Businesses are moving on ideas to incentize better quality and cost-efficient health care. Why is it taking so long for government to do the same? It's not because of red tape and agency capture and the like. There are at least two conceptual straight jackets holding back reform. 1. The enlightened statesman's view that the "entitlement crisis" is one of demographics and overusage and that it has nothing to do with market inefficiencies in the health care delivery system. And 2. the related, but distinct, belief held by conservative ideologues that the market can do no wrong, and that if there's an efficiency problem, it's probably a "moral hazard" issue caused by government interference. CBO's Peter Orszag is changing the elite discourse on long-term fiscal issues, so help may be coming. A big thanks to the private sector for leading the way, though.