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President Trump’s dismissal of David J. Shulkin, the secretary of veterans affairs — and the nomination of a man with no known policy views to take his place — has brought renewed focus to an increasingly contentious debate over whether to give veterans the option of using the benefits they earned through military service to see private doctors rather than going to government hospitals and clinics. (Fandos, 3/29)

President Donald Trump said Thursday he fired Veterans Affairs Secretary David Shulkin because he wanted to give veterans more choices, but a spokesperson said his actions did not signal a desire to privatize veterans' health services. "No one is talking about privatizing the VA," deputy press secretary Lindsay Walters said in an email. She also told pool reporters Thursday that the selection of Dr. Ronny Jackson, the White House doctor, to be Shulkin's replacement was not an indication of a privatization plan. (Lima, 3/29)

Kaiser Health News: Podcast: KHN’s ‘What The Health?’ VA Secretary Out, Privatization In?

David Shulkin, the secretary of Veterans Affairs, was fired Wednesday night by President Donald Trump. To replace him, Trump will nominate his White House physician, naval Rear Adm. Ronny Jackson. Shulkin, however, is not going quietly. He took to The New York Times op-ed page to claim he was pushed out by those who want to privatize VA health services for profit. (3/29)

The timing of President Donald Trump’s announcement to name Rear Admiral Ronny Jackson to lead Veterans Affairs was a snap decision that surprised his own chief of staff and knocked the government's second-largest agency, already bedeviled by scandal, deeper into disarray. White House chief of staff John Kelly had spoken with David Shulkin by phone Wednesday morning, reassuring the now-former VA secretary that he wouldn’t be fired by tweet that afternoon. Hours later, Kelly had to phone Shulkin again telling him plans had changed. (Woellert, Johnson and O'Brien, 3/29)

The White House was thrown on the defensive Thursday over President Trump’s choice to lead the Department of Veterans ­Affairs, forcing officials to fend off mounting skepticism that Ronny L. Jackson has the experience to run the government’s second-largest agency. Trump announced by tweet late Wednesday that the White House physician would succeed ousted secretary David Shulkin, surprising veterans groups and lawmakers, who were not notified beforehand and scrambled to learn the policy views of someone whose positions on the chronic challenges facing VA are unknown. (Rein, Kim, Wax-Thibodeaux, and Dawsey, 3/29)

Capitol Hill lawmakers reacted guardedly to President Donald Trump’s nomination of the White House physician to head the Department of Veterans Affairs, with key members noting that they know little about him. Dr. Ronny Jackson, a U.S. Navy rear admiral who has served as a White House physician during the past three administrations, is slated to succeed Secretary David Shulkin, who was ousted Wednesday. Mr. Trump indicated on Thursday that he removed Dr. Shulkin because change at the agency was coming too slowly. The secretary had also been the subject of a travel-expenses scandal. (Radnofsky and Nicholas, 3/29)

Ousted Veterans Affairs Secretary David Shulkin is going down swinging. Instead of disappearing into obscurity like others who were summarily fired by President Donald Trump, Shulkin is using his dismissal as an opportunity to step into the spotlight. Freed from the constraints of serving in the Trump administration, Shulkin is publicly — and loudly — raising red flags about what he sees as a sinister plot to privatize veterans’ health care. (Restuccia and Nelson, 3/29)

Former Veterans Affairs Secretary David Shulkin is blaming his sudden ouster from the Trump administration on "political forces" that he says are bent on privatizing the agency and putting "companies with profits" over the care of veterans. Shulkin, the lone Obama administration holdover serving in President Donald Trump's Cabinet, blasted a "toxic" and "subversive" environment in Washington that made it impossible for him to lead. In a tweet late Wednesday, President Donald Trump fired Shulkin, who faced a mounting internal rebellion at VA and a bruising ethics scandal. (Yen and Miller, 3/29)

Hours before he was ousted, former Veterans Affairs Secretary David Shulkin discussed his progress in his position with President Donald Trump — who gave him no indication that he would later fire him. Shulkin said during an interview with MSNBC that he spoke on the phone to Trump on Wednesday about needing to focus on polices to help the VA. (Morin, 3/29)

