More or less buried in the massive debate over what our health care system should look like is a provision to create a national long-term care insurance program. The Community Living Assistance Services and Supports (CLASS) Act would allow people to pay an average $65 a month and, after five years, be eligible for between $50 to $100 a day in benefits. Insurers oppose the CLASS Act — clearly, it would cut into their sales of long-term care insurance, which haven’t been all that great to begin with. Other criticisms of the act: The government doesn’t need to be expanding programs even further than it already is, and low benefits would give people a false sense of security.

While $100 is better than nothing, I can tell you from experience that it doesn’t cover very much. More

By now you’re probably accustomed to your health care costs climbing each year. But brace yourself: 2010 is shaping up to be a doozie — a year that could shake up your opinion about how attractive the current employer-provided health care system really is..

When I reported a story for the November issue of MONEY about selecting 2010 health benefits, I was shocked by the expected rise in health care costs. And while I thought the forecasted increase was alarming, I didn't have enough space in the print edition to fully explore its roots and magnitude. So here's what I couldn't include the first time around:

Next year, according to human resources consultant Hewitt Associates, employees on average will see a whopping 10% jump in their premium, bringing their share of annual premium costs to $2,085. They’ll also see additional out- of-pocket costs — deductibles, co-pays and co-insurance, for example — climb 10%. Adding up all these expenditures, Hewitt says total health care costs next year will be $4,023 — triple where they were a decade ago.

Appropriately enough, this price shock comes as Congress is debating the largest health care overhaul our country has attempted in decades. More

Many workers unfortunate enough to get the ax in this recession at least had one thing working in their favor: subsidized health insurance. This past February Congress threw out a temporary life preserver for workers laid off between September 1, 2008, and December 31, 2009: For up to nine months, Uncle Sam covers 65% of the monthly premium that these newly unemployed people have to pay to stay on their company health care plan. Previously, if you stuck with your company benefits (under the federal program known as COBRA), you had to pay your share of the monthly premium, plus how much your employer covered. For singles, that totaled an average of $400 a month, according to Kaiser Family Foundation; for families, it came to $1,050.

Thanks to this new subsidy, 38% of unemployed workers are opting to remain on the company health plan, double the number that typically stick with it, according to a study from Hewitt Associates, a human resources consulting firm.

But now that lifeline is running out. More

Here's part two of my extended interview with renegade supply-side economist Bruce Bartlett, including some thoughts on Medicare that might just scare the pants off you. See here for part one, and here for the less-wonky version that's running in Money's November issue.

David Futrelle: As one of the original supply-siders, you worry that supply side economics had been reduced to little more than a religion of tax cuts, tax cuts, and more tax cuts.

Bruce Bartlett: That's right. A lot of what's wrong with conservative economists today is that they still act as if we're living in 1980 — as if we're facing inflation and massively high tax rates — and they're advocating policies that were perfectly appropriate for 1980 in an environment in which they make no sense. More

It used to be that the mythbusters at Snopes.com were the go-to-guys for refutations of weird rumors. These days, though, those diligent debunkers can barely keep up. It seems like only yesterday that tongues were wagging about Obama's alleged non-citizenship — a false rumor the site addressed earlier this month with a typically withering takedown of the forged birth certificate that purportedly proves Barack Obama was born in Kenya.

Now the air is thick with talk of "death panels" hidden in the health care reform bills — a monumentally absurd notion endorsed by assorted Republican politicians, ex-politicians and talk show hosts, as well as by more than a few angry citizens at town hall hall meetings. (Not only are the claims untrue, but the wholly innocent, even laudable provision at the root of the myths that would have reimbursed doctors for counseling patients who wanted advice on living wills and other end-of-life issues has now been stricken from the Senate bill.) Snopes, which took on similar claims back in July, hasn't yet gotten to the latest round of rumors. So others have had to jump in and do a little mythbusting themselves.

