You've seen those parody maps in which the foreground frames a distinct locale, such as Manhattan's 9th Avenue, in magnified, bountiful detail, while letting other cities, states, and whole countries recede into the horizon as mere topographical specks. The conceit -- that the distinct locale is the center of the universe -- is one some clever health policy cartographer might enlist to depict 601 New Jersey Avenue, N.W., Washington, D.C., digs for MedPAC, as ground zero for all manner of great thinking on Medicare, as well as, by implication, the program's lesser private insurance pretenders. 
Indeed, MedPAC's influence has never seemed greater, a fact underscored just last Friday when the Commission let rip its annual June report, a health policy bible fertile with ideas that sweep across MA plans, hospitals, comparative effectiveness, home care, drugs, and all the other vital precincts. Growing out of two largely forgotten predecessor organizations, MedPAC now seems the outsourcee of choice for a Congress that desperately needs a politically neutral arbiter to help sort through Medicare's often-intractable issues. But lest our health policy map become myopically focused on New Jersey Avenue, two events remind us that those specks on the distant horizon can be pretty important, too.
The first such event, held the day before MedPAC released its report, looked north, as the Center for Studying Health System Change conducted its 12th annual Wall Street Comes to Washington Conference. The views of stock analysts, hedge fund managers, and other health care investors provide a useful tonic -- a reminder that real money rides on policy nuance. But it reminds us, too, of the difference 228 miles can make. For while on Wall Street good is simply good ( e.g., MA private fee-for-service plans make money), Washington can interpret the same facts to be bad (MA PFFS plans make too much money). Indeed, in Washington, with its Yossarian-like tendencies, bad can be the very essence of good, as policy combatants compete to demonstrate the depth of their relative disadvantage.
No such intrigue afflicts the second event, the Health 2.0 Conference, set for September in a burg practically off our MedPAC-centric map, San Francisco. Here, the combatants look much different -- from Cisco to Revolution Health to smaller players with names compelling enough to glimpse the future, like DNADirect. The agenda items -- "Providers and Social Networks," to cite one -- imply a fresh take, a parallel universe that seems remote from Washington in ways that go beyond geography. Indeed, while Washington has prepared adequately for the obvious -- an example is the electronic health record, an admittedly big deal -- one senses other IT-inspired health care changes that hover innocuously just over the horizon, like a low-pressure zone off the coast of Africa that won't be fully discernible until it crashes MedPAC's shores in a hurricane of mouse clicks, ring tones, and who knows what else.
And so as we give MedPAC's latest report its due, we shouldn't lose sight of those other forces in the distance, working quietly to shape the "health" at health policy's core.
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