Just hours after David Shulkin became the latest departure from the tumultuous Trump administration, the outgoing Department of Veterans Affairs secretary wrote a New York Times op-ed slamming the culture of Washington, D.C., and suggesting his ouster was the result of political forces in the Trump White House trying to get him out of the way. (Prignano, 3/29)

Walmart Inc. is in preliminary talks to buy insurer Humana Inc., according to people familiar with the matter, a deal that would mark a dramatic shift for the retail behemoth and the latest in a recent flurry of big deals in health-care services. It isn’t clear what terms the companies may be discussing, and there is no guarantee they will strike a deal. If they do, the deal would be big: Humana currently has a market value of about $37 billion. (Mattioli, Nassauer and Wilde Mathews, 3/29)

Should the talks lead to a tieup, it would be the latest deal to bring together a retail chain and a health insurer, following CVS Health Corp's $69 billion deal to acquire Aetna Inc and Cigna Corp's $54 billion deal to buy Express Scripts Holding Co. (O'Donnell and Roumeliotis, 3/29)

An acquisition of Humana’s size -- $37 billion -- would be rare for Walmart, which has mostly been focused on buying e-commerce companies, including last year’s deals for Bonobos Inc. and ModCloth. But the company still gets plenty of shoppers in physical stores who rely on its 4,700 pharmacies in the U.S. Like drugstore chain CVS, Walmart could use a partnership with an insurer, or even a merger, to take on a more powerful role in the delivery of medications to consumers. (Tracer and Hammond, 3/29)

Robert Redfield Jr., the new director of the Centers for Disease Control and Prevention, gave a deeply personal agencywide address Thursday in which he repeatedly underscored the importance of science and data and said the CDC's most critical public health mission is to protect Americans “from that which we don't expect.” (Sun, 3/29)

The AIDS epidemic in the United States could be ended in the next few years, the new director of the Centers for Disease Control and Protection predicted Wednesday, saying that health officials have all the tools they need to prevent its spread. Dr. Robert Redfield, a former AIDS researcher who has spent decades treating people infected with HIV, made the remark in an all-hands meeting for CDC staff on his second full day at the Atlanta-based agency. Redfield is the agency’s 18th director. (Branswell, 3/29)

He called the opioid-driven surge in drug overdose deaths "the public health crisis of our time," and he stressed the importance of getting treatment for addicts and enhancing the CDC's tracking of the epidemic. "We will help bring this epidemic to its knees," he said. He also talked about his decades working in AIDS research and treatment. "Ending the AIDS epidemic in America is possible," he said. "I think it can be done in the next three to seven years if we put our minds to it." (Stobbe, 3/29)

A congressional watchdog agency has concluded the Food and Drug Administration properly conducted a review of the controversial Mifeprex abortion pill before relaxing usage guidelines two years ago, a move that prompted complaints by some lawmakers and anti-abortion activists that the shift was politically motivated. (Silverman, 3/29)

Recent changes to the Title X family planning program for low-income women and men could undercut access to reproductive health care, Senate Democrats argued in a letter to the Trump administration Thursday. In a funding announcement released last month, the Department of Health and Human Services (HHS) said grantees should be able to provide primary health services, as well as reproductive health services. (Hellmann, 3/29)

The Tennessee Senate voted 24-2 on Thursday to ban any TennCare funds from going to health care providers that perform elective abortions. While no funds from TennCare, the state's Medicaid agency, directly fund abortions currently, sponsor Sen. Mike Bell, R-Riceville, said the purpose of the measure is to prevent any taxpayer dollars from indirectly funding abortions as well. (Buie, 3/29)

A Los Angeles judge ruled that California law requires coffee companies to carry an ominous cancer warning label because of a chemical produced in the roasting process. Superior Court Judge Elihu Berle wrote in a proposed ruling Wednesday that Starbucks and other coffee companies failed to show that the threat from the chemical was insignificant. (Malley, 3/29)

