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Pulling it Together: Implementation

When I was a graduate student at MIT my adviser Jeffrey Pressman was a great political scientist who had just written the seminal book on program implementation.  It was called, simply enough, Implementation, with a subhead that read: “how great expectations in Washington are dashed” (OK, we political scientists study…

Pulling It Together: Uninsured But Not Yet Informed

If there is one thing there is general agreement on when it comes to the Affordable Care Act (ACA) it’s that it will help the uninsured.  The estimates are that 32 million people will gain coverage under the law through an expansion of Medicaid and tax credits, which will help…

Pulling It Together: New Orleans Five Years After the Levees Broke

President Obama’s visit to New Orleans on August 29, five years after Hurricane Katrina and the levee failures nearly destroyed the city, presented an opportunity for him to deliver a message on behalf of us all: The country still cares. It was a timely message. Seven-in-ten residents of New Orleans…

Pulling it Together: Teaching An Old Dog New Tricks

Way back in the eighties when I was Human Services Commissioner in New Jersey, I established something called the Garden State Health Plan (GSHP).  It was the first — and I think the only — federally qualified state-run HMO for Medicaid beneficiaries.  One goal of the GSHP was to reallocate…

Pulling it Together: A Note on Presidential Leadership Strategy

In inside circles of the health reform debate there has been criticism of the President for not weighing in earlier and publicly on the details of health reform legislation. Does he want the Senate’s approach to employer obligations, or the approach taken in the House? What form of public option…

Pulling it Together: A Holiday Reminder on the Economy and Health Care

With so much of the focus on the political dynamics of the health reform debate and a few hot button issues, I wonder if we have lost track of what propelled health care to the top domestic issue in the first place—people’s concerns about paying for health care in the…

Pulling It Together: Predicting the Future

A fair amount of attention was given recently to projections made by the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS) about the new health reform law, and how they compare to previous estimates by the Congressional Budget Office (CBO). No doubt the various projections will be…

Pulling it Together: What Conservatives Are Winning

Conservatives are out of sorts these days about the direction in which health care is headed. They think the new health reform law expands the role of government too much and spends too much at a time when they believe deficit reduction should be a higher priority. The claims about…

Pulling It Together: A Recovery Raises Expectations Too

New Orleans is a city still struggling with the aftermath of Katrina and the levee breaks. The people of New Orleans feel that the nation and the federal government have largely forgotten them. Those are the results of our 2008 survey of the people of New Orleans, the second in a…

Pulling it Together: The Sleeper in Health Reform

The health reform legislation currently being crafted on Capitol Hill is undeniably complex.  To oversimplify slightly it can be boiled down into four parts: coverage (subsidies for private coverage and Medicaid expansions); delivery and payment reforms; insurance market reforms and regulations; and prevention, with each broad category containing a range…