Karen Tumulty provides a health care reform update:

When Obama began his push for reform, he asked Congress to create an independent commission to regulate Medicare costs. Medicare, which spends more than $450 billion a year, is such a huge health care player that any changes it makes can lead the way for reforms in the private market. As originally envisioned, the new agency would essentially take over Congress's current authority to set Medicare payment rates for hospitals, doctors, nursing homes and other health care providers. It would use a process like the military-base-closing commission, whose recommendations automatically go into effect unless Congress votes to block them.

As it turns out, however, lawmakers are reluctant to cede the power to steer extra money to hospitals in their own districts, and the House rejected the commission idea outright. While the Senate bill does contain a version of the commission, it has become weaker at every turn in the process.

Ezra Klein has more on the subject.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.