A California state judge in Los Angeles issued a tentative ruling in a lawsuit brought against dozens of companies, including Starbucks Corp., Target Corp., 7-Eleven Inc. and Whole Foods Market for their alleged failure to comply with the state’s required warnings. The companies failed to persuade the judge that “sound considerations of public health” support an exemption from California’s Proposition 65 warning for the chemical acrylamide in coffee. (Pettersson, 3/29)

Berle said scientists who testified on behalf of the coffee companies failed to prove that there was an acceptable level of acrylamide. Earlier in the trial, he also ruled that the coffee companies failed to show the chemical was not a significant risk or that requiring them to include the warnings would violate the 1st Amendment. "While Plaintiff offered evidence that consumption of coffee increases the risk of harm to the fetus, to infants, to children and to adults, Defendants' medical and epidemiology experts testified that they had no opinion on causation," he wrote. (Kim, 3/29)

In addition to the warning signs likely to result from the lawsuit, the Council for Education and Research on Toxics, which brought the lawsuit, has asked for fines as much as $2,500 for every person exposed to the chemical since 2002, potentially opening the door to massive settlements. Starbucks is the lead defendant in the case; others like 7-Eleven have already settled. Starbucks did not immediately respond to a request for comment. (Rosenberg, 3/29)

Under Proposition 65, cancer warnings already appear in places as far-ranging as apartment-building lobbies, parking garages and restaurants. Businesses must warn about the presence of any of more than 900 chemicals on a list of those known to the state of California to cause cancer, birth defects or other reproductive harm. Acrylamide, used for industrial processes like making paper and dyes, is also created during the cooking process for many baked and fried foods, including potato chips, bread and french fries. Many of those products also contain the cancer warnings as a result of litigation. (Randazzo, 3/29)

At a time when the country seems hopelessly divided, health officials are here to remind us of something that unites Americans from all walks of life: deaths tied to opioid overdoses. A report issued Thursday by the Centers for Disease Control and Prevention presents some alarming new statistics about the opioid epidemic that claims the lives of 115 Americans each day. Researchers from the CDC’s National Center for Injury Prevention and Control examined data on fatal overdoses from the 31 states that made reliable reports of drug-related causes of death to the CDC’s National Vital Statistics System. The District of Columbia was included as well. (Kaplan, 3/29)

The opioid epidemic is showing no signs of slowing down, as a new analysis reveals overdose deaths are rising among demographic groups and spreading geographically, and powerful synthetic opioids are largely behind the increases. “The opioid overdose epidemic in the United States continues to worsen,” according to an in-depth analysis of 2016 drug overdose data from the Centers for Disease Control and Prevention (CDC). (Roubein, 3/29)

The Blue Cross and Blue Shield Association has adopted a new standard that opioids should not be the first or second treatment options to manage pain, mirroring guidelines set by the Centers for Disease Control and Prevention. In most cases, ibuprofen and acetaminophen can treat pain more effectively than opioids, said Dr. Trent Haywood, chief medical officer for the Blues association, which has about 106 million members. It's important that physicians understand that alternatives like medication-assisted treatment exist, which pairs medication with behavioral counseling, he said. (Kacik, 3/29)

Arkansas officials filed a lawsuit against three drug manufacturers Thursday, claiming overzealous and deceptive marketing contributed to an increase in opioid abuse that fueled a spike in overdose deaths. The lawsuit in state court names Purdue Pharma, Johnson & Johnson and Endo Pharmaceuticals. The state claims they broke laws against deceptive trade practices and the filing of false Medicaid claims. (Kissel, 3/29)

Baltimore is trying a new way to treat people who are under the influence of drugs or alcohol, opening up a unique facility that will offer a safe, short-term place for them to recover and connect with other services. Officials call it a stabilization center, and they secured $6.2 million for it. The center will be the first of its kind in Maryland. Patients who meet the criteria will be taken to the 24/7 center instead of an emergency room. (Columbus, 3/29)

The Massachusetts U.S. attorney is investigating whether state prison officials are violating federal law by forcing inmates to stop taking their addiction medication when behind bars. U.S. Attorney Andrew Lelling has sent a letter to state public safety and health officials that says the federal Americans with Disabilities Act protects people who are receiving medication-assisted treatment for opioid use disorder. (Becker, 3/29)

