Stuart Altman of Brandeis University discusses the conflicting interests of stakeholders in the context of national and state-level health policymaking. According to Altman, health reform cannot be solved at only the federal or community level; it requires cooperation between the two. Altman describes how regional planning efforts in the 1960s, 70s, and 80s, tried to control healthcare through various incarnations of managed care. He says that managed care was working, but ultimately became unpopular because it left out patients. The solution to controlling costs, according to Altman, is to get the healthcare system to become more efficient. He believes that both government and private insurers need to change their payment systems. He is optimistic about accountable care, bundled payments, and the state-level efforts of Massachusetts and Vermont.

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