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In mid-November, a few dozen of the country’s most influential advocates of Medicare-for-all were reviewing details of Sen. Elizabeth Warren’s plan to finance the proposed government-run program when they learned that she had unexpectedly changed her position. Warren (D-Mass.), who had excited liberals when she initially embraced a Medicare-for-all idea first proposed by rival presidential candidate Sen. Bernie Sanders (I-Vt.), was suggesting a more centrist idea: to delay enactment of the single-payer system and, in the interim, give consumers the choice to opt in. (Linskey, Stein and Balz, 11/30)

What's happening: Poll after poll shows voters like the idea of Medicare for All. But the second you tell them about costs and tradeoffs, they turn on it. Why it matters: A harsh spotlight on Warren's specifics collided with Mike Bloomberg's massive spending on a moderate message, as well as rising angst among donors and investors about risks of Warren-Sanders socialism. (Talev and Nather, 11/29)

Mental health proposals from Sen. Kamala Harris (D-Calif.), Sen. Amy Klobuchar (D-Minn.) and South Bend, Ind., Mayor Pete Buttigieg (D) have sparked backlash from some advocates with disabilities, who argue that the plans would increase involuntary institutionalization. Plans by all three presidential candidates embrace a repeal of Medicaid’s Institutions for Mental Diseases (IMD) exclusion, which bars the federal program from paying for inpatient psychiatric treatment in facilities with more than 16 beds, according to Sara Luterman, a Washington, D.C.-area journalist focusing on disability issues. (Budryck, 11/27)

Nearly 2.4 million people have signed up for Obamacare coverage through the first three weeks of open enrollment, about the same as last year's pace — but the numbers are likely to dip again next week. More than 703,000 people enrolled in 2020 coverage through HealthCare.gov during the third full week of open enrollment, CMS said this afternoon. (Goldberg, 11/27)

The pace of Obamacare enrollment this year is up 9% so far in Georgia, a turnaround from declines since the beginning of the Trump administration. Nationwide, the pace of enrollment is up 2%. The open enrollment period still has a couple of weeks to go, and the numbers don’t mean a lot until the final tally is in. (Hart, 11/29)

Missourians shopping for health insurance on the federal government’s online marketplace are likely to see slightly lower premium prices, but health economists warn residents could still pay more for their health care next year. Deductibles, the prices customers pay out-of-pocket before insurance startas to cover bills, are increasing by $100-$200 a year on average, according to an analysis by the Missouri Foundation for Health. Some consumers have deductibles of more than $6,000. (Fentem, 12/2)

After Mark Liebergot’s heart attack in May, a surgeon inserted three stents in the right side of his heart to ease the blockage but warned him he would soon need a coronary bypass to unblock the left side. He was rattled, but took comfort knowing he had insurance after going without for years. Then, on Sept. 20, six days before his second heart surgery, he got a letter from his insurer, Pivot Choice, a short-term health plan, saying he had been dropped. Not only was parent company, Companion Life Insurance Company, rescinding coverage for his scheduled surgery, it was retroactively denying all pending claims, including the roughly $200,000 in initial billed charges that remained unpaid from his May surgery. (Deam, 11/27)

The goal is to deliver on an administration promise of lower premiums and greater choice. The trade-off, though, is a return to a past when polices came with restrictions and exemptions tucked inside, limiting coverage for pre-existing conditions, prescription drugs, hospitalization and preventative care. While the full impact of dismantling prior rules is unknown, the Centers for Medicare and Medicaid predicted the number of people buying just one type of newly deregulated plans will rise from 86,000 last year to 1.6 million by 2022. Regulators and consumer advocates worry that unsuspecting buyers could be vulnerable to staggering medical bills because the coverage they were sold is insufficient. (Deam, 11/27)

Blue Cross of Idaho will soon begin selling a beefed-up version of a short-term health plan that the company promises will offer comprehensive benefits to thousands of middle-class Idahoans who can't afford Affordable Care Act plan premiums. But because the plans still skirt some popular ACA consumer protections, critics say they're only likely benefit healthy individuals at the expense of those who buy coverage through the exchanges. (Livingston, 12/27)

North Carolinians spend a greater share of their money on health care costs than the national average. A new report shows that in 2018, North Carolinians paid almost 14 percent of the state’s median income on employer-sponsored health plan premiums and deductibles, up from around 11 percent in 2008. For comparison, in 2008, the average American spent just under 8 percent of median income on premiums and deductibles. By 2018, that rose to 11.5 percent. (Duong, 12/2)

In the latest move in the ever-consolidating health care industry, two of Massachusetts’ largest insurers have begun making the pitch for why they, too, should merge. The chief executives of Harvard Pilgrim Health Care and Tufts Health Plan told the Globe they must combine in order to provide more-affordable coverage to more people across New England, and to better compete against giant national insurers. (Dayal McCluskey, 12/1)

In late September, a woman in her 70s arrived at a skilled nursing facility in suburban Houston after several weeks in the hospital. Her leg had been amputated after a long-ago knee replacement became infected; she also suffered from diabetes, depression, anxiety and general muscular weakness. An occupational therapist named Susan Nielson began working with her an hour a day, five days a week. Gradually, the patient became more mobile. With assistance and encouragement, she could transfer from her bed to a wheelchair, get herself to the bathroom for personal grooming and lift light weights to build her endurance. (Dias and Lerer, 12/1)

A bill being considered by state legislators in Pennsylvania would require health care facilities to bury or cremate fetal remains after an abortion or miscarriage. House Bill 1890, which was introduced by predominantly Republican group of lawmakers in September and passed by the GOP-led state House last week, is now being considered in the state Senate. (Folley, 12/1)

A bill introduced in Ohio’s legislature would make physicians who end pregnancies guilty of “abortion murder” suggests that doctors should try to save ectopic pregnancies, in which a pregnancy grows outside of the uterus, by reimplanting the fetus in the uterus. It’s a procedure that does not exist. (Law, 12/1)

