Longer Looks: Atul Gawande; Replacing The Health Law; And Diagnosing Concussions

The New Yorker: The Heroism Of Incremental Care
Following the Second World War, penicillin and then a raft of other antibiotics cured the scourge of bacterial diseases that it had been thought only God could touch. New vaccines routed polio, diphtheria, rubella, and measles. Surgeons opened the heart, transplanted organs, and removed once inoperable tumors. Heart attacks could be stopped; cancers could be cured. A single generation experienced a transformation in the treatment of human illness as no generation had before. It was like discovering that water could put out fire. We built our health-care system, accordingly, to deploy firefighters.... But the model wasn’t quite right. If an illness is a fire, many of them require months or years to extinguish, or can be reduced only to a low-level smolder. The treatments may have side effects and complications that require yet more attention. Chronic illness has become commonplace, and we have been poorly prepared to deal with it. (Atul Gawande, 1/15)

Vox: Here’s How Donald Trump Could Replace Obamacare Without Courting Disaster
Republicans have a problem: The promises they’ve made about what their Obamacare replacement plan will do are impossible to keep. Over the weekend, Donald Trump told the Washington Post that his plan would provide “insurance for everybody” with “much lower deductibles.” Oh, and don’t worry about the cost. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it,” he said. “That’s not going to happen with us.” There is simply no way, within the GOP paradigm of private insurance, lower taxes, and less regulation, to make that work. But perhaps he doesn’t need to. (Ezra Klein, 1/17)

ProPublica: Dysfunction Disorder 
It is impossible to say precisely just how influential mental health assessments are in any individual Family Court case. Family Court proceedings are open to the public, but most case files, judicial decisions and trial transcripts are secret. Even lawyers who say their clients were harmed by decisions made with Montego’s input are reluctant to share details, in large part because of confidentiality rules governing attorney-client relationships, as well as fear of retribution by ACS or Family Court judges. What is indisputable is that Family Court cases are complicated and often life-altering. In the last decade, roughly 450 children have died while their families were known to ACS, many of them under the supervision of Family Court judges reliant to some degree on psychologists like those recruited by Montego. (Joaquin Sapien, 1/17)

WIRED: How A Mere Prick Of The Finger Can Diagnose A Concussion
When your head takes a hit (from an airbag, or a fall, or a 300-pound defensive tackle), your brain is subjected to shear forces that can actually tear it apart from the inside—without any of the structural damage you can see on a CT scan or an MRI. Deep in the brain’s white matter, tissues of different densities pull and strain against each other as they accelerate and decelerate at different speeds. Axons, the long, stretched-out arms of neurons that allow them to talk to each other, get frayed and severed. This is why you might have trouble remembering things or thinking clearly if you get concussed—and why a doctor might ask you to tell them what year it is or who’s the president. (Megan Molteni, 1/17)

The Atlantic: Tragedy Would Unfold If Trump Cancels Bush’s AIDS Program
In 2003, in a move that has been described as his greatest legacy, George W. Bush created a program called PEPFAR—the President's Emergency Plan for AIDS Relief. At the time, more than 20 million people in sub-Saharan Africa were living with AIDS, but only 50,000 had access to antiretroviral drugs that manage the disease and prevent its spread. Now, thanks to PEPFAR, 11.5 million people are on those drugs. For good reason, it has been variously described as a “globally transformative lifeline,” “one of the best government programs in American history,” and something “for all Americans to be proud of.” It seems that some members of President-Elect Trump’s transition team beg to differ. (Ed Yong, 1/17)

The New Yorker: On Health Care, We’ll Have What Congress Is Having
In the fall of 1994, the Clinton Administration’s much debated comprehensive, and complicated, health-insurance bill—known derisively as Hillarycare—died quietly on Capitol Hill. It was a moment that, the Princeton sociologist Paul Starr later argued, would “go down as one of the great lost political opportunities in American history.” But, before the end, talk of another approach kept bubbling up: to allow those Americans who couldn’t get insurance elsewhere to buy a policy that was just as good, and inexpensive, as what members of Congress got. When Senator Edward M. Kennedy, of Massachusetts, said that Americans should get “exactly what we have,” he meant the Federal Employees Health Benefits Program. (Jeffrey Frank, 1/17)

Vox: This Is What Keeps CDC Director Tom Frieden Up At Night
With President-Elect Donald Trump taking office this week, there’s a lot of uncertainty about how the US will handle public health and respond to potential future pandemics.There’s also uncertainty about what will happen to the CDC budget and vaccine coverage rates under a president who spreads vaccine conspiracy theories. And [agency director Tom] Frieden’s own future is currently in limbo, as he submitted his resignation as director on January 20. But when we met Frieden at the CDC offices in Washington, DC, last week, he was optimistic. (Julia Belluz, 1/17)