Faced with a fast-growing incarceration rate, Kentucky is moving forward with a plan to keep some pregnant women out of jail for nonviolent offenses. The House overwhelmingly passed a bill to allow women facing low-level drug or similar charges to get into rehabilitation as they wait for their cases to move through the court system. It also could apply to women already convicted of those offenses. (Schreiner, 3/29)

Central Florida Cares Health System, a state contractor that oversees state-funded mental health and substance abuse treatment services in Brevard, Orange, Osceola and Seminole counties, has added a new opioid resource section on its website, including contacts, videos and educational materials. (Miller, 3/29)

The Recovery Friendly Workplace initiative launched on March 1 by Gov. Chris Sununu is being adopted by Rhode Island and could spread to other states. At a State House news conference attended by many of the business leaders who have already adopted the program in New Hampshire, Sununu said the Granite State has extended an invitation to any state that wants to sign on, and is willing to share the website domains, logos and regulatory guidance at no cost. (Solomon, 3/27)

The attacks have taken on a numbing familiarity in recent years: five shot to death at an airport in South Florida. Twenty-six slain at a church in Texas. Five killed by a gunman rampaging through Northern California. These violent outbursts last year, and others like them, had key things in common. Chief among them: Long before the violence, the people identified as attackers had elicited concerns from those who had encountered them, red flags that littered their paths to wreaking havoc on unsuspecting strangers. (Berman, 3/29)

A super-resistant strain of gonorrhea has been reported in the United Kingdom following warnings from global public health officials that the common sexually transmitted disease is becoming more difficult to treat. Health officials in England said it is the first time that a case of gonorrhea could not be treated successfully with antibiotics that are commonly used to cure it. (Bever, 3/29)

The Trump administration will encourage the food industry to reduce the salt in processed foods and will take steps to overhaul some food labels to make them easier to understand, Food and Drug Administration Commissioner Scott Gottlieb announced Thursday. The FDA will also move forward with Obama-era plans to require calorie labeling on restaurant menus and new “Nutrition Facts” panels on food products, two rules the agency had delayed. (Dewey, 3/29)

In some households, cracking your knuckles is a declaration of war. Whether you’re in the camp that can’t stand the sound or the one that can’t see what the fuss is about, you might be surprised to learn that where exactly the sound is coming from — what precisely in the knuckle produces it — is still a subject of scientific research. (Greenwood, 3/29)

Sue Ellen King had circled her retirement date on the calendar: March 8, 2015. She had worked as a critical care nurse and nursing educator at University of Florida Health (UF Health) in Jacksonville, Fla., for 38 years; co-workers joked that she was there when the hospital’s foundation was laid, which happened to be true. So the send-offs went on for days — parties in the units where she had worked, a dinner in her honor, gifts including a framed photo signed by colleagues. (Span, 3/30)

Stanford professor Jeffrey Pfeffer doesn't mince words. Workplace stress -- the result of conditions like long hours, a lack of health insurance, little autonomy on the job, high job demands -- don't just hit productivity or damage morale. They're killing us. "It's pretty clear that the human costs -- in terms of death -- and the economic costs, in terms of elevated health care spend, are quite substantial," Pfeffer said in a recent interview about his new book, "Dying for a Paycheck." (McGregor, 3/29)

Kaiser Health News: ‘Aggressive’ New Advance Directive Would Let Dementia Patients Refuse Food

Treading into ethically and legally uncertain territory, a New York end-of-life agency has approved a new document that lets people stipulate in advance that they don’t want food or water if they develop severe dementia. The directive, finalized this month by the board for End Of Life Choices New York, aims to provide patients a way to hasten death in late-stage dementia, if they choose. (Aleccia, 3/30)

Hawaii lawmakers approved legislation Thursday that would make it the latest liberal-leaning state to legalize medically assisted suicide. The state Senate voted 23-2 to pass the measure that has already cleared the House. It allows doctors to fulfill requests from terminally ill patients for prescription medication that will allow them to die. The governor has said he will sign the bill, which would make Hawaii the sixth state to legalize the practice, plus Washington, D.C. (3/29)