The Ohio bill would also outlaw abortion and add new crimes, “abortion murder” and “aggravated abortion murder” to its laws to punish doctors who perform abortions. According to the proposed bill, aggravated abortion murder would be punishable by death. Ohio already has a six week abortion ban on the books. (Wade, 11/30)

The U.S. has continued to see a drop in the number of reported abortions, according to data released Wednesday by the Centers for Disease Control and Prevention (CDC). There were 623,471 abortions performed in areas across the country that reported data to federal officials in 2016, the latest available year for data, down from 636,902 the previous year, the CDC found. (Frazin, 11/27)

Massachusetts officials are struggling to understand why the state has been blacklisted by San Francisco over the state's abortion laws. Last month, San Francisco officials announced a ban on travel by city employees to Massachusetts and 21 other states whose abortion laws were deemed too restrictive by the San Francisco Board of Supervisors. The ban starts Jan. 1, 2020. San Francisco will not allow city contracts with Massachusetts-based companies after that date either. (Bebinger, 11/29)

Giving women with very dense breasts an MRI scan in addition to a mammogram led to fewer missed cancers but also to a lot of false alarms and treatments that might not have been needed, a large study found. The results give a clearer picture of the tradeoffs involved in such testing, but they can't answer the biggest question — whether it saves lives. (11/27)

Now, a new study provides strong evidence that supplemental M.R.I.s are more effective in finding tumors in these women than mammograms alone. The study, of more than 40,000 women with extremely dense breasts in the Netherlands, found that those who had mammograms followed by M.R.I.s, had more tumors detected than with mammography alone. The research also found that those who had M.R.I.s were less likely to find a palpable cancerous lump in between routine screenings; by the time tumors are big enough to be felt, they tend to be more advanced. (Rabin, 11/27)

Portia Smith's most vivid memories of her daughter's first year are of tears. Not the baby's. Her own. "I would just hold her and cry all day," Smith recalls. At 18, Smith was caring for two children, 4-year-old Kelaiah and newborn Nelly, with little help from her abusive relationship. The circumstances were difficult, but she knew the tears were more than that. (Feldman and Pattani, 11/29)

Pregnant women with asthma should take special care to keep their asthma in check. Canadian researchers have found that asthma attacks during pregnancy are associated with a number of serious health problems for both mother and child. The observational study, in The European Respiratory Journal, used data on 103,424 pregnancies in women with asthma. (Bakalar, 11/27)

The memory of our motionless baby boy on the ultrasound screen awakened me in the middle of the night. I squeezed my eyes shut repeatedly, but I couldn’t escape the image. My body ached, my heart raced and tears streamed down my face until they led to uncontrollable sobs, eventually waking my husband. I cried until morning. That was the first night after I miscarried at 12 weeks pregnant. Those early morning flashbacks lasted for weeks. (Reilly, 11/30)

About 1 in 3 women has experienced violence during her lifetime, according to the World Health Organization — an epidemic that is truly worldwide. In the days leading up to Human Rights Day on Dec. 10, the United Nations health agency wants to spread awareness to prevent violence against women and girls. (Blakemore, 11/30)

The Department of Homeland Security's inadequate medical technology and record-management for the thousands of migrants who pass through its custody are contributing to poor care and even deaths, according to lawsuit records reviewed by POLITICO. A review by POLITICO of 22 deaths of detainees in Immigration and Customs Enforcement custody between 2013 and 2018 revealed malfunctioning software and troubling gaps in use of technology, such as failure to properly document patient care or scribbling documentation in the margins of forms. (Tahir, 12/1)

Though President Trump has staked much of his presidency on halting the movement of undocumented immigrants across the southern border, the Oh family’s roundabout route to residence in the United States is part of one of America’s least widely known immigration stories. Some 350,000 travelers arrive by air in the United States each day. From Asia, South America and Africa, they come mostly with visas allowing them to tour, study, do business or attend a conference for an authorized period of time. (Jordan, 12/1)

By the time he called the Lung Health Institute, Ed Garbutt was desperate. The Dallas computer parts salesman could barely walk the length of his house without gasping for breath. Unable to work, Garbutt, 64, was going broke paying for trips to the emergency room. Lung Health Institute staffers were reassuring, Garbutt recalled, telling him that more than 80 percent of their patients with lung disease said they found relief through their stem cell treatments — which would cost him $5,500, thanks to a summer sale. He said they told him that if he didn’t have the money, he could get it other ways, like fundraising on GoFundMe. (Wan and McGinley, 12/1)

After nine visits to the emergency room at Baptist Memorial Hospital in Memphis, Tenn., in 2016 and 2017, Jennifer Brooks began receiving bills from an entity she'd never heard of, Southeastern Emergency Physicians. Unsure what the bills were for, Brooks, a stay-at-home mother, said she ignored them until they were sent to collections. She made payment arrangements, but when she was late, she said the collection agency demanded $500, which she didn't have. (Thomas, Miller, Raghavendran and Burke, 11/27)

General Electric Co. aims to excite investors about its health-care unit, a business that was tagged to be cast off but is now central to the company’s turnaround efforts. GE Healthcare, which is based in Chicago and employs more than 50,000 people, makes magnetic-resonance-imaging machines and other hospital equipment. At the depths of its crisis, GE set plans to spin off the division. Now, Chief Executive Larry Culp refers to it as one of the conglomerate’s pillars. (Gryta, 12/1)

The FBI is investigating the organ transplant program at Newark Beth Israel Medical Center, according to people contacted by the bureau. The bureau is looking into whether the program, which kept a vegetative patient on life support for the sake of boosting its survival rate, attempted to defraud federal insurers Medicare and Medicaid, said one person familiar with the situation, who spoke on the condition of anonymity. (Chen, 11/29)

