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People with relatively little education and comparatively low earnings don't live as long as those with higher levels of education and income. That much has been known for some time. But it turns out that this gap is widening significantly, and is starting to have big effects on Social Security, Medicare and other programs. The growing lifespan gap has been confirmed, most recently, by a committee of the National Academies of Sciences, Engineering and Medicine that we co-chaired, whose report is released Thursday. ... These trends mean that high earners will probably receive Social Security, Medicare and other such government benefits for many more years than low earners do. (Peter R. Orszag and Ronald D. Lee, 9/17)

What a difference four years -- and millions of people with health insurance -- can make in the Republican presidential campaign. In 2011, the last time GOP candidates for president gathered for a debate at the Ronald Reagan Library, the topic of the Affordable Care Act came up early and often. ... On Wednesday night, for this year’s debate at the Reagan Library, the health care law got almost no attention at all. Donald Trump made a quick reference to it during his introductory remarks, and Ted Cruz made his usual promise to repeal the law. ... So why didn’t the CNN hosts ask about it? Why didn’t any of the Republican candidates strain to bring it up, ... Here’s one theory: The issue is losing its resonance, even among Republicans. (Jonathan Cohn, 9/17)

The central question facing conservatives is how to bring Americas’ debt and deficit under control. And the central driver of America’s debt and deficit problem is the growth in government spending on health care: Medicare, Medicaid, and Obamacare. Furthermore, anti-Obamacare sentiment was a prime component of Republican electoral victories in 2010 and 2014. And yet, the CNN hosts asked a grand total of zero questions on how candidates would replace Obamacare or reform our health care entitlements. (Avik Roy, 9/17)

The second Republican presidential debate took place as the nation faces the possibility of another destructive government shutdown. Instead of the responsible discussion one would hope to hear from those asking to be entrusted with the fate of the country, the candidates by and large exacerbated the threat of a shutdown with inflammatory pandering on the subject of Planned Parenthood. (9/17)

Among the 15 candidates vying for the nation’s attention in Wednesday’s Republican presidential debate were two physicians, and late in the three-hour marathon CNN’s Jake Tapper gave them both an opportunity to strut their medical expertise before millions of TV viewers. First up was Ben Carson, who had earlier told viewers that his presidential candidacy is motivated by his concern for the future of America’s children. “Dr. Carson, Donald Trump has publicly and repeatedly linked vaccines, childhood vaccines, to autism, which, as you know, the medical community adamantly disputes,” Tapper began. (Brian Dickerson, 9/17)

Before the Affordable Care Act’s major provisions for coverage expansion were implemented in January 2014, there were concerns that the primary-care delivery system would struggle amid increased demand for services from patients gaining coverage, many for the first time. It’s not hard to find anecdotal reports of problems, but a systematic survey of primary-care physicians by the Kaiser Family Foundation and the Commonwealth Fund indicates that, so far, these fears have largely not come to pass. (Drew Altman and David Blumenthal, 9/18)

In this age of instant information, medicine remains anchored in the practice of releasing new knowledge at a deliberate pace. It’s time for medical scientists to think differently about how quickly they alert the public to breakthrough findings. Last week the National Institutes of Health announced that it had prematurely ended a large national study of how best to treat people with high blood pressure because of its exceptional results. ... The problem is that many details of the study have not been released. (Eric J. Topol and Harlan M. Krumholz, 9/17)

Like a lot of debates that hinge on deeply personal emotions and decisions, the right-to-die question rests for many people in that delicate balance between “what I believe” and “what I'd do if it were me or a loved one.” We can look at the history of another deeply fraught culture war battle — over abortion legislation — and see direct parallels in the way such issues tap into a particularly American brand of conflicted morality. (Meghan Daum, 9/17)

When can democracy become a bit too much for working politicians? In Montana politics, it seems, when leaders of the state’s solid Republican legislature go to court to complain that party orthodoxy is being unfairly compromised by non-conformist and moderate G.O.P. lawmakers daring to vote for such measures as expanded government health care, greater financial disclosure in elections, and a settlement with native Americans over water rights. (Francis X. Clines, 9/17)

Sylvia Burwell, Secretary of Health and Human Services, recently announced the department’s intention to tie most Medicare fee-for-service payments to value by 2018. Most commercial insurers already incentivize quality to some degree and encourage beneficiaries to consider quality and cost. Having payers aim for value should improve health system performance, certainly when compared with traditional incentives for the volume of services, which have failed to deliver the kind of care that is possible. Paying for value, though, requires measuring what actually matters to patients. Yet almost all current quality metrics reflect professional standards. ... serious, life-altering, and ultimately life-ending chronic conditions, often in old age, pose a particular challenge for the health care system because traditional professional standards may not effectively address what an individual most wants. (Joanne Lynn, Aaron McKethan and Ashish K. Jha, 9/17)