A million other people and I will do that this year, including our Governor Tim Pawlenty and wife Mary who will fish Lake Kabetogama in Voyageurs National Park on Saturday – the season’s opener. This is the earliest no frost/no snow spring in recent history. The ice went out on Kabetogama near the Canadian border nearly a month ahead of time and walleyes started spawning two weeks before they usually do.

THE LIMITS TO “PRUDENT FISCAL MANAGEMENT”
Were reached last week when the Minnesota Supreme Court overturned Governor Tim Pawlenty’s 2009 unilateral $2.7 billion cuts in state spending. Republican presidential candidate Pawlenty, reacting to the court’s 4-3 decision, said that in eight years as governor he had “done everything in my power to reduce spending, put a lid on taxes and reduce taxes.”

Pawlenty’s battles with a DFL majority in the MN legislature are well known. But none of the members of the MN Court were appointed by DFL Governors. A majority of them were appointed by Pawlenty, including the Chief Justice who wrote the majority opinion.

The governor undoubtedly has “managed” state government well: Good appointments to head state departments, strong state-of-the-state messages about reforming policies that drive costs and government re-organization efforts to create efficiencies in public service. However, his eight-year effort proves you cannot get out of the tax and spending hole by strong statements and “prudent management.” Only leadership will do it.

We Minnesotans elect a governor to help us define, understand and resolve the needs we have in common; and to define the role that we the people, our communities and state government play in responding to those needs. When the old responses are ineffective, we expect he will involve us, as much as the legislature we elected, in creating new ones. I think when he was first elected, Tim wanted to do this. But over time he has become part of the problem, challenging Democrats and government and taxes and spending.

WHY IS IT ALWAYS SOMEONE ELSE’S FAULT?
Former Bush speechwriter Michael Gerson described Pawlenty recently as “a nice guy in an angry time.” He quoted Tim to the effect that “something is happening for the first time in my adult life. Average people, not activists, are openly talking about debt and the deficit with an understanding that matters. They know something is amiss. One of the driving sentiments is that government is out of control.” Now, who can disagree with that? Not me.

Here’s the problem: Pawlenty has been our government for eight years. While his style and persona are different, he has contributed, right along with Sarah Palin, Michelle Bachmann, Rush Limbaugh and Sean Hannity, to creating this “angry time.” He talks about debt and deficits and the imperative to control government as though it’s a problem created only by Democrats to be resolved only by Republicans; created by taxes and spending to be resolved only by cutting both. It’s not. I am also the problem – my fellow citizens and me.

Democrats and RINO Republicans didn’t create this mess. We did it all together: Liberals and conservatives, right and left and centrists. Our appetites, our expectations, our corporate and union enterprises and their lobbyists, our single issue groups and our extra special interests did it. We are all responsible for $40 million dollar senatorial campaigns in states like Minn. and for the lock that lobbyists have on lawmakers. Managers work to assure that customers are satisfied enough to re-elect them…which sometimes involves blaming others for unresolved problems.

SERVANT LEADERSHIP
Robert Greenleaf, in his prescient book on “servant leadership,” suggests that in every society, in the best of times and the worst of times, we have among us people who have a vision for what should be and what can be. But we rarely recognize them because too many people in positions of leadership find it in their self-interest convenient to blame others for problems that affect us all. Greenleaf then describes the times in which we find ourselves today: “When the pupils are ready, the teachers appear.” Leaders who call us out to define and meet the challenges we face.

Leaders tell us what we don’t want to hear about the breadth and depth of the mess we’ve helped them create, and what we need to do, together, to work our way out of it. It means making your case to those of us who are willing to change in the name of our children and grandchildren, and the homeless in our church basement, and the hungry on our street corners, and the failing in our schools and our addiction treatment centers.

Frankly, to keep this as non-partisan as possible, let me suggest that many of us voted for Barack Obama because an instinct told us he was this servant leader the times required. I still believe that. But I have yet to see it. Or hear it. There is much to admire about the way in which he has confronted problems the likes of which no president has faced on the day he was inaugurated. But President Obama has yet to tell us what he thinks about why it is our problem and why he believes we, as Americans, have the potential to deal with it if we better understand it. A potential the Greeks and the Portuguese and the Germans don’t have.

