The Obama administration announced new EPA rules Tuesday that sharply limit the output of carbon dioxide emissions from new power plants.

And not surprisingly, the mining industry objected.

"Requiring coal-based power plants to meet an emissions standard based on natural gas technology is a policy overtly calculated to destroy a significant portion of America's electricity supply," said Hal Quinn, chief executive of the National Mining Assn. "This proposal is the latest convoy in EPA's regulatory train wreck that is rolling across America, crushing jobs and arresting our economic recovery at every stop. It is not an 'all of the above' energy strategy." 

Of course, what Quinn doesn't want to talk about is what types of jobs the EPA rules are "crushing."

To get a better idea of that, you need to read another Times story Tuesday, one headlined "Report: Safety agency failed to enforce laws at deadly mine."

That story tells of the regulatory and safety lapses at the Upper Big Branch mine in West Virginia, where an explosion in 2010 killed 29 coal miners and seriously injured two others.

It's a story of lax regulatory enforcement, of inspectors simply not doing their jobs, and of a mine operator that, as the Department of Labor's Mine Safety and Health Administration said in a report on the deadly incident, engaged in  "systematic, intentional and aggressive efforts ... to avoid compliance with safety and health standards, and to thwart detection of that non-compliance by federal and state regulators."

How bad were conditions at the mine?  Bad enough that "Alpha Natural Resources, the company that acquired Massey Energy Co. after the explosion, reached a settlement late last year with the Department of Justice in which it agreed to pay a record $209 million in compensation and fines and federal prosecutors agreed not to pursue criminal charges against the company," according to The Times' story.

Even so, some former officials at the mine are under criminal indictment. 

Last month, prosecutors charged the then-superintendent of the mine with conspiring with others to block federal regulators from enforcing safety requirements -- a charge that suggests other individuals are likely targets of action as well.

Prosecutors allege that the former superintendent altered the mine’s ventilation system while an inspector was taking an air sample and ordered that a monitor be rewired so that mining could continue despite elevated levels of methane.

What industry spokesman Quinn also didn't talk about is that EPA regulations would apply only to new power plants, and that, as The Times story said, "the proposed regulations further bolster a trend that the power industry began years ago, as more utilities replaced aging coal-fired plants with new natural gas plants. Very few new coal plants are now on the drawing boards."

Coal is a relatively cheap power source, but it's only really cheap if you ignore the costs in lost lives mining it and the health effects from burning it, not to mention the environmental costs from digging it up.

As The Times story concludes:

"[W]hat this essentially says is we will never be building dirty old coal plants ever again," said Michael Brune of the Sierra Club, one of the litigants in the lawsuit that led to the development of the new rules. "The dominant power source of the 19^th and 20^th centuries won’t be built the same again."

This isn't about "crushing" jobs.

This is about progress. And it's time to move on.

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-- Paul Whitefield

Photo: President Obama speaks about energy on March 22 at a TransCanada pipe yard near Cushing, Okla. Credit: Larry W. Smith / EPA

Rick Santorum stopped by the Supreme Court on Monday to argue -- again -- that he's better suited to run against President Obama in November than Mitt Romney. That's because of Romney's role in Massachusetts' healthcare reform law, which Santorum says makes the former governor too similar to Obama on that key issue.

Romney's criticisms of "Obamacare" and his pledge to repeal the federal law have rung hollow, at least to my ears. And if voters want nothing more than to chuck healthcare reform into the garbage can, then Santorum's position might be appealing.

But it's axiomatic that voters are reluctant to replace something with nothing, and to date Santorum hasn't offered much when it comes to improving the healthcare system beyond the standard Republican boilerplate. That's not going to satisfy voters who are alarmed by the rapid increase in insurance premiums and the jaw-dropping bills they receive when they run into seemingly minor health problems.

Santorum's website offers a six-point plan for replacing the Patient Protection and Affordable Care Act, proposing to give consumers more control over their healthcare dollars, encourage more competition among insurers and providers, and provide more flexibility to states in their Medicaid programs. There's value in all of the steps he lays out, and many economists agree that healthcare inflation is excessive in part because so much of the industry is shielded from market forces.

Nevertheless, Santorum's plan is built on the faulty premise that healthcare products and services are much like those in any other market. They aren't, and the differences make those products and services resistant to the sort of discipline that competition brings to other fields.

