Â鶹ŮÓÅ

Republicans are right: The employer health insurance mandate is dumb. But gently rejiggering it, as the GOP is trying to do, is not the solution. The mandate should instead get full death-panel treatment and be euthanized once and for all. (Catherine Rampell, 1/15)

Like a quiet revolution in health insurance, deductibles have been steadily increasing for many years. But a mountain was made out of a mole hill when Harvard University’s plan for employees to pay modest deductibles and other forms of cost sharing kicked off a firestorm at the university and a broader discussion about whether Harvard was somehow affirming conservative principles by giving its employees a little more skin in the game. (Drew Altman, 1/15)

Public-pension funds have garnered attention in recent years for being underfunded, but a more precarious situation has received much less notice: health-care obligations for public retirees. Unlike pension plans, governments are not required to contribute to separate trusts to support health-care promises. As a result, only 11 states have funded more than 10% of retiree health-care liabilities, according to a November 2013 report from the credit-rating agency Standard & Poor’s. For example, New Jersey has almost no assets backing one of the largest retiree health-care liabilities of any state—$63.8 billion. (Robert C. Pozen, 1/15)

Congress last year unanimously closed a loophole that allowed surviving Nazi war criminals to claim Social Security benefits, but that’s where the entitlement reform consensus ends. Now the political left is melting down over a modest budget change that could require Congress to be honest about the Social Security disability program’s fiscal problems and employment distortions. (1/15)

In California we stand at a once-in-a-generation crossroads. If we take action in four key areas, we will transform the lives of young people of color in our state for the better. ... Not too long ago, California was home to more than 800,000 uninsured children. Obamacare is projected to cut that disgraceful number in half. California needs to finish the job by passing State Sen. Ricardo Lara's Health for All Act. Every child, including the undocumented, should have access to healthcare.(Robert K. Ross, 1/15)

One pint of donated blood can help save as many as three people’s lives—a fact that you may have heard recently, since January is national blood-donor month. But unknown to many donors, recipients and physicians, blood is sometimes used capriciously and, if given when not needed, can cause patient injury and even death. The evolution of blood transfusions and their efficacy is a good example of the struggle in health care to apply the latest scientific findings to help patients and reduce costs. (Tim Hannon and Rishi Sikka, 1/15)

ACOs are accountable for all their patients' expenditures, whether incurred within or outside their organization, and many patients receive specialty care outside their ACOs. Influencing where patients receive care may be a mechanism for assuring quality and controlling cost by reducing duplicative, unnecessary, or high-priced care or by increasing the use of high-quality care — and may therefore be critical to achieving ACOs' cost and quality targets. (Matthew DeCamp and Lisa Soleymani Lehmann, 1/15)

Is a given health care intervention effective or not? Is it appropriate in a given clinical context or not? Should it be covered by health insurance or not? The search for answers to these questions leads to investment in comparative effectiveness research, the development of guidelines and appropriateness criteria, and payment systems aimed at ensuring delivery of appropriate care and reducing inappropriate care. Although such work is useful, the output has become overwhelming — without resulting in a high-value health care system. (Amitabh Chandra, Dhruv Khullar and Thomas H. Lee, 1/15)