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policymakers should be cautious about accepting industry self regulation at face value, because it redounds to the industry's benefit and it is ineffective [...]

Philip Morris USA and RJ Reynolds, and their trade association coordinated to mobilize ideologically diverse constituencies to help defeat health care reform under President Clinton. Actions included getting smokers' rights groups to heckle legislators at town hall meetings, and other tactics recently seen in opposition to reforms under President Obama, according to the authors. In some cases, groups appeared to have worked against their own interest, perhaps without full knowledge of who was funding these organizational efforts

If your market doesn’t work to set reasonable prices, then you need to acknowledge that and start thinking like serious regulators; you’re going to have to get a lot deeper into cost-of-service regulation than you ever imagined.

And setting rates is more than making consumers happy; you also have to allow premiums that keep the insurers from withholding service or withdrawing completely. Welcome to cost-of-service regulation of essential public services.

"There is a complete lack of transparency in the healthcare system." [...] Under the new approach, hospitals and doctors say they expect to share in savings when patients recover promptly, while bearing the risk of additional expenses when complications arise.

"We want to innovate," said Dr. Richard Afable, chief executive of Orange County's Hoag Memorial. "This is not about making money. It's about how we align financial arrangements so we can get the best outcomes for patients while reducing costs for all involved."

The most interesting, under-discussed, and potentially revolutionary aspect of the law is that it doesn’t pretend to have the answers. Instead, through a new Center for Medicare and Medicaid Innovation, it offers to free communities and local health systems from existing payment rules, and let them experiment with ways to deliver better care at lower costs. In large part, it entrusts the task of devising cost-saving health-care innovation to communities like Boise and Boston and Buffalo, rather than to the drug and device companies and the public and private insurers that have failed to do so. This is the way costs will come down—or not.

That’s the one truly scary thing about health reform: far from being a government takeover, it counts on local communities and clinicians for success. We are the ones to determine whether costs are controlled and health care improves...

@8:00 answers are not going to come out of Washington after this reform bill, rather individual communities @20:30 for a universal, private system to be effective, must be heavily regulated, transparent @25:25 medicine has become too complicated for one person to handle

Reform proponents exaggerate the complexity of the issue to elevate their own status as people who understand it; opponents exaggerate it to make the whole endeavor out to be a bureaucratic monstrosity.

This gets a bit tiresome for reporters such as me who are writing article after article about the debate, only to have another pundit, politician or colleague dismiss the whole subject as an incomprehensible mess. Well, health care is a mess. Our current system is a mishmash that consumes 16 percent of the economy. Fixing it could be very simple: a single-payer system. To the dismay of many liberals, President Obama and congressional Democrats think it's more realistic to build on what's already there, which is why legislation overhauling it comes in the form of 1,000-page tomes.

Yet the basic outlines are emerging. What follows is an attempt to boil the health-care debate down to 1,000 words

When it's The New Republic -- whose self-proclaimed editorial mission is to re-make the Democratic Party in Joe Lieberman's image -- taking the lead in dictating what every Good, Serious Progressive must affirm (this "bill is the greatest social achievement of our time"), you know the debate has gone seriously awry.

Today, The New York Times' Bob Herbert has an excellent column giving the lie to those tactics from the President's most loyal supporters. Herbert explains why the health care bill -- with its reliance on taxes on so-called "Cadillac" plans -- is far more likely to end up burdening the middle class and reducing health insurance coverage for tens of millions of people:

"It is tragic to see the promise from Washington this year for genuine, comprehensive reform ground down to a seriously flawed bill that could actually exacerbate the health-care crisis and financial insecurity for American families, and that cedes far too much additional power to the tyranny of a callous insurance industry," says National Nurses Union co-president Karen Higgins, RN.
"Sadly," adds Higgins, "we have ended up with legislation that fails to meet the test of true health-care reform, guaranteeing high quality, cost effective care for all Americans, and instead are further locking into place a system that entrenches the choke-hold of the profit-making insurance giants on our health. If this bill passes, the industry will become more powerful and could be beyond the reach of reform for generations."

[Ezra w/ a high-schooler's "take-down" of Jane Hamsher. Wow. Surprised.]

The lesson of Massachusetts is, broadly speaking, that you can't cut costs simply through making changes in the insurance market. Health care is expensive because, well, health care is expensive. You have to attack at the source. The Massachusetts reforms didn't do that, but the pressure of the individual mandate is forcing them to reconsider. The Senate health-care bill may not go as far as some would like, but it goes a lot further than anything we've ever done before. For more on that, see Atul Gawande, or this article from Ron Brownstein.