The door is closing on Medicare’s open enrollment period. If you are among the nation’s 60 million Medicare beneficiaries and want to switch plans, compare premiums or fish around for cheaper prescription drugs, you have a week left. If the barrage of TV commercials is any indication — with people such as National Football League legend Joe Namath hawking help lines — meeting the Dec. 7 deadline is hugely important. It affects your health, pocketbook and quality of life. (Heath, 11/29)

In late September, a woman in her 70s arrived at a skilled nursing facility in suburban Houston after several weeks in the hospital. Her leg had been amputated after a long-ago knee replacement became infected; she also suffered from diabetes, depression, anxiety and general muscular weakness. An occupational therapist named Susan Nielson began working with her an hour a day, five days a week. Gradually, the patient became more mobile. With assistance and encouragement, she could transfer from her bed to a wheelchair, get herself to the bathroom for personal grooming and lift light weights to build her endurance. (Span, 11/29)

Tennessee is the latest battleground for the Trump administration as it tries to implement drastic, conservative changes to Medicaid. While some red states have begun pushing back from imposing work requirements on Medicaid beneficiaries in the face of lawsuits, Tennessee is forging ahead with an even more controversial proposal. (Weixel, 12/1)

Tennesseans have one more chance to voice their opinions on a proposal to overhaul TennCare, the state health insurance program that covers one in every five people. The federal government will collect comments until December 27 on the controversial plan by Gov. Bill Lee's administration to give state officials more authority to decide who is covered, what services are provided and how much the state will pay for them. (Wadhwani, 11/29)

Gov. Mike Parson said Tuesday he would expand Medicaid if that’s what Missourians want, even though he has indicated he won’t support a ballot measure to grow the program. “If the people of the state of Missouri — that is their will and they vote to do that — that’s what I’m supposed to do is uphold the will of the people of this state, and that’s what I intend to do regardless of whether I agree with the issue or whether I don’t,” Parson told reporters at a news conference on Tuesday. (Suntrup, 11/27)

New York state’s chief fiscal officer wants Gov. Andrew Cuomo to quickly provide more information about potential cuts to the Medicaid program, which the governor’s office recently put on the table to deal with a $4 billion cost overrun. Comptroller Tom DiNapoli said in an interview last week that he’s concerned about the situation, which has been developing since the state began its new fiscal year in April. A midyear update released by Mr. Cuomo’s Division of the Budget last month said the state could reduce payments and reimbursements to health-care service providers by $1.8 billion. Details will be coming in January, the update said. (Vielkind, 12/1)

Eleven drugmakers led by Pfizer and Novartis have set aside a combined $2 billion to invest in gene therapy manufacturing since 2018, according to a Reuters analysis, in a drive to better control production of the world's priciest medicines. The full scope of Novartis' $500 million plan, revealed to Reuters in an interview with the company's gene therapy chief, has not been previously disclosed. It is second only to Pfizer, which has allocated $600 million to build its own gene therapy manufacturing plants, according to filings and interviews with industry executives. (11/27)

Novartis AG Chief Executive Vas Narasimhan has spent the past two years buying up cutting-edge science. His latest deal is a high-stakes bet that the Swiss health-care giant will succeed where many have struggled: launching a new heart drug. Cardiovascular diseases are the number-one cause of death in the U.S., but new drugs for conditions like high cholesterol and heart failure have proven tough to sell. (Roland, 11/29)

The Boston-based organization was founded as a way for new CEOs to get together and learn from each other. Most of the group’s members head up smaller companies, many of which are private and not yet turning a profit. In return for a $4,500 annual membership fee, these CEOs get the chance to connect with a small group of 10 peers to workshop the unique problems that come with managing a company — an issue with a board member, perhaps, or with how to recruit top scientists. They’re also mentored by legends of the biopharma world like Massachusetts Institute of Technology professors Phil Sharp and Bob Langer. (Florko, 12/2)

President Trump’s proposal to import cheaper prescription drugs from Canada faces significant headwinds from U.S. pharmaceutical companies and the Canadian government. Canadian officials warn their country is too small to supply their neighbors to the south with prescription drugs, an argument that American drugmakers quickly seized on after years of aggressively opposing all drug importation efforts. (Hellmann, 12/1)

In a twist on value-based contracting, a drug maker has agreed to offer a larger discount that a commercial health plan will receive for medicines – but only based on outcomes that patients report. In this instance, the UPMC Health Plan will pay less for two Biogen (BIIB) drugs — Tecfidera and Avonex — if patients say the medicines failed to help them, based on their assessments using a validated clinical scale known as Patient Determined Disease Steps. If the medicines work, however, both the health plan and patients could eventually be expected to experience lower overall health care costs. (Silverman, 11/27)

A person’s chance of dying from Ebola increases substantially every day until he or she receives treatment, according to results from a landmark clinical trial conducted during a large epidemic in a violent region of the Democratic Republic of Congo. The study, published Wednesday in the New England Journal of Medicine, confirmed that two experimental drugs outperformed two others in saving the lives of people stricken with the deadly viral disease in northeastern Congo. (McKay, 11/27)

Final data from a landmark clinical trial of four Ebola therapies conducted in the current outbreak in the Democratic Republic of the Congo show two of the drugs dramatically reduced the risk of dying from the disease, especially in people who started treatment quickly after onset of their illness. Findings of the PALM trial, published in the New England Journal of Medicine on Wednesday, show that two treatments based on Ebola antibodies led to a survival rate of about 65% in treated patients, compared to 33% in the outbreak overall. (Branswell, 11/27)

About 80,000 babies and toddlers die of AIDS each year, mostly in Africa, in part because their medicines come in hard pills or bitter syrups that are very difficult for small children to swallow or keep down. But on Friday, the Indian generic drug manufacturer Cipla announced a new, more palatable pediatric formulation. The new drug, called Quadrimune, comes in strawberry-flavored granules the size of grains of sugar that can be mixed with milk or sprinkled on baby cereal. Experts said it could save the lives of thousands of children each year. (McNeil, 11/29)

