Editor’s Note: In the post below, John Wennberg and Shannon Brownlee discuss the controversy over a proposed study of regional variations in Medicare spending. Wennberg and Brownlee rebut claims that spending and utilization variations among academic medical centers are due to differences in patient income, race, and health status. In another post coming next week, [...]

Editor’s Note: In addition to John Wennberg and Shannon Brownlee (photos and bios above), authors of this post include James Weinstein, MS, DO, and Elliott Fisher, MD, MPH. Weinstein is chair of the Department of Orthopaedic Surgery at the Dartmouth-Hitchcock Medical Center. Fisher is Director of the Center for Population Health at The Dartmouth Institute for Health Policy and [...]

Posts on public opinion about health reform and how to achieve high-quality, low-cost health care topped the Health Affairs Blog most-read list for October. Additional comment on these and all posts is always welcome.

Can Slumping Support For Health Care Reform Be Turned Around?
by S. Ward Casscells, Hiliary Critchley, Thomas Amoroso, James Tyll, and John Zogby
Are [...]

HR 3962, the Affordable Health Care for Americans Act, hit the House floor with a thud Thursday morning at 1990 pages, almost double the size of the bill we last saw before the Energy and Commerce hearings at the end of July.  The bill incorporates, of course, amendments from the House jurisdictional committees, but also [...]

Editor’s note: Health Affairs Founding Editor John Iglehart recently interviewed American Hospital Association CEO Rich Umbdenstock. The wide-ranging conversation, transcribed below, touched on the ongoing health reform debate, the evolving role of hospitals in community health, the effect of the economy on hospital finances, the evolution of integrated medicine, patient safety, workforce concerns, and other [...]

Uwe Reinhardt’s assessment of President Obama’s address to Congress on health reform tops the list of most-read Health Affairs Blog posts for September.  Additional comment on all posts is always welcome. 

Grading The President’s Health Care Speech
by Uwe Reinhardt
Health Affairs Briefing: Bending The Cost Curve In Health Spending
by Chris Fleming
Regional Payment And Delivery Reforms: Critical To [...]

The president’s speech to Congress struck important political notes.  It also included three tantalizing opportunities for adding some aspects of health care reform to what was becoming simply health insurance reform. 
Delaying Implementation of the Exchange
The most obvious new, and possibly controversial, point in the speech was the four-year delay in implementing the Insurance Exchange.  This [...]

After the August congressional recess, health care reform was on life support.  In a speech of remarkable force and eloquence on Wednesday night to a congressional joint session, President Obama made clear that he would use every resource available to him to assure that health reform survives to become law.
The August recess had left hopes [...]

The need to “bend the curve” of rising health care costs is certain. Less certain is the nation’s political will to take on that difficult task.
That conundrum emerged today at a Washington, D.C. briefing sponsored by Health Affairs. The briefing, held to launch the journal’s Sept-Oct issue, a thematic volume titled “Bending The Cost Curve,” [...]

If the growth rate in U.S. health care spending continues at current levels, a vastly greater share of personal income and economic resources will be devoted to health care, according to a new analysis in the September/October issue of Health Affairs. And even if that growth rate could be slowed sharply — to a pace [...]

The traditional summer break that provides members of Congress a respite from their official duties instead, in some areas, turned into a raucous, sometimes angry series of town hall meetings focused on the ambitious health care reform proposals of Democrats. The meetings have given reform opponents and advocates an opportunity to voice their opinions, although [...]

What exactly is the U.S. government’s role in health care and how might it change under health reform? What are the implications of slowing the rate of growth in Medicare spending and what would the impact be on beneficiaries? How do the issues involved in end-of-life care really look to the people and providers who live it?
These issues [...]

Editor’s Note: The post below argues that accountable care organizations (ACOs) represent a critical step away from volume-driven health care payment and toward better health and better care at lower cost. In addition to Aaron McKethan and Mark McClellan of the Engelberg Center for Health Reform at the Brookings Institution (pictures and bios above), the post is coauthored [...]

Editor’s Note: In the post below, Jeff Goldsmith argues that the concept of accountable care organizations (ACOs) is “not ready for prime time.” In a response, Aaron McKethan, Mark McClellan, Elliott Fisher, and Jonathan Skinner state that ACOs represent a critical step away from volume-based health care payment and toward better health and better care at lower cost.
Everyone [...]

The “public plan” is today’s ultimate Rorschach test; different observers may see very different perspectives.  Particularly when the advocates leave loose ends, their opponents weave those untied threads as they will.  Nobody’s on firm ground so no concrete debate is possible.  Lots of smoke, hardly any light. 
It seems that there are some simpler clarifying questions [...]

Medical spending on conditions associated with obesity has doubled in the past decade and is estimated to have reached an annual rate of $147 billion in 2008, say researchers in a new study published July 27 on the Health Affairs Web site. The study was presented at the U.S. Centers for Disease Control and Prevention’s “Weight of [...]

As President Barack Obama and his allies press their case for health care reform, the president exhorts that his vision will slow the growth of medical expenditures, expand coverage to millions, and improve the quality of care.  In the trenches, where millions of medical interventions occur daily, physicians and hospital managers who do the heavy lifting describe a [...]

At an 11:00 AM press conference on Monday, July 27, Eric Finkelstein of RTI International will discuss the findings from a new study on medical spending on obesity that will be published this morning on the Health Affairs Web site. Finkelstein will be joined by Thomas Frieden, Director of the Centers for Disease Control and Prevention, and Bill [...]

Editor’s Note: Below is the transcript of a Health Affairs Blog Roundtable on Atul Gawande’s New Yorker article on McAllen, Texas, and variations in health care costs. The roundtable used the article as a jumping-off point for a wide-ranging discussion on the policy implications of cost variations, delivery system reform, and other topics. Participants included Robert [...]

Editor’s Note: In the post below, Amitabh Chandra responds to criticisms of the Dartmouth Atlas and offers his vision of the lessons of the Dartmouth findings on variations in health care costs and practice styles. Watch the Blog tomorrow for a roundtable discussion on Atul Gawande’s New Yorker article on McAllen Texas and the policy [...]