KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

A Look Back As Congress Repeals Medicare 'Doc Fix' Law

KHN's Julie Rovner reflects on the constant battle over what Medicare pays doctors -- a fight that ended this week as President Obama signed into law an overhaul that repeals the old method and institutes new provisions to pay doctors based on the quality of care they give. (4/17)

Medicaid Expands In Other States, But Not Florida

Other states have overcome political opposition to Medicaid expansion and adopted plans to bring government-subsidized coverage to more of their low-income residents. (Daniel Chang, Miami Herald, 4/20)

Capitol Hill Watch

GOP On Obamacare: What To Do?

For Republicans, intraparty divisions continue over efforts to repeal the health law, with many focusing on other issues. Meanwhile, GOP lawmakers are also eyeing tax credits as a potential health law alternative if the Supreme Court overturns a key part of the law in the King v. Burwell case: the subsidies.

The Wall Street Journal: GOP Is Split Over Bid To Repeal Health Law
Republicans in control of Congress have a special tool they can use to push legislation to President Barack Obama’s desk with a simple Senate majority. But they are divided on whether to use it on a repeal of the Affordable Care Act. Such legislation would almost certainly be vetoed by Mr. Obama, so some Republicans believe using the legislative maneuver, known as reconciliation, would waste a good opportunity to achieve other budget goals. (Peterson, 4/19)

Los Angeles Times: Obamacare Repeal Falls Off Republicans' To-Do List As Law Takes Hold
After five years and more than 50 votes in Congress, the Republican campaign to repeal the Affordable Care Act is essentially over. GOP congressional leaders, unable to roll back the law while President Obama remains in office and unwilling to again threaten a government shutdown to pressure him, are focused on other issues, including trade and tax reform. (Levey, 4/18)

Reuters: Seeking Obamacare Alternative, U.S. Republicans Eye Tax Credits
If the U.S. Supreme Court blows up the tax subsidies at the heart of Obamacare in June, Republicans hope to deliver on their promise to offer an alternative healthcare plan. But key parts of it may resemble the one President Barack Obama delivered five years ago in the Affordable Care Act, partly reflecting Republican concerns that they could pay a political price if insurance subsidies are yanked from millions of Americans later this year. (Cornwell, 4/20)

In other news from Capitol Hill -

The Hill: Bill Would Help Combat Medics Become Civilian EMTs
A bipartisan bill introduced this week would facilitate the transition process for military combat medics to become emergency medical technicians upon returning to the civilian workforce. The legislation, introduced by Reps. Lois Capps (D-Calif.) and Adam Kinzinger (R-Ill.), would provide grants to states to simplify requirements for veterans with medical training to receive certifications as EMTs. (Marcos, 4/17)

House, Senate Negotiators Focus On Hammering Out A GOP Budget Blueprint

As negotiators reconcile Senate- and House-passed budgets, health programs like Medicare and Medicaid are expected to be at the top of the agenda. Republicans are also debating whether to use the fast-track budget process to try to repeal the health law.

The Associated Press: Talks To Begin On Capitol Hill Budget Measure
Cuts to Medicare and the health care law and almost $40 billion in unrequested money for overseas war-fighting operations top the agenda as congressional negotiators meet to begin ironing out a Republican budget blueprint for next year and beyond. Separate House- and Senate-passed budget plans have plenty in common. Both chambers want to use the fast-track budget process to send a measure repealing the health care law to President Barack Obama. And both call for padding war spending — it's exempt from budget limits — on new weapons and training of American forces. (4/20)

The Wall Street Journal: Congress Is Tiptoeing Away From Spending Curbs
Exhibit two: Lawmakers last week overwhelmingly passed a bipartisan deal to set new formulas to calculate the way physicians and other providers are paid when they treat patients on Medicare, the federal health program for the elderly and disabled. The change ends more than a decade of legislative patches for a system that had repeatedly threatened to cut doctors’ payments. The votes faced little opposition even though the deal adds $140 billion to the deficit over 10 years. Just eight of 100 senators voted no, along with 37 of 435 House members. The measure does include a provision to shift some costs onto higher-income Medicare beneficiaries, which Republican leaders say made the deal an initial step toward a broader overhaul of entitlement programs. (Timiraos, 4/19)

