Viewpoints: The Surgeon General On Addiction; How Trump Could Change Medicare

JAMA: Surgeon General’s Report On Alcohol, Drugs, And Health
[Today] the Office of the Surgeon General released Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. This is the first surgeon general’s report to focus on substance misuse, substance use disorders, and related harms, and it places substance abuse disorders in a public health framework rather than in a criminal justice framework. The report is a response to one of the most pressing public health issues in the United States. (Surgeon General Vivek H. Murthy, 11/17)

Forbes: How Trump May Remake Medicare
During his presidential campaign, Donald Trump was largely silent on Medicare, though he often suggested he’d leave the program untouched. Not any more. It now looks as if Trump may push for major changes in the principal health care program for older adults and some younger people with disabilities. But what will he do? He has not said, but House Speaker Paul Ryan (R-WI) has been explicit about what he has in mind. And since the election Trump seems to have adopted much of Ryan’s language, suggesting he may also embrace his policy proposals. Those include redesigning the basic financial structure of the program and making Medicare Advantage managed care plans more attractive. (Howard Gleckman, 11/16)

USA Today: Here's How To Reform Obamacare
Doctors’ offices are overwhelmed, and we are paid less and less per visit even as we are compelled to document more and more on our computers. We must see more patients to make ends meet, yet we are afraid to argue against excessive patient demands for fear that a poor outcome, no matter how remote the risk of that outcome occurring, will lead directly to a complaint or a malpractice claim. ... wouldn’t it be cheaper with less pressure on the overburdened doctor’s office for more services to be paid for out of pocket, with tax deductions attached? And if a doctor wasn’t worried about being sued, wouldn’t he or she be far less likely to order extensive tests and treatments? Surely catastrophic insurance is needed to cover hospitalization and severe illness just as it was essential in the 1930s, but beyond this, patients would ultimately be more frugal and cost conscious if they had some skin in the game and their doctors had less. (Marc Siegel, 11/16)

Arizona Republic: Trump Speeding Toward A Dead End On Obamacare
Donald Trump says that he’s inclined to keep the provision of Obamacare that requires insurance companies to cover people with pre-existing conditions. If so, he’s headed down a blind alley. And Obamacare won’t truly be repealed and replaced. If the United States isn’t to slide into treating health care entirely as a public good provided by government, as is the case in other industrialized democracies, then there has to be a robust individual health insurance market. (Robert Robb, 11/16)

The New York Times: Republican Falsehoods About Obamacare
A repeal of the Affordable Care Act, which the Republicans have been threatening for years, would obviously be unpopular with the 20 million people who have received coverage under the A.C.A. But Republican leaders don’t seem too concerned with those people. Instead, they are trying to convince people who don’t rely on the A.C.A. that repeal of the law would leave them better off. (Teresa Tritch, 11/16)

The Des Moines Register: Will Trump Make America Uninsured Again?
Americans placed the future of their health insurance in the hands of a Republican-controlled Congress that has voted dozens of times to repeal or dismantle the law. ... The "shake up" that Trump supporters were seeking may soon be realized, and it may get personal. Their candidate won the election, but it's not clear what the country won when it comes to health care. The GOP has no answers either. It has not arrived at anything resembling a consensus for an alternative that would guarantee insurance to all Americans. Only days after the election, Trump was already pointing out provisions in the law he wanted to retain. It also must be dawning on Republicans that stripping health insurance from millions of Americans will have political consequences. (11/16)

RealClear Health: The ACA’s Impact On Employer-Provided Health Benefits
President Obama will be leaving office with the Affordable Care Act (ACA), his signature policy initiative, in deep peril. An incoming Republican president and Congress, concerned with the cost of ACA exchange plans jumping by an average 25 percent next year and employee health care costs rising, have pledged to repeal the law. For his part, the President sought to shift the blame for rising out-of-pocket cost from the ACA’s flaws to employers and insurers. (Tevi Troy and Mark Wilson, 11/16)

Los Angeles Times: Will The Trump Presidency Mean The End Of FDA Drug Regulation?
Donald Trump will be coming into office waving the banner of deregulation. While most of the speculation about his plans has focused on the financial industry and the possibility of eviscerating Dodd-Frank reforms, keep your eyes on the Food and Drug Administration. In a Trump administration the agency, figuratively speaking, will have a big bull’s-eye on its back. (Michael Hiltzik, 11/16)

Forbes: You've Heard Of Trump Steaks, Now Trump Kidneys
As a new administration dawns, anyone with a beloved policy project starts to dream. Maybe this time the power brokers — now, president-elect Donald Trump and his appointees — will see the wisdom of our proposals. For my part, I am optimistic that my goal — easing the nation’s organ shortage — might just gain traction. This is because my preferred solution — rewarding kidney donors – will yield a fiscal windfall for the federal government. (Sally Satel, 11/15)

