(we're reposting this to correct a typo that might have confused you.. we wrote "payments" once where we meant "patients"..our proofreader was apparently too fixated on the ear to use his eyes...)

Not many people can incorporate Machiavelli, chemical energy barriers, and proton beam therapy for prostate cancer into a single health reform speech to a bunch of doctors in a hotel ballroom, but Ezekiel Emanuel did just that this week.

Zeke Emanuel, an oncologist and chair of Bioethics at NIH who is now a health policy adviser to OMB director Peter Orszag, went over what (to our blog readers) is probably familiar ground about health care cost trends, quality and evidence gaps, treatment patterns, and how parts of the country that pay more for health care don't get more in actual health.

It was hard to tell what the doctors at the American Medical Association conference absorbed. (In what may be the sign of economic times, there was no coffee and muffin table outside the hotel ballroom, and everybody sort of just melted away before we could collar many outside-the-Beltway docs in the audience about their reactions). But the patterns of questions and the audience response were interesting. Some of the questions were sharp and skeptical, and it's clear that the doctors won't like everything that's proposed about changing health care. But it's also clear that they know that change has to come, as their own "Vision for Health Reform" document makes clear. They applauded Emanuel repeatedly, and gave him a standing ovation. And Emanuel reassured them that doctors who actually know what it's like to take care of patients and deal with the crazy quilt payment system—he himself specializes in breast cancer—will have a voice. And that someone will actually listen to the voice.

Some of the most pointed questions were about the administration's efforts to discourage high rates of re-hospitalization through "bundling" of payments or payment for an episode of illness; many doctors seem to think that other physicians' patients might have unnecessary hospitalizations but that all of their own patients are properly or unavoidably hospitalized (or, if anyone was at fault, it was a non-compliant patient.) Emanuel reassured them that he understood that not all admissions were avoidable, and that caring for patients with advanced illness was complicated and that many doctors were involved in each case. There were a lot of questions about malpractice reform, and anti-kickback and antitrust legislation as it pertains to medicine. Without giving any specifics, Emanuel told them those questions were part of the policy mix. And while everybody agreed that we need to spend more on primary care, there were some questions about whether that would mean cutting the pay to specialists. "Out of the hides" of specialists is the term we think we heard used.

But none of the doctors asked a question equating comparative effectiveness with "cookbook medicine." (The AMA backs the concept of comparative effectiveness although AMA president, Nancy Nielsen, gave an interview recently warning that "Government control of the doctor-patient relationship is a no deal.") But at the session with Emanuel, nobody ventured the opinion (as may have happened in the AMA of old) that President Obama was engineering a government-takeover of health care. No one wondered about whether we could afford to fix health care during an economic crisis. In short, no one spoke up for the status quo. And that's progress.