The_AT Next_MD Step_NN1 on_II Health_NN1 Reform_NN1 President_NNB Obama_NP1 has_VHZ shown_VVN both_RR courage_NN1 and_CC sound_NN1 judgment_NN1 pressing_VVG for_IF quick_JJ action_NN1 on_II comprehensive_JJ health_NN1 care_NN1 reform_NN1 ,_, even_RR in_II the_AT midst_NN1 of_IO the_AT country_NN1 's_GE deep_RR economic_JJ crisis_NN1 ._. 
He_PPHS1 has_VHZ rightly_RR stressed_VVN the_AT urgency_NN1 of_IO reining_VVG in_II skyrocketing_VVG health_NN1 care_NN1 costs_VVZ that_CST are_VBR straining_VVG the_AT budgets_NN2 of_IO families_NN2 ,_, businesses_NN2 ,_, and_CC federal_JJ and_CC state_VV0 governments_NN2 ._. 
But_CCB his_APPGE proposals_NN2 ,_, for_IF all_DB of_IO their_APPGE ambition_NN1 ,_, do_VD0 not_XX fully_RR answer_VVI two_MC central_JJ questions_NN2 :_: how_RRQ to_TO cover_VVI tens_MC2 of_IO millions_NNO2 of_IO uninsured_JJ Americans_NN2 ,_, and_CC how_RRQ to_TO reform_VVI the_AT health_NN1 care_NN1 system_NN1 to_TO reduce_VVI costs_NN2 and_CC improve_VVI the_AT quality_NN1 of_IO care_NN1 ._. 
Mr._NNB Obama_NP1 has_VHZ decided_VVN to_TO let_VVI Congress_NN1 thrash_VVI out_RP the_AT details_NN2 of_IO those_DD2 issues_NN2 ,_, with_IW the_AT White_NP1 House_NN1 providing_VVG guidance_NN1 along_II the_AT way_NN1 ._. 
Democratic_JJ leaders_NN2 in_II Congress_NN1 ,_, many_DA2 of_IO whom_PNQO are_VBR far_RG more_RRR versed_VVN in_II the_AT issues_NN2 than_CSN the_AT president_NN1 is_VBZ ,_, will_VM have_VHI to_TO step_VVI up_RP and_CC fashion_VVI an_AT1 effective_JJ bill_NN1 ._. 
If_CS they_PPHS2 falter_VV0 ,_, Mr._NNB Obama_NP1 will_VM need_VVI to_TO step_VVI in_RP with_IW a_AT1 clear_JJ vision_NN1 and_CC vigorous_JJ leadership_NN1 ._. 
To_II his_APPGE credit_NN1 ,_, the_AT president_NN1 has_VHZ tackled_VVN the_AT first_MD tough_JJ issue_NN1 of_IO how_RRQ to_TO pay_VVI for_IF expanded_JJ coverage_NN1 and_CC systemic_JJ reforms_NN2 ._. 
His_APPGE budget_NN1 has_VHZ proposed_VVN huge_JJ expenditures_NN2 --_JJ $634_NNU billion_NNO over_RG 10_MC years_NNT2 --_JJ as_II a_AT1 down_JJ payment_NN1 ,_, and_CC it_PPH1 clearly_RR specifies_VVZ where_RRQ to_TO find_VVI the_AT money_NN1 ._. 
Half_DB would_VM come_VVI from_II raising_VVG taxes_NN2 on_II the_AT rich_JJ ,_, another_DD1 quarter_NN1 from_II eliminating_VVG unjustified_JJ subsidies_NN2 for_IF private_JJ plans_NN2 that_CST participate_VV0 in_II Medicare_NP1 ,_, and_CC other_JJ big_JJ chunks_NN2 from_II reducing_VVG payments_NN2 to_II drug_NN1 companies_NN2 ,_, hospitals_NN2 and_CC the_AT home_NN1 health_NN1 care_NN1 industry_NN1 ._. 
Yet_RR even_RR the_AT administration_NN1 admits_VVZ that_CST $634_NNU billion_NNO will_VM not_XX be_VBI enough_DD to_TO reach_VVI universal_JJ coverage_NN1 :_: some_DD experts_NN2 think_VV0 it_PPH1 will_VM take_VVI at_RR21 least_RR22 twice_RR that_DD1 amount_NN1 ._. 
The_AT administration_NN1 has_VHZ also_RR given_VVN no_AT clue_NN1 as_II21 to_II22 how_RRQ it_PPH1 will_VM significantly_RR reduce_VVI the_AT number_NN1 of_IO uninsured_JJ Americans_NN2 --_NN1 now_RT 46_MC million_NNO and_CC growing_JJ ._. 
The_AT expanded_JJ children_NN2 's_GE health_NN1 insurance_NN1 program_NN1 ,_, which_DDQ Mr._NNB Obama_NP1 signed_VVD into_II law_NN1 early_RR last_MD month_NNT1 ,_, will_VM cover_VVI more_DAR than_CSN four_MC million_NNO uninsured_JJ children_NN2 ,_, and_CC his_APPGE stimulus_NN1 bill_NN1 will_VM help_VVI millions_NNO2 more_DAR Americans_NN2 retain_VV0 or_CC gain_VV0 coverage_NN1 ._. 
But_CCB this_DD1 ,_, too_RR ,_, is_VBZ only_RR a_AT1 down_JJ payment_NN1 on_II the_AT problem_NN1 ._. 
The_AT president_NN1 's_GE main_JJ focus_NN1 is_VBZ on_II starting_VVG to_TO reduce_VVI the_AT soaring_JJ cost_NN1 of_IO health_NN1 care_NN1 ._. 
