The final bit of progress came with a bundle of amendments, offered by 11 freshman Democratic senators, to tackle costs. This is the great weakness of the current health-reform effort, which contains only timid proposals (such as a toothless independent commission to advise on Medicare costs, and mere pilot programmes to curb costs and improve quality). The new amendments will give the independent panel authority to push for changes across the entire health system, not just in Medicare, and successful pilot schemes could also be scaled up rapidly by administrative action, without going through Congress.

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