Michael Birnbaum interviews Bruce C. Vladeck about the landscape for national health reform in 2009. Vladeck, who worked under President Clinton directing Medicare and Medicaid as administrator of the Health Care Financing Administration, discusses some of the challenges and opportunities facing the Obama administration. By comparing the current political and economic environments with those he faced while working in the Clinton administration, Vladeck argues that this time around America might be ready for pragmatic reforms leading toward universal coverage. He explores the future of employer-based coverage; problems and solutions for America's aging workforce; poor customer service in Medicare; the “Medicaid Stigma”; the promise of immigration; and the trade-offs between access, quality, and cost in the American system. Finally, Vladeck offers a silver lining to the current economic catastrophe. As he sees it, common sense and results may be taking the place of ideology in policy making and policy analysis: “The intellectual hegemony of neoclassical economics has been blown out of the water.”

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