The Associated Press: Bipartisanship Breaks Out On Capitol Hill -- At Least For Now
Suddenly, bipartisanship has broken out on Capitol Hill. On Iran, Medicare, education and trade, Republicans and Democrats have come together to make deals, and that’s something rarely seen lately. “It’s great,” Republican Sen. John Cornyn of Texas said after the Senate followed the House’s lead this past week in overwhelmingly passing a bill overhauling the Medicare payment system for doctors. “There’s just a huge pent-up demand to actually get something done, on both sides.” (Werner, 4/20)

Health Law Issues And Implementation

Next President Will Have New Tool To Change Health Law Without Congress

Whoever succeeds Barack Obama will be able to use the health law's innovation waivers, slated to take effect in 2017, to grant states greater flexibility to design their own health care systems without the need for congressional approval. Meanwhile, Politico tracks the multiple lawsuits challenging aspects of the Affordable Care Act.

The Associated Press: Waivers May Give Next President Way Out Of Health Care Feuds
Republican or Democrat, the next president will have the chance to remake the nation's health care overhaul without fighting Congress. The law signed by President Barack Obama includes a waiver that, starting in 2017, would let states take federal dollars now invested in the overhaul and use them to redesign their own health care systems. (Alonso-Zaldivar, 4/20)

And The Philadelphia Inquirer looks at why Obamacare plans don't include dental coverage, while The Seattle Times assesses how the law has functioned in Washington state -

The Philadelphia Inquirer: Why ACA Plans Don't Include Dental Coverage
In some ways, health insurance is like car insurance. Both are designed to protect you from the financial risk of repair associated with body damage. But unlike a car insurance policy that comes with bumper-to-bumper protection, nongroup health insurance doesn't cover your grille. Dental insurance has always been a separate purchase from medical health insurance. (Calandra, 4/19)

The Seattle Times: How The Affordable Care Act Is Measuring Up
With the second round of Obamacare insurance sign-ups now closed, state officials expect to beat their numbers from last year only slightly when the final count is in, with more than 165,000 people enrolled through the Washington Healthplanfinder exchange. But while the government-run health-insurance exchanges have attracted significant attention, the goals of the Affordable Care Act (ACA) are much broader. It seeks to put health insurance within reach of most every American, bring down medical costs and provide better care to more satisfied patients. (Stiffler, 4/18)

Feds Seek To Push Texas Toward Expanding Medicaid

Meanwhile, in Missouri, lawmakers will not expand Medicaid, but they are pursuing changes to the existing program, including greater policing of eligibility and encouraging use of telemedicine.

The Texas Tribune: Feds Warn Texas: Expand Medicaid Or Risk Hospital Funds
The federal government is holding state leaders’ feet to the fire, hoping to get Texas to expand its Medicaid program to provide health insurance to more low-income Texans. Federal officials called the state's health agency this week to say that Texas' reluctance to expand Medicaid — a key tenet of President Obama's signature health law — will play into whether his administration extends a waiver that helps the state's hospitals cover uninsured patients. (Walters, 4/17)

The Associated Press: Missouri Republicans Inch Forward On Medicaid 'Reforms'
Missouri Republicans said early in the session Medicaid expansion was a non-starter again this year and despite Democratic attempts to address the issue using amendments and protests, they've stuck true to their word. But Republican leaders have also said they want to see reforms to the Medicaid system. Some tweaks to the state's Medicaid system are moving forward, including proposals encouraging the use of telemedicine, a raise to the asset limit for people with disabilities and more stringent policing of eligibility. (French, 4/19)

And on the topic of the Children's Health Insurance Program -


Entitlement Spending, Medicare Policies, Health Law Issues Emerge As Hot Topics On Campaign Trail

News outlets report on major issues that are emerging as hot topics in these early days of the 2016 presidential primary campaign.