Minnesota House Republicans want to spend $50 million to help make schools safer from violence. The plan, announced Thursday, significantly overlaps with a $21 million proposal by Gov. Mark Dayton, a Democrat, suggesting that agreement is possible — on measures that don’t include gun control. (Orrick, 3/29)

Students at North Carolina’s public schools would benefit from far greater access to school nurses who could treat injuries, dole out medicine, and monitor chronic illness, according to a report that legislative staff completed last May, based on a September 2016 request. In January, the General Assembly’s Program Evaluation Oversight Committee heard a short version of the long-delayed report by the nonpartisan Program Evaluation Division. The report was next scheduled to be brought forward at a February meeting that was canceled. (Goldsmith, 3/29)

During the frenetic last-day activity Thursday at the General Assembly, state lawmakers failed to agree on a way to curb surprise medical billing. ... Legislators couldn’t reach a compromise over two differing proposals. (Miller, 3/30)

The nation's top public health agency has its money for a new lab to handle dangerous germs. Last month, the Centers for Disease Control and Prevention asked Congress for funds to build a new state-of-the art laboratory building. CDC officials got $480 million for the endeavor. Money for the project was tucked inside a $1.3 trillion, 2,232-page government spending bill passed by Congress last week. (Stobbe, 3/29)

The largest medical center in the Kansas City area is warning patients and employees they may have been exposed to measles. The University of Kansas Hospital said Thursday that a person who was treated at the hospital from Friday, March 23, to Monday, March 26, has tested positive for the highly contagious viral illness. (Marso, 3/29)

Doctors and other health professionals in California can be disciplined or lose their licenses for criminal conduct such as possession of illegal drugs even if they complete a pretrial treatment program and have the case erased from their record, under a ruling that has now become final. The state Supreme Court unanimously refused Wednesday to take up a physician’s appeal of a ruling that said a licensing agency, such as the California Medical Board, can rely on arrest records as evidence that a license-holder committed professional misconduct, even if the underlying criminal case no longer exists. (Egelko, 3/29)

Southern New Hampshire Medical Center has appointed a new chief medical officer. “I am very excited for the opportunity to look at health care in this setting,” said Dr. Timothy Scherer, who will begin his duties on Wednesday. “I was always interested in moving forward into the new health care environment.” Currently, Scherer serves as medical director for Dartmouth -Hitchcock in Nashua, but has been working in the medical field for more than 15 years. (Houghton, 3/29)

The University of Connecticut announced Thursday that it has recovered more than $50,000 it paid to a slain researcher while it believed he was working from home. Police checking on the welfare of Dr. Pierluigi Bigazzi, a professor of laboratory science and pathology at UConn Health, found his body on Feb. 5 wrapped in plastic inside the house he shared with his wife. (3/29)

U.S. Sen. Lamar Alexander and the nation's chief director for Medicare and Medicaid met with members of the Center for Medical Interoperability on Thursday to highlight the center’s efforts to make it easier for health technologies, including electronic health records and medical devices, to exchange information. Alexander, the Senate health committee chairman, and Centers for Medicare and Medicaid Services Administrator Seema Verma gathered with CMI members and the Nashville Health Care Council on the second floor of OneCity's first office building in Nashville to learn about their work, as the Trump administration examines ways for people to better access their health information. (Alund, 3/29)

There’s a new guy in Sacramento-town — and he’s leading the charge to ease funding for “single-payer” health care in California.He’s not a doctor or nurse, not a lobbyist or legislator. Dale Fountain, 42, is a publicity-shy high-tech worker seeking signatures for his proposed ballot initiative, mostly through Facebook. (3/29)

Banner Health anticipates “negative findings” from an ongoing federal probe of a 2016 cyberattack that exposed the records of nearly 3.7 million patients, employees and others. The Phoenix-based health provider disclosed in its 2017 annual report that a U.S. Health and Human Services’ Office of Civil Rights’ investigation has included queries about the health provider’s security assessments. (Alltucker, 3/29)

LifeBridge Health patients will now be able to see all of their medical records on their iPhones because of an upgrade Apple made to it’s health app under the new operating system released Thursday. “Now your patients can aggregate their health records from multiple institutions alongside their patient-generated data, creating a more holistic view of their health,” according to an online description of the new app feature. (McDaniels, 3/29)

