many doctors chafed at the scope and speed of its experiments to change the way Medicare pays for everything from primary care to cancer treatment. Now, the Trump administration is siding with doctors — making a series of regulatory changes that slow or shrink some of these initiatives and let many doctors delay adopting the new system. (Goodnough and Zernike, 11/12)

In other news —

The Wall Street Journal: Fewer Return Visits To The Hospital, But Higher Rates Of Death, Study Finds
The Affordable Care Act required Medicare to penalize hospitals with high numbers of heart failure patients who returned for treatment shortly after discharge. New research shows that penalty was associated with fewer readmissions, but also higher rates of death among that patient group. The researchers said the study results, being published in JAMA Cardiology, can’t show cause and effect, but “support the possibility that the [penalty] has had the unintended consequence of increased mortality in patients hospitalized with heart failure.” (Evans, 11/12)

Modern Healthcare: Redesigning Hospitals With Patient Experience In Mind
The clinics are flanked by an atrium, a cafe and a library with an outdoor deck. Their main concourses are dotted with furnished alcoves. One thing they don't have: designated waiting rooms. That's because patients at the clinics in the Health Transformation Building at Dell Medical School, part of UT Health Austin, can either go straight to their rooms, if available, or if they arrive early, to any of those decidedly non-institutional spaces, where in the future they'll be buzzed via a smartphone app. (Arndt, 11/11)


7. Maine Gears Up For Funding Fight Next Year Over Medicaid Expansion

The governor says he won't implement the expansion approved by voters in a referendum this month unless lawmakers fully fund it. Elsewhere in the news, other states consider the Maine experience while considering their own voter referendums on expansion, one family in Iowa bemoans the experiences trying to get specialized care for their son from his Medicaid managed care plan, West Virginia officials consider work requirements for Medicaid enrollees and health care jobs are at stake as Ohio cuts reimbursement rates.

The Hill: Maine Governor's Refusal To Expand Medicaid Sets Off New Battle
Maine Gov. Paul LePage’s (R) steadfast opposition to abide by overwhelming voter support of expanding Medicaid is likely to set off a funding battle when the state legislature meets early next year. Estimates over the expansion cost differ wildly, and the governor has said he won’t approve a plan if it involves raising taxes or raiding the state’s rainy day fund. (Weixel, 11/10)

NPR: Medicaid Expansion Takes A Bite Out Of Medical Debt
As the administration and Republicans in Congress look to scale back Medicaid, many voters and state lawmakers across the country are moving to make it bigger. On Tuesday, Maine voters approved a ballot measure to expand Medicaid under the Affordable Care Act. Advocates are looking to follow suit with ballot measures in Utah, Missouri and Idaho in 2018. ... A study from the Urban Institute may shed some light on why Medicaid eligibility remains a pressing problem: medical debt. While personal debts related to health care are on the decline overall, they remain far higher in states that didn't expand Medicaid. (Smith, 11/10)

Des Moines Register: Troubled Iowa Teen's Progress Stalled Again By Private Medicaid Manager
In his worst moments, Logan Polly kicked holes in walls, beat himself and attacked others. He threatened to kill his mother, filled his school locker with hoarded food, ran away often and stopped eating for days at a time. Back in April, the 14-year-old adopted teen’s prospects of a productive future seemed dim and getting dimmer. His hard-to-find treatment, funded by Medicaid, was at risk of being cut short. AmeriHealth Caritas, one of three firms Iowa hired to manage Logan's care, was trying to rein in the cost of his care, Tina Polly said. (Rood, 11/10)

California Healthline: Wary Of Exchanges, Insurers Are Wooed By Expanded Medicaid Program
In California and much of the country, it’s a tale of two programs under the Affordable Care Act: state insurance exchanges and expanded Medicaid. Many health insurers, citing financial losses or the uncertainty of federal funding, have left the government exchanges where consumers buy subsidized coverage. The nation’s largest health insurer, UnitedHealth, exited the Covered California marketplace at the end of last year, and for 2018 Anthem will stop selling exchange policies in about half of California’s counties. (11/10)

