NOTES FROM THE ACADEMY HEALTH POLICY CONFERENCE.

Susan Dentzer, editor-in-chief of Health Affairs, brags that Tom Daschle reads her journal to unwind. "We're thinking of including a free version of Turbotax with future subscriptions," she says. The crowd groans. She also notes that health spending is now one out of every five dollars in the economy and, not coincidentally, about one out of every five dollars in the stimulus.

Jeanne Lambrew, Daschle's co-author and, in theory, his deputy director at the White House Office of Health Reform, gave the opening plenary. Not a whole lot of news in her talk. She noted that the growing recognition that our system provides poor quality is new to this health reform debate. Fifteen years ago, most observers thought our health outcomes were at least competitive with peer nations. Now we know they're not, and particularly not when divided by cost, and particularly not when divided by cost and including the trends. In other words, we're getting worse on many important measures at the same time that we're getting more expensive. Our health system isn't only a moral disgrace. It's also a bad value.

She aggressively framed health reform as a response to the fiscal crisis. Every one percent drop in employment means 1.1 million more uninsured, larger Medicaid rolls, more people relying on COBRA as transitional insurance. She divided the stimulus spending into multiple parts. The first part she called "protection policies" to deal with that displacement: More money for COBRA and Medicaid. Allow unemployed adults to buy into Medicaid for one year (why only one year?). The next set of policies are being framed as job creation. This includes workforce training programs, money for health IT adoption, money for prevention, and money for comparative effectiveness research. She noted that a Kaiser Family Foundation poll showed a solid majority of Americans saying the recession makes health reform more, not less, urgent. She also mentioned a study showing that half of families in foreclosure pointed to medical debt as a partial cause.

She didn't say much more than that on comprehensive health reform. I asked her if it would be a year one policy. "Tom Daschle has said that FDR and Lyndon Johnson often moved very fast to take advantage of momentum coming out of an election," she said. "Barack Obama has said this is a top priority. But we'll have a lot more to say on our 2009 agenda in a few weeks." In other words, no answer. She also didn't say anything on the likely fate of her potential boss.