Arizona Department of Corrections Director Charles Ryan has filed an affidavit saying he had "mistakenly testified" this week in federal court about incentive payments made to prison health care provider Corizon Health. Ryan now says all incentive money paid to Corizon "came entirely from funds appropriated for health care." (Jenkins, 3/29)

Though the Sacramento area traditionally has among the highest per capita water use in California, there has been little interest among local water districts in using recycled water to augment local drinking water supplies. The reason? Local waterways such as the Sacramento and American rivers and Folsom Lake provide abundant and comparatively cheap water supplies. (Sabalow , 3/29)

The University of Michigan received the largest donation in the history of its medical school, a $150 million gift from an alumnus who made his fortune in the health insurance industry. In making the gift, Richard Rogel, the founder of the Preferred Provider Organization of Michigan, and his wife, Susan, will have the university’s cancer center named after them. The donation will fund cancer-focused research grants, scholarships and the establishment of a program that brings international researchers to Michigan, the school said in a statement Thursday. (Kate Smith, 3/29)

For Eugene resident Roxanne Loomis, seven is her lucky number. Her birthday is on the seventh day of the seventh month, July 7. On Feb. 7, 2017, Loomis paid for a billboard advertisement that asked for a kidney. And on Feb. 7 of this year, she got one. (3/29)

During 3 months after hospital discharge, more than a quarter of smokers attempting to quit used e-cigarettes, mostly to aid cessation, but few used them regularly. This pattern of use was associated with less tobacco abstinence at 6 months than among smokers who did not use e-cigarettes. (Rigotti, Chang, Tindle, et. al., 3/27)

What are the spatial and temporal trends in mortality due to lower respiratory infections, diarrheal diseases, HIV/AIDS, meningitis, hepatitis, and tuberculosis among US counties from 1980 to 2014? ...Between 1980 and 2014, there were declines in mortality from most categories of infectious disease, but an increase in mortality for diarrheal diseases; however, there were large differences among US counties. (Bcheraoui, Mokdad, Dwyer-Lindgren, et. al., 3/27)

In this randomized clinical trial of 304 participants, patient-centered alcohol care management did not decrease heavy drinking or alcohol-related problems at 12 months even though more patients engaged in alcohol-related care, including medications for alcohol use disorders. (Bradley, Bobb, Ludman, et. al., 3/26)

Residents of the US territories were less likely to receive recommended care (24 percent lower odds of receiving diagnostic needle biopsy and 34 percent lower odds of receiving adjuvant RT) and to receive timely care (45 percent lower odds of receiving surgery and 82 percent lower odds of receiving adjuvant RT, both within three months). (Layne, Aminawung, Soulos, et. al., 3/1)

Insurers are increasingly tying health service payments to clinical outcomes to improve care value and quality. Outcomes-based pricing—setting treatment reimbursements to reflect their prospectively determined value to patients and the health care system—is a promising alternative payment model for promoting higher-value care. While use of outcomes-based pricing agreements (OBAs) for pharmaceuticals has increased, to date there has been little focus on using OBAs to promote shared clinical and financial accountability for medical devices. (Blumenthal et al, 3/29)

In this randomized clinical trial of 304 participants, patient-centered alcohol care management did not decrease heavy drinking or alcohol-related problems at 12 months even though more patients engaged in alcohol-related care, including medications for alcohol use disorders. (Bradley et al, 3/26)

While spending per beneficiary in traditional Medicare rose 5.0 percent between 2009 and 2014, MA payment benchmarks rose 1.5 percent and payment to plans decreased by 0.7 percent. Plans’ expected per enrollee costs grew 2.6 percent. Plans where payment rates decreased generally had slower growth in their expected costs. HMOs, which saw their payments decline the most, had the slowest expected cost growth. (Guterman, Skopec and Zuckerman, 3/14)