For starters, the care that's really costly tends to be the kind that's urgently needed. It's hard to shop around for an emergency room after you've been hit by a car or when you're having a stroke. Even when someone does have time to consider where to obtain treatment, the huge information gap between doctors and their patients makes it tough for the latter to push back when they're told they need an expensive treatment or drug. And unlike insurers or corporate buyers, individual consumers have little leverage to negotiate for better prices from physician groups and hospital chains.

Consider, for example, Santorum's call for strengthening health savings accounts that are tied to high-deductible insurance plans. In theory, these plans can help reduce the demand for less-vital healthcare services, easing the pressure on prices. In practice, however, big deductibles can give providers an opportunity to soak individual consumers. Witness my colleague Steve Lopez's column Monday about a family being hit with a $5,000 bill for their 11-year-old daughter's stomach ache. There's also the risk that penny-pinching consumers will put off treating ailments until they become full-blown crises.

Another issue is whether competition encourages insurers and providers to reduce costs through more efficient and effective care, or whether it simply encourages regulatory arbitrage. Like many Republicans, Santorum wants to let people buy health policies from insurers based in other states. As Santorum admits, though, the sole purpose is to let people avoid the coverage mandates that certain states (such as California) impose -- for example, a requirement that all policies include coverage for pregnancy. Such a change would make insurance less expensive for some, especially the young and healthy. But it would also make it more expensive for others because the risks they face wouldn't be spread across as many policyholders.

The current insurance system is already warped to favor the young and the healthy. By denying coverage or imposing repeated double-digit rate increases, insurers push older customers and those with preexisting conditions onto rival carriers or into costly state insurance plans for "high risk" consumers. Santorum's plan offers no solutions to that problem, however; instead, it counts on competition to somehow make healthcare and insurance policies more affordable to those who need those products the most.

Well, there is one other thing that Santorum adds to the mix. He calls for "meaningful" medical liability reform to "increase access" and reduce the cost of defensive medicine. There's fairly broad support for some type of medical tort reform, and "Obamacare" encourages states to experiment with it. But it's worth noting that two of the states that have already enacted significant medical liability limits -- California and Texas -- have seen their healthcare costs rise faster than most other states.

The Affordable Care Act leaves much to be desired, particularly in the area of slowing the growth of healthcare costs. But it would be a mistake to toss the law out and count on market forces to yield a better result. Doing so wouldn't address some of the most problematic incentives in the current system, which encourages healthcare providers to look at illness as a profit center and insurers to look at the sick as someone else's problem.

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--Jon Healey

Credit: Brendan Smialowski / AFP/Getty Images

This post has been updated, as indicated below.

The Supreme Court devoted 90 minutes Monday to arguments on a question about the 2010 healthcare reform law that is deceptively simple: Does the Anti-Injunction Act bar courts from reviewing the legality of the individual mandate before it takes effect?

The Anti-Injunction Act is a federal law from 1867 that forbids courts to consider lawsuits that try to prevent a tax from going into effect. The point was to postpone any challenge to a new tax until after people started paying it.

The deceptively simple reading of the issue before the Supreme Court is whether the individual mandate in the Patient Protection and Affordable Care Act -- the requirement that all adult Americans obtain health insurance policies -- is a tax. To the extent that the mandate bears even a passing resemblance to a tax, it's because the Internal Revenue Service imposes a penalty on those who don't maintain insurance coverage for at least nine months of the year. The penalty is phased in over the first three years, starting with tax returns for 2014, and is based on the taxpayer's income.

Unlike excise taxes, income taxes, estate taxes and any other form of tax you can think of, however, the penalty isn't intended to raise money to support government programs. Washington isn't counting on that money to help pay for the insurance subsidies in the healthcare law; it's counting on compliance with the mandate to help keep down the cost of insurance. Indeed, the less money the IRS collects, the more successful the mandate and the healthcare reform law will be. The clear inference is that the mandate isn't a "tax" in the sense that Congress meant in the Anti-Injunction Act.