Charleston (W.Va.) Gazette-Mail: DHHR Considering Work Requirements For Medicaid Recipients
The West Virginia Department of Health and Human Resources is considering adding work requirements to the Medicaid program. Jeremiah Samples, deputy secretary of the state DHHR, said Friday that state officials are considering whether to add work requirements for about 170,000 West Virginians covered by Medicaid expansion. He said the requirement, if enacted, would focus on able-bodied people. (Beck, 11/12)

Crain's Cleveland Business: State Medicaid Cuts Could Run Deep In Northeast Ohio
A proposed cut to the state Medicaid reimbursement rate could mean a loss of up to 2,500 health care jobs in Northeast Ohio, advocates say. The Ohio Department of Medicaid has proposed a rate cut of 5% over the biennium for the care provided to Medicaid recipients. The Center for Health Affairs, an advocacy group representing Northeast Ohio hospitals, estimates that would result in a loss of $160 million over fiscal years 2018 and 2019 for the region's hospitals, leaving them with few options to make up those costs. (Coutré, 11/12)

Hillary Clinton raises concerns about the delay in funding for children's health coverage --

The Hill: Clinton: Congress Playing 'Roulette' With Children's Health Funding
Hillary Clinton says Congress is playing "roulette" over extending funding for the Children's Health Insurance Program (CHIP). ... As first lady, Clinton was a champion of CHIP when it first made its way through Congress during former President Bill Clinton’s first term in office. Funding for the program, which covers 9 million children, technically expired at the end of September, but the first states aren't expected to run out of funding until the end of the year. (Hellmann, 11/10)

Administration News

8. Fallout From Price: Internal Feuds, Pressure From Congress Rock HHS Long After Secretary's Departure

Tom Price stepped down from the top position at the Department of Health and Human Services after information came out about his use of taxpayer-funded private jets. But the investigation didn't end with his resignation.

Politico: Price Investigation Continues To Roil HHS
Tom Price left his job as Health and Human Services secretary in September, but the investigation into his use of private jets for official travel now threatens to enmesh others in the department. The department’s inspector-general’s probe will review who approved — or should have been approving — Price’s use of private jets on at least 26 trips from May to September, some of them quick jaunts on routes heavily traveled by commercial aircraft, according to three people with knowledge of the probe. (Pradhan and Diamond, 11/13)

In other news on the administration —

The Associated Press Fact Check: Trump Hails 'New' VA As Old Problems Persist
President Donald Trump speaks with pride about the progress of his overhaul of health care for veterans, declaring that the Department of Veterans Affairs already "is a whole new place." Old problems persist, though, and some of his steps are not as advanced as he advertises. For Veterans Day, the White House came out with a two-page statement to support the contention that "tremendous progress has been made in a short period of time." (Yen, 11/10)

Capitol Hill Watch

9. Advocates Worry GOP's Plan To Cut Orphan Drug Tax Credit Will Hurt Patients

The credit reimburses drug developers for half of their research costs on treatments meant for diseases with patient populations fewer than 200,000 people.

CQ: Consumer Groups Protest Tax Plan Changes To Rare Disease Credit
Patient advocates fear that the Republican tax plans' proposed changes to a tax credit for drug companies that develop rare-disease treatments will chill research. Proponents of the GOP plans say they could save tens of billions of dollars over a decade and curb abuses by companies that exploit the credit. The House tax bill (HR 1), which the Ways and Means Committee approved Thursday and which will likely get a floor vote next week, would completely eliminate the Orphan Drug Tax Credit, which effectively reimburses drug developers for half of their research costs on treatments meant for diseases with patient populations fewer than 200,000 people. The Senate tax plan released Thursday would not go as far as the House in rolling back the incentive, but would still cut down the size of the multibillion-dollar subsidy for drug research. (Siddons, 11/10)

Public Health And Education

10. Profit-Mining The Opioid Crisis: Treatment Facilities Target Union Workers For Their Generous Benefits

A Stat and Boston Globe investigation found that these workers are bused into these facilities and can be cut off from their family and friends. “I felt like a prisoner,” said Michael Barone, a special education aide in a New Jersey public school. In other news: scientists try to find ways to combat chronic pain without opioids; experts are trying to figure out how people with chronic pain can be treated with opioids but avoid addiction; and more.

