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It does seem incongruous. At a time when the U.S. president is undermining democracy at home and human rights abroad, all the while vigorously attacking truth wherever it finds refuge, the Democratic Party's midterm election messaging is focused on Obamacare. New York Times columnist David Brooks is surely not alone in complaining that the Democratic response to Trump's dangerous "ethnic nationalism" is "inadequate." Yet in many ways a Democratic campaign centered on Obamacare is the perfect vehicle for the political moment. (Francis Wilkinson, 10/24)

In the face of these very real and difficult challenges, lawmakers have achieved little, settling instead for tired campaign slogans — “Repeal and Replace ObamaCare” vs “Medicare for all” — that suggest simple solutions are available. This flawed framing of the political dialogue has trapped our elected officials in unproductive debates. They are too narrowly focused, inadequately informed by relevant facts and experience; and more concerned with winning political points and preserving existing institutions than with improving health care or reducing costs. (Mark Litow and Marc Goldwein, 10/24)

Who would have thought that an attack on socialism would be so controversial? But these days it is. The White House’s Council of Economic Advisers  issued a report called “The Opportunity Costs of Socialism” to a scathing reception on social media: “dreck,” said the economist Justin Wolfers, while Paul Krugman referred to it as “amazingly dishonest.” I’m here to tell you that I have read the entire report, and many of the sources it cites, and most of it is correct. (Tyler Cowen, 10/24)

It’s not often you hear about a proposal to lower prescription drug costs that is supported by 76 percent of Americans as well as Democratic and Republican senators, AARP, doctors, hospitals, insurance companies and the administration. But you have it with our bipartisan legislation to require pharmaceutical companies to disclose list prices for their medications in direct-to-consumer television advertisements. Our measure passed the Senate unanimously in August, and we remain undeterred in providing American patients and taxpayers with the transparency they deserve for the ever-growing cost of prescription drugs. (Sens. Richard J. Durbin and Chuck Grassley, 10/24)

Last year, he declared that transgendered men and women could no longer serve openly in the armed services, claiming that they were a burden on the military. Also, the administration revoked an Obama-era rule that allowed students in federally-funded schools to use the restroom corresponding to the gender with which they identified. Now Trump has said that his administration is considering a further policy change. His comments were vague, but reports said that the administration might narrowly define “sex,” for the purposes of anti-discrimination policies, as an unchanging condition determined at birth by a person’s genitalia. That would be foolish and inhumane. (10/25)

The University of Notre Dame accepted James for this year’s freshman class. It was his first choice for an undergraduate education. No financial issues blocked him from going, no last-minute academic problems emerged during his final days of high school. But James is not attending Notre Dame; he is now a student at another top university. He was forced elsewhere because Notre Dame insisted that, to join the class, James (not his real name) had to increase his risk of dying. (Kurt Eichenwald, 10/25)

It was billed as a town hall for Venice residents to hear about the shelter for homeless people that city officials had proposed for an unused Metropolitan Transportation Authority bus yard in that coastal community. Mostly, however, it was a three-hour flogging of Los Angeles Mayor Eric Garcetti, City Councilman Mike Bonin — whose district includes Venice — and Police Chief Michel Moore.People packed into the auditorium of the Westminster Elementary School last Wednesday didn’t want to hear that the project would move at least 154 homeless people off the surrounding sidewalks and into ”bridge,” or interim, housing. (Carla Hall, 10/24)

A constant democratic struggle is protecting the public from professional guilds that use government power to block competition. A ballot measure in Oklahoma next month would make it easier for patients to get vision care, if voters can overcome the medical lobby. State Question 793 would amend the Oklahoma constitution to let optometrists conduct eye exams and write prescriptions in a Walmart, Costco or other retailer. Under current law, if optometrists want to practice in a retail environment, they must have a physical wall cutting off their office from the sales floor. Oklahoma also bars the sale of glasses or contact lenses in stores where optical products are less than half of income. (10/24)

The National Academies of Sciences, Engineering, and Medicine (NASEM) recently released a report on sexual harassment of women working in academic sciences, engineering, and medicine. Its findings are deeply disturbing: sexual harassment is common across scientific fields, has not abated, and remains a particular problem in medicine, where potential sources of harassment include not just colleagues and supervisors, but also patients and their families. To highlight one statistic, as many as 50% of female medical students report experiencing sexual harassment. Imagine a medical-school dean addressing the incoming class with this demoralizing prediction: “Look at the woman to your left and then at the woman to your right. On average, one of them will be sexually harassed during the next 4 years, before she has even begun her career as a physician.” The report’s conclusions are consistent with the lack of progress in closing gaps between men and women in salary, career advancement, and leadership in medicine. (Esther K. Choo, Jane van Dis, M.D., and Dara Kass, 10/25)

A July 2018 report from the National Academies of Sciences, Engineering, and Medicine (NASEM) sounded an alarm that high rates of sexual harassment in academic sciences, engineering, and medicine are compromising the integrity of education and research. The report also contained a finding that should be deeply worrisome for leaders of academic medical institutions: medical students experience sexual harassment more often than their peers in sciences and engineering, by a considerable margin. (Victor J. Dzau and Paula A. Johnson, 10/25)

After nearly a decade of experimentation with value-based payment (VBP), U.S. health care payers, providers, and purchasers are confronting uneven adoption of new care guidelines, modest early results, and still-unacceptable gaps in spending and quality. In determining what comes next, we believe it’s important to extrapolate from the lessons of these experiences to guiding principles for designing new approaches. It’s also essential to recognize that to truly redesign a system, one has to take a holistic approach and move multiple levers in concert, rather than fiddling with individual factors serially and hoping for a coordinated effect. Though we focus on tactics for private payers to consider, many of these principles and a holistic strategy could also be adapted to Medicare or Medicaid contexts. (Hoangmai Pham and Paul B. Ginsburg, 10/25)