At least two factors, however, complicate the question. The first are Supreme Court precedents that take a broad view of what constitutes a tax -- precedents that led the Fourth Circuit Court of Appeals to throw out one anti-healthcare reform lawsuit as premature. As Judge Diana Gribbon Motz of the Fourth Circuit wrote, "An exaction qualifies as a tax even when the exaction raises 'obviously negligible' revenue and furthers a revenue purpose 'secondary' to the primary goal of regulation. Thus, the term 'tax' can describe a wide variety of exactions." (citations omitted)

The second is the contorted argument by the Obama administration that the courts shouldn't consider the mandate a tax for the purposes of the Anti-Injunction Act, but that they should consider it an exercise of Congress' power to levy taxes when evaluating its constitutionality. (Let's just pause for a moment on that dizzying thought.) Rather than trying to sort that out myself, I'm going to refer you to the nicely clarifying analysis done by Lyle Denniston at Scotusblog.

[Updated, 1:30 p.m. March 26: Justice Samuel A. Alito invited the Obama administration's solicitor general, Donald B. Verrilli Jr., to explain that apparent contradiction Monday. Here's their exchange:

Alito: General Verrilli, today you are arguing that the penalty is not a tax. Tomorrow you are going to be back and you will be arguing that the penalty is a tax.

Has the Court ever held that something that is a tax for purposes of the taxing power under the Constitution is not a tax under the Anti-Injunction Act?

Verrilli: No, Justice Alito, but the Court has held in a license tax cases that something can be a constitutional exercise of the taxing power whether or not it is called a tax. And that's because the nature of the inquiry that we will conduct tomorrow is different from the nature of the inquiry that we will conduct today. Tomorrow the question is whether Congress has the authority under the taxing power to enact it and the form of words doesn't have a dispositive effect on that analysis. Today we are construing statutory text where the precise choice of words does have a dispositive effect on the analysis.]

Denniston and my colleague David Savage sat in on Monday's arguments, and they both reported that the court seems ready to rule that the Anti-Injunction Act doesn't apply. If the justices are so inclined because they don't believe the mandate is a tax, that could make it easier for them to rule that Congress overstepped its bounds when it enacted the mandate. Another possibility, though, is that the court will carve out an exception to the Anti-Injunction Act that allows judges to consider some challenges to a tax before it takes effect.

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-- Jon Healey

Photo: Protesters from the Tea Party Patriots against the healthcare reform law in front of the Supreme Court building on Monday. Credit: Jacquelyn Martin / Associated Press

On the second anniversary of the Patient Protection and Affordable Care Act, a.k.a. “Obamacare,” health reform continues to provoke heated debate among our letter writers.

Sometimes, it’s not the stories but the letters themselves that prompt an outcry.

On March 23, The Times published several letters responding to the March 21 story, “Obama’s health reform law still a hard sell.”

Times staff writer Noam Levey wrote:

As President Obama and his allies gear up to defend the landmark healthcare law he signed two years ago, they confront an unforgiving math problem: Just a tiny fraction of Americans has experienced a major benefit from the law.

Levey cited one of the law’s “early benefits” for that fraction of Americans -- allowing adult children to remain on their parents’ health plans until age 26.

But not everyone agreed on calling that a “benefit.”

Reader David Goodwin of Los Angeles said in his Friday letter:

There are no “adult children,” only adults who act or are treated like children.  There are progeny, offspring, and “my kids.”  Your son maybe 24, but he is not a child, I hope.

“Obamacare” and the nanny state treat people like children.  They can drink, drive and vote, but are not responsible enough to pay their way, although that’s the least-expensive age bracket for buying insurance.

His view, however, didn’t sit well with those who favor the reform law.

A few hours later, by email, Laura Jaoui of Claremont shot back:

Please enlighten the public like your letter writer who think  that “covering adult children costs someone or something. Nothing is free.” Indeed, parents of adult children (students often) like me are delighted to pay for keeping their kids on their health plan until the age of 26. Nothing is free.... And before the Affordable Care Act, parents weren't allowed to keep their kids on the plans no matter how much we would willingly pay! Your letter writer should thank “Obamacare” that he will no longer have to pay for these young peoples' healthcare!

Karen Dauphin of Agoura Hills also weighed in:

The letter writer who criticized the Affordable Care Act for extending coverage of adult children was way off base. He … implied that those making use of this provision were just leeches and slackers. The people affected by this law are those like the daughter with lymphoma in another letter -- people whose health history, even at that young age, would make insurance prohibitively expensive, if  obtainable at all. Perhaps he feels that they should simply die and "decrease the surplus population.”

Not everyone was offended, though.

James Webster of Santa Barbara offered his take on Goodwin’s letter:

I enjoy glancing through the “political” letters you publish looking for that proverbial needle in a haystack.  This morning I found one.  What a great feeling it was to read a letter that didn't make my eyes roll and wonder what this world is coming to!