Stat: Targeted By An Addiction Treatment Center, Union Workers Feel Trapped As Their Benefits Are Drained
STAT and The Boston Globe interviewed 10 people treated at the institute over the last five years — teachers, mostly from New Jersey, as well as school custodians and social workers or their relatives. Most said they were allowed only limited contact with family. They complained about inadequate and cookie-cutter treatment, consisting mostly of group counseling and 12-step meetings, massages at a local chiropractor’s office, and plenty of free time. Several said the staff warned that their jobs would be at risk when they tried to leave before the treatment center deemed it appropriate. Although the patients were there voluntarily, many needed letters indicating they were fit to return to work. (Armstrong and Allen, 11/10)

NPR: Brain Scientists Look Beyond Opioids To Conquer Pain
The goal is simple: a drug that can relieve chronic pain without causing addiction. But achieving that goal has proved difficult, says Edward Bilsky, a pharmacologist who serves as the provost and chief academic officer at Pacific Northwest University of Health Sciences in Yakima, Wash. "We know a lot more about pain and addiction than we used to," says Bilsky, "But it's been hard to get a practical drug." (Hamilton, 11/13)

NPR: Is There A Way To Keep Using Opiod Painkillers And Reduce Risk?
Jon McHann, 56, got started on prescription opioids the way a lot of adults in the U.S. did: he was in pain following an accident. In his case, it was a fall. "I hit my tailbone just right, and created a severe bulging disc" that required surgery, McHann says. McHann, who lives in Smithville, Tenn., expected to make a full recovery and go back to work as a heavy haul truck driver. But 10 years after his accident, he's still at home. (Aubrey, 11/13)

The Associated Press: NY State Lawmakers To Discuss Heroin, Opioid Epidemic
The New York state Senate is planning another meeting to hear from local law enforcement, mental health experts and the loved ones of those lost to heroin and opioids. Tuesday's meeting in Newburgh in the Hudson Valley will be hosted by Republican Sens. George Amedore, Fred Akshar and William Larkin. 11/11)

CQ Magazine: Almost By Default, FDA Takes The Lead Role In Opioid Crisis
During his confirmation hearings to lead the Food and Drug Administration, Scott Gottlieb promised to make the opioid crisis his top priority, calling it “a public health emergency on the order of Ebola and Zika.” His comparison of the opioid crisis to those attention-grabbing international outbreaks was a reflection of its growing magnitude. Abuse of prescription painkillers, heroin and other opioids in the United States caused 33,000 deaths in 2015, a number likely to exceed 53,000 when 2016 data is finalized. It was also a course correction for Gottlieb. When he was an FDA official in 2005, he warned against FDA actions that could limit patients from getting pain pills, calling chronic pain an “undertreated medical problem.” (Siddons, 11/13)

Miami Herald: Rushing An Overdosing Woman To The Hospital, This Paramedic Overdosed, Too, Police Say
Across the country, rates of opioid addiction and abuse have been skyrocketing in recent years — killing more than 30,000 Americans each year, according to Centers for Disease Control and Prevention data analyzed by Blue Cross Blue Shield, one of the largest health insurers in the country. Blue Cross Blue Shield reports that, among those it insures, diagnoses of opioid use disorder have spiked nearly 500 percent in just the last seven years. (Gilmour, 11/10)

11. Medical Practices Borne On The Battlefield Can Become Standard Care For Civilians

A look at six common practices that have their roots in war-time care. In other public health news: falling, Alzheimer's, ankle replacements and racism.

