Viewpoints: 'Zombie' plans for Medicare; James Baker's grand bargain advice; Conservative govs' choices

The New York Times: Life, Death And Deficits
America's political landscape is infested with many zombie ideas -; beliefs about policy that have been repeatedly refuted with evidence and analysis but refuse to die. ... the most dangerous zombie is probably the claim that rising life expectancy justifies a rise in both the Social Security retirement age and the age of eligibility for Medicare. ... What would happen if we raised the Medicare eligibility age? The federal government would save only a small amount of money, because younger seniors are relatively healthy and hence low-cost. Meanwhile, however, those seniors would face sharply higher out-of-pocket costs. How could this trade-off be considered good policy? (Paul Krugman, 11/15).

The Wall Street Journal: How To Get To A Grand Bargain
One way to generate the necessary political will for a deal would be to establish a mechanism guaranteeing that any agreed-upon spending cuts actually happen-;and then remain in place after taxes are raised. ... If a part of any grand bargain is that the wealthy should pay more in taxes, why not means-test entitlements such as Medicare and Social Security, two of the biggest contributors to our deficits? This wouldn't hinder economic growth as much as raising marginal tax rates would (James A. Baker III, 11/15).

The Washington Post: Putting Obamacare Into Effect
Should conservatives help implement the Affordable Care Act, the health-care law they detest? For months, it seemed that Republican state leaders hoped they would not need to decide. ... Now conservative governors are facing their first deadline to decide how much they will cooperate with a federal government that will push forward. ... The more states that take an active role in this experimentation, the more likely that Congress's bet on America's laboratories of democracy will pay off (11/15).

The Arizona Republic: Exchange Must Stay Within State's Control
As of today, the [Obamacare] law is embracing us, one way or another. The choice before Gov. Jan Brewer today is whether to take some measure of state control of the sweeping health-care reforms by creating for Arizona one of the law's signature health-insurance "exchanges." ... The responsible choice going forward is to consider the state's best interest once the law is in effect. And that would be with a state-controlled exchange (11/16).

Los Angeles Times: Mitt Romney's Misperception Of President Obama's 'Gifts'
(Mitt Romney's) explanation is beyond simplistic, ahistorical and more than a little self-serving. Didn't polls show throughout the election year that most Americans opposed healthcare reform? Didn't Republicans think the policy would prove so problematic that they hung it around the president's neck, with the epithet "Obamacare?" How many candidates have won the White House just by delivering up pork? Romney couldn't be expected to acknowledge that he offered up "gifts" of his own (James Rainey, 11/15).

The New England Journal of Medicine: Lessons Learned Preparing for Medicare Bundled Payments 
The Bundled Payments for Care Improvement Initiative has great potential to engage hospitals in clinical redesign and care coordination that could improve both care and efficiency. ... The success of the initiative will depend on whether it protects participating hospitals against losses resulting from both random and systematic variation in illness severity. ... If hospitals are confident that the program will financially reward successful clinical performance, many more will be willing to pursue the opportunities for care improvement that this program seeks to encourage (Robert Mechanic and Christopher Tompkins, 11/15).

The New England Journal of Medicine: Reducing Administrative Costs and Improving the Health Care System
The average U.S. physician spends 43 minutes a day interacting with health plans about payment, dealing with formularies, and obtaining authorizations for procedures. In addition, physicians' offices must hire coders, who spend their days translating clinical records into billing forms and submitting and monitoring reimbursements. The amount of time and money spent on administrative tasks is one of the most frustrating aspects of modern medicine. ... it may be necessary to establish a senior-level office in the DHHS focused solely on implementation and innovation in the realm of administrative simplification (David Cutler, Elizabeth Wikler and Peter Basch, 11/15).