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During the 2008 financial crisis, “too big to fail” became a familiar phrase in the U.S. financial system. Now the U.S. health-care system is heading down the same path with a record number of hospital mergers and acquisitions—95 last year—some creating regional monopolies that, as in all monopolies, will likely result in higher prices from decreased competition. Hospital consolidation, done properly in a competitive marketplace, can have positive effects. Multi-hospital conglomerates can quickly disseminate best practices and quality initiatives, for example. But competition and the choices it provides can also disappear. (Makary, 4/19)

The repeal of the SGR means that the temporary measures to override the growth rate formula will no longer dominate Medicare policy discussions, as they have for the last decade. The replacement of the SGR should also accelerate the movement away from unconstrained fee-for-service payments and toward continued payment reforms. Many physicians, no doubt, would prefer regular payment updates, not updates based on complex measures of quality and value. The momentum in Washington for continued payment reforms, however, is strong. The repeal of the SGR is the carrot; the far-reaching payment reforms that the legislation facilitates are the stick. (Robert Steinbrook, 4/17)

Anti-vaccination parents showed up last week in Sacramento threatening to leave the public schools en masse, and the Senate Education Committee crumbled like a batch of overbaked cookies. Sen. Richard Pan (D-Sacramento), who has written legislation that would mandate vaccines for almost all public school students, was forced to take back his bill for revision. (4/19)

The latest attempts to restrict abortion rights don't even bother to pretend to protect women's health — as various state legislatures argued they were doing with recent laws requiring abortion doctors to have admitting privileges at nearby hospitals. The new efforts go straight for the drama. (4/19)

The laughter of the ER staff echoed down the hall as Lauren, a nurse in Texas, talked about a patient who had ingested “a thousand ears of corn,” requiring her to repeatedly unclog kernels from the oral-suction tubing. The episode had earned Lauren surprise gifts of corn nuggets from a respiratory therapist and a can of corn from an EMS technician. But not everyone found the story so funny. When Lauren entered a patient’s room nearby, the patient said to her: “I hope you’re not that insensitive when you’re telling your friends about me later.” Although patients typically don’t overhear it, a surprising amount of backstage joking goes on in hospitals — and the humor can be dark. Doctors and nurses may refer to dying patients as “circling the drain,” “heading to the ECU” (the eternal care unit) or “approaching room temperature.” Some staff members call the geriatric ward “the departure lounge.” (Alexandra Robbins, 4/16)