It's the time of year for countdown lists, and I've compiled mine for health policy. This week, my candidates for the five worst ideas of 2011. Next week, I'll end the year on a more optimistic note with the five biggest accomplishments and good ideas.

Here, in reverse order of perniciousness, are the bad proposals of 2011 that I find most noteworthy.

5. Repealing the CLASS Act

This law, passed as part of health reform, was intended to create a self-funded system of affordable long-term care insurance. Unfortunately, in the current economy the finances won't work out as planned.

Instead of going back to the drawing board, health reform opponents want to repeal the Act entirely. That would eliminate any chance of finding a solution for affordable long-term care anytime soon. (See blog post of November 4.)

4. Not keeping Donald Berwick as head of Medicare

Dr. Donald Berwick is one of the most eminent physicians in America. His efforts to improve health care quality have saved over 120,000 lives. He has gained praise from leaders of both parties and even an honorary knighthood from Queen Elizabeth.

No one is better suited to run Medicare during this time of change. Unfortunately, he was caught up in the politics of health reform. Seeing no chance of permanent confirmation, he resigned before his recess appointment expired at the end of the year. (See blog post of December 9.)

3. Cutting funding for public health

Prevention saves more lives than anything else in health care. Clean water, vaccination, and screening have turned dreaded diseases of 100 years ago into dim memories. Proposals in Congress to cut public health funding are a "cost control" measure we would pay for dearly for many years to come. (See blog posts of March 11 and May 5.)

2. Raising Medicare's eligibility age to 67 and turning it into a voucher program

If the eligibility age rises, where will those aged 65 to 67 find coverage? They will either have to delay retirement, assuming they have a job with benefits, or use health reform to find a policy in the individual market, assuming it goes into effect. Either way, their presence in the risk pool will increase costs, and therefore premiums, for everyone else. (See blog post of July 7.)

Proponents claim that giving vouchers for purchasing private coverage will lower costs through price competition among insurers. We have experience doing that under Medicare Advantage, and costs are actually higher. (See blog post of April 8.)

The only truly effective way to control Medicare spending by reducing overall health care costs. There is no quick fix. (See blog post of August 5.)

1. Repealing health reform

Opponents in Congress have yet to follow through on their promise of repeal. For now, they're hoping the Supreme Court does it for them. Either way, repeal would be a disaster for millions of Americans who have recently gained coverage under the law. (See blog post of December 15.) And it would be a tragedy for millions more who are waiting for guaranteed coverage in 2014.

The bright side is that we did many things right in 2011, which will be the subject of my next list.

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