The Supreme Court is expected to weigh in on some aspects of the healthcare reform law next week.  And, of course, it will be a major point of contention in this fall’s election.

Expect The Times to cover all of that extensively, which will undoubtedly generate more letters, pro and con -- and more letters on the letters.

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'Obamacare' and the rationing myth

Supreme Court should lift its blackout

--Sara Lessley

Photo: Rep. Steve King (R-Iowa) rips a page from the text of the 2010 healthcare reform bill as he stands in front of the Capitol. Credit: Win McNamee / Getty Images

As part of their ongoing efforts to dismantle "Obamacare," a.k.a. the Patient Protection and Affordable Care Act, House Republicans are set to vote Thursday on a bill to repeal one of the law's main cost-control features: the Independent Payment Advisory Board, the panel of experts tasked with keeping a lid on rising Medicare costs. But the IPAB is just a more explicit -- and probably less onerous -- way to do something House Budget Committee Chairman Paul Ryan (R-Wis.) proposes in his own Medicare overhaul.

The 2010 law includes a wide variety of initiatives and experiments aimed at reining in the cost of medical care. The IPAB, whose 15 members are appointed by the president with the Senate's approval, is essentially a backstop in case those efforts don't pan out. The board's job is to recommend cost-cutting measures each year that Medicare spending is projected to grow faster than the law's targets, starting in 2014. Those recommendations go into effect automatically unless Congress approves an alternative way to achieve the same savings.

The fiscal year 2013 budget resolution that Ryan unveiled Tuesday requires Medicare spending to increase no more than half a percentage point more than GDP starting in 2023. That's a tighter cap than the healthcare law sets with its spending targets. And unlike the healthcare reform law, Ryan's budget plan offers only one significant mechanism for holding down Medicare costs: an insurance-buying exchange where the elderly can shop for subsidized coverage from private insurers. The bill the House is voting on Thursday, HR 5, would provide another: strict limits on medical malpractice claims.

If competition and tort reform don't slow the rapid growth of treatment costs, they won't make much of a dent in Medicare spending. At that point, someone (Ryan's proposal doesn't specify who) will have to cut something (the proposal doesn't specify what) to keep Medicare within the limits the Ryan budget would set.

The "Path to Prosperity" report that Ryan issued Tuesday implies that the premium subsidies would be spared the axe because they would always be large enough to cover the cost of the second-least-expensive insurance plan in the new Medicare exchange. That exclusion would leave payments to doctors, clinics, hospitals, nursing homes and other providers the most likely targets.

At a hearing Wednesday, however, the Budget Committee's GOP staff director, Austin Smythe, said that the premium subsidies would, in fact, be on the chopping block if costs rose faster than GDP plus 0.5%. That would change the nature of Medicare, ending its longstanding guarantee of affordable health insurance for seniors. The more costs grew above the cap, the less affordable the insurance would be for the millions of seniors on tight budgets.

That's as alarming as the rationing that Ryan says the IPAB would do. Except that it wouldn't. According to a white paper by the Kaiser Family Foundation, the healthcare reform law forbids the board from making recommendations that would "(1) ration healthcare; (2) raise revenues or increase Medicare beneficiary premiums or cost sharing; or (3) otherwise restrict benefits or modify eligibility criteria."

The law also takes fees for many in-patient and hospice services off the table until 2020, and shields reimbursements for clinical laboratories until 2016. That leaves payments to physicians as the most obvious target, which is why the American Medical Assn. supports repealing the IPAB.

The intent of the measure, though, is to have experts look at the efforts going on across the country to make healthcare more efficient and effective, then apply those lessons to Medicare. That might include new ways to deter fraud, make better use of nurses and physicians' assistants or keep patients with chronic ailments out of emergency rooms and nursing homes.

Granted, there's some mystery about what the IPAB would do if it had to restrain Medicare spending. But at least it's clear what the board couldn't do, and who would be making the decision. You can't say that for the Ryan plan.

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Photo: Rep. Steve King (R-Iowa) rips a page from the text of the 2010 healthcare reform bill as he stands in front of the Capitol. Credit: Win McNamee / Getty Images

Betting on whether the Supreme Court will declare "Obamacare" unconstitutional this year? At least some of the smart money is on "no."

