Groundhog day.

• Author: Glastris, Paul
• Position: Editor's Note

I know it's the Twenty-first Century, and the World Is Flat, and 9/11 Changed Everything. But when I look at the big issues facing the nation--rising health care costs and declining coverage; stagnant wages and growing income inequality; war and instability in the Middle East; our dangerous overreliance on oil--what I see is not the dawn of a new day but Groundhog Day. These issues are pretty much the same ones that dominated the headlines when I got into the journalism business a quarter century ago.

The enduring nature of our problems could mean three things. It could mean that the problems themselves are irresolvable, though I'd hate to think--in fact generally don't think--that's true. Or it could mean that old ways of thinking have failed and we need an entirely fresh approach, a new paradigm--though I have not come across any persuasive new paradigms lately.

Or there is a third option: that our public officials are not complete idiots, that over the years many of them have given a great deal of thought to these problems, and that they have fashioned promising solutions that are sitting in the government's toolbox waiting to be fully deployed.

Consider the dilemma of rising health care costs. When this issue was heating up twenty years ago, the Democratic Congress and the first Bush administration created the Agency for Health Care Policy and Research (AHCPR). The agency's mandate was to look at existing clinical studies and (it was hoped) fund new ones to determine which medicines, devices, and treatments work best and which are a waste of money. AHCPR was then supposed to use this knowledge to advise Medicare about what to pay for and what not to. Had the agency been allowed to do its job, the nation might now be spending countless billions less on health care. But as Shannon Brownlee explains this month (see "Newtered," page 27), antigovernment ideologues in the Gingrich House, egged on by health care industry lobbyists, managed to get much of AHCPR's funding and authority stripped out. Today, probably the single best way to lower health care costs and improve quality would be to create a beefed-up version of AHCPR. And indeed, Hillary Clinton, Barack Obama, and John Edwards have all announced plans to do just that.

Or take the issue of the uninsured. As Phil Longman argues elsewhere in this issue (see "Best Care Everywhere," page 21), we already have an ad hoc system that serves those who lack coverage: local public and charitable...