When babies are born with HIV, starting treatment within hours to days is better than waiting even the few weeks to months that’s the norm in many countries, researchers reported Wednesday. The findings, from a small but unique study in Botswana, could influence care in Africa and other regions hit hard by the virus. They also might offer a clue in scientists’ quest for a cure. (11/27)

The Minford High School Class of 2000, in rural Minford, Ohio, began its freshman year as a typical class. It had its jocks and its cheerleaders, its slackers and its overachievers. But by the time the group entered its final year, its members said, painkillers were nearly ubiquitous, found in classrooms, school bathrooms and at weekend parties. Over the next decade, Scioto County, which includes Minford, would become ground zero in the state’s fight against opioids. It would lead Ohio with its rates of fatal drug overdoses, drug-related incarcerations and babies born with neonatal abstinence syndrome. (Levin, 12/2)

Homeless drug users in Scotland will be allowed to inject pharmaceutical-grade heroin twice a day under the supervision of medical officials as part of a new program intended to reduce drug deaths and H.I.V. infection. From 9 a.m. to 5 p.m. seven days a week, a $1.5 million facility in Glasgow that opened on Tuesday will allow a handful of drug users to receive doses of the drug alongside other treatment for their physical and psychological health, according to Glasgow City Council. (Schaverien and McCann, 11/27)

Sarah Mackin runs a cotton swab around the inside of a tiny plastic baggie that appears to be empty. She spreads whatever residue the swab picked up onto a test strip that resembles a Band-Aid, then slides the strip into a buzzing machine about the size of a boxed, take-home pie. Then she waits, hoping for information that she can share with Boston's community of opioid users. (Bebinger, 11/27)

But in Louisiana and other states with large rural populations where opioids have hit hard, one of the biggest hurdles has been providing long-term treatment programs that tackle the isolation and loneliness that are one of the root causes of addiction. The sober-living residence where [Kim] Christian, [Christie] Silvis and their roommates live is part of a network run by Oxford House, a national nonprofit that has founded dozens of such homes in Louisiana. Addiction researchers and service providers say that these types of homes are an important stepping stone between treatment and independence, and have prompted some recovering addicts from rural areas to seek out cities like New Orleans as places where they can get clean. (Woodruff, 11/28)

With just over a month left in the year, Minneapolis has recorded more than 1,300 drug overdoses — a sobering milestone that’s the highest in at least a dozen years. The 1,360 count through Nov. 18 easily surpassed the 954 overdoses reported in all of 2018 and left city and public health officials scrambling to respond to the opioid crisis. The data dating back to 2007 only captures cases in which police, firefighters or paramedics respond to a reported overdose, fatal or otherwise, and not those instances in which victims are revived by someone at the scene or get to the hospital on their own. (Jany, 11/24)

The focus on trauma has filtered throughout Cecil County’s emergency and social services. [Ray] Lynn combs through police reports and emergency calls to find every child affected by their parent’s drug use to make sure they’re connected with counselors or mental health professionals. Those kids might have watched paramedics revive an overdosed relative. He and others help the staff at after-school programs understand that a child’s meltdown might have more to do with what happened at home. (Davis, 12/2)

Her sentencing marks the end of a deadly era: For more than 15 years, rogue doctors preyed on patients in the southern Ohio county. Many people drove for hours to pay cash for prescriptions. Some sold the pills on the streets; countless others became addicted. Dozens died. (Caniglia, 12/1)

More than 10,000 people have died across the Bay Area in the drug overdose epidemic, but the main killer hasn’t been prescription painkillers for several years — methamphetamine is now the biggest cause of deaths, and overdoses on the superpotent opioid fentanyl are spiking. Nationally, hundreds of thousands of people have died in the opioid overdose crisis, using prescription painkillers and similar street drugs like heroin and fentanyl. (Allday and Fagan, 12/1)

The mortality rate of middle-aged Ohioans has increased more than it has in 47 other states and a new study shows the ongoing opioid epidemic might be partially to blame. From 2010 to 2017, Ohio’s mortality rate for people ages 25 to 64 increased by 21.6%, according to a study published Tuesday in the Journal of the American Medical Association. The study, conducted by researchers at Virginia Commonwealth University and the Eastern Virginia Medical School, examined data on life expectancy in the United States for more than a half-century and found that mortality rates accelerated just as the nation’s opioid crisis set in. (Filby, 11/27)

The decision to terminate the contract that allows Granite Pathways to operate the adolescent drug treatment center at the Sununu Youth Services Center in Manchester was met by approval from both local and state officials. Manchester Mayor Joyce Craig and Patricia Reed, the state director for Granite Pathways, both agreed with Gov. Chris Sununu's decision to terminate the contract in the wake of teen drug use and overdoses at the state's sole youth treatment center for adolescents. (Landrigan and Hayward, 11/27)

As a volunteer “cuddler,” [Judy] Buckley’s job is to soothe some of Concord Hospital’s smallest, most vulnerable patients. The retired teacher spends hours holding and comforting babies, most of whom have neonatal abstinence syndrome, meaning they were born exposed to drugs in the womb. Babies with NAS are essentially born in withdrawal – they suffer tremors, rashes, sleep deprivation and seizures, among other symptoms. Many of the symptoms mimic normal newborn behaviors: babies are fussy at times, they want to eat or be held. The difference is, with NAS babies, those symptoms don’t stop even after needs are met. These babies need to be held for hours at times before they are able to rest. (Willingham, 11/30)

In her office at Boulder High School, the assistant principal has a large cardboard box where she can toss the spoils of her ongoing battle with the newest student addiction. "This is what I call the box of death," says Kristen Lewis. "This is everything that we've confiscated." The box is filled with vape pens like Juuls, the leading brand of e-cigarettes, dozens of disposable pods for nicotine liquid, and even a lonely box of Marlboros. (Daley, 11/29)

