I recognize its sort of unfair to criticize without really hearing the argument, and instead react to one sentence. But I don't have time to watch the video, so...

the basic argument is, first, that health care is a political problem more than it is a policy problem

Really? Health care coverage, perhaps. But cost control? The politics and policy are equally the problem. The politics, because no one is willing to use political capital and offer any real solutions. But the policy is just as much of a problem-- no one has a solution that actually fixes the problem. I keep harping on this- but its important-- no one has really figured out how to control costs. Sure there are a couple of Nordic and small Asian countries with cost growth approximating GDP growth, but government-run health care in most OECD countries is still on a unsusntainable course. Health reform is one of their major issues, too.

I say this because I caution on the solution "of the moment." Today, its all about comparative effectiveness, health IT, medical homes, bending the curve" rather than reducing costs. There's lots of waste to cut out without any impact on quality, they say. You throw in a graph from the Dartmouth Atlas, mention Wennberg's name, and it sounds like the experts have got stuff figured out. But we've seen this scene played out before. In 1993, it was all about global budgets, managed competition, integrated health networks, and Enthoven was the academic buzzname of the day. You can go further back and talk about HMOs, and how they were going to solve the problem back in the 1970's with a greater empshasis on preventive medicine. There is a long history of "clear" policy fixes. The point being, this stuff is a lot harder than folks in DC are either willing to admit or understand.

There's a caution when someone like Orzsag is the driving intellectual force behind health care reform this time around. He's a relative newcomer to the game. And while he's correctly diagnosed the problem and gotten up to speed and just a few years, his faith-based adherence to how his plan will save $300 billion, and not understand the criticism against it-- he simply doesn't have the experience, nor do many on the Obama health reform team, that cost control is a lot harder than they (and I suspect you, hence my excerpt above) really understand. For those of us that have seen a few cycles of reform "fads" and followed carefully and/or contributed to the policy proposals, we recognize that there aren't any easy answers, or clear tough ones, for that matter. Health care is a very complicated, and intensely personal issue.

The recent Kaiser poll showed the fundamental policy challenge. People are understanding the 30% waste issue. But they "know" that the 30% waste is happening with other patients and other physicians. They are getting the right care. They don't want anyone-- public or private-- getting in the way of a patient-physician decision on health care. Ezra, you like saying, "One man's waste is another man's profit." Very true. But what's also true is "One man's waste is another patient's hope for treatment." When you throw in genetic variability, differences in response rates from different subpopulations and the like-- that hope isn't completely unjustified. What may be less effective or deemed not cost-effective at the population level, may be precisely the right treatment for the patient at hand. Determining how we ration care, in order to control costs, that addresses the medical complexities of population-based medicine, as well as people's beliefs that they (and their doctors) are the best ones to determine their own care-- that ain't any easy policy fix. Far from it.

So back to the beginning. Health care reform is more a political problem than a policy problem? Not when you're talking about the big picture on quality and cost. The policy is as much, if not more, of the problem.

The problem is that the adult population will allow a 24 year old's rube goldberg schemes to get a footing. Really absurd

Inconsequential side note: ever since I clicked on your SEIU/Forward Montana video link, my Ezra Klein bookmark ceased to contain an American Prospect icon and now contains a big purple S right next to your name. Not a bad logo to be affiliated with, just not entirely accurate.

Thanks for flying to Montana for this event!