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91 days of health-care reform

The landmark health-care reform package took effect 91 days ago - on March 23 - and the Obama administration now is trying to turn the 2,700-page bill into a working program. What that means is that we all need to watch closely how the law is being enacted. In that light, there are two pieces of news today that are worth noting.

First, the Department of Health and Human Services today announced it was establishing a Patient's Bill of Rights that begins to turn some of the law's promises into reality. According to HHS, these rules, which take effect Sept. 23, will prohibit insurance companies from past practices that they used to limit the care they cover, as well as eliminating any requirement that you need to get prior approval before going to an emergency room or that women need to get a referral to see an Ob/Gyn. While it isn't at all surprising, it is still important to see that it's happening.

Second, is a New York Times story about how Obama's nominee to head up the Medicare program, Donald M. Berwick, MD, faces a bruising confirmation battle due to Republican opposition. How this plays out is critical for the success of the legislation. A huge component of making this bill work is the ability to enforce protocols for care that could lead to big cost savings. The Republicans who oppose Berwick's appointment are trying to cast him as a proponent of rationing. Berwick's supporters say that he is an advocate for uniform standards that will ensure that all of us are getting better care - and that there is more care available for all of us because of the improved efficiencies that accompany adoption of such standards. How this nomination battle plays out could augur how successful will be the future efforts to rein in costs.

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