WATCHING THE PRIMARIES
In Kentucky, the hottest primary in the country goes down May 18. The establishment there, and around the country, is supporting KY Secretary of State Trey Grayson against Dr. Rand Paul, the son of libertarian GOP Cong. Ron Paul (R-TX). Retiring GOP Senator Jim Bunning, who hates “the establishment,” including Senator Mitch McConnell for forcing him out, endorsed Paul. So did Sarah Pailn, Steve Forbes, Gun Owners of America and No. KY Right to Life.

Grayson is counting on former VP Dick Cheney, right wing former senator and presidential candidate Rick Santorum (R-PA) and Rudy Giuliani, who told Kentuckians, “Grayson is not part of the blame America first crowd that wants to bestow the rights of U.S. citizenship on terrorists.”

THE ANTI-INCUMBENT MOOD COULD CARRY THE 2010 ELECTION
Senator Bob Bennett (R-UT) has been a close friend for a long time. I watched the process by which new Republicans took over the party convention in Utah and used men half Bob’s age to deny him the endorsement of a conservative party of which he has long been emblematic. The debate was not about better conservative ideas for the problems faced by Utah or the country.

It was simply that Bennett’s been there too long and has become part of the problem. Although Bob was re-elected in 1998 and 2004 by “landslide” votes, he helped bail out Bush with TARP and he worked with a Democrat, Senator Ron Wyden (D-OR), on a bipartisan health reform plan in 2007-08.

Another good friend, Dan Coats of Indiana, who served two terms as a Republican Senator and then retired to be Bush’s ambassador to Germany, won a narrow primary victory to succeed retiring Evan Bayh (D-IN). Dan was up against a better known congressman and a right-winger endorsed by Senator Jim DeMint (R-SC) and squeaked by with 39% of the vote.

Next up: Senator Arlen Specter of PA, who left the GOP for the Democratic party and faces a tough Democratic primary. Arlen could win the primary and lose the general election against a man he has already defeated simply because he’s part of the problem for which no one knows the best solution. And too many people don’t seem to care.

PRESIDENT OBAMA APPOINTS A CYPHER TO THE SUPREME COURT
Everyone who has worked with Elena Kagan speaks highly of her. But no one knows what positions she is likely to take on the constitutional issues of the day. Kagan is clearly a product of the “SCOTUS as policy-maker” times we live in. The Republican base, for example, makes no bones about the fact that nothing President George W. Bush did can compare with his Supreme Court appointments which tipped the balance in their favor. The Wall Street Journal calls her “Elena Obama.” Senate GOP leader Mitch McConnell (R-KY) complains about Kagan’s lack of a “paper trail” of opinions, to which Judiciary Chair Pat Leahy (D-VT) replies, “If law-giver Moses were nominated they’d reject him for lack of a birth certificate.”

The president selects someone he knows very well, respects and is confident will make an excellent justice. But, as NYT columnist David Brooks opines, “She seems to be smart, impressive and honest – and in her willingness to suppress much of her mind for the sake of her career, kind of disturbing.” But then, so is the Supreme Court Justice “confirmation – as – election” process.

Ironically, I recall that President Jimmie Carter’s nomination of Kagan’s former mentor, Congressman Abner Mikva (D-IL), to the federal court was the occasion for my decision to stand by the president of the U.S. on court nominees unless hearings demonstrated lack of good judgment, character or professionalism. That position was not at all unusual back then. But not today, I regret to say.

THE SUPREME COURT AND THE CONSTITUTIONAL PROTECTION OF FREE SPEECH
I don’t agree with the Court’s decision in Citizens United v. FEC that corporations have the protection of individuals when it come to advertising for and against candidates. Federal Judge Paul Magnuson just ruled that under the Citizens United ruling that Minnesota corporations are constitutionally assured the right to spend whatever they will. My concern is three-fold: (1) Money makes a big difference in today’s televised election campaigns and national money can easily distort the record of state and local candidates. I believe the court was wrong also in 1976 in Buckley v.Valeo when it assured wealthy citizens the right to spend as much as they want on their own campaigns. We’ve watched this ruling result in “buying” elections…repeatedly.

(2) Anonymity is assured. Accountability is not. Who is XYZ Inc.? What is its interest in policy? Who at XYZ decides my senator is worth supporting or not and why? Or, as President Obama said recently, “voters ought to have the right to know when some group like ‘Citizens for a Better Future’ is actually financed by ‘Corporations for Weaker Oversight.’ ”

(3) Nationalization of public policy. We are gradually eroding the influence of the average American and the average Minnesotan in national and state policy that directly affects each and every one of us. The influence of money on policy-making is stronger even than its influence on elections, but the two are directly related in the minds of Minnesotans. That’s one good reason why they’ve lost what trust they had in elected representatives.