Stat: 6 Medical Innovations That Moved From The Battlefield To Mainstream Medicine
Wartime medicine is an incredibly challenging setting for the doctors, nurses, and paramedics who practice it: Not only are the injuries frequently serious ones, but the tools at hand are often more limited than in a traditional hospital. Over the centuries, that has meant that battlefield medical personnel have had to innovate. Those wartime practices, in turn, often served to refine medical practice beyond the military. (Samuel, 11/10)

The Wall Street Journal: Falling Is Dangerous For The Elderly—And Often Preventable
One of the biggest health threats facing Americans age 65 and older is also one many of them don’t like to talk about: falling. At least half of senior Americans who fall don’t tell anyone, according to a report from the Centers for Disease Control and Prevention. Whether it’s a spouse declining to tell a partner, or an elderly parent hiding it from the children, many seniors keep quiet because they are embarrassed and fear losing their independence. (Sadick, 11/12)

The Washington Post: The U.S. Postal Service Is Taking On Alzheimer’s With A New Stamp
For the 5 million Americans living with Alzheimer’s disease, help can seem far away. Scientists don’t fully understand the disease. The progressive dementia it brings can be scary and disorienting. And social isolation and loneliness are often part of the equation, further affecting brain function. Starting Nov. 30, a new stamp will lend a helping hand. (Blakemore, 11/11)

The Wall Street Journal: Ankle Replacements Take Off As Devices Appear Durable
Ankle replacements, a new kid on the block compared with knee and hip replacements, used to be deemed a risky bet for patients under 65. But as doctors steadily gain confidence that the replacements will last, Carrie Kvitko, 60, from Columbus, Ohio, is one of a growing group of younger patients to sport a new ankle, made of metal and plastic and bending nearly as well as the original. In September, a year after her surgery, Mrs. Kvitko went on vacation to Magic Kingdom Park in Orlando and climbed 116 steps to the top of the Swiss Family Tree House. (Johannes, 11/12)

NPR: Scientists Start To Tease Out The Subtler Ways Racism Hurts Health
The day Dr. Roberto Montenegro finished his Ph.D. was memorable. But not for the right reasons. "I still cringe when I think about it," says Montenegro. It had started well. His colleagues at UCLA had taken him and his girlfriend (now wife) out to a fancy restaurant to celebrate. "I was dressed up in the fanciest suit I had at the time and my wife looked beautiful, like always," he says. "We laughed and we ate and we were excited we didn't have to pay for this." (Bichell, 11/11)

State Watch

12. State Highlights: Newly Elected Va. Lawmaker To Push For Easier Access To Transgender Care; Calif. Hospitals Face IV Bag Shortage After Hurricane

Media outlets report on news from Virginia, Florida, Pennsylvania, Arizona, Tennessee, California, Texas and Ohio.

The Washington Post: Danica Roem To Push For Transgender Health Care Along With Focus On Traffic
Del.-elect Danica Roem, the transgender woman who is perhaps the best known of the flood of Democrats who won seats this week in the Virginia state house, said Friday that she wants to make it easier for people to get health insurance coverage for treatment related to gender transitions. Roem (Prince William), who plans to focus mostly on easing traffic congestion in her district, said she also wants to work with the Democratic caucus in the House of Delegates to develop a bill that would require insurance companies to cover the costs of hormone medication, surgery and other treatments. (Olivo, 11/10)

San Jose Mercury News: Shortage Of Life-Saving IV Bags Challenges Bay Area Hospitals
It’s usually one of the first items you’ll see after you enter a hospital room: a small, clear plastic bag filled with a saline or sugar-water solution, hanging above a loved one’s bed. But a serious shortage of the bags used to inject drugs intravenously is now alarming many Bay Area hospitals after Hurricane Maria in September slammed into Puerto Rico and shut down production at three plants owned by Baxter International, which makes a large percentage of the IV bags used in the United States. (Seipel, 11/10)

