Reforming health care-a personal perspective.

As I write this Editor’s Page, the mid-term elections are upon us. I don’t know about you, but I have become tired of hearing ‘‘attack ads’’ that tout the need for ‘‘change’’, and the incessant phone calls from various interest groups who do not seem particularly interested in the fact that I might find it irksome to be disrupted repeatedly! The thought that this would all be over soon has helped to keep me on an even keel, until last week I noticed at a stop light that the car in front of me was sporting a license plate holder that included a small video ‘‘reader board’’ across which scrolled a continuous stream of negative political messages! I realize that years ago we had access to a limited amount of information about candidates whowere running for office. We could get information from articles in the newspapers (some cities even had more than one newspaper!), and from news commentators on the radio or television. For presidential elections, we could even watch a debate or two between the candidates, and listen to them discuss their goals and agendas. As I learned in high school (at this point in my life, I am just glad to be able to remember going to high school!), however, information can be—and often is—presented in ways designed to influence the opinion of the viewer. Hence, having access to limited amounts of information meant that our opinions were to some degree at risk to be shaped by a few influential ‘‘providers’’ of what was considered news-worthy. Of course, in 2010 the news cycle is 24/7, with more television channels to choose among than time to watch all of the material available. Add to that the enormous amount of material (both written and video) available on the Internet and through telephone access, let alone on license plate holders, and one could argue that since we now have access to a lot of information, we are less likely to be influenced by a few voices. On the other hand, it seems clear that sometimes there is just too much information for normal humans to process. And, of course, to whom should we pay attention? Who is believable? The information that is provided to us often is still ‘‘spun’’ in ways designed to help us reach conclusions that someone wants us to reach. I am sure that you, too, have seen ads that show an unflattering picture of given candidate’s opponent, often with unpleasant background music in a minor key, accompanied by selected quotes (sometimes taken out of context) designed to show why they are ‘‘not on our side’’. Have you had trouble figuring out who was behind such ads? Have youwonderedwhy the candidates could not just stick to presenting their thoughts and goals and plans, instead of spending most of their time impugning the opposition? While the pre-election rhetoric has covered a large range of topics, and while it seems that the top 3 concerns to voters are the economy, the economy, and the economy, one area of particular interest to me is health care. I suspect that many readers of this Journal share that interest. It is widely reported that in the United States, we spend too much on health care, and get too little in return. A recent summary from the Commonwealth Fund Commission on a High Performance Health System, ‘‘Results From a National Scorecard on U.S. Health