Los Angeles Times: 2016 Election Pits Desire For Change Against A Demographic Shift
Obama came into office with hopes of leading the country toward a new acceptance of activist government. Some Democrats hoped, for example, that successful implementation of the Affordable Care Act would cause Americans to warm toward the expanded government role in guaranteeing health coverage it represents. Obamacare by now has helped more than 20 million Americans get insured, the biggest increase in coverage in half a century. Contrary to dire warnings from the law's opponents, healthcare costs have not shot upward — the rate of healthcare inflation is the lowest in years — the job market has improved and the cost to the federal government is below forecasts. (Lauter, 4/19)

CNN: GOP Presidential Contenders Talk Entitlement Reform
Leading Republican presidential contenders aren't shying away from proposals to overhaul Social Security and Medicare—once considered untouchable third rails of American politics. Chris Christie, Marco Rubio and Jeb Bush all told audiences at the Republican Leadership Summit in New Hampshire this week that the United States must rein in spending on those programs, largely by raising the minimum age of eligibility. (Bradner, 4/18)

The New York Times: Jeb Bush Proposes Requiring Medicare End-Of-Life Directives
Jeb Bush, defending his efforts to keep alive Terri Schiavo, a brain-damaged woman, when he was governor of Florida, suggested on Friday that patients on Medicare should be required to sign advance directives dictating their care if they become incapacitated. A similar proposal by President Obama — that doctors should be paid to advise patients on end-of-life decisions — became a political firestorm in 2009, when Sarah Palin, the former Alaska governor and vice-presidential candidate, claimed that the legislation would give bureaucrats the power to decide if some frail or disabled people were deserving of medical care. The assertion was shown to be false. (Haberman, 4/17)

The Wall Street Journal: New Jersey Gov. Chris Christie: A Presidential Candidate-In-Waiting
Heading into the weekend, the governor appeared to escape gaffe-free, and his controversial proposal to conduct means testing for seniors receiving Social Security and Medicare drew national attention as the emerging field of GOP contenders jostled for the limelight. Still, Mr. Christie will have to have many good weeks to develop momentum in the crowded 2016 field, political analysts said. (Haddon, 4/17)

Politico Pro: Abortion Opponents’ New Litmus Test For GOP
For decades, Republican presidential contenders would commit to support a constitutional amendment banning abortion — a seemingly definitive statement on the issue that nonetheless had almost no chance of making it through the cumbersome process to change the Constitution. Then, having sewn up anti-abortion support, they would move on to other issues. (Hohmann, 4/17)

Medicare Cards Will No Longer Show Social Security Numbers

Social Security numbers will not be imprinted on Medicare cards for much longer. Government watchdogs have long advocated for the change based on growing identity theft concerns.

The New York Times: New Law To Strip Social Security Numbers From Medicare Cards
Concerned about the rising prevalence and sophistication of identity theft, most private health insurance companies have abandoned the use of Social Security numbers to identify individuals. The federal government even forbids private insurers to use the numbers on insurance cards when they provide medical or drug benefits under contract with Medicare. (Pear, 4/20)

UPI: Social Security Number Removed From Medicare Cards
Medicare cards will no longer display Social Security numbers, in an effort to change the way doctors are paid for treating Medicare patients and to prevent identity theft. President Barack Obama requested a $50 million down payment "to support the removal of Social Security numbers from Medicare cards" in his 2016 budget. Federal auditors and investigators have recommended removing the numbers for more than a decade, and Obama signed a bill doing so last week. (Pestano, 4/20)

Coverage And Access

Consumers Will Soon Be Able To Order Lab Tests Without A Doctor

Laboratory Corp. of America Holdings will let customers go online to pay for tests, visit a service center to have blood drawn, then view the results online. And MediBid helps patients find less costly, cash prices for medical procedures by getting bids from providers.

