Medicare and Social Security embody a peculiarly American version of social insurance that is notably conservative and market-oriented, Theodore Marmor and Jerry Mashaw of Yale University assert in an article published March 21 as a Health Affairs Web Exclusive. Marmor and Mashaw say that Medicare and Social Security should and do evolve, but they maintain that many current proposals to "reform" or "modernize" the entitlement programs would destroy their important social insurance function.

Oncologists who are more generously reimbursed by Medicare tend to prescribe more costly chemotherapy regimens, although reimbursement levels do not seem to affect the initial decision on whether to prescribe chemotherapy at all, the University of Michigan's Mireille Jacobson and coauthors report in the March/April Health Affairs. Jacobson's team looked at Medicare claims data from 1995-98, when oncologists were reimbursed for chemotherapy drugs under the now discarded "average wholesale price" methodology. The researchers predict that Medicare's new payment system will make the choice of chemo agents more dependent on clinical considerations and less on financial ones.

Hurricanes Katrina and Rita inflicted massive damage on New Orleans and the Gulf Coast, as well as revealing a disaster that the storms did not cause: the long existence of an essentially third-world health care system that left many of the region's poorest residents without even the most basic primary care. That theme runs throughout "Witness to Disaster," a series of first-person accounts by those whose lives were touched by the storms, collected in the March/April 2006 issue of Health Affairs as a special edition of the journal's "Narrative Matters" section. An accompanying online supplement, http://content.healthaffairs.org/cgi/content/full/25/2/478/DC1, carries up-to-the-minute updates from three authors and an extraordinary portfolio of recent New Orleans photos.