Miami Herald: Want To See Emergency Plan For Your Mom’s Nursing Home? Good Luck.
To protect the elderly and disabled residents of Florida’s 683 nursing homes from the ravages of an Irma-like storm or other disaster, state law requires that administrators submit detailed emergency plans to regulators every year. ...Two counties, Broward and Palm Beach, refused to release emergency plans when the Miami Herald filed public records requests, citing a state law designed to protect public spaces from terrorists. (Marbin Miller and Ostroff, 11/11)

The Associated Press: ‘There Was A Breakdown’: Inmate’s Suicide Leads To $7M Deal
The family of a mentally ill woman who killed herself inside a Pennsylvania detention center in 2015 will receive $7 million after a lawsuit against the private company running the prison was settled, according to a lawyer handling the case. The recent settlement capped a case that began with a descent into depression and paranoia in Janene Wallace’s late twenties and eventually resulted in imprisonment, a nearly three-month stint in solitary confinement and finally, a death by hanging, family attorney David Inscho said. (Izaguirre, 11/11)

The Tennessean: Barry's Nashville General Proposal Raises Questions About Where Care Is Given And How It's Funded
Mayor Megan Barry's proposal to close the inpatient services at Nashville General Hospital reignited the debate over the future of the city's safety net hospital. Barry revealed her plan the same day Meharry Medical College unveiled a landmark agreement with HCA Healthcare to train students at TriStar Southern Hills Medical Center. Barry wants to make Nashville General an ambulatory surgery center and outpatient clinic, while creating a fund to pay for indigent care at Nashville's other hospitals for the city's poorest residents. (Fletcher, 11/10)

Dallas Morning News: Keller Family Sues Texas Emergency Room Chain For Over $1 Million After Preschooler’s Death
The lawsuit claims the facility, among other things, failed to properly evaluate Olivia’s condition and improperly discharged her instead of immediately transferring her to a hospital. An autopsy report from the Tarrant County medical examiner, done on Aug. 8, the day after the incident, found Olivia’s primary cause of death was bacterial meningitis, a brain infection that can turn deadly in a matter of hours. (Rice, 11/11)

Philadelphia Inquirer: Crozer-Keystone Community Foundation Wins Arbitrator Decision Against Prospect Medical
An arbitrator ruled that Prospect Medical Holdings Inc., a private-equity backed California company that acquired Crozer-Keystone Health System Inc. in a deal valued at $300 million, still owes Crozer-Keystone Community Foundation $23.7 million. The foundation, based in Media and established to use the proceeds from the sale to improve the health and quality of life of Delaware County residents, and the for-profit Prospect were in a dispute over how much money Prospect had to pay at closing to settle working-capital accounts. (Brubaker, 11/10)

Cleveland Plain Dealer: Nuisance Laws Penalize Residents For 911 Calls
Designed to give cities a legal route to manage what they consider problem properties or residents, the nuisance laws disproportionately affect renters, people of color, survivors of domestic violence and those experiencing mental health crises, a new study by Cleveland State University students and researchers finds. (Christ, 11/10)

San Francisco Chronicle: Widow Caresses Husband’s Transplanted Face
Sixteen months after transplant surgery gave Sandness the face that had belonged to Calen “Rudy” Ross, he met the woman who had agreed to donate her high school sweetheart’s visage to a man who lived nearly a decade without one. The two came together last month in a meeting arranged by the Mayo Clinic, the same place where Sandness underwent a 56-hour surgery that was the clinic’s first such transplant. (Potter, 11/11)

Columbus Dispatch: Sober-Housing Provider Lacks Licenses, Columbus Says
The William Brady Charitable Organization has worked for years to grow its housing program, eventually operating 11 homes that have served more than 3,000 people whose addiction, mental illness or other chronic problems make it all but impossible for them to rent on their own. ...Columbus code inspectors discovered the lapses after a former resident complained about conditions at one of the Brady houses, which also were cited for not having rooming house licenses. (Price and Ferenchik, 11/12)