Like, for example, AARP. Now, if there were anything to all this talk of "death panels," you'd think the AARP would be raising holy hell. After all, the nonprofit devoted to people age 50 and over has what you might call a vested interest in keeping America's elderly alive and well. But there isn't any substance to these "death panels," so the group has instead taken aim at the rumors. "Much of the debate is being driven by special interests that are deliberately kicking up clouds of dust to obscure the facts," the group notes on a page set up to combat the "misinformation and fear-mongering" that now clouds the debate. AARP's site is eminently useful for anyone who wants to make sense of what's really at stake in the health care reform battle, offering the group's own detailed refutations of the myths and lies, as well as links to mainstream press coverage of the scare tactics adopted by some opponents of reform.

For an even more thorough factchecking of what is and isn't true about health care reform, you can turn to Polifact.com, an online project of the St. Petersburg Times. For a quick overview of some of the disinformation that's being spread around, check out the site's health care Truth-O-Meter page. (Or simply look at the the health care "Greatest Hits, Vol. 1.") If you get tired of reading about what isn't true, and want nothing but the truth, Polifact.com's "simple explanation" of the health care bills now under consideration is the clearest I've seen anywhere

Polifact.com isn't partisan. In addition to refuting some of Sarah Palin's wild Facebook assertions about "death panels," they've also factchecked various pronouncements from Obama himself on health care and found some of them highly questionable — such as his claim at a town hall earlier this week that AARP had endorsed his reform plans. (In fact, the group, while supportive of many elements of reform, has not officially endorsed any of the plans now out there, as a spokesman for the group quickly made clear.)

Oh, and in case you're wondering, that video that got forwarded to you earlier this week of the guy shooting off a waterside and landing in a tiny pool — it's fake, too.

In the Great Health Care Debate, much has been ballyhooed about the United States' low life expectancy when compared to other first-world countries. Our life expectancy at age 50 ranks 29th in the world — 3.3 years behind Japan (the leader) and also behind Canada, France, Iceland and Spain, among others. In contrast, the U.S. spends 16% of its GDP on health care — more than any other country.

Of course, the big question: Is the poor ranking because our health care system is broken or because of some other factor, such as irresponsible behavior outside the system (smoking) or genetic predispositions?

An as-yet unpublished study by a couple of researchers at the University of Pennsylvania's Population Studies Center concludes that the current system actually does a very good job at discovering and treating fatal diseases when compared to other countries. The authors looked at U.S. practices in finding and treating prostate cancer and breast cancer and found that the U.S. screens more extensively and treats more aggressively than European countries. (Some lively debates on the study's merits have taken place on the blog of University of Chicago professor Gary Becker and judge/lecturer Richard Posner and Tyler Cowen's blog.)

The study points out some fascinating comparisons between the performance of the U.S. health care system and those of other developed nations when it comes to treating serious medical conditions. Since the mid-1990s, age-standardized death rates for prostate cancer have fallen well below those of other countries; age-standardized death rates for breast cancer, while declining rapidly in the 1990s, merely caught up to the lower death rates in other countries.

So what's behind the lower life expectancy for 50-year-olds in the US? While the researchers don't draw any solid conclusions, they point to a history of heavy smoking and high obesity rates as factors. They also make clear that they are studying what happens after a disease has developed. "It is possible," they write, "that the US health care system performs poorly in preventing disease in the first place."

Samuel Preston and Jessica Ho, the study's authors, say that there might still be inefficiencies or unfairness in the system, and they acknowledge that they aren't measuring the overall well-being of cancer survivors. "The question that we have posed is much simpler," they write, "Does a poor performance by the US health care system account for the low international ranking of longevity in the US? Our answer is, 'no'."

Here's my suggestion for solving the nation's healthcare crisis — the one that I would propose at one of those town-meeting shoutfests if I could get in a word edgewise: Make sure that members of Congress are living with the same health benefits that the rest of us are.

