The passage of the health insurance legislation has two overriding positive effects: it brings more clarity to the health insurance issue and it demonstrates the President's ability to govern.

The legislation also affirms that Americans should not face financial ruin from being unable to afford health insurance. It also makes good progress on prevention, on increasing the supply of health care professionals, on eliminating the flawed "doughnut hole" in the Medicare prescription drug system, and on beginning to address the long term care crisis. These are the good elements of this legislation.

As health insurance system restructuring, the legislation has deep flaws that must be addressed in subsequent legislation. We cannot guarantee coverage, prevent people from being subject to pre-existing condition exclusions, and prohibit insurers from canceling policies for those who become ill during the policy period without significantly increasing costs for all policyholders unless we cause healthy uninsured people to buy insurance, reduce what we pay health care providers, or levy more taxes on people to pay for increased subsidies.

The penalties for healthy people refusing to buy insurance are far too low and do not take effect for several years. Reducing payments to doctors and hospitals either drives them out of the system or causes them to drop Medicaid patients. Raising taxes on everyone to pay for these increased costs worsens our economic situation.

One situation illustrates my point: in the 8th Ward of Washington D.C., there is a severe shortage of specialists, including one urologist for a large population. Most people have health insurance or Medicaid. After this legislation passes, there will be even more people with insurance, but still a severe physician shortage. We have more work to do before our health care system is viable. Health insurance affordability does not produce health care access.

At one of many low moments of World War II, a breathless young aide barged in on Winston Churchill to report bad news. Churchill responded: "I've heard worse." That's the resilience Democrats need this week.

Democrats lost their filibuster-proof Senate majority, but this should not undo their tremendous achievement in passing a landmark bill through both houses of Congress. We need to settle our nerves here. From the perspective of both politics and policy, the smartest course is for the House to pass the Senate bill, and then to use the reconciliation process to fix the bill's major shortcomings.

So chin up everyone, and let's get this done. By the way, I'm not the only one saying this. As you can see by clicking here, this is the consensus of most key figures in the health policy community.

No, it is not necessary to pass this confusing, verbose mess of legislation this year. The health-care reform issue has been convoluted to the extreme. We have politicians making decisions based on factors they don't even understand. Millions of us no longer trust their motives and know their representatives don't, quite frankly, know what they're doing.

When a matter of this importance becomes a power play, our elected officials are no longer listening to the people. Perhaps that is the reason for the rush to pass this ridiculous 2,000 page bill in the House and who-knows-what in the Senate. "Quickly now, let's do this to prove the politician is quicker than the eye of the average American."
Most of us recognize slight of hand when we see it. Yes, we need some changes and some solutions but those decisions should be made by those who have experience in the field of health care.

As to the question of feasibility? Of course, it's feasible if enough of our representatives compromise, as their arms are twisted by those with greater political aspirations. There would be a high price to pay if they pass this legislation without cleaning it up, simplifying it and getting to the heart of the real issues. This mess isn't about helping the citizens of this fine country. It is now a game of Monopoly to see who can win, own and achieve the most power. Some forms of treachery have been around forever. This is just another shell game with bigger shells and so much more at stake.

The magnitude of the changes in our current health-care system necessary to "get it right" warrants thorough, informed and thoughtful analysis and debate. The federal legislature is the worst place for that to happen. There are other priorities such as unemployment, the need for banking oversight and wars, to name just a few, that interfere with the "informed and thoughtful" part.

By rushing the delivery of a bill by the end of 2009, the Democrats and President Obama will be able to produce an accomplishment, and there will be several very good things in that bill. If a bill is delayed, it will continue to distract from the other very important priorities. The delay will be evidence of the lack of leadership by Sen. Harry Reid (D-Nev.) and the lack of support for Obama. The very significant problems with our current health-care system will continue.

I am in favor of the deadline simply because it focuses attention on delivering a very necessary change. Given the politics of the Senate, the deadline is probably not feasible.

The Baucus Plan of taxing insurers for expensive plans is yet another example of shot-gun approaches to reducing health care costs with no understanding of the economics or key drivers that are at the core of the crisis.

For years employers have been working with insurers to modify plan designs and change economic incentives for consumers(employees) to hopefully choose the right plans that will optimize both cost and quality. The reality is, however, that despite their best efforts, employers are still struggling with understanding a clear perspective of three fundamental factors that impact healthcare: cost, utilization and risk. As a result they often find that people with severe illness end up choosing health plans that cost more- a term called adverse selection.

Any time you try to change an economic incentive in health care you need to be able to determine at a very precise level the underlying drivers of health care and be able to measure the downstream impact of change. The Baucus plan is yet another example of balloon economics.Taxing expensive plans will only drive utilization and costs elsewhere if there is no accurate measurement of cause and effect. Many have tried such mechanisms with little success because they are blind approaches supported by very little data.

The system needs reform but its time to start involving folks that have been in the trenches that understand health care. The patient is in critical condition and lets stop allowing people in the waiting room to make suggestions unless they truly understand what is going on.

Sen. Kennedy's death is a deep loss, particularly for those who care deeply about health-care reform. I was struck by the fact that even when I met Republican lawmakers quite far away from Kennedy on the political spectrum, they felt that he had a unique ability and passion to get people with deeply adversarial positions together and find sufficient common ground to get legislation passed. He obviously had a unique skill, and he will be missed.

