Congress is in August recess.  Hot as a pistol in Washington, DC.

Where are we this week?  All the players have staked their positions.   The president and the administration have not articulated a definitive plan.  They have offered a dreamy vision.  As we have noted, both strategically and rhetorically, this vision keeps evolving. Most recently, the focus has shifted to insurance reform.  An easier sell.    As one commentator said this Sunday, “nobody likes their insurance company.”

Who are the players?   The President and the Administration, the Democratic Congress, the Republican Congress, health insurance companies, Big Pharma, labor unions and … the mobilized masses … the pitchfork crazies and the outspoken talk radio infotainers.

Harry and Louise have been resurrected.  This time they are promoting health care coverage.  Why do you think they have changed their minds? Remember, the large insurance carriers and Big Pharma will not lose.

Interestingly, there was a failed attempt offered two years ago by Representative Barbara Lee.  Do we even remember this bill?  HR 3000 would have:

establish[ed] a United States Health Service to provide high quality comprehensive health care for all Americans and to overcome the deficiencies in the present system of health care delivery.

Here are some important resources.  This from the Congressional research service — Health Care Reform: an Introduction.

Solutions to these concerns may conflict with one another. For example, expanding coverage to most of the uninsured would likely drive up costs (as more people seek care) and expand public budgets (since additional public subsidies would be required). Cutting costs may threaten initiatives to improve quality. Other challenges include addressing the interests of stakeholders that have substantial investments in present arrangements and the unease some people have about moving from an imperfect but known system to something that is potentially better but untried. How much reform might cost and how to pay for it is also an issue.

The current bill for discussion is HR 3200.  A mammoth 1017 page document.  And yet it is still a work in progress.

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Polls are notoriously difficult to read.  Most are quite biased.  The Quinnipiac poll seems the least biased.  The latest reading shows slipping approval for any health care reform plan.

Do you approve or disapprove of the way Barack Obama is handling health care?

                     Aug 5   July 2
                     2009    2009

Approve              39      46
Disapprove           52      42
DK/NA                 9      13

A good review appearing in the Sunday New York Times.   This abstracted graphic tries to make sense of the increasing complexity of choices facing Congress … and us.

I have also included a permanent Link to the New England Journal of Medicine series of articles on health care reform.  Well worth perusing as it remains above the fray.

It is a dizzying array of views, positions, dilemmas and beliefs.  Too big for legislation.  We should be fostering centers of excellent.  We should be promoting new models and paradigms. Not trying to synthetically reconstruct a dysfunctional system.   One where the “dysfunction” is in the eye of the beholder.

Keep reading.