As reported recently by the Los Angeles Times, you see, senators and members of the House of Representatives enjoy a health insurance program that insulates them from the costs, problems and worries suffered by millions of uninsured and underinsured Americans. Like other government workers, they have their choice of ten different health plans, while 85% of companies offering a health plan to their employees offer a single option. They pay a modest $300 a month for family coverage, according to the Times. And — in stark contrast to the difficulties faced by cancer survivors or diabetes sufferers who try to get health insurance on the individual market — they don't have to worry that pre-existing medical conditions will prevent them from getting coverage or sorely limit their coverage if they do manage to get a policy.

With such cushy benefits, it's easy for members of Congress to get all passionate about the theoretical issues surrounding health care funding and the social safety net, while ignoring the practical realities what it's like to go broke paying for catastrophic or chronic medical expenses. So let's help them focus their minds and best intentions on the problem at hand.

What we'll do is randomly select senators and representatives to live with a particular quality of health care in the same proportion as the rest of Americans. Forty-six million Americans — 18% of the non-elderly population (in other words, too young to qualify for Medicare) — don't have health insurance at any one time, according to the U.S. Census. So 18% of members of Congress — 18 senators and 78 representatives — will start walking around uninsured. Very quickly, one supposes, they'll be a lot more nervous crossing the street and a lot more worried when a family member starts running a temperature during flu season.

But that wouldn't give Congress a complete taste of the anxiety that Americans feel about their health care — the knowledge that even if you do have affordable health insurance, you could lose it at any moment. All it takes is a job loss or an employer who decides it's just too expensive to provide insurance as a benefit. So, because by one estimate one-third of the non-elderly went without health insurance over 2007 and 2008, we'll make sure that 33 senators and 145 representatives randomly lose their health coverage for a time over each two-year session of Congress. That averages out to roughly a year without health insurance for all those lucky congressmen and congresswomen and their families. Again, let's hope for their sake that they don't choose that year to come down with an expensive medical condition.

Finally, let's make sure that an appropriate number of congressmen feel the financial pain felt by those for whom having health insurance doesn't protect them from financial pain. Seventeen percent of employees with coverage through their employer (see page 7) ended up paying more than 10% of their after-tax income on health expenses such as premiums, co-pays and co-insurance. A whopping 53% of people purchasing non-group private insurance paid more than 10% of their income on health care. So, with the number of people getting health insurance through their employer declining on a regular basis, let's split the difference and dock 10% of the after-tax pay of 35% of congressmen — 35 senators and 152 representatives — and call it a day.

What do we end up with? Two-thirds of elected officials in the legislative branch who either have no health insurance or have reason to be unhappy about it. As the Samuel Johnson quote goes, "(W)hen a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully." If congressmen knew that their own physical and financial health were at stake, I'm sure they'd solve the health care problem faster than you can say, "Tea party."

Older nonwealthy Americans are racking up credit card debt at a rate that outpaces other groups.

People age 65 and up carried an average of $10,235 credit card debt in 2008, according to a study released Tuesday by  Demos, a public policy research group. That's an increase of 26% since the organization's last survey of low- and middle-income borrowers in 2005. The average debt for all borrowers in the survey rose just 3%, to $9,827, during that same time period.

Rising health care costs may be one reason seniors are turning to plastic, the study shows. More than half of indebted families surveyed cited medical expenses as a major factor that contributed to credit card debt; the average household, in fact, attributed $2,194 of credit card debt to medical expenses. Senior households, however, blamed almost $4,000 of credit card debt on out-of-pocket medical costs. Prescription drugs were the medical expense most often cited.

Another key finding in the survey, aptly titled "Plastic Safety Net," contradicts the notion that credit card debt is strictly a result of frivolous spending. Three out of four households surveyed said they used credit cards to pay for expenses including car and home repairs, job loss, college attendance, loans to relatives and operation of a business. More than a third of households reported relying on credit cards to cover basic living expenses for five of the last 12 months. Households that used credit cards for basic living expenses had a much higher average balance — $13,302 — than those who did not ($7,795).

