A challenge to the Horn report

Interesting paper. I have long thought that anyone who tries to implement systematic change in a national health system is going to end up trying to herd cats. That said, change can be implemented through careful discussion and negotiation with the professional bodies and medical schools. An example of this is the GP contracts in the NHS which have resulted in significant changes to practice through the QOF. This was definitely a 'carrot' rather than a 'stick' though which may not be affordable in the long term.
 
Another thought that struck me when reading the article is the negative take on the US system. When you talk to people in the US you find that they are actually pretty happy with their health care. It may be inefficient but as a normal person, you have access to very high quality if your health insurance covers it. The problem is really the lack of health insurance and inequality across the population. However, from the discussions that I've had at some recent conferences, I get the impression that many Americans are not willing to give up their inefficient, high quality care to ensure less inequality and better care for other people who are under-insured or have no insurance at all. It will be very difficult for the government to resist the demands of health 'consumers' who can afford it, wanting higher quality care, even if it increases inequalities and decreases efficiencies.