Bloomberg: The Doctor Is Out: LabCorp To Let Consumers Order Own Tests
Consumers will soon be able to bypass their doctors by going online to order cholesterol readings, thyroid tests and other bloodwork from the biggest diagnostics company in the U.S. Laboratory Corp. of America Holdings will let customers go online to pay for tests, visit a service center to get blood drawn, then view the results on the Web. The company has already been doing back-office lab work for a number of Internet firms that let people order up tests without a doctor. (Koons, 4/20)

Los Angeles Times: Shopping Tools Help Patients Find Cash Prices For Medical Procedures
MediBid, which has been in business since 2010, has returned up to 17 bids from doctors nationwide for knee replacement surgeries and often six or seven for common procedures, such as colonoscopies, says founder and Chief Executive Ralph Weber. Dr. Peter LePort, a general surgeon practicing in Fountain Valley, participates with MediBid. He says he's seen a rise in the number of patients with high-deductible health plans looking for cheaper alternatives. Paying cash instead of using insurance often helps them get lower prices. (Zamosky, 4/19)

Meanwhile, a jury is told that Pfizer Inc. failed to warn pregnant users about possible health risks to their babies -

Bloomberg: Pfizer Jury Told Zoloft Risks Known But Hidden From Patients
Pfizer Inc. failed to properly warn about its Zoloft antidepressant’s health risks even though internal reports noted some women who took the drug produced babies with birth defects, jurors were told at the end of the first trial of more than 1,000 lawsuits over the drug. Pfizer’s internal reviews found links between Zoloft and heart abnormalities in babies but the company didn’t update the drug’s U.S. safety label to alert doctors and patients, Shelley Hutson, a lawyer for a family suing the company, said Friday in closing arguments in St. Louis state court. (Feeley, 4/17)

And former Medicare chief Marilyn Tavenner joins a health system board -

Bloomberg: Ex-Medicare Chief Tavenner Joins LifePoint Hospitals Board
Marilyn Tavenner, who resigned as head of the Centers for Medicare and Medicaid Services earlier this year, is returning to the hospital industry. Tavenner is joining the board of LifePoint Hospitals Inc., which operates more than 60 hospitals in 21 states. Before she began state government work in 2006, Tavenner had worked at the largest for-profit hospital chain, HCA Holdings Inc., for 25 years. (Tracer, 4/17)

Public Health And Education

Even In The Amazon, Diseases Become Resistant

The Washington Post reports on a new antibiotic-resistance study with huge implications for public health. Meanwhile, the Los Angeles Times reports on how, when outbreaks occur, hospitals put up a veil of secrecy.

The Washington Post: Even Uncontacted Amazon Tribe Harbors Bacteria Resistant To Antibiotics, Study Finds
Hand wipes. Hand sanitizer. Penicillin and Cipro. The tools the modern world has to fight diseases are many — but as diseases learn to fight back, they’re getting deadlier. And people in the know are scared. “Antibiotic resistance has been called one of the world’s most pressing public health problems,” according to the Centers for Disease Control and Prevention. “Almost every type of bacteria has become stronger and less responsive to antibiotic treatment when it is really needed. … For this reason, antibiotic resistance is among CDC’s top concerns.” (Moyer, 4/20)

Los Angeles Times: A Veil Of Secrecy Shields Hospitals Where Outbreaks Occur
The cardiac surgeon had unknowingly spread a staph infection from the rash on his hand to the hearts of at least five patients by the time Los Angeles County health investigators learned of the outbreak. The doctor had operated on more than 60 others in recent months, and county officials feared those patients could be struck with the same dangerous infection. (Petersen, 4/18)

State Watch

Fifteen States Up Medicaid Pay For Primary Care Physicians

Stateline reports that some states are using their own funds to continue the health law's temporary -- now ended -- increase in reimbursements for doctors who accept Medicaid patients. Meanwhile, news outlets from Iowa, Kansas, Florida and New York also cover developments related to state Medicaid programs.