JAMA Forum: Notes On The Presidential Transition
After a difficult and divisive campaign, the election of Donald Trump and Michael Pence has stunned many in the fields of medicine and public health who had hoped for a different outcome. Eight years ago, I was part of the transition after the election of President Barack Obama. Our excitement about what was now possible for the country was tempered with a recognition that others saw matters quite differently. This experience informs several thoughts about the current transition. (Joshua M. Sharfstein, 11/16)

JAMA: Expanding Payment Reform in Medicare: The Cardiology Episode-Based Payment Model
Cardiovascular disease is the leading cause of death and disability in the United States, accounting for 1 in 4 deaths and more than $200 billion in direct and indirect costs annually. In July 2016, the Centers for Medicare & Medicaid Services (CMS) proposed a new episode-based payment model for myocardial infarction. This model aims to improve the quality and efficiency of cardiac care and helps move the United States toward CMS’s goal of having 50% of traditional Medicare payments in value-based models by 2018. (Zirui Song and Daniel M. Blumenthal, 11/15)

Bloomberg: How To Make Drug Prices Fair To U.S. Consumers 
Americans pay far more for branded prescription drugs than people in any other developed nation, exactly the kind of bad deal that President-elect Donald Trump decried repeatedly in his campaign. The U.S. was reminded of this outrage in September when it learned that drugmaker Mylan NV has been charging Americans more than $600 for its EpiPen two-pack while selling it for only $69 in the U.K. Why does this kind of inequality persist? The main reason is that, by law, Medicare and Medicaid cannot use their volume purchasing power to negotiate lower prices, as do health agencies in virtually all other developed nations. (Red Jahncke, 11/16)

The New York Times: First Comes The Emergency. Then Comes The Surprise Out-Of-Network Bill. 
Doug Moore was out of town at a Florida conference on information technology in October 2015 when he was struck with terrible abdominal pain. He tried to go to an urgent care center and called several local doctors. No one could see him. So he headed to the nearest emergency room. On the way, he called his insurance company to make sure the visit would be covered. Once he got to the Palms of Pasadena Hospital emergency room, a doctor gave him some medication and tests, and let him go. A month later, feeling better and back at home in Baton Rouge, La., Mr. Moore, 34, received an out-of-network bill from the doctor who treated him — for $1,620. (Margot Sanger-Katz and Reed Abelson, 11/16)

Modern Healthcare: Systemwide Employee Awareness Is Key To Cybersecurity In Age Of Ransomware
Extortion increasingly is the motive behind cyberattacks of healthcare companies, a panel of experts told a luncheon audience of the Nashville Health Care Council. The evolution from worms and viruses to large-scale breaches aimed at exposing clients and extracting ransoms should put every employee of a healthcare organization on high alert, said Paul Connelly, vice president and chief information security officer at hospital giant HCA Holdings and a former chief information security officer at the White House. Having a chief information officer isn't enough, he said. (Dave Barkholz, 11/16)

Chicago Sun Times: The Mentally Ill, Once Again, Will Be Among First Hurt 
If the Affordable Care Act is repealed by the Trump administration and the U.S. Congress, people suffering from mental illnesses will be among the first victims of those cuts. Whenever there’s a mass murder or sensational violent crime and the person suspected of the offense has a history of mental illness, the public immediately wants to know if that person has received proper treatment and, if not, why not. Of course, the vast majority of people suffering from mental illnesses commit no crimes. ... Yet, we know that about one-third of the people in Cook County Jail have been diagnosed with a mental ailment and Cook County Sheriff Tom Dart has said the jail has become the largest mental health care institution in Illinois. (Phil Kadner, 11/16)

Georgia Health News: The Future Of Health Care Must Be Patient-Centered, Like Its Past 
For many wistful Americans, the image of the community physician making routine house calls is a lost icon, a symbol of nostalgia. In a simpler time, in a much more rural United States, often the local doctors knew all their patents well and may even have been paid in produce or poultry instead of money. Those days are long gone, and house calls are a rarity in the medical profession, not the norm. ... But it is a time for reflecting about how we deliver our services and what the future of health care will look like. (John Marrero, 11/16)

Cincinnati Enquirer: Here's One Key To Curbing Infant Deaths
Here in Hamilton County, more than half of the babies who died in our community in the past year died because they were born before the end of the second trimester. Building on recent success in reducing our local preterm birth rate belongs at the top of our community’s agenda. This month, Cradle Cincinnati and the March of Dimes came together to jointly issue a report on extreme preterm birth in Cincinnati. Thursday, as we mark World Prematurity Day, we are calling on new partners to get involved in the fight for our babies. (Ryan Adcock, 11/16)

WBUR: Sex Therapist: When Trump Election Worsens Old Pain From Sexual Aggression
For millions of women with Lena's experience or worse — sexual molestation or rape — Donald Trump’s election stirs up painful feelings or actual traumatic memories. What does it mean for them when a man on record describing women using words like "bimbo" or "dog" or "slob" and boasting about grabbing women's genitals is rewarded with the highest office in the land? (Alie Zoldbrod, 11/16)