Bloggers tuned into hearings for Supreme Court nominee Elena Kagan looking for clues to her views on the health overhaul law as well as abortion restrictions. Others take a look at new polls and the ‘tanning tax’ set to kick in tomorrow.

April Fulton of NPR’s Shots Blog describes an exchange Tuesday between Sen. Tom Coburn, R-Okla. and Kagan: “An ardent opponent of the health care law, Coburn asked Kagan whether it would be constitutional if Congress required Americans to eat three vegetables and fruits a day to save on health costs. ‘Sounds like a dumb law,’ Kagan said. ‘But I think that the question of whether it’s a dumb law is different from … the question of whether it’s constitutional and I think that courts would be wrong to strike down laws that they think are senseless just because they’re senseless.’”

Caroline May of The Daily Caller writes of the exchange, “Her non-answer  has made some question Kagan’s views on how much power the government can exert over its citizens. John Hart, Coburn’s communications director, told The Daily Caller, ‘I think what she said reflects a belief that the Constitution does not protect the individual rights the founders intended to protect.’ Hart said the senator was pointing out that there is a whole group of leaders who have eroded the original intent of the commerce clause to usurp the rights of Americans.”

The Guardian’s Michael Tomasky notes, “To me it’s like this. Any society is full of competing values and interests. Here, we have the value of individual liberty competing with the value of overall social health. I have big trouble taking seriously the idea that making fast-food joints post their nutritional information is fascism. …Anyway, Kagan didn’t answer, as any liberal would not, because she knew Coburn was really talking about healthcare reform. But if this is the best they got, she has no worries.”

On abortion, Lindsay Beyerstein of the Media Consortium looks at an exchange Tuesday on abortion rights where Kagan said, “Senator Feinstein, I do think that the continuing holding of Roe and Doe v. Bolton is that women’s life and women’s health have to be protected in abortion regulation.” Beyerstein writes, “That’s a good start, but it’s hardly the ringing endorsement of choice that progressives would have hoped. Kagan went on to talk [about] the special case of ‘partial birth abortion bans,’ which she encouraged Bill Clinton to support while he was president. ‘Partial birth abortion’ isn’t even a medical term. It’s a marketing term coined by anti-choicers in their bid to chip away at Roe v. Wade. For pro-choicers, it’s disappointing to see Kagan uncritically buying into that frame.”  There’s video of the exchange here.

Elsewhere, Ezra Klein looks at public opinion polling on health reform, including a new poll out Wednesday by the Kaiser Family Foundation, and concludes support continues to rise: “These are fairly small changes in the numbers, to be sure. But then, the numbers on health-care reform were always fairly closely divided. It’s possible we’re just seeing random shifts in the same direction in multiple consecutive polls, and if so, future surveys will bear that out.”

Wonk Room’s Igor Volsky looks at the same poll, noting, “Moreover, just 27% of Americans want to repeal the law entirely and 12% of those who have an unfavorable impression said that the “law should be given a chance to work, with Congress making necessary changes along the way.” For all of the noise we’re hearing about repealing the law and the health care lawsuits, these aren’t very impressive numbers. On the whole, most Americans believe that the law will have a neutral impact but think that the country as a whole would be better off.”

The New Republic’s Jonathan Cohn (on his new Citizen Cohn blog) also talks about polling: “Reform has generally been more popular on the Kaiser tracking poll than most of the others I’ve seen. And the increase in popularity it shows is not huge: The figure is still in the 40 to 50 percent range, where it’s been for a while. But the trend towards higher popularity is consistent with other recent polling.”

(KHN is a project of the Kaiser Family Foundation.)

Cato’s Michael Cannon looks at a new study from Massachusetts that seeks to quantify how many individuals are buying coverage once they get sick: “In the hope of preventing this sort of gaming behavior, RomneyCare requires Massachusetts residents to purchase health insurance.  Yet that ‘individual mandate’ appears not to be working, probably because the penalties for non-compliance are far less than the cost of the mandatory coverage. … ObamaCare contains similar price controls and requires nearly all Americans to purchase health insurance by 2014.  Yet ObamaCare’s penalties for non-compliance are also far less than the cost of the required coverage for most people. As goes Massachusetts, so goes the nation.”

And The Heritage Foundation’s Tina Korbe reports on the new “tanning tax,” which was implemented to help pay for the health care overhaul, and is scheduled to take effect tomorrow: “Approximately 19,000 ‘mom and pop’ small businesses might be affected by the new tax — and those businesses will likely spend an average of more than $74 an hour to comply with federal tax paperwork burdens, according to a factsheet distributed by the NFIB.”

Bloggers are back on the new health overhaul law as they dig into Supreme Court nomination hearings as well as new polls and studies.

Wonk Room’s Igor Volsky explores the difficult situation for Supreme Court nominee Elena Kagan. He writes that yesterday Republican senators questioned her at length about whether she would be a “judicial activist” and today they may well try to prod her to become one when they “ask Kagan if she believes Congress has the authority to impose an individual mandate under its authority to regulate interstate commerce.”

The Weekly Standard’s Jeffrey Anderson disagrees with a post from Ezra Klein in which Klein noted that popular support for reform has increased.  Anderson rebuts: “The number of polls has dwindled substantially — from 22 in the month before Obamacare’s passage and 19 in the month afterward, to just 4 in the past month — and hasn’t included a poll of likely voters in the past two months (compared to 7 in the month before passage).  This is important because Obamacare has consistently polled far better among Americans as a whole than among Americans who vote — and far better among those who are largely indifferent than among those who care deeply.”