Antibiotic-resistant infections are a global health care concern. The Centers for Disease Control and Prevention estimates that 23,000 Americans with these infections die each year. Rising infection rates add to the costs of health care and compromise the quality of medical and surgical procedures provided. Little is known about the national health care costs attributable to treating the infections. Using data from the Medical Expenditure Panel Survey, we estimated the incremental health care costs of treating a resistant infection as well as the total national costs of treating such infections. To our knowledge, this is the first national estimate of the costs for treating the infections. We found that antibiotic resistance added $1,383 to the cost of treating a patient with a bacterial infection. Using our estimate of the number of such infections in 2014, this amounts to a national cost of $2.2 billion annually. The need for innovative new infection prevention programs, antibiotics, and vaccines to prevent and treat antibiotic-resistant infections is an international priority. (Thorpe, Joski and Johnston, 3/21)

If you’re like us, your initial reaction upon hearing that President Trump had picked his personal physician to head the Department of Veterans Affairs was: “What? You mean the guy who looks like a retired Grateful Dead roadie and said ‘unequivocally’ that Mr. Trump would be ‘the healthiest individual ever elected to the presidency’”? No, not him. The doctor with no managerial experience nominated to head the second-largest federal bureaucracy is Dr. Ronny Jackson, the lead White House physician since 2013 and a rear admiral, who said after an exam in January that Mr. Trump was in “excellent health,” despite being overweight and needing a higher dosage of cholesterol-lowering medication.” (3/29)

Four years ago, Americans were shocked by the scandal at the Phoenix VA hospital, where VA employees were letting veterans wait months to receive critical health care. For some patients, this wasn’t just an inconvenience. It was fatal. America understood that our veterans were not receiving the timely health care they had earned. So, Congress quickly passed legislation that allowed some veterans to see private doctors. The ensuing “choice” program offered limited opportunities for some veterans to access private care if they were unable to get timely treatment at the VA. It was an important reform, but it wasn’t enough. (Dan Caldwell, 3/29)

The other day the Trump administration announced a new trade deal with South Korea. It also announced that President Trump was nominating the White House physician to head the Department of Veterans Affairs. What do these announcements have in common? The answer is that both are indicators of how Trump views his job. He doesn’t seem to see actual policymaking as important; instead, he treats it all as an exercise in reality TV. (Paul Krugman, 3/29)

You can’t make this stuff up: President Trump has announced he will nominate a medical doctor who has no discernible management experience to run the second-largest agency in the federal government. Can presidents be sued for malpractice? (Eugene Robinson, 3/29)

Hard questions about whether Dr. Ronny Jackson’s résumé qualifies him to do this job need to be asked at Senate confirmation hearings. There also should be scrutiny of his plans for the agency, specifically his views on the controversial issue of the privatization of VA services. If it is to make good on its members’ frequent promises to the men and women who have served the country, the Senate must take seriously its responsibility to advise and consent on the next VA secretary. It should not rubber-stamp an appointee who makes the president feel comfortable. (3/29)

Easily lost amid the latest Twitter-announced firing within the Trump administration — in this case, dismissal of VA Secretary David Shulkin — is what is best for the millions of veterans he was serving. Ethical missteps by Shulkin, the only Trump nominee confirmed 100-0 last year by the Senate, left him exposed to dismissal. But the underlying issue is whether the Department of Veterans Affairs' health care system should be largely privatized. Shulkin, rightly in our view, made clear that would never happen on his watch. (3/29)

In announcing Dr. Ronny Jackson, the White House physician, as his choice to be the new secretary for veterans affairs, President Trump has taken his latest misstep in what has been the worst presidential personnel process in modern history. We take no pleasure in saying so, including because one of us (Mr. Eisen) worked with Dr. Jackson in the White House, was even treated by him, and can testify that he is a very capable physician. But that good opinion of Dr. Jackson, which was widely held in the Obama administration, by no means qualifies him to run one of the largest, most complex and troubled cabinet agencies in the federal government. (Norman L. Eisen and Brandy X. Lee, 3/29)