When Nicholas Calico got suspended for three days from his high school in Mandeville for vaping, that didn't convince him to quit. "I went and bought another vape, not even 30 minutes after that," he said, laughing. When he heard about people across the U.S. with vaping-related illnesses, that didn't stop him and his friends, either. (Woodruff, 12/1)

Massachusetts Gov. Charlie Baker (R) on Wednesday signed into law the country’s most stringent ban on flavored vaping products, as well as menthol cigarettes. The new law immediately restricts the sale of all flavored nicotine vaping products and will ban menthol cigarettes starting June 1. Under the law, flavored vaping products will only be sold in licensed smoking bars, and they must be consumed onsite. (Weixel, 11/27)

When the vaping industry and its allies launched a major push to dissuade President Donald Trump from banning flavored e-cigarettes this fall, they pointed to a newly identified demographic group: vaping voters. Battleground state polling conducted for the industry by one of the president’s trusted campaign pollsters suggested a ban could tip the balance against the president — 96 percent of vapers said they would be less likely to vote for a candidate who wanted to ban flavored e-cigarettes. (Shepard, 11/27)

Fort Collins and Larimer County are crafting policies to combat youth vaping, including raising the legal age for buying tobacco products from 18 to 21. Larimer County is working with Fort Collins, Loveland, Berthoud and other municipalities and stakeholders to develop regulations that could apply countywide, possibly including regional licensing for retailers of tobacco and vaping products and raising the legal age of purchase. Some Fort Collins City Council members said they might be interested in pursuing additional regulations locally, such as a ban of flavored vaping products and a local sales tax. (Marmaduke, 12/1)

Dr. Rose Marie Leslie is hoping to reach teens with a message about the dangers of e-cigarettes. So she’s started posting regularly on TikTok, the popular short video app, and has collected a large following. Leslie, who goes by @DrLeslie and is a family medicine doctor at the University of Minnesota Medical School, has amassed more than 300,000 followers on the platform in recent months. (Farr, 11/29)

While school districts in Washington have raised awareness on substance abuse and prevention for decades, the state’s Student Assistance Prevention-Intervention Services Program that funds drug- and alcohol-prevention specialists in state schools has dwindled. Between the 2004-2005 and 2017-2018 school years, the number of schools served through the program dropped from 809 to 91, an 88% decline, said Mandy Paradise, program supervisor for the state education department. (Bazzaz, 11/29)

Mia St. John’s cellphone lit up with a message from the psychiatrist treating her son. The voicemail shimmered with hope, the first she had felt in months. The doctor said Julian, admitted to a psychiatric facility with schizophrenia, seemed more cheerful, was talking more with other patients and would soon begin a new art project. (Karlamangla, 12/1)

Over the last decade, more than 50 people have died by suicide while admitted to psychiatric facilities in California. The figure paints a bleak picture of the options available for people in the midst of a mental health crisis. So for families whose loved ones are suffering from suicidal thoughts, is there hope? Can hospitals actually stop people from dying by suicide? The short answer, experts say, is yes. (Karlamangla, 12/1)

On the day before his 25th birthday, Jeannine Pembroke’s son killed himself. Soon the calls from family and friends dwindled, and Ms. Pembroke was alone with her grief. One afternoon, she sat at her computer in the house where her son had grown up and sent her first message to an online support group. “We are devastated, numb, angry, and so very sad,” she wrote. As suicides rise in the U.S., more attention is turning to the struggles of the people left behind. New research shows just how severe the aftermath is—and that it is different from other kinds of loss. People who lose a loved one to suicide are at a greater risk for post-traumatic stress disorder and suicide themselves. The grief can be longer-lasting and more debilitating. (Petersen, 12/2)

It’s hard to look past the challenges families in agriculture have faced this year. Between floods, late planting, and trade turmoil, many families are operating under an extra layer of stress. But addressing the culture of mental health in rural schools and communities is proving more complicated than increasing resources. ...Regional behavioral health agencies this year have increased their outreach to agricultural areas where families are struggling to recover from the flooding. And organizations like the Rural Response Hotline in Nebraska are finding some success connecting families to free counseling during financial advisor appointments. (Stella, 12/2)

The bureau started training all officers - as well as non-sworn civilian bureau employees - during annual refresher training classes this fall, bringing in physical therapists to share tips on how best to stretch muscles or control breathing to reduce stress. As the bureau struggles to retain veteran officers while being unable to fill more than 100 vacancies fast enough, Training Sgt. Todd Tackett and Harris are tasked with developing a program that will help police get through their law enforcement careers intact, both physically and mentally. (Bernstein, 11/30)

Susan Deveau saw Mark Papamechail’s online dating profile on PlentyofFish in late 2016. Scrolling through his pictures, she saw a 54-year-old man, balding and broad, dressed in a T-shirt. Papamechail lived near her home in a suburb of Boston and, like Deveau, was divorced. His dating app profile said he wanted “to find someone to marry.” Deveau had used dating websites for years, but she told her adult daughter the men she met were “dorky.” (Flynn, Cousins and Picciani, 12/2)

For 15 years, scientists have put various stem cells into seriously ill patients’ hearts in hopes of regenerating injured muscle and boosting heart function. A new mouse study may finally debunk the idea behind the controversial procedure, showing the beneficial effects of two types of cell therapy are caused not by the rejuvenating properties of stem cells, but by the body’s wound-healing response — which can also be triggered by injecting dead cells or a chemical into the heart. (Johnson, 11/27)

The flu season is off and running in the Deep South. The most recent weekly flu report from the Centers for Disease Control and Prevention finds high levels of flu-like illness in Alabama, Arkansas, Georgia, Nevada, South Carolina and Texas. The highest level in that report for the week ended Nov. 16 was in Mississippi. Doctors in the Magnolia State say they’re already seeing lots of patients. (11/29)

