Category: NEJM

Will Courts Allow States to Regulate Drug Prices?

Pharmaceuticals are consuming increasingly large portions of U.S. state budgets, and high prices are preventing patients from getting, and adhering to, essential medicines. In mid-May 2018, President Donald Trump announced a heavily hyped but relativel…

A New Threat to Immigrants’ Health — The Public-Charge Rule

The United States is making major changes to its immigration policies that are spilling over into health policy. In one such change, the Trump administration is drafting a rule on “public charges” that could have important consequences for access to me…

Self-Insured Employers — The Payment-Reform Wild Card

Each year, U.S. health care becomes less affordable. Medicare and Medicaid account for an ever-increasing share of the federal budget, commercial premiums continue to rise, and consumers pay higher copayments and deductibles. We cannot solve this spend…

The Republican War on Obamacare — What Has It Achieved?

For nearly a decade, Republicans have opposed the Affordable Care Act (ACA). They have fought Obamacare in Congress, the courts, and the states and, since 2017, from the White House. Given the scope, intensity, and duration of this campaign, it is wort…

Protecting Mothers and Babies — A Delicate Balancing Act

More than 50 years ago, an epidemic of serious birth defects caused by prenatal exposure to thalidomide shattered the prevailing notion that the placenta served as a barrier against damaging influences and led to recognition that exposures during pregn…

Evaluation of Medicare’s Bundled Payments Initiative for Medical Conditions

Episode-based payment holds promise for improving the quality and efficiency of care. The Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013. BPCI is a voluntary program, and …

The Inevitable Math behind Entitlement Reform

The projected growth in Medicare and Medicaid spending, which exceeds projected aggregate economic growth, is pushing policymakers to seriously consider further entitlement reform. At some point, Americans will probably be unwilling to pay higher taxes…

A Remembrance of Life before Roe v. Wade

We chatted as the dialysis shift began. She was a young nursing student whose name and face I still remember five decades later, but I will just call her “Jane Roe.” She was from the Virgin Islands and had come to New York for nursing school. She was n…

Radical Changes for Reproductive Health Care — Proposed Regulations for Title X

On June 1, 2018, the Department of Health and Human Services (HHS) proposed new regulations for the Title X Family Planning Program. If enacted, these regulations will radically alter the mix of health care providers and the range, quality, and effecti…

Parenteral Opioid Shortage — Treating Pain during the Opioid-Overdose Epidemic

The opioid-overdose epidemic now causes more than 30,000 deaths per year in the United States. In response to the increasing death toll, many measures have recently been implemented, including reclassification of hydrocodone as a Schedule II opioid and…