YOU CAN’T JAIL A WALL STREETER FOR NOT ASKING QUESTIONS
Warren Buffett made it clear that Goldman Sachs, with which he has done business for 50 years, did not engage in criminal behavior. So there you have it. Who needs a Crisis Inquiry Commission and the theatrics of congressional investigations of The Street? Or another elaborate 13-month Senate debate between political partisans over a Consumer Protection Banking Reform Bill? Or a lawsuit by the SEC?

Here in MN, attorney Mike Ciresi, on behalf of four large nonprofits, including his own foundation, is suing Wells Fargo over the failures caused by its securities lending program. The CEOs of Wells Fargo, Dick Kovacevich and now John Stumpf, are testifying in court they didn’t know they were doing it. In fact, says Stumpf, he had to learn from Wikipedia what these “structured investment vehicles” were.

Sounds just like the infamous Bill and Hillary Clinton defenses which set the standard for big-shots to claim ignorance of what understudies were up to. Stumpf compounds his version of corporate accountability by claiming to be “the CEO of 80 CEOs,” implying that we just can’t expect him to know everything.

There are directors of these mega billion dollar corporations doing the same thing, and collecting millions in compensation for not asking, “what’s an SIV?” Or what is the product we peddle that makes me so much money on my stock options? Can’t go to jail for what you don’t do, right? In this fight, in a Minnesota federal courtroom, I’m putting my money on Mike Ciresi.

OIL AGENCY CEDED OVERSIGHT OF SAFETY TO INDUSTRY
The WSJ story (5-7-10) on off-shore oil drilling worker safety in the U.S. compared with Europe reflects a national conservative philosophy on the role of government. Set performance goals and allow the industry to determine how best to achieve them. In a perfect world, I love it. It’s what we need in insurance payment for health care – to re-align incentives, with oversight to assure that “best practices” by some are quickly adopted by others.

That doesn’t happen where worker safety is involved like it would when doctors decide 10 times a day what are the most appropriate and medically necessary diagnostic and therapeutic choices for patients, then live with peer-reviewed results. But it is ideology and Republicans own it. As part of Newt Gingrich’s “Contract with America” in 1995, he created the Progress and Freedom Foundation, funded by industry money, to delegate authority for medical device and drug safety and efficacy determinations from the FDA to private and industry-funded companies.

PFF employed people such as former Bush 41 HHS Secretary Lou Sullivan to add legitimacy to the effort which, fortunately, went nowhere, thanks to oversight by the likes of Congressmen John Dingell and Henry Waxman. The ideology found a home in other agencies, including the Mineral Managements Service of the Dept of Interior. MMS collects drilling revenue and oversees worker safety. In 2005, it launched its industry self-regulation effort, citing authority in a 1996 law passed by the new GOP Congress. Senator Bill Nelson (D-FL) on CNN Sunday said, “Big oil would call in its votes to prevent congressional oversight of safety violations.”

by Chan Lowe

ARIZONA – IMMIGRATION POLICY
In America, we routinely produce drivers licenses or other official government documents. The frequency has increased as hackers access our social security numbers and credit card numbers and drug dealers, terrorists, refugees and rich people have found thousands of ways to get into or out of (Saudis on 9-12-01) our country. This is not because we have become a police state in which any uniform can “demand our papers.”

We are a nation of laws rather than of men, and laws in this country are frequently broken by all kinds of Americans, and only infrequently are we caught at it. And even less frequently arrested, tried, convicted, and jailed. Our national government should have an enforceable immigration policy. But does any nation other than Israel, North Korea, Iran, Burma and, to some degree, the island of Japan? The idea that we can ring the country – land, sea, air – with members of the armed services who will police illegal entry and exit is incongruous.

The constitutional and political issue is whether in our constitutional federalism, any state has the right to abrogate the rights of citizens of the nation because the national government is not “enforcing” some law a majority of the state legislators think is dangerous to the welfare of the state’s citizens (with one rancher death and one allegation of who killed him) to light the fire.