A lifelong swimmer leapt into deep water near his lakeside home, and was horrified to find himself completely unable to swim. Had his wife not rescued him, he might have drowned. He had recently received an electronic brain implant to control tremors and other symptoms of Parkinson’s disease, and somehow the signals from the device had knocked out his ability to coordinate his arms and legs for swimming. (Grady, 11/27)

Dr. Joshua Hauser approached the bedside of his patient, treatment in hand. But it wasn’t medicine he carried. It was a copy of a 19th-century poem titled “Invictus.” It isn’t often that doctors do rounds with poetry. But Dr. Hauser, section chief of palliative care at the Jesse Brown VA Medical Center, and colleagues are testing it as part of a pilot study. He entered Mr. Askew’s room. The patient had asked for “Invictus,” a dark poem by William Ernest Henley that he remembered from his past. (Reddy, 12/1)

Parents of young diabetes patients say they haven’t been getting crucial readings from blood-sugar monitors worn by their children since early Saturday. The technological breakdown, the origin of which isn’t certain, threatens the proper care of the young diabetes patients. (Loftus, 12/1)

CONCORD, N.H. — For several years now, it has been almost de rigueur for skiers and snowboarders to strap on a helmet amid rising concerns about safety on the slopes. But a new study caution that helmets cannot protect skiers from all head injuries. (11/28)

Kaiser Health News: For Artist Inspired By Illness, ‘Gratitude Outweighs Pain’

People often ask Dylan Mortimer how it feels to breathe through transplanted lungs. He gets that a lot because while most people go through life with one pair of lungs, Mortimer is on his third. The 40-year-old artist has endured two double lung transplants in the past two years. He often shares his journey onstage as a speaker. But when the curtain closes, he leaves the rest of the storytelling to art. “I’m alive because of what someone else did,” Mortimer said. “That is humbling in all the best ways.” (Anthony, 12/2)

Nothing Jenn and Jason learned in parenting class prepared them for the challenges they've faced raising a child prone to violent outbursts. The couple are parents to two siblings whom they first fostered as toddlers and later adopted. In some ways, the family today seems like many others. Jenn and Jason's 12-year-old daughter is into pop star Taylor Swift and loves playing outside with her older brother. (Herman, 11/29)

We didn't expect to need the card table for spillover seating at this year's Thanksgiving dinner. We would be fewer than usual, just nine altogether, and the littlest one's high chair needs no place setting. As we got things ready, I felt deep gratitude for the family members who would be here — my husband, our two daughters, their husbands, my sister-in-law's 90-year-old mother and our two delightful granddaughters. But I also knew I would deeply miss the ones who couldn't make it. (Henig, 11/28)

A Chinese man sought medical attention for seizures and a headache that lasted nearly a month. Doctors found that tapeworms from undercooked meat were causing his pain. Researchers at the First Affiliated Hospital of Zhejiang University published a paper last week that details the plight of 46-year-old construction worker Zhu (an alias for the patient) in the eastern Zhejiang province of China who bought pork and mutton about a month ago for a spicy hot pot broth. (Beachum, 11/27)

Bertha Mae Beavers remembers hearing stories as a child about the promises of California, a place so rich with jobs and opportunity that money, she was told, “grew on trees.” So in the summer of 1946 she said goodbye to her family of sharecroppers in Oklahoma and set out for a piece of it. For decades she labored in the Central Valley’s vast cotton and grape fields, where eventually her children joined her. Looking back, Ms. Beavers, who turned 90 this year, has sometimes wondered why she left home at all. It was all the same trouble, she said. (Del Real, 11/29)

Utah is on its way to becoming the 19th state to ban the discredited practice of conversion therapy in January after state officials formed a proposal that has the support of the influential Church of a Jesus Christ of Latter-day Saints. Republican Gov. Gary Herbert announced Tuesday night that church leaders back a regulatory rule his office helped craft after legislative efforts for a ban on the therapy failed earlier this year. (11/27)

An Uber driver says a South Carolina hospital dumped a patient on him, saying where she ended up was his responsibility. Chris Wilson tells The Greenville News that he stopped in October at AnMed Health Medical Center, a common pickup location for patients headed home. He says he instead was greeted by 59-year-old Tambralyn Hill, who was moaning in pain and too weak to walk. (11/29)

Five people, including two boys, ages 10 and 14, were shot in the Bronx on Wednesday by a man firing into a crowd, the police said. The hail of bullets caused chaos on a block with stores, a day care center and students headed to after-school classes the day before Thanksgiving. None of the injuries sustained by those who were hit in the shooting, on Courtlandt Avenue near East 151st Street in the Melrose neighborhood, were life threatening, the police said. The other victims were two women, ages 35 and 19, and a 20-year-old man, the police said. (Shanahan, 11/27)

New Orleans police said that, early Sunday morning, 11 people were shot on the edge of the city’s famed French Quarter. A statement from police said two people were in critical condition and no arrests had been made. Police Supt. Shaun Ferguson told the Times-Picayune/the New Orleans Advocate that a person of interest had been detained. Police said 10 people were taken to two hospitals and another walked in. Further details haven’t been released. (12/1)

St. Francis Regional Medical Center in Shakopee is spending about $44 million to build a free-standing surgery center while also expanding the hospital’s emergency room and cancer center. The projects, which were disclosed in a financial statement this month, were approved by the hospital’s board of directors earlier this year and are scheduled for completion by autumn 2021. (Snowbeck, 11/29)

There is no end to the glittering emblems of privilege in this city. Teslas clog the freeways. Affluent families scramble for coveted spots in fancy kindergartens. And up in the hills of Bel-Air, where a sprawling estate just hit the market for a record $225 million, lush trees line the streets, providing welcome relief from punishing heat. They say the sun has always been the draw of Los Angeles, but these days, shade is increasingly seen as a precious commodity, as the crises of climate change and inequality converge. (Arango, 12/1)