Results were based on a phone survey between April and August 2008 of 1,205 low- and middle-income households whose incomes fell between 50% and 120% of the local median income. Participating households had to have credit card debt for more than three months at the time of the survey.

There's no question about it: When you go to a doctor nowadays, you're more likely to be diagnosed with something, and sent home with a prescription, than you were a generation ago. A much tougher question to answer is whether or not these new diagnoses, and new tests and treatments that come along with them, are actually worth all the money they cost you and/or your insurance company.

As Darshak Sanghavi points out in an interesting piece in Slate, there are certainly plenty of people who think that they aren't. Sanghavi cites a New York Times op-ed by a couple of doctors who complain that our country has been overrun by an "epidemic of diagnoses." Over the last few decades, they argue, we've seen a "medicalization" of everyday life, in which "physical or emotional sensations we don’t like [that] in the past [were] considered a part of life … are [now] considered symptoms of disease. Everyday experiences like insomnia, sadness, twitchy legs and impaired sex drive now become diagnoses: sleep disorder, depression, restless leg syndrome and sexual dysfunction."

But, Sanghavi asks, is this really such a bad thing? Many of the things now being diagnosed are real medical problems, and treatment can make a world of difference. "As a child, I coughed myself to sleep for years," he writes. "(T)oday, it's clear I have allergic asthma." I can certainly sympathize: A couple years back, I was wheezing and choking all night every night, and awakening in the morning seemingly as tired as when I'd gone to sleep. Then I was diagnosed with sleep apnea; now I sleep with a breathing machine, which has quite literally changed my life. A generation ago, no one had even heard of sleep apnea.

Is it really fair, Sanghavi asks, to "blame people with dyslexia, erectile dysfunction, or restless leg syndrome for the [health care] mess[?]"

Well, no. But in making this case, Sanghavi misses the broader picture: Researchers at Dartmouth, led by Jack Wennberg and Elliot Fisher, have demonstrated clearly and unequivocally that while health care has improved over time, as things stand today, higher health care spending does not in fact correlate with better care.

As Fisher explained in an interview I recently did with him in Money, some regions in the US spend much more per capita on health care than others. "More health care doesn't necessarily mean better health care," he told me. What it means, rather, is "unnecessary days in the hospital, unnecessary referrals to specialists, and unnecessary diagnostic tests." All of which can be hazardous not only to your wealth, but also to your health: Because of the risks of infections and medical errors, "hospitals are dangerous places to be if you don't need to be there."

One of the biggest problems, he told me, is that doctors and hospitals who've invested in expensive diagnostic equipment — like CAT scanners, for example — have huge financial incentives to use these machines whether they're necessary or not. Whether or not you get a CAT scan often depends less on your medical condition than on whether or not your doctor owns a scanner. Changing the incentives, and reducing these unnecessary tests, could save the country an enormous amount of money.

If you want to see just how these perverse incentives can affect the care you get, take a look at Atul Gawande's astonishing New Yorker article about a small Texas town where "Medicare spends three thousand dollars more per person here than the average person earns." It's a piece that reveals far more about what is wrong with our current health care system than you'll ever learn from watching talking heads squabble over health care reform on TV.

The 2010 fiscal year for most states began July 1. Facing severe budget shortfalls, some states have used the new year to introduce higher income tax rates. In Delaware, for example, the highest tax rate went from 5.95% to 6.95% on earnings over $60,000. In Hawaii, the maximum tax rate jumps from 8.25% to 11% for earnings above $200,000. And in New Jersey, the tax on earnings above $500,000 jumps to 10.25%, up from 8.97%; for a new bracket above $1 million, the rate is 10.75%.

As you can see, most of the tax increases are limited to high earners, the same tactic President Obama has proposed to help pay for expanded health-care coverage and other government spending measures.

