I know deadlines seem completely arbitrary, but the reality is that deadlines are often necessary to get work done. How many of us wait until April 15 to pay our taxes? Without a deadline, we would probably wait even longer.

The same is true for health-care reform. Like taxes, it is a painful process. There are potential winners and losers. Politicians are making many difficult decisions as part of reform, and people typically don't like change, especially if they don't think it will benefit them. The strategy is then to delay. Delay can often weaken reform, or when there are competing priorities, delay can shift focus elsewhere. A deadline forces all parties to come together to make a decision. It is true that too early a deadline can result in a bill that isn't ideal. But let's face it...no one bill is going to address all the problems with our health-care system. There are going to be many bills necessary over many years to continue to refine the changes. We need to start somewhere, and making people take action by an imposed deadline is an effective strategy to get work done! For those who say the deadline is not feasible, I say let's go ahead and see!

The 2009 deadline for health-care is more a race against the 2010 mid-term elections and the fear of losing more seats in Congress than it is about the right outcome.

There are still many issues that remain unresolved as it pertains to merging the two bills that are, essentially, oil and water. Will there may be a public plan? Will there be more taxes and, if so, for whom? These remain two of many critical laments that remain unresolved. The Senate is still awaiting yet more numbers from the Congressional Budget Office on what these options will really cost.

The goal of having the president sign a bill before the end of the year seems unrealistic with so many unanswered questions. President Obama has an opportunity to pass landmark legislation on health-care reform, but it is far more important to get it right then simply get it done.

My spirits tend to sag a little bit at this time of the year. I'm pretty sure it's a sunlight/Vitamin D deprivation sort of thing. But the health-care non-reform legislation coming down the pike has me dragging even more than normal compared to the typical Wisconsin November. We've read proposed legislation from the House of Representatives that expands access to care dramatically (with an expanded price tag to boot) while doing nothing to rein in wasteful spending nor drive towards health. In its present state it's just another deferred tax for our children and their children and their children's children to pay. So where's the health-care delivery transformation in the bills being bandied about in Congress? Where's the waste removal effort going to come from? Certainly not from government. And that's why my biggest beef is with the weak employer non-penalties for non-participation.

It's a very simple formula, folks. Public option + weak employer penalties = socialized medicine.

Why do I want to see employers retain responsibility for providing health-care? Because employers -- not government -- will drive accountability, innovation and value in ways that government simply will not.

Can Congress present something by year's end to President Obama? Is it feasible or even necessary? In its present form, I certainly think not. It seems that the House passed its legislation, packed as it is with bogies, knowing that in reconciling their bill with the Senate many of the more left-leaning pieces would be shot down when the moderates finally flex their muscles. At least I hope that will prove to be the case.

I can understand the political reasons why President Obama has set a 2009 deadline for passing health-care legislation. As Congressional sessions head into federal election years, the political difficulties of passing any major legislation increase significantly. It gets harder for proponents and opponents to focus on the merits of the legislation simply because everything they do gets looked at through the lens of election campaigning.

That being said, this is a complex piece of legislation with far-reaching implications with many details that can have big negative long-term consequences. It must be done right, and getting it right is more important than getting it done fast. Having worked on complex postal reform legislation that dragged past the 2006 elections into a one-week special session that passed at 2:45 am December 10, I found that, even if it would have been easier for the legislation to have passed in 2005, the final product was better for having been delayed almost a year.

The President has done a masterful job keeping this legislation on the front burner and pushing it forward even when it looked like it could have gone off the rails. He should give Congress a chance to work out the tough issues even if it takes beyond the end of the year.

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.

I was disappointed in the tone of the president's speech. His oratory was as well honed as ever but the added blustering and threatening tone was counter-productive. I wasn't surprised because many editors in news journals and newspapers have been urging him to be more decisive and apparently, this was his way of displaying decisiveness.

To call the opinions and fears of his fellow citizens "bickering" revealed an intolerance for them. Isn't he supposed to represent all of us whether we agree with him on every issue or not? Many of us are beginning to believe his intolerance for dissension is his way of expressing irritation and impatience; because many opinions expressed are delaying his agenda which he so obviously took office to achieve.

Crucial details of how to bring about the changes in health care according to the Obama plan were still missing. And to think the changes can be financed by uncovering fraud and misuse in the current system? That's a little hard to believe. We know there is much fraud which is swallowing millions of dollars, so why not take care of that first to stop the bleeding in Medicare and Medicaid?

I was also disappointed by the many theatrics which were displayed by the sad stories, carefully selected for their pathos. I also believe the president is a bit young to pull off the irate paternal attitude. Just give us some facts we can believe that also make sense. Will it work and how are we going to realistically pay for it?

I applaud the administration for shining a bright light on health reform. The government -- as buyer, regulator and leader -- must be a part of any solution. The political calculus has created a real sense of urgency to do something about this complex system which touches everyone and accounts for one sixth of our economy. The consequence however, through a lack of transparency and understanding, has reduced the public dialogue to be between "public insurance options" vs. "death panels." Framing the debate this way and consuming available public attention on "wedge" issues won't lead to a sustainable future system.

My attendance at an Institute of Medicine workshop this week in the midst of the buzz about the speech served as a stark reminder about the depth and breadth of the hard problems:

• Access (too many uninsured)
• Costs (growing faster than inflation)
• Demographics (aging populations driving up systemic costs)
• Quality (not enough -- as measured by comparative outcomes, disparity in care geographically)
• Worsening health (people dying because of a lack of focus on improving the care delivery process).