Sleek and featherweight in metallic black or navy blue, Juul-brand electronic cigarettes have become a fashion -- you could say, a contagion -- among high-school students across America. Easily mistaken for an ordinary flash drive, the gadgets let kids "Juul" without notice in hallways or school cafeterias and conveniently recharge on their laptops. This is a sure sign, if one were needed, that the U.S. Food and Drug Administration is failing in its responsibility to regulate e-cigarettes. By its inaction, the agency allows a wall of vapor to obscure the fact that tobacco in any form poses a real danger -- and imperils children's lives. (3/29)

Transgender Americans who want to serve their country in the military, but whom Trump has deemed unworthy. If the courts don’t come to their defense, they will be banned from service. We hope the courts make clear that a ban is unconstitutional. (3/29)

As a registered nurse and office manager of a small subspecialty (pulmonary) physician practice, I am amazed at “Republicans’ Quiet Health Victory” by Bobby Jindal (op-ed, March 22) endorsing how wonderful Medicare Advantage plans are. He mentions the Mayo Clinic, but fails to mention it will not see patients with advantage plans. I have traditional Medicare and a supplemental policy. If I have a rare brain tumor, I can more easily go to the best neurosurgeon in the country. In many “advantage” plans the copay to see a specialist is often double the amount to see a primary-care provider. I guess the plans are so “consumer oriented” they want enrollees to see the physician with three to six years less training. (Colleen Davis Stinar, 3/29)

Centers for Medicare and Medicaid Services (CMS) is proposing a limit on the amount of opioids a physician can prescribe to a patient. This limitation, that may take effect on Jan.1, 2019, would be unrelated to the patient's past experience or need. It would render pharmacists unable to fill prescriptions that CMS has defined as “high” or long-term dosages unless an appeal is approved. (Lynn R. Webster, 3/29)

Independent contractors and freelancers make up an increasing share of the workforce, yet Washington is largely neglecting the market where self-employed workers get health insurance. That's bad news for people in the burgeoning "gig economy," where work is divorced from an employer — and thus from employer-sponsored insurance. (Caitlin Owens, 3/30)

Kansas law requires children who attend day care or preschool to be immunized with an initial dose of measles-mumps-rubella between 12 and 15 months of age, but there’s no law requiring day care workers to be immunized. Kansas lawmakers should quickly rectify that to help prevent a future outbreak of the contagious disease. (3/29)

In mid-March thousands of students across the country left school to protest gun violence. The same day Sen. Chuck Grassley spoke to the Senate Judiciary Committee about the mass shooting at a Florida high school. A transcript of his speech was sent to media in a press release. The subject line of the email was spot-on: We must hold government accountable for failures before the Parkland tragedy. Unfortunately, Grassley failed to demand accountability from the legislative branch of government. Congress has incredible power to limit access to firearms in this country, but too many members refuse to support meaningful reform.  (3/29)

Illinois’ economic and government dysfunction manifests itself in countless ways. One of the most damaging is population loss. People keep packing up and moving out because taxes smother them and government doesn’t stoke job growth — it hinders it. So a state that keeps losing people year after year — a net 33,703 fewer residents in 2017 — needs the most accurate count possible of who’s left. Why? Population is a basis for how many billions of dollars in federal money Illinois gets annually. It also dictates representation in the U.S. House, the Electoral College, and factors into setting boundaries for federal, state and local government districts. (3/29)

Don't downplay lead problems, or solutions, for kids in Flint water crisisMona Hanna-Attisha Published 7:59 Flint’s blood lead levels are not the worst in history nor even the worst in the country. But it is important to understand that the way children in Flint were exposed to lead — via drinking water and not the more-common lead exposure through paint, soil, air or dust — and the current screening procedures developed to test for exposure from those common sources were inadequate to document the extent of Flint's lead-poisoning problem. It's even more important to renew and refocus our efforts to ensure that kids in cities like Flint, Detroit, Chicago, Baltimore and Philadelphia aren't exposed to lead in the first place. (Mona Hanna-Attisha, 3/28)

Much has been written about the escalating crisis of opioid-overdose deaths in the United States and its mounting social and economic costs. Although political and public health leaders have begun to confront this urgent problem, hidden beneath it lies another danger: the increasing spread of hepatitis C virus (HCV) associated with injection-opioid use. (Jake Liang and John W. Ward, 3/29)