But as Mark Robyn points out in his post for Tax Policy, a blog for the non-partisan Tax Foundation, raising taxes on the wealthy doesn't always have the desired effect. As some states have discovered, high earners have the means to move. The well-off also can afford to hire smart accountants to lower their tax bill.

That's not to say that wealthy folks shouldn't be taxed at a higher marginal rate. But the strategy seems like a shortsighted way for the federal government to raise the funding needed to fix health care. Howard Gleckman makes the point in his post for the non-partisan Tax Policy Center's blog, TaxVox.

What's the alternative? Len Burman, director of TPC, offers one option in this May editorial in The Washington Times. In the meantime, Obama can witness firsthand just how well targeted tax hikes work: While higher state tax rates were introduced this month, the rates are retroactive to January 1, 2009.

How many calls do you think accountants are getting right now?

President Obama is a pretty good persuader, but he's been having a hard time selling his health care reform plan. His health care town hall meeting on ABC last Wednesday drew dismal ratings, garnering fewer viewers than a rerun of CSI: New York (and drawing gleeful responses from many of his non-fans). Meanwhile, some of his putative allies in the Democratic party have been sniping away at the plan, and negotiators in the senate have been slashing costs by lopping off some of the plan's most progressive elements, like subsidies for lower-income Americans to help them afford to buy insurance. (Huh? Wasn't helping the uninsured get insurance one of the main reasons for the plan in the first place?)

Cost isn't the only stumbling block for the plan. The other biggie is Obama's advocacy of the "public option" — that is, a Medicare-like public insurance plan that would compete with private insurers. While some have made alarmist claims that such a plan would drive private insurers out of business, others simply complain that it would cost too much. Indeed, some note, when the Congressional Budget Office added up the costs of early versions of the bill, arriving at a total cost of $1.6 trillion, they did so without including the cost of a public plan. Just imagine, critics say, how much Obamacare will cost with the plan included!

These critics are looking at it backwards, say researchers at the liberal Economic Policy Institute: Including a public plan will actually reduce the overall costs of health care:

While a public plan would indeed likely raise the level of federal government health spending, it is just as likely to reduce total national health spending. Independent research evaluating proposals produced by EPI and other sources has consistently found that a public plan would save money and result in better health outcomes by providing all Americans regular access to health care.

Indeed, they point out, one independent analysis found that having a public plan could actually save the US up to $1 trillion over ten years, while providing health care to all. Some of the elements of the plan contributing to that figure include increased competition among health care providers and lower administrative costs.

It's a compelling argument, and one that deserves to have a more central place in this debate, lest we nickel-and-dime ourselves into an anemic health care plan that ends up costing us more in the long run, while abandoning the goal of health care for the currently uninsured.

I've been a personal-finance journalist for over a decade, and what I'm about to say almost amounts to heresy in my line of work: Some of your most pressing financial questions just don't have any satisfying answers. There may not be much you can do.

Most financial advice sounds like something out of a how-to manual. Building a table with a dovetail joint? Go get a fine-tooth saw and sharp chisels. Want to shelter your retirement savings from future taxes? Put it in a Roth IRA. But there's a whole set of money problems that can't always be solved by finding (or buying) the right tool.

The best example of this: Paying for long-term care, whether it's for your aging parents or for yourself. In his new book Caring for Our Parents, the journalist and Urban Institute researcher Howard Gleckman makes a compelling argument that the cost of long-term care will be the next shoe to drop in America's ongoing health-care crisis.

This story is personal for Gleckman (who also edits an excellent blog on tax policy). In the course of just a few months, first his father-in-law and then his father fell ill. His family had shell out thousands of dollars to pay for just a few weeks of nursing-home care, and then battled with a Medicare managed-care insurance company that refused to pay $85 a day for his dad's at-home aide. Even little things were a struggle: For a time, the only way his father (who lived in a different state) could get to a doctor was to call an ambulance. "I was a journalist and my wife was a lawyer, [but] we were hit with this huge crisis and we didn't even know where to start," Gleckman told me recently.