The American Bar Assn. devoted all 40 pages of the latest Preview of United States Supreme Court Cases magazine to the high court's review of Obamacare, formally known as the Patient Protection and Affordable Care Act. (The court is scheduled to hear arguments about the law's constitutionality this month.) For this special issue, the editors of Preview polled "a select group of academics, journalists and lawyers who regularly follow and/or comment on the Supreme Court" to get their predictions on how the court would rule.

The result: 85% said the act would be upheld, mainly because they believed the court would find the requirement that all adult Americans obtain insurance coverage to be constitutional. A small faction -- 9% -- believed the court would hold that the challenge to the law was premature because the provisions being challenged won't go into effect until 2014. Most of those polled also said that if the court struck down the individual mandate, it would leave the rest of the act intact.

Granted, these are just educated guesses. The ABA didn't identify any of the experts it polled, so it's hard to know how much their own views of the healthcare law or the Constitution's commerce clause influenced their prognostications. We probably won't know the actual disposition of the appeal until the very end of the current Supreme Court term in late June or early July.

In the meantime, you can look at Preview -- the healthcare issue is free online -- and second-guess the unnamed court-watchers. The editors asked the experts to predict how each justice would vote on each of the four issues before the court. Here's how their answers broke down:

Most members of the group predicted a unanimous ruling that the challenge to the law was not premature, although 44% felt that Justice Sonia Sotomayor would dissent.

The group predicted a 6-3 decision to uphold the individual mandate, with Chief Justice John G. Roberts Jr. and Justice Anthony M. Kennedy joining the court's liberal wing in support, and Justices Clarence Thomas, Antonin Scalia and Samuel A. Alito Jr. dissenting. Kennedy was seen as the most likely to go the other way, with 47% predicting he would vote to hold the mandate unconstitutional.

(I'm no expert, but I suggested two years ago that Scalia would be sympathetic to the mandate, based on the concurring opinion he wrote in the case of Gonzalez vs. Raich.)

Asked whether the court would throw out the entire law if it ruled against the individual mandate, those polled predicted an 8-1 ruling in favor of letting the rest of the law remain in effect. Similarly, they expected an 8-1 split in favor of the law's expansion of Medicaid, which two dozen states have challenged as unconstitutional. The sole dissenter on both issues, the group projected, will be Thomas.

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When it comes to domestic issues, Americans should trust the private sector.

That's a Republican Party mantra, and two stories in The Times this week have me convinced as well.

Now, I know you think one concerns gasoline prices. Really, though, who cares about that? Snore.

That's right: I'm talking about snoring.  As The Times' Lauren Beale reported:

A so-called snore room is the latest offering from Del Webb, which builds communities for people 55 and older.

Buyers whose marriages are plagued by a spouse who snorts, grunts and wheezes while he or she sleeps can opt for an adaptable bedroom plan marketed as the "owners retreat" at Sun City Shadow Hills in Indio. Designed for couples who start out in the same bed but end up apart because of ear-piercing snoring, insomnia or late-night TV viewing habits, this secondary bedroom is connected to the bathroom of the master bedroom.

See?  Big problem; private-sector solution. You leave that to government, and pretty soon you've got government-run snore insurance instead.

Still, even the private sector can stumble. For example, I'm a bit puzzled by Del Webb's logic:

"A nice enclave that shares the master bathroom provides a civilized alternative to the family room sofa," said Jacque Petroulakis, corporate communications spokeswoman for PulteGroup Inc., the parent company of Del Webb.

About a quarter of couples in the 55-and-older age group sleep apart to get a good night's rest, according to PulteGroup, which got the data from a third party but also conducted focus groups and interviews as it developed the bedroom plan.

Now first of all, the sofa isn't for snoring husbands; it's for misbehaving husbands, or came-home-late-drunk husbands -- which, come to think of it, is redundant. (It's never for wives, of course, who are too savvy to choose the sofa, regardless of their transgressions.)

Second, if you're 55 or older and still married to someone who snores, isn't it a bit late to be dealing with the problem? Seems to me the snore room should be marketed at 30-year-olds, who need all the help they can get keeping their marriages together.

But, staying true to the private sector's can-do spirit, in addition to the snore room, Del Webb is offering other conveniences:

Among other new life-easing features the builder is offering are pass-throughs from the closet to the laundry room. A door large enough to push a hamper through connects the two spaces.

Which brings me to my second domestic issue story of the week: widespread thievery of Tide detergent.