Lieberman has tossed the process into chaos. But the short-term satisfactions won't overwhelm the long-term judgments. Lieberman is "point person" because he has appointed himself the 60th senator. Every other member of the Democratic caucus could have done the same, but most all have judged the underlying bill more important than their disagreements with it. Lieberman did the opposite, and there's little evidence that he actually had disagreements with the bill so much as dislike for some of its supporters.

We've all seen in recent months how the insurance companies, the drug cartels, Wall Street bankers, corporate lobbies and other powerful interests are reaching deep into their pockets to stifle efforts at reform. And they've been winning. It's been a year since the big financial firms blew a hole in the economy and took down the jobs, wages, pensions and homes of millions of people. They would have gone down too — devoured by their own greed — were it not for the taxpayer bailout.

Vermont's Catamount Health, first implemented in 2007, provides a low-cost health care plan to individuals without access to employer-sponsored insurance. Other Vermont initiatives include assistance paying premiums for low income employees with insurance, charging businesses fees for each employee not offered insurance, and "Blueprint for Health," which focuses on support and prevention for chronic conditions.

Vermont's reforms are paid for by insurers, hospitals and a cigarette tax hike. In May, Rep. Peter Welch (D-Vt.) called his state's health care system a "model for the nation," and promised to take its reform ideas to Congress. Upon returning to Vermont for the August recess, Welch said the House bill includes cost cutting initiatives found in the state's plan.

The Massachusetts plan, signed into law in 2006 by then-Gov. Mitt Romney, includes an individual mandate requiring every state resident to purchase health care by the end of 2007. It also consists of an employer mandate, subsidized coverage for moderate and lower income levels, and something called the Commonwealth Connector -- an independent state agency that provides an even playing field marketplace for insurance plans, enabling individuals to more easily compare which plan works best for them.

"Massachusetts has probably gone the farthest of the states in implementing health care reform," said Jennifer Tolbert, a principal policy analyst at the Kaiser Family Foundation. Tolbert also said that the health reform proposals that have come out of the three House committees and the Senate Health, Education, Labor and Pensions committee "reflect" the Massachusetts plan, which "has served as a bit of a roadmap for how to move forward at the national level."

The attempt in all these ideas to nudge the medical system away from fee-for-service medicine toward an approach that ties compensation more closely to results captures how much the health care debate has shifted toward cost-control. So far, the rise in health care spending has proven almost invulnerable to every previous attempt to tame it, like the managed care revolution in the 1990s. Even if Obama signs into law a final bill embodying all these reform proposals, many skeptics wonder if they can bend, much less break, the seemingly inexorable increase in health care spending. Reischauer understands that skepticism, but isn't able to entirely suppress a kernel of optimism that this latest reform agenda may prove more effective than its predecessors. "One never knows whether we're turning the corner or if this is just playing the same old game for another inning," he says. "But I sense there's something different out there. I think the medical profession and its leaders have read the handwriting on the wall and are trying to evolve." If so, the ideas the Senate will begin voting on tonight could mark a milestone in that journey.

Several pilot programs with similar aims have made it into some of the health-reform bills considered by Congress. One is a bundling program, in which Medicare would pay hospitals a set fee for certain operations or chronic illnesses, rather than paying piecemeal for every aspect of the treatment. Hospitals would then have an incentive to avoid complications and readmissions, because they would no longer be automatically reimbursed for them. The hospitals that did the best job of keeping their patients healthy would end up helping their bottom lines. The details are still being fleshed out, but Medicare or private hospital groups would most likely monitor outcomes to make sure the incentives didn’t lead hospitals to skimp on care or turn away the sickest patients.

The point is that when you have capitalism, capitalism encourages you to think of ways to make money or to make more money. And the judges never could have gotten the kickbacks had the county not privatized the juvenile hall. But because there's been this big push in the past twenty or thirty years to privatize government services, take it out of our hands, put it in the hands of people whose only concern is their fiduciary responsibility to their shareholders or to their own pockets, it has messed everything up.

With the US Senate bogged down in the fight over reforming health care, American leaders have said that the senators might not move on climate legislation until 2010, well after the global climate change conference in Copenhagen in December. That drew a sharp response from John Bruton, head of the European Union delegation: "The United States is just one of the 190 countries coming to this conference," Bruton said, "but the United States emits 25% of all the greenhouse gases that the conference is trying to reduce. I submit that asking an international conference to sit around looking out the window for months, while one chamber of the legislature of one country deals with its other business, is simply not a realistic political position"...Europe has proposed far-reaching reforms designed to impose new rules on executive pay and bonuses, requiring that banks link pay to long-term rather than short-term performance...

#1 If I don't have health insurance now, how will reform affect me? #2 If I currently have health insurance, how will reform affect me? #3 How much is reform likely to cost? #4 How much does the federal government now spend on health care? #5 What will happen to small businesses under health-care reform? #6 I keep hearing about plans to create a "public option" or health insurance cooperatives. How would those work? #7 What is likely to happen to my Medicare coverage under current proposals? #8 What do the current bills have in common, and what are the major legislative challenges that lie ahead?