Stateline: Some States Pay Doctors More To Treat Medicaid Patients
The Affordable Care Act gave states federal dollars to raise Medicaid reimbursement rates for primary care services—but only temporarily. The federal spigot ran dry on Jan. 1. Fearing that lowering the rates would exacerbate the shortage of primary care doctors willing to accept patients on Medicaid, ... 15 states are dipping into their own coffers to continue to pay the doctors more. It seems to be working. (Ollove, 4/17)

The Associated Press: Iowa's Medicaid Privatization Draws Scrutiny
Gov. Terry Branstad's plan to privatize the state's Medicaid program is moving forward, though critics are raising questions about how the shift will impact patients. Earlier this year, the state began an effort to shift Medicaid administration to two or more managed care organizations, to which Iowa will pay a fixed amount per enrollee to provide health coverage. State officials predict cost savings and say patients will still have access to quality health care. But Democratic Senate President Pam Jochum, of Dubuque, said this week that she is not convinced. (Lucey, 4/19)

The Des Moines Register: Iowans Wary Of Shift In Medicaid
Iowans with serious disabilities have the most to lose — or gain — as the state moves swiftly to have national insurance companies run its giant Medicaid program. Tens of thousands of people with serious disabilities, including cerebral palsy, brain injuries and Down syndrome, rely on the public health insurance program, even if they also have private insurance coverage. That's because private insurance usually doesn't cover the wide array of services needed to keep them at home. (Leys, 4/19)

The Des Moines Register: Kansas' Medicaid Shift Hasn't Gone Well, Official Says
Rocky Nichols, executive director of the Disability Rights Center of Kansas, warns Iowans that they should watch closely as their state hires managed-care companies to run their Medicaid program. Kansas has made the same shift over the past two years, and it has not gone well, he said. "Kansas is not just on the leading edge — it's on the bleeding edge when it comes to Medicaid managed care," Nichols said. (Leys, 4/18)

Health News Florida: Florida Medicaid HMOs Losing Money On Drugs
Florida Medicaid, which has been touting its "Managed Medical Assistance" program as a national model, may want to hold off. The program, which shifts virtually all Medicaid recipients into managed-care plans, underestimated how much their care would cost. (Gentry, 4/17)

The Wall Street Journal: NY Comptroller Approves Medicaid Contract For Xerox
New York's comptroller has approved the state award of a $565 million contract to Xerox to redesign and operate the information management system for its Medicaid program. The comptroller's office says its review found insufficient grounds in the protests by Computer Sciences Corp. and Hewlett-Packard to overturn the award. (4/17)

State Highlights: Outcry In Conn. Over Proposed Cuts To Mental Health Funding; Georgia Lags In Public Health Spending

News outlets cover health care issues in Connecticut, Georgia, California, Massachusetts, Nebraska, Texas, North Carolina, Illinois, Rhode Island and Virginia.

The Associated Press: Mental Health Funding Cuts Stir Outcry In Connecticut
Gov. Dannel P. Malloy's proposal to cut money from a state grant program to community mental health and substance abuse providers is prompting an outcry from advocates and families of Newtown massacre victims in Connecticut, who warn patients will suffer from a lack of services. The governor's plan reduces the grant funding by $25.5 million in the next fiscal year, according to an analysis by the Connecticut Community Providers Association, a collection of nonprofits that provide various treatment and prevention programs. The grants have helped those agencies pay for uninsured clients and cover the gap between the state's reimbursement for Medicaid patients and the actual cost of mental health services. (Haigh, 4/19)

The San Jose Mercury News: California Vaccine Legislation Spurs Legal Debate Over Right To Education
California's Constitution spells out the right to a free public education, and lawmakers have fortified that guarantee over the years by safeguarding students against discrimination and inequality in the classroom. But now a debate over that protected access to an education has surfaced in the most contentious legislative battle in Sacramento this year: Does one student's right to an education trump another student's right to stay healthy? (Seipel, 4/18)

The Boston Globe: State Questions Rise In Overdose Drug Price
Attorney General Maura Healey is demanding that companies selling naloxone in Massachusetts explain why the cost of the drug, which is used to reverse heroin overdoses, has skyrocketed since former governor Deval Patrick declared a public health emergency a year ago. (MacQuarrie, 4/20)