The Times Dalina Castellanos reported:

Thieves seem to be embarking on an anti-grime spree, some media outlets are reporting, saying thousands of dollars in Tide detergent is being swiped from shelves across the country.

One Minnesota man stole about $25,000 worth of the liquid laundry detergent from a West St. Paul Wal-Mart over 15 months, authorities there say.

And who's to blame for this crime wave?  Sadly, dear liberals, it appears that Rush and Sean and Glenn are right: It's the government -- or, in this case, at least one peson who apparently has fallen prey to the liberal-nanny-state mentality.  

Lt. Matt Swenke of the West St. Paul Police Department said in an interview with The Times that Patrick Costanzo, 53, was the suspect in the Minnesota thefts.

"He told [police] he didn't have a job and the state didn't help him in any way so he did what he had to do to get by," Swenke said.

Yes, it's true, liberals: You do a man's laundry, he's clean for a day. You teach him to do his own laundry, and he won't steal Tide.

Which doesn't make a lot of sense, I'll admit. But then again, my wife keeps me awake a night -- either snoring or doing the laundry.

Speaking of which:  Why do we have so much Tide?

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--Paul Whitefield

Photo: A so-called snore room is the latest offering from Del Webb, which builds communities for people 55 and older. Credit: Handout

It might be smart to take the new data against red meat -- a study links the consumption of even a small portion daily to a higher risk of dying -- with a grain of (possibly blood-pressure-raising) salt. Not that red meat should get a pass: Overconsumption has been tied, over and over again, to poor health outcomes. And the fact that your grandfather ate 12 ounces every day until his 102nd birthday is no argument against the study; lots of people who smoke cigarettes live to a ripe old age. But there is no getting around the number of people who would live to much riper ages if they abstained from tobacco.

Still, this study was correlational, meaning that we know red meat is tied statistically to higher death rates within the time range of the Harvard study. If that's even so: The study didn't examine what people ate; it asked them what they ate. The question is, did the red meat cause the deaths? Was it all of the reason for the deaths, most of it, a small part of it, or perhaps an indicator of other factors? And is it the meat itself, or perhaps substances used in the raising of cattle or in cooking? Processed meat was linked to still-higher death rates.

Maybe people who avoid red meat are more likely to live healthier altogether. Considering the warnings over the years about beef, that's entirely possible. People who heed health warnings might be more likely  to eat vegetables, exercise regularly, meditate occasionally, fasten their seatbelts and, of course, not smoke, since cigarettes are still the No. 1 cause of premature death.

That would help explain the seemingly nonsensical finding that people who partake of red meat only occasionally and sparingly are less likely to die of any cause -- not just heart attack, diabetes or other ailments associated with poor diet but, say, in accidents. The only way a hamburger is more likely to cause a fatal accident is if it's being held in one hand by a driver.

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Red meat will kill you? Stick a fork in me, I'm done!

--Karin Klein

Photo: Red meat. Credit: Dave Thomson / AP Photo

You can have my steak when you pry it from my cold, dead fingers.

I hate to be politically incorrect, but that's my, well, gut reaction to a study released Monday that says eating any amount of red meat increases one's risk of premature death.

Now mind you, it's not that I don't believe the study. Its lead author is a postdoctoral fellow at the Harvard School of Public Health, and only really smart people get into Harvard. And it's not as though the researchers weren't thorough: They looked at the eating habits and the health of more than 110,000 adults for more than 20 years. Which, on a scale of boring tasks, certainly tops the homework in the geology class that I took in college.

But first I read this -- "adding just one 3-ounce serving of unprocessed red meat ... to one's daily diet was associated with a 13% greater chance of dying during the course of the study" -- and I think, wow, I'm pretty sure that just two bites of that T-bone I had last month were more than 3 ounces.

Then I read this -- "Even worse, adding an extra daily serving of processed red meat, such as a hot dog or two slices of bacon, was linked to a 20% higher risk of death during the study" -- and I think, that probably means the bacon-wrapped hot dogs I had for lunch last week should've killed me by now. (To give me some credit, I skipped the onions and the fries; perhaps that's why I'm still walking around.)

Also, this part moves me not at all: "Eating a serving of nuts instead of beef or pork was associated with a 19% lower risk of dying during the study. The team said choosing poultry or whole grains as a substitute was linked with a 14% reduction in mortality risk; low-fat dairy or legumes, 10%; and fish, 7%."

