This was the week that even President Bush noticed that healthcare costs have been a drag on the economy. At the moment what passes for health policy in the US is a combination of a half-hearted expansion of Medicaid programs in the states, a complex and confusing drug benefit for seniors, and the steady decline in employer-based health insurance, the source for coverage for most Americans. Filling in the gaps are struggling public and county health systems. Meanwhile, there is more pressure on providers to put in new information technology, while physicians face the real prospect of significant Medicare pay reductions. Most providers realize that there's no real help coming from the federal government, and so they must look to internal efficiency and community-based reforms to get through this next tough patch. - Matthew