That_DD1 ,_, he_PPHS1 argues_VVZ ,_, is_VBZ a_AT1 prerequisite_NN1 to_II making_VVG universal_JJ coverage_NN1 affordable_JJ and_CC politically_RR palatable_JJ ._. 
But_CCB in_II the_AT meantime_NNT1 ,_, many_DA2 millions_NNO2 of_IO uninsured_JJ Americans_NN2 continue_VV0 to_TO go_VVI without_IW adequate_JJ care_NN1 ._. 
Congress_NN1 will_VM need_VVI to_TO look_VVI hard_RR at_II whether_CSW bigger_JJR strides_NN2 can_VM be_VBI made_VVN toward_II universal_JJ coverage_NN1 at_II the_AT same_DA time_NNT1 that_CST costs_NN2 are_VBR addressed_VVN ._. 
The_AT president_NN1 's_GE plans_NN2 make_VV0 a_AT1 start_NN1 toward_II reforming_VVG the_AT health_NN1 care_NN1 delivery_NN1 system_NN1 ,_, but_CCB it_PPH1 is_VBZ only_RR a_AT1 start_NN1 ._. 
His_APPGE stimulus_NN1 program_NN1 is_VBZ pouring_JJ money_NN1 into_II electronic_JJ medical_JJ records_NN2 ,_, preventive_JJ care_NN1 and_CC comparative_JJ effectiveness_NN1 studies_NN2 of_IO medical_JJ treatments_NN2 --_NN1 all_DB of_IO which_DDQ should_VM help_VVI improve_VVI care_NN1 and_CC possibly_RR lower_JJR costs_NN2 in_II the_AT long_JJ run_NN1 ._. 
His_APPGE budget_NN1 plan_NN1 calls_VVZ for_IF Medicare_NP1 to_TO change_VVI its_APPGE reimbursement_NN1 rates_NN2 for_IF hospitals_NN2 to_TO promote_VVI higher_JJR quality_NN1 ,_, greater_JJR efficiency_NN1 and_CC substantial_JJ savings_NN2 ._. 
All_DB told_VVN ,_, the_AT changes_NN2 are_VBR projected_VVN to_TO cut_VVI the_AT growth_NN1 rate_NN1 in_II Medicare_NP1 spending_NN1 --_NN1 from_II 7.3_MC percent_NNU a_AT1 year_NNT1 to_II 6.1_MC percent_NNU in_II the_AT fifth_MD year_NNT1 ._. 
That_DD1 looks_VVZ like_II a_AT1 modest_JJ reduction_NN1 for_IF now_RT ,_, but_CCB when_CS compounded_VVN over_II many_DA2 decades_NNT2 ,_, it_PPH1 could_VM greatly_RR reduce_VVI projected_JJ Medicare_NP1 expenditures_NN2 by_II midcentury_NN1 ._. 
Since_CS Medicare_NP1 policies_NN2 often_RR ripple_VV0 through_II the_AT entire_JJ health_NN1 care_NN1 system_NN1 ,_, overall_JJ health_NN1 expenditures_NN2 should_VM slow_VVI ._. 
Meanwhile_RR ,_, the_AT administration_NN1 has_VHZ deliberately_RR ducked_VVN some_DD of_IO the_AT most_RGT contentious_JJ issues_NN2 ._. 
There_EX is_VBZ no_AT mention_NN1 of_IO requiring_VVG individuals_NN2 to_TO carry_VVI health_NN1 insurance_NN1 on_II themselves_PPX2 or_CC their_APPGE children_NN2 ._. 
No_AT mention_NN1 of_IO requiring_VVG employers_NN2 to_TO pay_VVI for_IF coverage_NN1 ._. 
No_AT mention_NN1 of_IO having_VHG a_AT1 public_JJ plan_NN1 compete_VV0 with_IW private_JJ plans_NN2 in_II a_AT1 national_JJ insurance_NN1 exchange_NN1 ._. 
No_AT discussion_NN1 of_IO whether_CSW employee_NN1 health_NN1 benefits_NN2 should_VM be_VBI taxed_VVN ._. 
No_AT talk_NN1 of_IO requiring_VVG insurers_NN2 to_TO cover_VVI all_DB applicants_NN2 ._. 
No_AT mention_NN1 of_IO government_NN1 negotiating_VVG Medicare_NP1 drug_NN1 prices_NN2 ._. 
The_AT White_NP1 House_NN1 has_VHZ obviously_RR decided_VVN that_CST it_PPH1 is_VBZ best_JJT to_TO let_VVI Congress_NN1 work_VVI out_RP the_AT compromises_NN2 and_CC decide_VV0 how_RRQ to_TO allocate_VVI the_AT pain_NN1 ._. 
That_DD1 is_VBZ the_AT opposite_NN1 of_IO the_AT Clinton_NP1 administration_NN1 's_GE approach_NN1 ._. 
It_PPH1 hatched_VVD a_AT1 highly_RR detailed_JJ plan_NN1 in_II secret_JJ that_CST never_RR won_VVN Congressional_JJ support_NN1 and_CC crashed_VVN under_II a_AT1 barrage_NN1 of_IO opposition_NN1 from_II affected_JJ industries_NN2 ._. 
We_PPIS2 do_VD0 not_XX challenge_VVI Mr._NNB Obama_NP1 's_GE political_JJ instincts_NN2 ._. 
We_PPIS2 simply_RR note_VV0 that_CST someone_PN1 will_VM need_VVI to_TO make_VVI the_AT hard_JJ choices_NN2 if_CS health_NN1 care_NN1 reform_NN1 and_CC universal_JJ coverage_NN1 are_VBR to_TO succeed_VVI ._. 