WHERE DOES IT END?
Every time the U.S. goes to war somewhere – from Viet Nam/ Cambodia/Laos to Nicaragua and Somalia – we end up with massive numbers of refugees settling in places like Minnesota. My German and Polish relatives can’t get here unless their governments go to war with us. Does the national government provide refugees with financial subsistence or does that fall on our state and local governments, and on our charity?

The point is, there isn’t a lot of constitutional logic to this issue – one way or the other. But this country is divided right down the middle on who we like and who we don’t, who we trust and who we don’t, what we should do and what we shouldn’t. Only half of us support the president – because we either like him, voted for him or realize he’s the only one we have.

Limbaugh/Beck et al. make a lot more money than our president, but they have absolutely zero responsibility for the consequences of what they preach. To them, President Obama is at least a liberal, a socialist or maybe a Nazi or Marxist. Anyway, he’s damned dangerous. So we have to “fight” him and to “kill” his programs.

Fight the insurance mandate, cap and trade, bail-outs, repeal health care for all, cut taxes and increase spending on defense and border patrols, get the guys who caused the recession and our job loss, but don’t keep Wall Street from making money any way it can, make pregnant women take C-Scan tutorials on a pregnancy they didn’t expect, but do not expand health care to poor women.

People believe Congress represents none of us, left or right, but the self-interest which ensures re-election off the money spent influencing their judgment on national policy. So they live off opinion polls, ridiculous oversight hearings and sound bite statements of “principle.”

AT THE MN PRAYER BREAKFAST in April, the chaplain of the 47th National Guard Division, just returned from his third tour in Iraq, said a prayer. It reflected the growing frustration of Minnesota guardsmen and women who are being stretched to the physical and emotional limit by repeated deployment in wars to which they are unaccustomed, but to which they must adjust.

They watch the Americans for whom they do this on TV, and the Internet, etc. spend all our energy fighting each other over issues which to the “Red Bull” division just don’t measure up to the America they signed up to defend and protect, with their lives and those of their families.

NORM COLEMAN AND MICHAEL STEELE
The National Republican answer to the election of Barack Obama as America’s first African-American president was to elect Michael Steele chairman of the GOP. He hasn’t done well at it, on any front. So we can expect former MN Senator Norm Coleman soon to be asked to replace Steele as national party chair. The move may not take place until after November 2. But it will happen. Norm’s political and fund-raising prowess is well known and he also knows former Sen. Barack Obama from four years in the Senate.

MICHELE BACHMANN STILL IN TOP FIVE
According to ohmygov.com, Cong. Ron Paul (R-TX) has 193,959 Facebook fans as of April 20. That puts him way ahead of Cong. Paul Ryan (R-WI) at 26,146 who is followed by Cong. John Boehner (R-OH), Cong. Adam Putnam (R-FL) and Cong. Michele Bachmann (R-MN).

WCCO RADIO RETIRES THE BEST ‘POLITICS IN MINNESOTA’ JOURNALIST
Eric Eskola, or “muffler man” as we call him at home during his Friday night TPT gig with wife Kathy Wurzer, took a buy-out after 30 years as one of the very best local journalists. In the competing Star Tribune, columnist Jon Tevlin honored Eric by quoting his journalist competitors and then, ominously, suggested, “Nobody I spoke with can understand WCCO Radio letting Eskola walk out the door, unless it is giving up on news.” In his piece entitled “There goes a stellar part of the ‘Good Neighborhood,’ ” Tevlin then quoted NY Times media critic David Carr: “The neighbor may still be good, but he’s a lot dumber.” Eskola refused to be interviewed.

SMALL TOWN MINNESOTA
My St. John’s Prep and University classmate, Floribert “Flip” Spanier of St. Martin, MN., is retired in St. Paul. Flip responds to my comment about small town Minnesota and products like John Stumpf, the CEO of Wells Fargo. “I am proud of John, having helped him get an internship with the American National Bank in St. Paul which launched his career. He is the second oldest of 10 children, paid his way through St. Cloud State University and then married my daughter whom he met while I spent 11 years at the bank in Pierz. Like you, Dave, John’s father was German and his mother Polish. Which provided a superior intellect from the mother and a work ethic second to none from the father.

CONFIRMING BERWICK FOR CMS WILL BE LIKE CONFIRMING PRESIDENT OBAMA’S SUPREME COURT CHOICE
I hate to even suggest it, but if Republican repealers and their tea-party allies and “angry Americans” and “right-to-lifers” and “tenthers” hate the health policy reform bill as much as they say they do, then Dr. Donald Berwick will make a great target. The Senate Finance Committee chaired by Max Baucus (D-MT) must hold hearings on Berwick’s qualifications to be President Obama’s choice as head of the Center for Medicare and Medicaid Services (CMS).

