Doctors can be killjoys! First it was the bacon double cheeseburger you love and they told you it would lead to a heart attack. Then it was the low-fat diet that was sure to protect you from a heart attack – until it wasn’t! Then they told you eggs were bad for you – and now they say they’re good for you! What’s next?

What’s next is melatonin. If you’ve ever suffered from insomnia, and who hasn’t, you’ve probably taken melatonin to help you sleep. Veronique Greenwood, writing for Time, tells us between 1999 and 2018 the number of adults taking melatonin has more than quintupled. Available over the counter, melatonin is marketed as a natural sleep aid. However, because it’s classified as a supplement, not a medicine, it is not evaluated by the Food and Drug Administration (FDA).

What do the sleep experts say?

The American Academy of Sleep Medicine does not recommend melatonin for insomnia according to Marie-Pierre St. Onge, director of the Center of Excellence for Sleep and Circadian Research at Columbia University.

The effects of taking the hormone daily for long periods of time are not well-understood. In November, preliminary, unpublished results reported at the American Heart Association meeting found a connection in adults between taking melatonin for more than a year and heart failure. Although that study may be less informative about melatonin than about the link between heart disease and insomnia, it highlights the fact that there is relatively little known about using melatonin the way an increasing number of people are.

What melatonin does

In the evening, your body begins to produce melatonin, which is made primarily by the pineal gland. Melatonin levels peak in the early morning and taper down after sunrise. The hormone is thought to provide the body with a sense of how long the night is, to help synchronize biological processes with the sun.

Once it’s floating around, however, melatonin affects more than sleep. Some decades ago, scientists were surprised to find that it tunes the immune system, increasing and decreasing different forms of inflammation. A lack of melatonin leads to increased fat accumulating in the livers of mice. There is evidence that tissues other than the pineal gland, including bone marrow, make their own melatonin, and the list of cell types with receptors allowing them to sense melatonin turns out to be immense. The hormone also appears to help direct the death of cells, so scientists are curious what role it might have in aging more generally.

Careful studies of melatonin and its metabolites in people’s blood and urine have revealed that there are a number of disorders where its levels are disrupted, including depression, schizophrenia, bipolar disorder, Type 2 diabetes, and certain types of cancer. Some people with Alzheimer’s disease may have very little daily cycling of melatonin, perhaps contributing to the sleep difficulties that are a feature of the neurodegenerative disorder.

Taking melatonin under a doctor’s advice can be helpful for people in these situations. Studies have shown, too, that blind people whose natural melatonin cycles get out of whack, leaving them with a form of constant jet lag, can benefit from supplementation. Children with autism can sometimes benefit from being prescribed melatonin, says Owens. It’s also been explored as a potential therapy after heart attacks, says Dr. Tom Scammell, a professor of neurology at Harvard Medical School and physician at Beth Israel Deaconess Medical Center.

There is a big gap between how researchers and doctors think about melatonin and how many people are using it. To try to trace connections between long-term melatonin use and other health conditions, some researchers have turned to electronic health records.

On November 3, an abstract from an American Heart Association meeting described an unpublished study using this type of data. It included some startling numbers: Over the course of five years, adults who were prescribed melatonin and took it for a year or more had a 90% greater risk of heart attack than people of a similar health status who didn’t take melatonin.

However, it’s not necessarily the case that melatonin caused the heart failure documented in this study. In fact, points out Scammell, insomnia and heart disease often travel together, with 50% of people with heart failure having insomnia compared to 15% in the general population. So, people who have insomnia and are given melatonin by their doctors in an attempt to cope may already be on the way to developing more serious heart problems. “It is possible that the poor sleep that triggered use of melatonin was an early sign of heart problems,” Scammell says.

Is occasional use of melatonin dangerous? Not likely, but it makes sense to study the issue further. If you are having trouble sleeping, a better choice, St-Onge and Owens agree, is to try changing behavior around bedtime. Cognitive behavioral therapy for insomnia, or CBT-1 is the gold-standard treatment for sleeplessness in both children and adults. Studies show that this modification–which involves a number of stages designed to set you up for better sleep–has a longer lasting, better effect than any sleeping pill.

ObamaCare is a train wreck. I wrote a book entitled The ObamaCare Train Wreck in 2014, before the new healthcare law went into effect, and it has certainly lived up to my expectations. It’s now nearly twelve years later and Democrats keep trying to put this train back on the track by increasing government subsidies to offset the rising costs. But throwing good money after bad never made sense and it certainly doesn’t now.

The Biden administration increased ObamaCare subsidies and increased eligibility limits during the Covid pandemic as a response to the rising costs. They flow to more than 20 million people. Without those subsidies, many enrollees will see their monthly payments jump and could decide to drop coverage altogether.

But those temporary measures are due to expire the end of December. The Congressional Budget Office has estimated that extending the enhanced ACA subsidies permanently would cost $350 billion over the next 10 years. Democrats want to make those increased subsidies permanent and that’s one reason they shut down the government for 42 days. But now that the shutdown is over, this issue is still on the table until the end of the year.

The White House is responding with new proposals to address the issue. Natalie Andrews, Lindsay Wise, and Olivia Beavers write in The Wall Street Journal that the subject is under discussion, but President Trump has yet to weigh in on his opinion.