It is highly unlikely that any current leader can single-handedly do what Kennedy would have done. However, sometimes groups of leaders will emerge to fill a vacuum, and that could certainly happen here. There appears to be a broad-based desire to get some legislation passed, and there is actually more common ground among lawmakers of both parties than the media coverage would indicate. The key to getting this done will be for all stakeholders to step back and determine what they must have to achieve their policy goals, as opposed to what they would like to have to score a "victory" over their opposition.

What Kennedy did beautifully and regularly across a variety of issues was to make everyone focus on their "needs," rather than their "wants." Once that happened, there was ample room for compromise. Never has it more necessary to get that to happen.

The loss of Sen. Kennedy as a true legislative, political and social leader can not be over stated. I only hope that our elected leadership will go back and listen to or watch his many powerful speeches given on behalf of the disadvantaged and under-represented people of our country. Despite coming from a most privileged background, he committed every ounce of his ability and effort to helping to establish basic rights for every member of society. His bipartisan accomplishments in health care, including numerous improvements to the FDA and the establishment and re-authorization of the Children's Health Insurance Program (CHIP) represented the tip of the iceberg compared to his hopes for establishing an essential right to affordable, high-quality health care for every American. He was not afraid to use his own personal experiences to advance this agenda. I am certain he would have encouraged the use of his untimely death to pass meaningful reform.

The danger in delay is that it gives conservative opponents of healthcare reform more time to distort the truth about what reform will mean. Over the past month Media Matters has done a good job of tracking how even the mainstream media "continues to spread conservative misinformation on health-care reform."

The month of August will give conservatives ample opportunity to further muddy the waters. Meanwhile, Congressmen who want true reform won't have a single clear bill that they can point ot and talk about. Opponents will be able to fear-monger by telling the public that "no one knows what will wind up in the legislation. Who knows how a "government takeover" will limit your rights and benefits?

Earlier this week, even the New York Times repeated claims that reform legislation will include "government-encouraged euthanasia."

In fact, the House bill would pay doctors to explain palliative care to patients. Palliative care does not mean abandoning hope. Quite the opposite. Palliative care specialists spell out the potential benefits and risks of various treatments so that patients (or families) can share in decisions about which treatments to pursue. At the same time, these specialists are trained in the fine art of controlling pain.

On the other hand, August could give both the White House and progressive Congressmen a chance to clarify what reform means, addressing some of the questions Mark Kelley outlines. The president should continue to take his case directly to the public.

He should emphasize that the House bill would reduce Medicare spending only by discouraging unnecessary, ineffective and potential risky care that provides no benefit to certain patients. He should remind Americans that most Medicare beneficiaries like Medicare, and that the House bill aims to improve Medicare by paying more for higher quality care and better outcomes.

He should reassure voters that a public insurance plan would be modeled on a new, improved version of Medicare that offers better coordinated, more efficient, patient-centered care.

"If we're going to have a successful democratic society, we have to have a well educated and healthy citizenry". - Thomas Jefferson

Some have suggested that, instead of Congress voting on health reform before the August recess as originally planned, we're better off if we wait and spend the month talking about the problem and the proposed solutions. As a long time participant in the dance of public policy, I actually love the idea of an August in which Americans spend time really reading, listening, thinking, discussing and debating the key parts of the health reforms being developed in Congress. Imagine each evening, you could watch programs and webinars where detailed explanations lay out exactly what is - and what is not - in the House bill or Senate bill, with time for questions to clarify and illuminate. (For example, where exactly is the section that allows the government to withhold care from our senior citizens? What really happens to small business? What section directly or indirectly rations care? Explain the costs and how it would be paid for, piece by piece). Imagine if we had publicly broadcast debates - honest-to-goodness structured debates -- between proponents and opponents of the major elements. And local town halls where the impact on your community would be explained - what will it mean for your local hospital? It could be a major turning point for health reform and a step toward regaining civility in our participatory democracy. An informed society.

However, experience tells us something entirely different will happen. Experience tells us we will be subjected to endless ads spreading fear and misinformation, plus a steady stream of talking heads on TV and radio, interested in generating heat, not light. Will it end up killing health reform? Will we re-live August of 1993? Instead of missing the opportunity, what if, for once, we made Thomas Jefferson proud?

The public debate has illuminated the realities of health care reform:

Universal coverage-details?--No one opposes the concept but concerns remain about the benefits design, administration, limits of coverage, "rationing" etc. Strangely, everyone ignores Medicare which has excellent, durable coverage.

Universal coverage-expensive--The soaring costs of the Massachusetts health plan are sobering. Cost savings from preventive services and better access take time-- but even that may be wishful thinking.

Political messages-confusing-- The White House has been promoting universal coverage while citing health care costs as a threat to the nation's economy. It is hard to reconcile these two concepts. If our current delivery system is such a mess, how does expanded coverage reduce cost?

Cost savings--elusive -The Congressional Budget Office will not book any immediate cost savings from proposed improvements in health care delivery. The CBO is right--these savings will take years. The inflationary curve can only be bent by redesigning systems of care and changing the payment incentives. This will not be easy but it is THE "game-changer".

Revenue source-taxes--Universal coverage cannot be achieved without new taxes. This has sent a torpedo into the bow of health reform. Now, every taxpayer is wondering why we should rush into universal coverage during a major recession.

The country is facing some hard questions. Are we serious about real change when we have not fixed Medicare? Do we have the will and the patience to implement fundamental reforms or are we content with "quick fix" political wins? Finally, is health care reform even possible with the current political process?

Members of Congress should declare a time out. The issues are clear but the solutions obscure. It is now time to go home and discuss these things with folks back home. I suspect most citizens want steady progress, not reckless speed.