Republican staffers have been busy fact-checking every expression of every possible Supreme Court nominee for at least a year, with help from all the single-issue social issues groups. Because of the election volatility of health reform, they must do the same with Berwick. For the “sound bite” journalism crowd, there will be plenty of material.

Berwick is, if nothing else, an honest, constructive, and medically qualified critic of much of the U.S. health system and payment policy. That’s why he was chosen to make a difference in both. The editors of the Wall Street Journal, who have led the print media opinion attack on health reform from the get-go, have just started on Berwick. In a recent editorial criticizing President Obama for promising to bring down health care costs, the editors quoted a 2009 Berwick interview as ff: “The decision is not whether or not we will ration care – the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.”

RATIONING OF U.S. HEALTH CARE BY ACCEPTING LIMITS ON ACCESS AND COVERAGE
Anyone who knows health care policy knows that Berwick is absolutely right. We are rationing care to tens of millions of Americans right now by running a system in which only hospitals are required to provide medical services to all Americans, a system in which excellent care is not financially rewarded and needed care is not provided.

Medical costs have so far outstripped the revenue of American families, and of state and local governments, that each is having to rob from the needs of education, behavioral and mental health, and a wide variety of needed services that reduce the incidence of accident and disease.

But, with the health reform record of the past year, every town hall meeting, every tea party meeting, and every Republican fund-raising mailer replete with words like “kill Obamacare, death panels, socialized medicine and European style rationing,” the opponents will have a field day.

POLLS SHOW HEALTH BILL IS CONFUSING US
No kidding? Kaiser Family Foundation poll shows 55% of us are confused by the recent health reform law, 45% are pleased by it, and 30% are ANGRY. When Republicans passed the Medicare Modernization Act of 2003, similar numbers of us reflected confusion, but no anger. There was an outpouring of information and advice from HHS/CMS, from AARP and from many of us at a local level cooperating with radio and television to help seniors make decisions. Not likely this year, except from AARP. Voters in 2003 knew that there was plenty in the bill for Medicare beneficiaries; they simply needed help making decisions. Taxpayers knew the costs were being passed on in the form of deficit rather than premium or tax increases.

PHYSICIAN/HOSPITAL ACCOUNTABLE CARE ORGANIZATIONS
Francis J. “Jay” Crossan and Laura A. Tollen have finished their three-year effort entitled: Partners in Health: How Physicians and Hospitals Can Be Accountable Working Together. The 234-page book is well done and well researched and is available at www.josseybass.com for those of you interested in the future of health care delivery. For many years, Jay was head of the physician side of Kaiser-Permanente and, for the last six years, a member of the Medicare Payment Advisory Commission. Laura is a senior policy consultant at Kaiser Permanente Institute of Health Policy and an author whose work with Alain Enthoven at Stanford in 2004 is well known.

NURSES MAY GO ON STRIKE IN MPLS – ST. PAUL
Have you ever heard of doctors threatening to go on strike if their income and hourly work demands aren’t met by their employers? I haven’t. However, doctors, unlike nurses, are able to increase their income by prescribing more medical services or creating shortages in their specialties or just lobbying for increases in pay for specific procedures. Doctors will refuse to see Medicaid patients to put pressure on state legislators; or refuse to see Medicare patients to pressure Congress. Or just not work in rural or inner city areas. Not nurses.

This is not an argument for nurses being able to do what doctors do, but a description of an unhealthy national health care system in which withholding of services is regularly rewarded, and making your professional skills and judgment more available under more difficult circumstances is penalized. It is an argument for professionalism and self-discipline among both professions. It is an argument for integrated care systems in which the risks and the rewards of patient care are shared among all those who choose to make a career of serving those of us in need.

SISTER CAROL KEEHAN
Bishop Lawrence Brandt of Greensburg, PA, has decreed that any religious community that takes a public stance against the church’s teaching on human life will be denied use of the diocese’s resources. This was aimed at the Sisters of St. Joseph of Baden, PA, who supported passage of the health reform bill. A very small man stands up to exceptional women, simply because he can.