Proposals being considered include a two-year extension of the ACA subsidies as an enticement to get Democrats to get on board. As part of the new plan, the White House has discussed imposing income caps for Affordable Care Act enrollees to qualify for the enhanced subsidies, as well as measures to crack down on healthcare fraud, some of the people said. Republicans also have discussed moving the subsidy money into newly created health savings accounts and barring taxpayer funds from going toward plans that cover abortion and transgender care, the people said.

Health Savings Accounts (HSA) allow taxpayers to use money deposited into accounts by employers that can be used for healthcare expenses. HSA accounts are tax free and give families control over their healthcare expenditures. These accounts were first created by John C. Goodman, healthcare economist, in 2003 but they were phased out by the Biden administration. Re-establishing these accounts is a great idea.

Republicans are coalescing around taking the money spent to extend Obamacare subsidies and putting it in a health savings account, a proposal Trump supports. “Rather than giving money to insurance companies, we want to start giving the money to patients,” said Sen. Roger Marshall (R., Kan.), who has discussed plans with the White House and senators.

Marshall said that Republicans also want to eliminate fraud in Obamacare, by eliminating “zero-premium” subsidies now offered under some plans. Republicans say such subsidies lead to people being signed up for plans that they don’t know about—while insurance companies receive taxpayer funds.

Should a bipartisan measure fail, Republicans are considering pushing their healthcare plan without Democrats by using a budget process called reconciliation. The approach requires a simple majority vote in the Senate, where 60 votes are usually required. GOP lawmakers used reconciliation earlier this year to pass Trump’s “big, beautiful” tax bill, but the process takes months.

A vote on extending the healthcare subsidies is expected by mid-December—part of a deal struck between Senate Majority Leader John Thune (R., S.D.) and a group of centrist Democrats to end the shutdown earlier this month. It is unclear if the House will take up the measure.

Republicans need to put forward their own plan to improve healthcare insurance. It is clear now more than ever that ObamaCare is not the long term solution.

In 2015 I published a book called The ObamaCare Reality. In addition to exposing the flaws in ObamaCare, I also discussed the flaws in Medicaid.

It has always been postulated that the uninsured are more likely to use Emergency Rooms for routine healthcare than those with insurance. But research has proven this assumption to be false.

In 2008, the State of Oregon was faced with a dilemma. They wanted to expand Medicaid eligibility to more residents, but they didn’t have enough money to pay for everyone. So, they held a lottery for low-income uninsured adults. Winners in the lottery would get Medicaid and the losers would go uninsured. This created an ideal situation for studying the impact of Medicaid in a randomized, prospective manner.

This study, now known as The Oregon Health Insurance Experiment, has revealed many surprising conclusions about the impact of healthcare insurance. Thus far, the researchers have learned that having Medicaid does not improve health, at least in standard measurements of blood pressure, blood sugar, and cholesterol. Medicaid reduced observed rates of depression by 30% but increased the probability of being diagnosed with depression. Medicaid significantly increased the probability of being diagnosed with diabetes and the use of diabetes medication, but did not have the expected impact of lowering blood sugar. In other words, Medicaid had no impact on actual healthcare outcomes.

But the real surprise was the impact on Emergency Room usage. The Oregon study showed those with newly enrolled Medicaid were 40 percent more likely to use the E.R. than the uninsured! Medicaid expansion actually increased Emergency Room visits. A report from the Colorado Hospital Association published in 2014 confirmed the same findings. They reported that in states that expanded Medicaid, E.R. visits increased 5.6%, while in states without Medicaid expansion E.R. visits increased only 1.8%.

Why does expanding Medicaid increase E.R. visits?

John C. Goodman, in his book Priceless, said having Medicaid may actually be worse than having no insurance at all. That’s because most doctors do not accept Medicaid patients, and the ones who do often ration their appointments making waiting times very long. Many doctors are listed in directories as accepting Medicaid patients, but in actual practice they don’t. Medicaid patients are forced to respond by going to the Emergency Rooms where they are sure to be seen the same day.

This reality of poor access to healthcare by Medicaid patients was dramatized in a recent Wall Street Journal article by Christopher Weaver, Anna Wilde Mathews, and Tom McGinty. They say, “Private Medicaid insurers dominate the government healthcare program that covers more than 70 million low-income and disabled Americans. But when Medicaid-plan enrollees need care, they often can’t get appointments with the doctors listed in those insurers’ networks.”

A Wall Street Journal analysis of state and federal data showed that the networks of doctors that insurers listed for their Medicaid members are less robust than they appear. Some doctors are erroneously shown in states or cities where they don’t actually work. Others won’t book appointments for Medicaid patients, who typically are far less lucrative than those with employer coverage. Some medical practices limit slots allotted for Medicaid visits, or simply won’t take new Medicaid patients.

To assess private insurers’ Medicaid networks, the Journal compared the insurers’ lists of providers with records of Medicaid care provided across 22 states in 2023. The analysis found that more than a third of the doctors listed in the networks didn’t treat the insurers’ Medicaid patients that year.

This confirms what I said in my book ten years ago. The uninsured actually have greater access to health care. The reason is the uninsured can choose any doctor they wish and usually pay cash at a discounted rate wherever they go. Medicaid patients do not have the same option since taking cash from a Medicaid patient is a violation of the law that threatens a doctor’s license. The Medicaid patient then resorts to the E. R. for healthcare they can’t wait any longer to receive.

Here is a graphic published in the WSJ that shows specialists listed in Medicaid networks and the likelihood of them actually treating a Medicaid patient: