While much of Washington worries about how to constrain Medicare costs, two contrarian legislators want the program to spend $1 billion more annually to fund residency training for new doctors.

Their plan responds to a projected physician shortage. There's heated debate about whether there will be a physician deficit in...

Rich people have paid more for Medicare coverage since the program began in 1966. Subsequent changes have regularly increased the extra amount those with high incomes must pay for coverage. That history often seems totally forgotten into today's Medicare reform debate about whether the program should be means tested (if...

Many Americans have an unhelpful habit of viewing the health reform debate as a morality play where those who treat us -- usually doctors and hospitals - are viewed as the good guys and those who pay for those services - generally insurance companies or government programs like Medicare --...

If you're an uninsured New Yorker shopping for a hip replacement, the going rate in Manhattan is $18,260. If that sounds steep and you're willing to try medical tourism, the rate drops to $7,500 in Boston, $7,099 in Baltimore or $6,399 in Washington.

If you're willing to go further...

In a surprising outcome better ascribed to the law of unanticipated consequences than a clever plot, a small group of moderate Republicans, particularly in the House of Representatives, are now poised to play an extremely powerful pivotal role.

This group, recently nominated for inclusion in the endangered species list, was...

No issue with less potential impact on public good gets more attention than tax reform. It is possible to argue that the amount of taxes collected from the public impacts the national economy, but there's no compelling evidence suggesting that the mechanism used (income tax vs, value-added tax vs. personal...

It's looking like a very merry holiday season with an extremely prosperous new year ahead for the lobbying community. Fiscal austerity is an ill wind that does blow some good to those paid to influence where the painful spending cuts will be made. And the growing possibility of tax reform...

A Supreme Court decision, surprising to many, has allowed the health reform experiment to proceed, but it doesn't guarantee its success. If President Obama wins re-election, that may still be unclear at the time of the 2016 election and could be an issue then.

As Massachusetts is...

The annual report of the Social Security trustees predicting when the funds they monitor (retirement, Medicare and disability) will be depleted has become a meaningless rite of spring that provides more heat than light. The news is always viewed as bad and ignored, a response that's helpful only to those...

This year's election may be the last one where it is possible to win the American presidency while receiving fewer votes than your opponent. A proposal to have states apportion their electoral votes to reflect the popular vote - known as the National Public Vote Interstate Compact --...

Analysts who fret about the health of America's democracy and fear that the voters are being marginalized by insiders, the rich and the media exercising outsized power must be breathing an enormous sigh of relief as they watch the Republicans select their presidential candidate.

Any doubts that the...

It would be hard to find a Washington political insider with greater power and fewer enemies than Jack Lew, who's moving over from the OMB directorship, which he's occupied twice, to become the White House chief of staff.

Not only does the appointment confirm that nice guys often finish near...

The last two Washington insiders elected president were Lyndon Johnson and Richard Nixon, each of whom did his part to fuel the distrust of government that's now a chronic campaign theme. So it is hardly surprising that Newt Gingrich portrays himself as a Washington outsider. He may be undisciplined at...

Presidential campaigns are less about substance than a test of how candidates will react to new and unexpected situations. I think that's a good thing because it is nearly impossible to predict the problems that will confront a new president, but likely that they'll be issues that weren't discussed in...

Criticism of American colleges never goes out of style. Costs are high. The institutions are reluctant to extend the spirit of open inquiry they espouse to their own operations. And there's ongoing dissatisfaction with the job they do, which isn't particularly surprising inasmuch as there's little agreement on precisely what...

Herding cats is easier.

That's the sole lesson to date from our debt ceiling cliffhanger. The center is less than solid.

Some analysts have wrongly concluded that we have a leadership crisis. If President Obama or Speaker of the House John Boehner, their argument goes, would only threaten to either...

It is easy to criticize the economic perspective of the Tea Party bunch in the House of Representatives (it sometimes seems that they aim to destroy the economy in order to save it), but even those of us who disagree must admit that they've created a bit of a boom...

There's a popular story circulating suggesting that America suffers from a shortage of medical care and the doctors who provide it.

The narrative basically goes like this. Many people fail to get care they'd benefit from because of inadequate insurance and a shortage of physicians that is...

Were I to attempt to influence Texas Gov. Rick Perry's decision on joining the 2012 presidential race by writing him a check for a million dollars, I'd probably get a lot of critical media attention and risk prosecution for violating campaign finance laws.

Were I to write...

For the past two years, I've been trying to ignore criticism suggesting that President Obama did an inadequate sell-job on health reform and should have spoken to the American people more directly and candidly about what he was up to. Until now I've contested these comments, responding that the very...