Older people are more likely than younger people to need expensive medical care. So should they pay higher premiums for health insurance to reflect their higher health costs? If so, how much more?

On the individual market, people in their 50s can now pay five or six times as much as twentysomethings, according to a story in this morning’s WSJ on the whole age/premiums issue.

The big health-care bills in Congress would still allow variation, but the range would be capped. Under the House bill, insurers could charge older people twice what they charge younger people. The Senate bill could allow a ratio of 3 to 1,

Like everybody else, we’ve been busy scrutinizing the details of how the various health-care bills would affect Medicare. As it turns out, though, a whole new special commission — not mentioned in any of the bills — could wind up driving big changes to Medicare, Medicaid and Social Security.

Those three programs are account for “almost all of the projected growth in federal spending” (not counting interest payments on the debt), according to CBO. And they aren’t sustainable; Medicare’s hospital insurance trust fund will be insolvent by 2017, according to

If you go home from the hospital after being treated for congestive heart failure, there’s a good chance you’ll be back in a few weeks.

Nationwide, about one in four Medicare patients hospitalized for heart failure is readmitted within a month of being discharged. The feds started reporting the figures for individual hospitals online earlier this year — a move that Joseph Ross, a geriatrician at Mount Sinai in New York, hopes will push hospitals to drive the rate down.

“We

Researchers are studying whether swine flu can be transmitted in the blood, as part of an ongoing effort to keep the blood supply safe from infectious disease. That’s the subject of my latest column.

There’s also another new effort underway to improve the safety of blood transfusions by monitoring adverse reactions and errors through a collaboration between the federal government and organizations involved in blood collection, transfusion, and tissue and organ transplantation.

A pilot program launched last spring has so far gathered data

The standard narrative of contemporary medicine tells us that doctor visits with patients are getting shorter and shorter, as docs struggle with rising overhead and pressure to be more efficient.

But as it turns out, the amount of time primary-care docs spend with each patient actually increased a little bit between 1997 and 2005, according to an analysis published today in the Archives of Internal Medicine.

This may have been driven in part by the aging population, because older people tend to be sicker and require more complex treatment. But even within each age group, the average time docs spent with patients increased, the authors said.

Another possible driver, they suggest, is an

*In the opinion of the people who chair hospital boards.

Ninety-nine percent of hospital board chairmen think their hospital fares at least as well as a typical hospital on standard quality measures. Among the chairmen of hospitals that perform worst, 100% say their hospital performs at least as well as a typical hospital.

The figures are from a survey published in the journal Health Affairs, based on responses from 722 people who chair the boards of nonprofit hospitals.

Yes, measuring quality can be a tricky thing. Yes, some hospitals treat sicker patients, on average, than others. Still, the quality data the authors used are drawn from those reported on the feds’

In the middle of the 20th century, the number of people dying of heart attacks was rising sharply in the developed world, but nobody knew why. Jeremy Morris, a doctor who died the week before last, figured it out.

Morris thought there might be some link between occupation and heart-attack risk. And when he looked at the men who worked on London’s double-decker buses, he found a striking result: The conductors — who went up and down the stairs on the bus all day long — were half as likely to die of heart attacks as the drivers, who sat at the wheel all day.

He was admirably cautious about interpreting the results, trying to poke holes in his hypothesis that exercise lowered heart-attack risk. “We set about destroying this observation,” he told the FT, which ran a