"I am not an advocate for frequent changes in laws and constitutions. But laws and institutions must go hand in hand with the progress of the human mind. As that becomes more developed, more enlightened, as new discoveries are made, new truths discovered and manners and opinions change, with the change of circumstances, institutions must advance also to keep pace with the times. We might as well require a man to wear still the coat which fitted him when a boy as civilized society to remain ever under the regimen of their barbarous ancestors." - Thomas Jefferson (appears in the Jefferson Memorial)

That health care reference

During President Barack Obama’s state of the union speech last night, he spoke (near its beginning) about health care, and included some references to changes that might cut costs. There was this significant line, for example: “We’ll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn’t be based on the number of tests ordered or days spent in the hospital; they should be based on the quality of care that our seniors receive.”

This, and a couple of other bits, were actually a specific reference – though Obama didn’t explicitly say so – to Oregon, whose Governor John Kitzhaber was sitting in the first lady’s guest area. Oregon’s health care experiment, centered on the use of regional community care organizations, probably is the most advanced such effort in the country, aimed at reducing costs while keeping medical care as good or better.

It isn’t a something-for-nothing, free lunch proposition; rather, it’s better organization of resources.

It got some good national promotion in a recent article in the Washington Post, which probably deserves some additional reading by policy makers around the country.

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