[this is page 2 of 4] Today, "open content" is the biggest front of innovation in higher education. The movement that started at MIT has spread to more than 200 institutions in 32 countries that have posted courses online at the OpenCourseWare Consortium. But, as Wiley points out, there's still a big gap between viewing such resources as a homework aid and building a recognized, accredited degree out of a bunch of podcasts and YouTube videos. "Why is it that my kid can't take robotics at Carnegie Mellon, linear algebra at MIT, law at Stanford? And why can't we put 130 of those together and make it a degree?" Wiley asks. "There are all these kinds of innovations waiting to happen. A sufficient infrastructure of freely available content is step one in a much longer endgame that transforms everything we know about higher education."..."My idea was to first, aggregate this huge critical mass of content disconnected over various sites; second, apply best practices in user interface design and Web standards to do for educational content what Hulu has done [for TV]; and third, build an educational ecosystem around the content," Ludlow explains. "Showing the videos is one thing, but building the right interactive tools and the right commenting system will really create something of value."

# Have the right to our own health data\n# Have the right to know the source of each health data element\n# Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost

On the strength of this data, members of the administration will tell you that the important comparison of health care reform is not between America and France, but Minnesota and Florida.

valuable comments section

David Leonhardt's article

Health reform is, I think it fair to say, in danger right now. The news out of the Senate Health, Education, Labor, and Pensions Committee was bad. The Congressional Budget Office had scored a partial bill and the result was a total fiasco. But the news out of the Finance Committee is much, much worse.

Ezra's summary: The public plan is given, for its first three years of existence, access to the provider networks used by Medicare, and for its first two years, access to the payment rates negotiated by Medicare.
http://voices.washingtonpost.com/ezra-klein/2009/06/jay_rockefeller_and_the_questi.html

[MUST read]
When you look across the spectrum from Grand Junction to McAllen—and the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine...When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care.

must read. I love the last one where he describes an "ecology"

Our survey results show that Americans are solidly center-left in their ideas about role of government, the economy, and domestic politics and somewhat less so on cultural and social issues.

http://change-congress.org/ al gore @ 37:00 - "democracy crisis" Q&A 42:00

Zero. That's how many Republican votes the stimulus bill received in the House. Zero. Not one. Not Mike Castle of Delaware, whose constituents gave 62 percent of their votes to Obama. Not Anh Cao of Louisiana, whose district when 74 percent for Obama. Not Illinois' Steven Kirk, whose district went 61 percent for Obama. Zero. A popular new president elected amidst an economic crisis was not able to attract one crossover vote on his first major priority. In the more moderate Senate, Obama is expected to attract three Republican votes. They will have cost him hundreds of billions in concessions, and they will have cost America hundreds of thousands of jobs.

True reform requires transformation at a stroke. But is this really the way it has occurred in other countries? The answer is no. And the reality of how health reform has come about elsewhere is both surprising and instructive.

Executive leadership is important, of course, but the continual failure of our presidents should be lesson enough that it is not sufficient. The executive is but one actor in a sprawling drama. Consider this: Comprehensive health reform has been attempted or considered by Franklin D. Roosevelt, Harry Truman, Lyndon B. Johnson, Richard Nixon, Jimmy Carter, and Bill Clinton. It cannot be that they were all dunces, or weaklings, or incapable legislative tacticians.

re: this Op-Ed: http://www.nytimes.com/2008/10/24/opinion/24beane.html

see Orszag's "Demographics, Access and Costs: A Federal Perspective on Health Care Policy and Innovation" @13:00 Information Technology is "necessary but not sufficient [to increase efficiency]..." @17:00 "...an affront to traditional econ 101 thinking...the default mattered more than the financial incentive...[placebo effect in medicine]...simply telling people that what they do every day is physical exercises generates results that are similar to actual exercise..."

...watch this for physicians' responses

...Which brings me to the deeper reason you will need not simply to address food prices but to make the reform of the entire food system one of the highest priorities of your administration: unless you do, you will not be able to make significant progress on the health care crisis, energy independence or climate change.

I predict that the domestication of biotechnology will dominate our lives during the next fifty years at least as much as the domestication of computers has dominated our lives during the previous fifty years.

Taxes, in short, are rarely the reason a middle-class family struggles. But conservatives were able to craft a new rhetorical conception of “freedom”—a conception in which the issue of taxation trumped all concerns of building a fairer society.

...the ideology of diversity...treats economic difference along the lines of racial and sexual difference, thus identifying the problem not as the difference but as the prejudice against the difference...Diversity keeps the left barking up the wrong tree.