• require more employer coverage
• insurance reform (particularly limits on pre-existing conditions)
  
• subsidize coverage for the poor (initially did not include an individual mandate)
• Obama only reluctantly accepted the necessity of an individual mandate, but the system won't work without something to keep people from waiting to buy insurance until they are sick
  
• expanding Medicaid is less expensive than subsidizing insurance
• subsidies and tax incentives for those making more
  
• state or nationally run insurance exchanges (initially to include a public option similar to Medicare)

Political games being played:

• pharmaceutical industry brought on board by agreeing Medicare would not negotiate drug prices
• heath insurance industry realized something needed to be done and Obama's was the least worst option
• hospitals wanted to get out of the high costs of patients who cannot pay and saw more people covered bringing them more income.  Hospitals have tended to support insurance because people just can't pay otherwise
  
• the AMA traded support for postponement of fee reductions and malpractice reform
• doctors had almost always opposed insurance
  
• wouldn't you get more business because more people could pay?
• but they wanted to be able to set their own fees, were afraid that insurance would mean standard reimbursement
• insurance companies or government would standardize how to treat illnesses
• but they had already lost that fight: private insurance companies were limiting fees, as were Medicare and Medicaid
  
• Republicans/conservatives
  
• big government: government taking on a larger role in health care and probably increased costs in the future, contributing to the national debt
  
• what's funded: no government funding for abortion, opposition to funding for birth control
• didn't want to pay for other people's care that they didn't approve of (so they saw it as not just individual choice)
  
• insisted on removing the public option, which frustrated liberals terribly
• Medicare expansion would cost insurance companies money
• how to make the plan cost neutral

Death Panel issue:

• bill called for payment for doctors to have longer conversations with patients about end of life issues
• there are choices already in place people can make
• living will: specify in advance what treatment if permanently unconscious (breathing, feeding tubes)
• medical power of attorney: assign someone to make the decision for you
• Do Not Resuscitate: (has to be signed by a doctor saying that you have a terminal condition), no CPR
  
• comparative effectiveness research (CER): fund research on which treatment is most effective
• useful measures got taken out because they could be used as political weapons
• how do you balance between doing the research to know what works best and taking away the choices of patients and doctors--we are back to science vs. individualized treatment
  

Political strategy:

• be willing to compromise and minimize change
• work with special interests
• make sure the middle class benefits
• figure out how strong the sides are on controversial issues
  

• science vs. individualized treatment
• rising cost of health care primarily as a result of advances in technology
• how do we make sure everyone has available the most up to date treatment
• do we have a right to health care even if we can't afford it?
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