Maryland lawmakers say they’re concerned and closely monitoring the University of Maryland Medical System’s behavior after the state’s top legislative auditor said the hospital network was “hindering” his work. Some legislative leaders, including the sponsors of sweeping reform legislation passed this year after a self-dealing scandal at UMMS, say more bills could be needed if the hospital network refuses to comply with the state audit. (Broadwater and Rector, 11/27)

A Melbourne osteopathic physician has been disciplined by the Florida Department of Health after an interaction with a patient that involved hugs and kisses, but the manner of lip contact is in debate.According to the emergency restriction order (ERO), Eric Lang saw a female patient on Aug. 21 and examined one of her legs after she complained of swelling. He hugged her as she left. (Neal, 12/1)

Ohio Medicaid recipients go to the hospital emergency department for care more often than Medicaid receipients in all 30 other states reporting like data to federal regulators. The Centers for Medicare & Medicaid Services warn that the findings in the recently released state scorecards for Medicaid and the Children’s Health Insurance Program may indicate beneficiaries are having difficulty accessing primary care providers or specialists and could cause overcrowding and longer wait times at hospitals. (Candisky, 11/28)

Poor families in Massachusetts with state-subsidized day care still pay, in proportion to their income, the highest child care fees in the nation. Some, in order to get the child care they need to work, wind up spending more than 20 percent of their income for care, nearly three times what federal guidelines recommend for needy families. (Lazar, 12/1)

State records indicate an Arkansas youth mental health treatment center broke federal rules by using chemical injections to restrain young people held in seclusion. Inspection records obtained by the Arkansas Democrat-Gazette say the Piney Ridge Treatment Center was cited for at least 13 violations of Medicaid rules prohibiting simultaneous restraint and seclusion in 30 days. (12/1)

Primary care doctors are a hot commodity across California. Students are being lured by full-ride scholarships to medical schools. New grads are specifically recruited for training residencies. And full-fledged doctors are being offered loan repayment programs to serve low-income residents or work in underserved areas. (Aguilera, 11/29)

An Omaha woman who contracted hepatitis A after eating blackberries she bought at a Fresh Thyme grocery store has sued the company. The woman who filed the lawsuit Wednesday, Kerrie Tabaka, said she was hospitalized for a week for treatment of hepatitis A and continues to experience fatigue and other symptoms. (11/27)

Tuberculosis put Saranac Lake on the map. Through the middle of the 20th century, ailing people seeking a “rest cure” reclined on cottage porches in the community to take in the crisp Adirondack Mountain air. Saranac Lake grew into a mini-metropolis of medical care, with a dozen trains chugging in and out daily, a famous mountainside tuberculosis sanitorium, hotels — and three undertakers. (12/1)

B. Don Russell wasn’t thinking about preventing a wildfire when he developed a tool to detect power line problems before blackouts and bigger disasters. The electrical engineering professor at Texas A&M University figured he might save a life if his creation could prevent someone from being electrocuted by a downed live wire. (12/2)

The idea that most middle-class Americans have been treading water economically is conventional wisdom. It is already playing a role in the 2020 campaign, as the Democratic presidential candidates propose policies (Medicare-for-all, free college tuition at state schools, subsidies for child care, to mention a few) intended to relieve the financial stress on millions of middle-income families. But the conventional wisdom is wrong — or at least misleading. Although the squeeze is not a myth, it’s highly localized: uncontrolled medical spending. (Robert J. Samuelson, 12/1)

A millstone hangs around the neck of every company in America, and this dead weight gets heavier each year. Americans currently spend nearly 18% of gross domestic product on health care, with some projections suggesting this will reach 21% by 2027 before continuing to rise. Since the 1970s the U.S. has failed to control the cost of care, and a great deal of this burden falls directly on companies and new entrepreneurs. These costs undermine competitiveness and make it harder to create jobs and pay decent wages. (Simon Johnson, 12/1)

One of the first things that happens when you find out your child has a life-limiting illness, before the exhausting hours of treatments and the Make-a-Wish vacation, is that you learn you need to enroll in Medicaid. Hours after being told that my daughter, Calliope, had metachromatic leukodystrophy (MLD), a disease that destroys nerves throughout the body, a social worker at the Children’s Hospital of Philadelphia kindly told my husband and me, “You can’t leave this hospital until we start this paperwork.” As a sociologist who has written books about poverty in America, that surprised me. I assumed that Medicaid is for low-income families.“ Oh, you are going to need this, honey,” she said with a smile. (Maria Kefalas, 12/2)

Most Americans like private health insurance. That's the key finding of a recent Wall Street Journal/NBC News poll. Fifty-six percent of voters oppose Medicare for All if it eliminates private coverage. Many moderate lawmakers are well aware of these polling figures. So they're calling for an expanded version of Medicare — or the creation of a new government-run plan to compete against private insurers. All these approaches — whether Medicare for All, Medicare for All Who Want It or a public option — would be disastrous. Each would raise taxes, reduce the quality of care and eliminate the private health coverage that most consumers have, like and expect to keep. (Janet Trautwein, 12/1)

Here’s what good health care looks like: it emphasizes prevention, is accessible and affordable, and puts patients’ needs first. Unfortunately, recently proposed health care reforms from Congress don’t look like that at all. Instead, they seem to be leaving patients behind. Lawmakers in Washington are turning to overly complex alterations of the market and restrictive models of care that do little to directly help patients now. To get a clearer picture, they need to start listening to patients. They especially need to listen to those with chronic illnesses, who know all too well the damage that unexpected changes to treatment plans can cause. (Liz Helms, 11/29)

They call the years between ages 25 and 65 the prime of life because it is supposed to be the period during which an adult enjoys his or her best health and maximum productivity. Yet to a disturbing degree, that description no longer fits Americans’ experience. Between 2010 and 2017, the mortality rate for 25-to-64-year-olds increased from 328.5 deaths per 100,000 to 348.2 per 100,000 — or about 6 percent — according to a new study in the Journal of the American Medical Association. This contributed to a reversal of what had been decades of progress (albeit slower since the 1980s) in life expectancy, which stood at 78.6 years in 2017, down from the all-time high of 78.9 years in 2014. This simply should not be occurring in a rich country whose peer nations have maintained or improved life expectancy figures in recent years. (11/30)