Los Angeles Times: Disneyland Shuts Down 2 Cooling Towers After Legionnaires' Disease Sickens Park Visitors
Disneyland has shut down two bacteria-contaminated cooling towers after Orange County health officials discovered several cases of Legionnaires’ disease in people who had visited the Anaheim theme park, authorities said. Twelve cases of the bacteria-caused illness were discovered about three weeks ago among people who had spent time in Anaheim and included nine people who had visited Disneyland in September before developing the illness, according to the Orange County Health Care Agency. (Barboza, 11/11)

Editorials And Opinions

13. Viewpoints: Arguments For Finding Tax Relief By Repealing Individual Mandate; Should Gov't Help Pharma Rehab From Painkiller Marketing?

A selection of opinions on health care from around the country.

The Wall Street Journal: ObamaCare Tax Relief
Republicans in Congress are plowing ahead on tax reform, and one obstacle is the complexity of Senate budget rules that limit how much taxes can be cut. The good news is that for once Washington’s fiscal fictions could be deployed to improve policy by repealing ObamaCare’s individual mandate as part of tax reform. The Senate Finance Committee on Thursday released the details of its tax proposal, which includes a permanent 20% corporate rate and more. Senators Pat Toomey and Bob Corker cut a budget deal to allow for $1.5 trillion in net tax cuts over 10 years without accounting for faster economic growth (and more revenues) as a result of reform. (11/12)

The Wall Street Journal: The Individual Mandate Is The Worst Tax Ever
If you were deliberately trying to design the most arbitrary, painful and pointless tax possible, how would you go about it? First, you would structure it to inflate the cost of an essential product. Then, you’d create exemptions so vast that only 5% of taxpayers were subject to it. You might even ensure that it hit people only when they were particularly vulnerable—like when they’d lost a job. Finally, you would use it to drive enrollment in entitlements, so that it increased the federal deficit by $338 billion. (Chris Pope, 11/12)

The New York Times: The Insanity Of Taxpayer-Funded Addiction
The pharmaceutical industry was listed as one of the “Contributors to the Current Crisis” in the final report of President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis. The report cites decades of aggressive marketing and industry-sponsored physician “conferences” aimed at expanding opioid use by minimizing the dangers of addiction. Lawsuits by state attorneys general, counties and local jurisdictions allege that the industry fostered the epidemic by overpromoting its products, while raking in billions as Americans became addicted and overdosed. “To this day,” the commission says, “the opioid pharmaceutical industry influences the nation’s response to the crisis.” (11/10)

Richmond Times-Dispatch: Medicaid's Costs Continue To Soar
Over the past decade, Medicaid spending has grown at an annual rate of 8.9 percent — far faster than the budget as a whole (although that has grown plenty, too). ...Officials hope a new approach will keep it from hitting one-fourth of the budget. They intend to shift thousands of beneficiaries from the traditional fee-for-service model to a managed-care system conducted through private insurance companies. (11/11)

The Wall Street Journal: The Hype Of Virtual Medicine
Will “virtual medicine” transform the American health-care system? Will the latest computer-based technologies—apps, wearables, remote monitors and other high-tech devices—make Americans healthier? That’s the promise made by tech gurus, who see a future in which doctors and patients alike track health problems in real time, monitor changing conditions and ensure both healthy habits and compliance with drug and therapy regimens. (Ezekiel J. Emanuel, 11/10)

WBUR: The Cost Of Assuming Your Doctor Knows Best
Most doctors are not geniuses, but even geniuses make mistakes. As a diagnostician myself, I’d like to believe I’ve made some good, even great, diagnoses in my day. But patients need to spend more time focusing on a more important issue — physician error. (Vinita Parkash, 11/13)