Well, I had peanuts on Saturday afternoon. It didn't make me glad it wasn't steak; it made me think of being on an airliner. Then I had sushi on Saturday night. It made me think of fishing.

But here's the part of the study that has me really puzzled:

The Harvard researchers hypothesized that eating red meat would also be linked to an overall risk of death from any cause. ... And the results suggest they were right: Among the 37,698 men and 83,644 women who were tracked, as meat consumption increased, so did mortality risk.

Which means what, exactly? If I grill a nice New York strip on Sunday, that increases my chances of being hit by a bus on Monday?

Granted, I didn't go to Harvard, but that seems like a stretch. Or maybe it's just that all the red meat is killing my brain cells, in addition to clogging my arteries (and making me more likely to die in an airplane accident).

Probably a lot of people are going to have fun with this story. They may even ignore the more salient points, among them that at least cutting down on the consumption of red meat is good for your health and good for the planet.

But sorry, Harvard, my bottom line remains: As a red-blooded, red-meat-eating American, I just can't stomach a future that doesn't include a juicy rib-eye.

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Dr. Wendy Sue Swanson, a pediatrician in Seattle, is brimming with ideas for how she could use technology to improve the practice of medicine. She's not thinking about exotic devices or personalized therapies; for Swanson, it's mainly about using communication tools like YouTube to answer the basic questions all parents ask so that she can focus her time with patients on their unique medical problems.

The problem, Swanson said at the South by Southwest conference Sunday, is that insurers won't pay for the videos she creates to educate patients or the blog posts she writes about important new developments in pediatric care. No matter that these steps would lead to healthier patients who place fewer demands on the healthcare system.

She does them anyway, but the idea of communicating online with patients is anathema to her fellow doctors. "There's an overwhelming climate of fear" among physicians, she said, about the liability they may incur or the privacy violations they might commit if they respond to emails or write blog posts about medicine.

Swanson's panel at SXSW was a reminder that healthcare reform is a work in progress. While politicians and litigators fight over the provisions of the law Democrats pushed through Congress in 2010, the industry itself is still trying to overcome some of the basic hurdles to creating a more effective, efficient and affordable healthcare system.

One of the keys to that effort is enabling primary-care physicians like Swanson to spend more time understanding their patients' health needs and managing their care. The 2010 law, however, will extend insurance to millions more people, thereby increasing the demands on doctors' time. Swanson wants to use online videos and tablet computers in her waiting room to instruct patients on routine matters -- e.g., the issues surrounding vaccinations -- so the time they spend with her in an examination room is meaningful. She'd like to see some pilot projects done, but adds, "It has to be paid for, and that's what we're trying to figure out."

Her comments drew a sympathetic response from Michael Golinkoff, head of clinical specialty operations for insurer Aetna Inc.'s national care-management unit. Golinkoff wants to increase the amount of information flowing to doctors and patients, in part to "help an empowered patient to be a more active participant in their healthcare." Patients need to see the "continuity" between the lifestyle choices they make and their health, he said. The problem today is getting patients to see that connection and to change the lifestyles that bring on chronic illness.

Another thing insurers can do, Golinkoff said, is help patients tap into a community of people with the same ailment. That's what panelist James Heywood is doing with his company, PatientsLikeMe, whose website lets people read and share their experiences with different prescription medicines, therapies and symptoms.

Heywood wants to see more information flowing too, particularly about the effectiveness of treatments and the profit margins for the doctors who perform them. When heart surgeons tells you that you need a bypass, "the fact that they're making like a car's worth of personal income off of this, they don't have to disclose to you." The current system has so little transparency, he said, patients can't help but be suspicious about doctors. "We have to figure out how to get out of this war where nobody can trust anybody and into some new model," he said.

Golinkoff pointed to accountable care organizations, a new approach promoted by the 2010 law, as a possibility. Primary-care physicians, specialists and hospitals form such groups to coordinate care in the hope of saving money by improving results. Although the industry is still waiting to see how well they work, Golinkoff said, these groups align physicians' interests with their patients' and encourage investments in wellness.

Heywood wasn't so sanguine. The potential problem of accountable care organizations, he said, is that the budgets they impose may create a new bad incentive: instead of being encouraged to perform costly treatments, physicians may have a financial motive to choose cheaper but less effective alternatives.

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-- Jon Healey in Austin, Texas