I was struck by the number of smart, passionate people representing the major stakeholders working together to drive change. Veterans of the process recognize that change is imperative but hard -- because the details matter. We are in this predicament because incentives, tax policies, government reimbursement schemes and increasing specialization and capability of medicine have led us here.

The president delivered an inspirational speech, laying out basic principles: everyone should have access, nobody with insurance will have to change it and cost growth must be slowed. Voters know there is no free lunch, and health is no different.

We can't achieve reform without educating the public. A sustainable system is not as simple as providing more access. Consumers are ultimately responsible for their health and their daily choices cost the system. We need to help them engage in their health differently, be wiser purchasers, and understand trade-offs. As long as they believe the price of care is their co-pay and continue to engage as they have, there won't be sustainable reform.

There are best practices at organizations like Geisinger that have re-invented care delivery and consumer engagement models. These leaders will tell you that success is about aligning incentives, understanding the details and making trade-offs.

The difficult work of figuring out the details and making hard choices is still ahead.

President Barack Obama's speech before the joint session of Congress was reminiscent of the savvy presidential candidate who starred on the campaign trail: part controlled swagger, poignant elocution and deft political gamesmanship. Though he emerged on the Washington scene a long shot, a virtual David in a crowded room of Goliaths, he quickly out-lapped veteran opponents. But then came the summer of partisan bickering, outlandish hyperbole, and sneakily Goliath regained stature and bravado, leaving the wunderkind to prove he wasn't a fluke.

Thus the stage had been set: A ripe moment which dared the president to turn the political tide and nudge a confused and reticent nation in the direction of deliberate resolve. Could he wrestle progressives, moderates and a few conservatives to forge a coalition of the willing along that road less traveled? May be his speech wasn't a game-changer, but it did serve notice that the president was ready to play ball and pull out a win, even if the victory was measured.

The polarized reaction that night, however, does beg the question to which interests are we beholden? In his speech he enumerated a menu of reforms, not all objectionable. Still much of the opposition did not flinch. He firmly supported a public option, though he did not stipulate it as mandatory -- signaling his willingness to compromise. He approached the discussion of malpractice reform, advocated for a health insurance exchange, signed on to catastrophic coverage and called for radical insurance industry changes -- the latter being the least abrasive to our collective psyche. Yet, many lawmakers did not budge although some in the public may have thawed. And perhaps the rude outburst of one heckler shamed a few and in comparison cast the president in a more compelling light.

We are faced with a choice. President Obama proposed a legitimate start. Now it's time for others to coalesce around a do-able close. As the endgame looms, hopefully we will summon the courage of days bygone and conjure the moral imperative and the fiscal wisdom to recalibrate the health-care landscape. There is no silver bullet. Change will not be perfect. Nor will the first incarnation be the last. Indeed the President stepped into the bully pulpit and sounded the full weight of his office, but will other unlikely heroes and underdogs show-up and stare down the demagogues? Or have the rants of Goliath scared us into our respective corners and left another historic appointment un-kept? The answer waits.

The President was at his oratorical best during his recent address to Congress. Obama is clearly committed to health reform, even risking his political future on the outcome. He did a good job of explaining his own position while covering a wide range of controversial topics. He courageously challenged Congress to set high aspirations, well beyond partisan politics. This message undoubtedly resonated with most Americans.

That said, the content of his address was long on vision but short on details. Obama dangled tort reform before the Republicans, only to offer "demonstration projects" rather than substantive legislation. His promise of durable insurance coverage is admirable but is unrealistic without government subsidy. Finally, he pledged to preserve Medicare benefits while cutting its costs. That will certainly require changing the Medicare payment system.

Hopefully, both Congress and the administration finally recognize that health reform is a long and difficult journey. Even the president acknowledged that there are many details to be worked out. That comment drew nervous laughter from the members of Congress--and for good reason.

Health care is something that virtually every voter understands and experiences. Americans will not be easily fooled by half-baked ideas. Now is the time for our politicians to agree on principles and work out realistic solutions, which have been woefully absent in the health reform debate.

It has now obvious that no single piece of legislation will deliver all the promises of health reform. Instead, fundamental change will require years of hard work for both the executive and legislative branches of government. In this era of "quick fix" politics, we need leaders with a long-term commitment to health care reform, even at the risk their own political futures.

That may be the most important message from this presidential address.

As a former high school and college debater, I have the habit of outlining a speech to evaluate the key points and how they are made and defended. President Obama was clear about his three areas of focus: Provide a secure and stable system for those already insured, provide options for insurance for those who are not currently insured and slow the growth of health care costs.

I want Obama to succeed because I agree that this country now has the opportunity to fix a system with too many flaws. As is often the case, however, the problems are in the details, and some key "details need to be worked out." For those currently insured, no changes are necessary, but insurance companies will be required to enlarge coverage. Pre-existing conditions cannot be considered, out-of-pocket expenses will be capped and there can be no dollar cap on coverage. Those conditions will increase medical expense and increase the cost of health insurance, which erode the "security and stability."

President Obama was quite effective and thorough in outlining the alternatives for those not currently insured. Defining how the growth of health care costs would be slowed and the overall plan paid for were not so clear. My own organization, Intermountain Healthcare, and the Geisinger system were mentioned as examples of high quality and low cost health care. But how is that translated to an action plan for a nation? Similarly, for a plan that will cost $900 billion, very little was said about the details of paying for it.

To focus the debate, Obama needed to deliver a speech that answered the distractions raised by his opponents. He did that. He also needed to define what he was proposing as the solution to our health care problems. He also did that fairly well. Except for those pesky details.