The Associated Press: New Nebraska Law Could Help Put Medical Marijuana On Ballot
Worried that lawmakers may not act, advocates for medical marijuana could take their campaign to Nebraska voters next year, and a new state law could make their job easier. Supporters said they've started gathering signatures to place the issue on the November 2016 ballot. Despite significant hurdles, activists from the Omaha chapter of the National Organization for the Reform of Marijuana Laws said the new petitioning law will make a difference. (Schulte, 4/19)

The Texas Tribune: Texas Psychiatrists Resign After Pharma Accusations
Two psychiatrists at Terrell State Hospital resigned this week after being told they would face disciplinary action for accepting hundreds of thousands of dollars from a pharmaceutical company to promote the drug Seroquel, according to the Texas Department of State Health Services. (McCrimmon, 4/17)

The New York Times: Service Members Are Left In Dark On Health Errors
Lt. Col. Chad Gallagher was T. J. Moore’s squadron leader when the 19-year-old recruit arrived for basic training last spring at Lackland Air Force Base in San Antonio. He was watching at the quarter-mile track nine days later when Mr. Moore, on an easy mile-and-a-half test run, collapsed at the finish line and was rushed to a hospital. (LaFraniere, 4/19)

The Chicago Tribune: Bill Would Make Catholic Hospitals Tell Patients About Options Elsewhere
A measure before Illinois lawmakers would require Roman Catholic hospitals to tell patients they can go elsewhere for birth control, certain medical procedures and other health care choices that violate church teachings. The proposal would amend the state's Health Care Right of Conscience Act, which generally allows workers and institutions to deny services for religious and ethical reasons. And while it would apply to all hospitals in Illinois, it's particularly relevant for Catholic hospitals, which handle more than 1 in 4 admissions statewide. (Pashman, 4/17)

The Providence Journal: New Hepatitis C Treatment Far Too Expensive For R.I. Prisons
New drugs are proving exceptionally effective at treating hepatitis C, but their jaw-dropping price tags are making it difficult for prison officials to decide when to treat inmates and how to pay for their care. In fact, a new study by Brown University — which was based on research conducted in Rhode Island at the Adult Correctional Institutions — finds that it would cost double the prison's entire health budget to treat all of its chronically ill inmates. (Salit, 4/20)

The Associated Press: Long-Term Care Issue Hits Close To Home For Sen. Warner
Five years after U.S. Sen. Mark Warner’s mother died of Alzheimer’s, he is still haunted by what he might have done differently for her — if only he had known her wishes. When the disease first took hold of Marjorie Warner in about 2000, her son was already a wealthy, self-made businessman, on his way to being elected Virginia’s governor the following year. He prided himself on being a take-charge executive who could solve tough problems. (Bartel, 4/18)

The Wall Street Journal: Mental-Health Treatment For Defendants Dogged By Delays
In most states, mentally ill people deemed incompetent to stand trial, like Ms. Roberts’s son, are transferred to a state hospital, where they are given limited treatment that may include medication and therapy. The goal is to bring their mental state to a point where they can be taught about the legal system and their rights, so they eventually can be tried—a process known as restoration. The U.S. Supreme Court has ruled it is unconstitutional to try a person who fails to grasp the consequences of the proceedings against him and is unable to participate in his own defense. (Palazzolo, 4/19)

Editorials And Opinions

Viewpoints: Obamacare And Hospital Monopolies; Carrot, Stick Of SGR Repeal

A selection of opinions on health care from around the country.

The Wall Street Journal: The ObamaCare Effect: Hospital Monopolies
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)

JAMA: The Repeal Of Medicare's Sustainable Growth Rate For Physician Payment
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)

Los Angeles Times: California Lawmakers Should Pass The Vaccination Bill
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 Washington Post: Nurses Make Fun Of Their Dying Patients. That’s Okay.
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)