That huge complexity is likely in your future, too. About 70% of seniors will eventually need some kind of long-term care, according to one study Gleckman cites, and most of that isn't covered by Medicare. (Long-term care isn't medicine and doctors—it's the people with strong backs who lift you out of bed and make sure you are eating.) A day in a nursing home runs an average of $180, and the rate keeps going up faster than inflation. After you burn through your lifetime of savings or home equity, the main safety net to pay for this is Medicaid, the government insurance program for the poor. With 77 million baby boomers hurtling towards retirement, that system is likely to come under major financial pressure.

This is where the "right tool" problem comes in. There is a product on the market that's supposed to solve this: long-term care insurance. But it's an answer with a lot of asterisks. A couple of years ago, MONEY's Amanda Gengler and I took a close look atLTC insurance and who it might be right for. Read it here.That story kept me up at night with worry about offering the right advice—the stakes of the decision to buy insurance can be very high, and the product is dauntingly complex.

Among the questions you'll have to tangle with: Are you buying enough coverage (or the right kind) to pay for unpredictable future costs? Will you be able to afford to keep paying the policy 10, 20, or even 40 years from now, especially if premiums rise? And these days, you'd have to add: Can you trust the financial strength of the insurance company?

Speaking very broadly, long-term care insurance can make sense if you'll have enough money to comfortably pay premiums for life, expect to have an estate worth preserving, and are willing to do a lot of careful research to make sure you get the right policy. In short, while today's private LTC insurance can work for some people, it's not going to be an affordable solution for most us. And so it also won't protect the younger taxpayers who are going to be on the hook for more and more of these costs in the coming decades.

Gleckman thinks we'll need to set up some kind of public or hybrid public-private insurance system, so that more Americans will be preparing in advance to pay for the cost of their own care. This insurance might pay just part of the costs, leaving plenty of room for private insurers to sell supplemental coverage. Ideally, Gleckman says, the insurance would be mandatory, so that, by spreading the cost among millions, the premiums could be kept low.

America is already facing a hefty bill for boomers' retirement and regular medical costs—can we really add long-term care to the government's menu of responsibilities? The truth is that cost is going to hit us whether we plan for it our not. And this is one problem we'll need to face as a society, not just as individuals.

—Pat Regnier

If there's one regulatory trend that may define 2009, it could be the creation of exchanges. The U.S. Treasury wants to start a type of exchange, or clearinghouse, for the buying and selling of over-the-counter derivatives, those obscure asset-backed contracts that helped bring the financial system to its knees.

Now, Congress is dabbling with the idea of creating a health insurance exchange.

Legislation with more details isn't likely to become available until later this summer. But the House Committee on Ways and Means introduced an outline this week. The Senate Committee on Health, Education, Labor & Pensions, led by Sen. Ted Kennedy (D-Mass.), has also put forward a bill, (though at the moment the bill does not come up online, only the press release). At any rate, the Senate's proposal also calls for a "gateway" through which individuals can shop for insurance.

What's the point of an exchange? Well, it would set some ground rules for how insurance is bought and sold, just as there are rules for how stocks are traded in the market. For example, insurers wouldn't be allowed to sell policies that exclude pre-existing conditions. Individuals could choose between a newly formed public health insurance option and private plans, encouraging competition among insurers. Furthermore, the exchange would make it easier for consumers to comparison-shop policies.

In other words, the exchange would help create a more equitable, controlled health insurance market. At least that's the theory–but one perhaps worth gambling on. Because we've seen what happens when an opaque market, such as OTC derivatives, is allowed to run wild. I certainly don't want to take as much risk with my, your and future generations' health. (Click here to see the White House report, "The Economic Case for Health Care Reform.")

