The health care Rubik's cube.

T he fundamental di lemma of health policy is that the system is so interdependent that apparently no one part can be fixed without fixing them all. But efforts to change the system as a whole, to finance insurance expansion by reducing waste, or to improve quality by restructuring delivery arouse the sleeping dogs of health care. Each economic interest group knows its own interest and knows how to make the slumbering mass of voters fear that change is more likely to be for the worse than for the better, and that the devil we know is better than the devil we don’t. Health reform is again near the top of the political agenda, but every politician studiously tries not to evoke the system-transforming would-be solutions of years past. The mantra today is, think big but promise no new taxes, no changes for the currently insured, no payment cuts to providers or suppliers, no 500-page policy documents, nothing that can be lampooned as regulation gone amok. Just change the red side of the Rubik’s Cube, without changing the yellow or the green. In this issue we present several sets of papers that look at health care reform in this constrained environment, with an emphasis on financing and insurance. We begin with two papers on tax reform, the centerpiece of Republican proposals and an important component of Democratic offerings. Jason Furman of the Brookings Institution summarizes the reasons why everyone likes tax policy in health policy, but also why meaningful changes are so fraught with unintended consequences. Furman concludes that tax policy needs to be coordinated with structural reform of the insurance industry, which might be translated into a proposal to kick some sleeping dogs into F r o m t h e E d i t o r