Meanwhile, one of the critically important forces behind the passage of the bill, Sister Carol Keehan, was named to this year’s Time magazine list of the world’s most influential people. Carol Keehan is president and CEO of the Catholic Health Association and ranked 22nd most influential world leader. Victoria Reggie Kennedy nominated Carol and said, “Leadership is not about doing what’s easy. It’s about doing what’s right.”

INTERESTING NEW LEADER AT S.E.I.U.
I first met Mary Kay Henry when she sought help in persuading Fairview Health System to “see the light of day” on contract negotiations with SEIU a few years ago. We visited a few times, the last being at Amy Klobuchar’s office in D.C. with Andy Stern, the man she is succeeding.

Having known Stern for a much longer time, I found Henry’s approach to her role much more interesting. Hospitals in America face a most challenging future, and the SEIU is going to have to think strategically about a more cooperative than confrontational role in adjusting to the realities of changes in payment policy and the increased efficiencies essential to this new world of reformed health care.

CATHOLIC HOSPITALS
12.5% of all U.S. community-based hospitals are Catholic and account for 15.5% of all hospital admissions. Catholic hospitals are required to follow the U.S. Conference of Catholic Bishops religious directives on medical care that prohibit contraception, abortion and sterilization services and, in some instances, prohibit ending artificial hydration and nutrition.

The on-line version of the Journal of General Internal Medicine reports on a survey of 446 family physicians and internists that says 20% report having experienced a conflict over faith-based patient care policies. Eighty-six percent said they would encourage patients to seek the service elsewhere, 10% would offer alternative treatment, and 4% endorsed violating the hospital’s policy to provide care.

THE AMERICAN BOARD OF ANESTHESIOLOGISTS
Has acted to keep its 40,000 members from participating in death penalty executions. There are 3,200 prisoners on death row in prisons in 35 states. Most of the 50 executions each year are by lethal injection. States recruit doctors, including anesthesiologists, to assist in the injection, including inserting the catheter and infusing the three-drug cocktail. From now on, any ABA member doing so risks revocation of his or her certification, without which it’s difficult to practice in American hospitals.

Publication of group practice performance paper
We are pleased to announce that the results of the research sponsored by CAPP on the performance of group practices has been published in this month’s edition of Health Affairs. The study, “Higher Health Care Quality and Bigger Savings Found at Large Multispecialty Medical Groups” by William B. Weeks, Daniel J. Gottlieb, David E. Nyweide, Jason M. Sutherland, Julie Bynum, Lawrence P. Casalino, Robin R. Gillies, Stephen M. Shortell, and Elliott S. Fisher provides compelling evidence that large multispecialty groups and organized health care delivery systems deliver higher quality care at a lower cost than other providers in their market regions.
http://content.healthaffairs.org/cgi/content/full/29/5/991?ijkey=4ZetkUR.7pMYg&keytype=ref&siteid=healthaff

University of St. Thomas, Minneapolis, MN
On February 17, more than 100 physicians and health care leaders gathered at the University of St. Thomas to spend an evening networking and gaining valuable takeaways on the hot topic of physician leadership competencies. James Stoller, M.D. from the Cleveland Clinic, shared his expert opinion on effective physician leadership in health care organizations. Watch an excerpt from Dr. Stoller’s talk and video of the Q&A session. http://exed.stthomas.edu/plcstoller/landing-67814-1076GY.html

New Briefing on Payment Innovation: What Lies Ahead Under Health Reform?
A May 10 briefing sponsored by the Alliance for Health Reform and The Commonwealth Fund, “Pathways to Payment Innovation in a Post-Health Reform Era,” explored the major payment initiatives in the new law and their potential effects.

Panelists—including Mark Miller, executive director of the Medicare Payment Advisory Commission (MedPAC); Gail Wilensky, a senior fellow at Project HOPE and former chairman of MedPAC; Stuart Guterman, The Commonwealth Fund’s assistant vice president for Payment System Reform; and Nick Wolter, CEO of the Billings Clinic in Montana—explored such questions as: What role can payment changes play in moving health care away from the fee-for-service system toward value-based reimbursements? What can be learned from earlier public and private efforts to better align payment incentives with program goals? How will the new Center for Medicare and Medicaid Innovation work to test new approaches, and then scale up the successful ones?

Resources from the briefing are available on the Alliance for Health Reform Web site, and a webcast and podcast of the event are available on the Kaiser Family Foundation’s site.