These resistance efforts are not about law — they are about politics. But of course at this point, health care reform is only about politics, except insofar as it is still about the morality of equal treatment for all.

I am not a constitutional lawyer, but I believe that states have the right to determine how to care for, educate, tax their constituents... pls correct me if I am wrong. While VA's republican majority gov't has put this bill forward, it did have significant Democratic support. As far as I know, this is the only reform legislation that can claim that...sad as it is.

Our recommendation: scrap it and start over. Its key elements—mandates, heavy-handed insurance regulation, and entitlement-based, middle-income subsidies—must go. None of them address health care's fundamental problem: high and rising costs. Instead, the various versions of health reform put forth by the president and his party are based on expanding health-insurance coverage. The inevitable consequence will be to exacerbate the cost problem. And the American public knows it.

To bring down costs, we need to change the incentives that govern spending. Right now, $5 out of every $6 of health-care spending is paid for by someone other than the person receiving care—insurance companies, employers, or the government. Individuals are insulated from the reality of what their decisions cost. This breeds overutilization of low-value health care and runaway spending.

View Full Image

Corbis

To reduce the growth of costs, individuals must take greater responsibility for their health care, and health insurers and health-care providers must face the competitive forces of the market. Three policy changes will go a long way to achieving these objectives: (1) eliminate the tax code's bias that favors health insurance over out-of-pocket spending; (2) remove state-government barriers to purchasing and providing health services; and (3) reform medical malpractice laws.

“We are about to embark on a huge transformation of our health care system,” Dr. Bach said. “If we start with a bunch of flawed measures, it will be as devastating as putting in the wrong coordinates before a moon shot.”

Dr. Elliott S. Fisher, director of the Center for Health Policy Research at the Dartmouth Institute, said the larger issue was that just because a hospital charges a lot does not mean that it delivers good care. But Dr. Fisher agreed that the current Atlas measures should not be use to set hospital payment rates, and that looking at the care of patients at the end of life provides only limited insight into the quality of care provided to those patients. He said he and his colleagues should not be held responsible for the misinterpretation of their data.

For quite a while now, it had been *widely accepted* that the Dartmouth Atlas analysis should be utilized as the guiding or organizing principle for health care reform. Atul Gawande's New Yorker article also utilized the D.A as the basis for many of his arguments.

IN the last issue of the NEJM, Peter Bach issues a strong statement that the Dartmouth Atlas should not be used to determine payment formulas to hospital and physicians, nor form the cornerstone of reform.

Perhaps more interesting, Dr Elliot Fischer, the Director of Health Policy Research at Dartmouth states that "...he and his colleagues should not be held responsible for the misinterpretation of their data."
REALLY ??? In the end, even Dr Fischer agrees that his institutions data should not be utilized as the basis for payment reform.

No wonder there is so much confusion about health care reform... some of its core or guiding principles make sense... but the data that the administration is using to formulate the particulars is flawed... and as Dr Bach concludes... “If we start with a bunch of flawed measures, it will be as devastating as putting in the wrong coordinates before a moon shot.”

Most physicians are clearly vertical thinkers. The longer a physician practices medicine, the more "vertical" his or her thinking methodology becomes... IMHO.

Innovation in the health care space clearly requires lateral thinking capabilities.

Does it make sense that the tradition of elevating senior medical staff to leadership positions (based on seniority) within a health care system would/could lead to disruptive innovation, improved care, outreach, cost effective treatments, etc???? I don't think so... Quite a dilemma... or Catch 22... need to disrupt typical hospital political hierarchy to create an environment for disruptive innovation across the system... hmmm