Not a very inspiring performance, I thought. He seemed subdued. Also, this steady emphasis on cost control as the rationale for action on health reform just does not work, I think, since the bills which Obama is ready to support largely fail to address that issue--a point which the CBO and others have driven home to the public. The substance and the presentation seem persistently at cross purposes to me. I did think it was good to underline the benefits of guaranteed coverage to those who already have insurance, though. Better late than never. I think this has been a seriously neglected theme in the drive to sell reform. That guarantee is worth a great deal to everyone, not just the uninsured.

This reference pointed to something new and significant:

We also want to create an independent group of doctors and medical experts who are empowered to eliminate waste and inefficiency in Medicare on an annual basis, a proposal that could save even more money and ensure long-term financial health for Medicare.

That idea isn't in the bills at the moment, but the administration is right to try and insert it. It might not be easy. The WSJ reports on House Democrats' response: many object.

Why is this idea significant? Because what "cost control" is going to boil down to under any of this family of proposals is the way Medicare (and the public option, if that happens) is managed. Under these structurally timid plans, the system as a whole won't move away from fee-for-service until Medicare does.

The problem is, Medicare is popular precisely because it wastes so much money. The harder Congress and/or the administration press down on Medicare outlays, the better the prospects for cost control across the whole system, and the louder Medicare's existing beneficiaries and their advocates will complain. This is the political challenge that will kick in as soon as any reform to widen coverage--any "health insurance reform", as Obama called it last night, in an interesting choice of words--is on the books.

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