As of October 1, 2009, the currently proposed health reform legislation pending in Congress does little to "bend the cost curve." There are 2 general ways of bending the cost curve: incremental vs "radical" or dramatic. I, as second author of the lead paper in this issue of the journal, am a proponent of the incremental approach, an approach that also insists on documented savings at every step of the way. There are 10 commentaries from around the country. We provide a final summing up response.

Next, Kristina Lowell and John Bertko walk us through accountable care organization (ACO) 101. By now we have all heard the term ACO. This article explains exactly what it is and provides initial comments on setting one up and issues to keep in mind.

I believe that most medical home demos will not succeed in significantly increasing income to primary care physicians and will have little impact on "bending the cost curve." The last article in this issue by Fuller et al on payment reform focuses on what may be more viable at least from a bending the cost curve and primary care physician payment point of view.

We conclude with our regular management column from Ron Goodspeed and new findings from the "Republic of Texas."

-Norbert I. Goldfield, MD

Editor