The push for reform is hitting its head against a wall of political posturing.  From the practical and 'get it done, already' point of view, this is crazy -- we've never been in a better position, given the nexus of the health care crisis and Obama charisma, economic sense and stimulus money, to effect change.

What can be done to move things forward?  Managed care (or something similar) will emerge just as it always has, when the sting of costs becomes even more palpable and as the inequities of accessibility and the unremarkable return on investment give even the causal observer, pause.  Managed care is required to balance the three-legged stool: quality, cost and access.  Incentives will be aligned.  The uninsured will be no longer and advocacy in the setting of the medical home will emerge and be funded.