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Health care costs too much for what we get in return. Is it more reasonable to hope that doctors will curb unnecessary spending, or consumers? I have long believed that while both are useful, our primary focus should be on influencing what doctors recommend.Recent evidence shows that should indeed be where we put most of the emphasis. Consumer-driven health care may have some benefits, but it doesn’t come close to a doctor-driven approach. (Peter R. Orszag, 8/8)

On both sides of the aisle, lawmakers often propose lowering health-care costs, which consume a growing share of the U.S. economy each year. On track to claim about 1 in 5 of all American dollars in 2026, the health sector is a complex political landmine. The idea of a national “Medicare for all” plan is gaining popularity and prominence. Already 59 percent of Americans support it, according to a Kaiser Family Foundation poll. The sell for this idea, often presented by Bernie Sanders and other politicians on the left, is that capitalism has failed in American health care, and a government solution is needed to ensure equity and hold down costs. (Hadley Heath Manning, 8/8)

As the midterm elections loom, politicians are trotting out their stump speeches promising, among other things, to lower the cost of prescription drugs. We’ve been hearing these kinds of promises for years, with few results. If members of Congress really want to get serious about tackling the mounting cost of medications, they need to start by doing two simple things: Stop relying on drug companies for information about medication. Hire more policy staffers who can go head to head with big pharma. Creating a permanent commission to advise Congress on drug policy accomplishes both goals. (Scott Levy, 8/9)

About 30 million Americans have diabetes, and an estimated 1.5 million more are diagnosed each year. More than 25 percent of our seniors have diabetes, and minority populations are at the greatest risk of developing this disease. African Americans, for instance, have a 77 percent higher risk of developing diabetes compared to White Americans. Hispanic Americans have a 66 percent higher risk. Most meticulously monitor their blood sugar,  as they know that failing to keep diabetes in check can damage the kidneys, eyes, and feet. ...What few know, though, is that the disease also threatens the heart. People living with diabetes are more than twice as likely to develop a heart problem and up to four times as likely to die from cardiovascular disease. Yet half of people living with diabetes aren't aware of this risk. That needs to change. Educating doctors and patients about the connection between diabetes and heart disease and ways to protect heart health could save millions of lives and billions of dollars. (Ken Thorpe, 8/8)

Diligent oversight of the federal government is a priority of mine. It’s imperative that legislators root out waste, fraud, and abuse while holding bureaucrats responsible for the decisions they make when they think no one is watching. At its core, oversight is about keeping faith with the taxpayers and working to give the American people confidence that their government plays by the rules and, if it doesn’t, it is held accountable. Health care is an issue that requires constant attention because it directly affects the life of every American. One area of importance is federally funded medical research. Results of health-care-related studies are often indicators to the public on how to live healthy lives. When the processes of such studies are subject to impropriety, millions of taxpayer dollars can be needlessly wasted on biased results. (Sen. Chuck Grassley, 8/9)

Although prescribing limits seem like a commonsense approach to restricting exposure to opioids, adoption of these policies is outpacing the evidence, and opioid prescribing for acute pain is not a one-size-fits-all situation. (Margaret Lowenstein, David Grande and M. Kit Delgado, 8/9)

The long-standing chasm between federal and state marijuana policy recently widened when U.S. Attorney General Jeff Sessions rescinded Obama-era guidance indicating that the Justice Department would not make it a priority to prosecute federal marijuana crimes in states where the activities are legal. At present, a budgetary amendment is the only legal barrier to Justice Department enforcement of the Controlled Substances Act (CSA) against users and sellers of medical marijuana in the 30 states that have legalized it. Nothing prevents federal prosecution of recreational marijuana activities in jurisdictions where they are legal. However, spurred by Sessions’s policy, Senator Elizabeth Warren (D-MA) introduced a bipartisan bill in June 2018 (S.3032) that would exempt most marijuana-related activities from CSA application when they’re allowed under state or tribal law — legislation that President Donald Trump says he will support. As the marijuana-policy terrain shifts, it’s important to consider the potential public health benefits of closing the federal–state divide. (Rebecca L. Haffajee, Robert J. MacCoun and Michelle M. Mello, 8/9)

The clinician who coined the term “burnout” was not a primary care physician buried under paperwork, nor an emergency physician beset by an unwieldy electronic health record. He was Herbert Freudenberger, a psychologist working in a free clinic in 1974. Discussing risk factors for burnout, he wrote about personal characteristics (e.g., “that individual who has a need to give”) and about the monotony of a job once it becomes routine. He also pointed to workers in specific settings — “those of us who work in free clinics, therapeutic communities, hot lines, crisis intervention centers, women’s clinics, gay centers, runaway houses” — drawing a connection between burnout and the experience of caring for marginalized patients. In recent years, burnout has become a chief concern among physicians and other front-line care providers. But somewhere along the way, the concept was separated from its original free-clinic context. The link between marginalized patients and clinician burnout seems to have gotten lost. (Leo Eisenstein, 8/8)

The difficulty of adopting and sustaining healthy lifestyle changes is a source of substantial frustration for patients, health professionals, policymakers, and others with a vested interest in reducing the burden of diet-related disease. So what do we do? (Sara N. Bleich, 8/9)

Sacramento Mayor Darrell Steinberg and state Sen. Scott Weiner make a reasonable case for why youth should be prioritized for Mental Health Service Act funding. ...Yet the bill narrowly defines prevention and early intervention outreach as targeting “secondary school and transition age youth, with a priority on partnerships with college mental health programs.” This cuts out all other population groups. (Janet Frank, 8/8)

Healthcare-for-All is an admirable goal and is quite likely achievable in our lifetime. However, the national conversation and the national parties have gotten ahead of themselves. If we truly believe that health care is a human right, and I do, then we need to address the catastrophic shortage of health care infrastructure in rural America. No fewer than 14 rural hospitals have closed in Texas since 2010, and 83 have closed nationwide in that timeframe, mostly in the South. (Dayna Steele, 8/9)

Substance use disorder — drug addiction — including opioid addiction, is a growing problem in Kansas. That’s why I was honored to be appointed to serve on the governor’s task force to address substance use disorders. When the task force was created, I had high hopes that bringing experts in the field together with legislators like me would produce a strong set of recommendations for addressing this critical health issue. Regrettably, the task force has not lived up to its promise. A key component of effectively dealing with substance use disorder – or any other health issue – is availability of and access to treatment services. And vital to making treatment available and accessible is ensuring payment for these services. Too many Kansans, however, do not have health insurance coverage and cannot get the health services they need. Many task force members, including me, have urged the committee to recommend expanding KanCare, the Kansas Medicaid program, to help fill this coverage gap. Dr. Greg Lakin, the medical director of the Kansas Department of Health and Environment and chair of the task force, has shut down discussion of KanCare expansion. (Rep. Elizabeth Bishop, 8/8)