While there are still about a million people living with H.I.V. in the United States, in some of America’s largest cities, the news about H.I.V. and AIDS is surprisingly positive. “New H.I.V. Diagnoses Fall to Historic Lows,” the New York City Department of Health announced on Nov. 22, reporting that the largest city in the United States had fewer new diagnoses of H.I.V. in 2018 than during any year since statistics were first kept in 2001. This was just a few weeks after Philadelphia’s Department of Public Health reported a 14 percent drop in the number of newly diagnosed H.I.V. infections overall, and a drop of more than one-third among black men who have sex with men — an especially vulnerable population. (Steven W. Thrasher, 12/1)

“End the AIDS epidemic” seems to be the battle cry of the day. It’s a lofty goal that we all hope is attainable. But if West Virginia, where I live and work, is any indication, we have far to go. Sunday is the first World AIDS Day since President Trump announced in his 2019 State of the Union address a federal initiative to reduce new HIV infections in the United States by 75% in five years and by 90% by 2030. A plan to end the epidemic shows how far we have come since the first World AIDS Day in 1988, when a call was sent for solidarity against a pandemic that was taking a terrifying toll on families, communities and countries, and for a commitment to end its global impact. (Judith Feinberg, 12/1)

Todd White is superintendent of the Blue Valley School District in Johnson County, Kan. It’s an enviable position. The Blue Valley schools serve a relatively upscale population in the suburbs of Kansas City. On an average day, more than 95 percent of Blue Valley students are in school. The graduation rate is 97 percent. The dropout rate, less than 1 percent. Every student in grade three and above has a computer.Yet White confessed recently that his prosperous district is in the midst of an epidemic. “In my 35 years in education, I’ve never seen anything that has been so rapid and devastating to the health and well-being of students, nor so disruptive to the daily work of teachers and administrators in educating our students,” he said of the crisis. What wreaks such havoc? Vaping. (David Von Drehle, 11/29)

Some days I’m grumpy; other times, my head hurts or my feet or my arms do. Yet when I play the trumpet, my mood improves and the pain disappears. Why? Alternative medicine — including music therapy — is full of pain-relief claims. Although some are simply too good to be true, the oddities of pain can explain why others hold up, as well as why my trumpet playing helps. One thing we tend to believe about pain, but is wrong, is that it always stems from a single, fixable source. (Austin Frakt, 12/2)

One of the first things I learned about pain was its value. I was a third-year medical student in 1976. My first clinical rotation was in general surgery. The chief resident explained that a patient’s abdominal pain was the most useful tool we had in distinguishing the life-threatening condition of acute appendicitis from a more benign ailment such as stomach flu or constipation. He warned us not to treat that pain before the attending surgeon had a chance to place his hands on the patient’s abdomen. We were also encouraged to listen carefully to the patient’s experience of pain, the timing, the duration and any factors that made it better or worse. Forty years later, our concept of pain couldn’t be more different. Instead of learning from pain, we now regard it as an illness in and of itself. (James D. Hudson, 11/27)

Since September, the last thing a caller to the National Suicide Prevention Lifeline hears before being connected to a counselor is this: “Your call may be monitored or recorded for quality assurance purposes.” As a Lifeline counselor, this alarms me. Suicide is the 10th-leading cause of death in the U.S., and rates have increased in nearly every state from 1999 through 2016, according to the Centers for Disease Control and Prevention. (Ray Regan, 11/29)

There’s a home movie — an old one, on actual film — that I like to watch around the holidays. It features my two siblings and me in front of our childhood home after a huge snowstorm. We’re toddlers. There’s a favorite red sled and the three of us in matching snow gear: puffy blue coats, adorable earflap hats, mittens. But the real star of the show is our dad. He zigs and zags us relentlessly through mounds of fluffy white powder, beaming frequently back at my mother, who holds the camera. His joy is palpable. At one point the sled tips over, and I start wailing. He turns it right-side-up, plops me back in and we resume. He is laughing, and before long, so am I. (Jeneen Interlandi, 12/1)

Nine years ago, my family attended a medical conference in Philadelphia for the genetically unblessed. My husband, Eddie, and I found kinship with the other parents there, born of shared purpose: We refused to accept the diagnosis that our child was going blind. Not long after we brought my newborn son, Anthony, home from the hospital, we noticed his eyes kept darting to the nearest light. If left in a room alone, he couldn’t self-soothe unless we placed him beside a sunlit window out of which he would obsessively gaze. He was eventually diagnosed with Leber congenital amaurosis, or LCA, a rare retinal disease affecting one out of every 50,000 newborns. (Kristin Papiro, 11/29)

The fabled “fountain of youth” has remained elusive for thousands of years. So when you see an ad for modern science’s newest incarnation of anti-aging hope in a bottle — supplements that boost the body’s levels of nicotinamide adenine dinucleotide, or NAD for short — it’s deeply tempting to click “Buy now.” The marketing messages on these sleek websites offer promises of not just longevity, but healthy longevity. Unfortunately, the hype is ahead of the research, and it’s unclear whether the research will ever confirm the hype. (Carrie Dennett, 11/26)

After I signed up for my insurance plan, I got an email with a link to a “wellness program” that, if I traded some health data — such as steps from a pedometer or smartwatch exercise data — could earn me a small monthly payout and some gift cards. But the second I logged in, I felt paranoid about the whole thing. If you work for a company with employer-sponsored health insurance, there’s a chance you’ve come across wellness programs such as UnitedHealthcare Motion, Humana Go365, Attain by Aetna, and Vitality. (Thorin Klosowski, 11/27)