Last summer, when I was writing a story about health insurance options for early retirees, I found an incredibly useful resource for individuals trying to obtain health insurance for themselves and/or their families: a web site run by Georgetown University's Health Policy Institute. The web site, operating under the generic-sounding title healthinsuranceinfo.net, was a collection of 51 exhaustive guides to the rights and options that individuals have for obtaining health insurance in each of the states plus the District of Columbia. I found these guides, formally known as the Consumer Guides to Getting and Keeping Health Insurance, extremely valuable in navigating the patchwork of laws and organizations that serve as the health insurance safety net, such as it is, in the US.

Unfortunately, just as my article started arriving in people's homes, healthinsuranceinfo.net went offline, the victim of a funding loss at HPI. And offline it has sat, unavailable to the public for the past few months, gathering dust in an electronic lockbox somewhere.

Until recently, that is. Just recently, healthinsuranceinfo.net came back online, thanks to an emergency grant from the Robert Wood Johnson Foundation. HPI says it has also received funding to update 15 of the consumer guides over the summer. America is sorely in need of a healthcare and health-insurance overhaul; until the day that comes about, this is a great place for learning about your choices in today's system.

Move over, The Money You Could Be Saving With GEICO. Obama trumped the poor little fellow with googly eyes when he announced earlier this week that bigwigs in the medical, hospital and insurance industries had pledged to him that they could shave some $2 trillion off our nation's health care costs over the next ten years.

Naturally, any time a government official says he can produce $2 trillion out of nowhere, it's hard not to be a little suspicious.

Indeed, Republican Senator Chuck Grassley quickly issued a statement essentially saying: We'll believe it when we see the details. On the National Review Online, meanwhile, conservative economist Larry Kudlow declared that Obama's plan would "bankrupt the nation." (Rush Limbaugh, meanwhile, compared Obama to Don Corleone.)

At the other end of the political spectrum, a blogger for the Leigh Valley Pennsylvania Express-Times wondered how it was that the health care industry could suddenly find $2 trillion in savings. If all that free money is just sitting there, he wondered, doesn't that suggest that "they've been stealing from us for all these years[?]"

It's not quite as simple as that, of course, and the health care industry isn't quite as villainous as the blogger makes it out to be. But he's right about one thing: the trillions in savings may actually be more than a pipe dream.

The confidence that Obama and other in his administration have that big savings in health care are possible stems from their reading of some very interesting research conducted over the last couple of decades at Dartmouth. Led by researchers Jack Wennberg and Elliott Fisher, the folks at what's called the Dartmouth Atlas of Health Care found out two very interesting things when they began examining regional patterns of health care spending.

First, they discovered that spending varied tremendously from city to city, region to region, and that much of this variation had nothing to do with demographics or any other factor that might logically explain the differences.

Second, they discovered that those regions that spent the most on health care didn't actually get better results than the regions where spending was much lower. Patients in the high-spending regions got more MRI scans, and spent more time in the hospital, but all that extra attention didn't make them any healthier. More money, in other words, didn't mean better health care.

That's the glass-half-empty way of looking at it, anyway.

The glass-half-full way suggests something rather extraordinary: if we can figure out what the more effective hospitals are doing right, we could save a lot of the money we now waste on ineffective care. We could get the same or even somewhat better results than we get now, while spending a great deal less — by some estimates, as much as a third.

Of course, getting to this rather utopian state of affairs will require a lot more than mere pledges like the ones Obama got this week.

For more of the gory details of the research and the reforms that may come out of it, check out this story in Dartmouth Medicine by health journalist Maggie Mahar.

Researcher Fisher points out a few options in this New York Times roundtable; if this merely whets your appetite for more, check out the white paper titled "An Agenda For Change" on the Dartmouth Atlas' own web page.

In any case, you can rest assured that you'll be hearing a lot more about this research in the months and years to come.

–David Futrelle