Brad Wright of Wright on Health looks at a new study about states and the new Medicaid expansion, noting that “it seems that many states are worried that currently eligible, but non-enrolled individuals will suddenly decide to enroll because of the high visibility of the health reform efforts. Such individuals would not fall under the federally-funded expansion, and the states are guarding their checkbooks.”

Heritage’s Vincent Coglianese looks at comments from Sen. Orrin Hatch, R-Utah, about repealing the health overhaul bill. Hatch said, “I’ve been working to dismantle Obamacare … We have to fight this terrible law that’s a threat to liberty itself.”

In a separate post for Critical Condition, Jeffrey Anderson gives four reasons Republicans should support high-risk state insurance poolsfor people who have trouble getting insurance because of preexisting conditions. Among his reasons are the lower cost of expanding high-risk pools and that they wouldn’t “invite government control of our entire health-care system.”

Insurance broker Henry Stern of Insure Blog looks at news that the temporary early retiree reinsurance program is now accepting applications and quips, “As a side note, ObamaCare©’s certainly turning out to be quite the cash cow for those evil, greedy, heartless insurance carriers, isn’t it? Funny how that happened.”

Elsewhere, Merrill Goozner says the Supreme Court decision’s on business patents is bad news for biotech firms. Goozner writes that “the ruling could lead to more patent challenges against overly broad patents that claim ownership of genes and pathways based on their proven relationship to a disease, even when the claimant has no ‘machine or apparatus,’ i.e., a drug, that would affect the disease.”

Health Beat Blog’s Maggie Mahar disagrees with reports suggesting Dr. Donald Berwick’s nomination to head Medicare and Medicaid is in trouble. She interviews Tom Scully, former director of CMS under President George W. Bush, who says, “He’s universally regarded and a thoughtful guy who is not partisan. I think it’s more about … the health care bill. You could nominate Gandhi to be head of CMS and that would be controversial right now.”

A variety of health care news this week kept bloggers busy analyzing new regulations and wondering if Congress will change the formula that determines Medicare physician payment.

On the health reform front, for instance, John Goodman calls a new media campaign promoting the health overhaul law “propaganda” and asks, “Will it work? Will a big lie, repeated often enough, come to be accepted as truth? Will the administration be able to pull off the biggest lie of all — convincing seniors (who will bear way more than half of the cost of health reform) that they in fact will gain? Maybe. But I doubt it.”

Meanwhile, legal expert Timothy Jost writes on the Health Affairs blog about regulations announced Tuesday and immediately tagged by the Obama administration as the new  “Patients’ Bill of Rights.” Jost notes, “In fact, these regulations, in combination with other provisions of the Affordable Care Act, do finally implement many of the protections of the McCain-Edwards-Kennedy bipartisan Senate patient bill of rights legislation (and of its House equivalent), which was debated contentiously through the summer of 2001 and nearly adopted before the events of that September changed the nation’s agenda.”

Cato’s Michael Cannon looks at the new required coverage mandates and says, “All told, ObamaCare’s unlimited-coverage mandates will increase the premiums of affected consumers by an average of about 1 percent, and as much as 7 percent for some consumers.  Or maybe more: the administration acknowledges that a ‘paucity of data’ about the impact of these mandates means that there is ‘tremendous,’ ’substantial,’ and ‘considerable’ uncertainty about the mandates’ costs.”

Don McCanne of Physicians For A National Health Program examines the new grandfathering rules released by HHS for health insurance plans and concludes, “‘Keeping the insurance you have’ was only a slogan used to market the reform proposal. It wasn’t a serious long term strategy. Instead of wasting time in another political dogfight – this time over grandfathering – we should move forward with supporting policies that will work for everyone – like a single payer national health program.”

Hot Air’s Ed Morrissey says health reform amounts to “price controls” for insurance companies, and warns “If government caps prices so that insurance companies cannot cover the cost of providing its services, insurance companies will go out of business and shortages will drive up the actual cost of health care.”

And Naomi Freundlich of Health Beat Blog tackles the related topic of physician reimbursement by raising some key questions: “Will Medicare beneficiaries really face a shortage of providers and restrictions on their access to care [because of the cut in Medicare payment rates]? Or is this a scare tactic being used for political reasons?”  She concludes, “The take-away message is that while the 21% cuts doctors are now facing are an administrative nightmare, they will be fleeting. And reports of a mass exodus by doctors from Medicare are overblown. Everyone agrees that Medicare needs an overhaul—but a misguided formula from a Republican Congress in 1997 will have no part in it.”

The Washington Post’s Ezra Klein looks at new public opinion polls on the health overhaul law: “Two polls is enough to make me curious, so I headed over to Pollster.com, and it does seem we’re looking at a trend. The site’s aggregate chart of recent polls doesn’t yet show support overwhelming opposition, but it does show support rising and opposition falling. In fact, the bill’s spread looks better than at any point in the past year.” Klein posts the aggregated graph at his site.

And Brad Wright of Wright on Health hosts the most recent edition of Health Wonk Review, a biweekly roundup of health policy blogging. He focuses on new health policy research.

Bloggers react to news that Office of Management and Budget Director Peter Orszag will announce his resignation soon.  Other commentators look at President Barack Obama’s speech on new rules governing health insurers.

The Atlantic’s Joshua Green writes, “Orszag will be remembered chiefly for two things: his key role in designing the stimulus and the new health care law and his odd status as the Justin Bieber of the executive branch, the wonk whose personal life was splashed all over the tabloids. Orszag’s true legacy won’t be established for years, of course, not until his ideas about how to “bend the cost curve” of health care expenditures–many of which were crammed into the new law–have been tested in the real world.”

Hot Air’s Ed Morrissey isn’t pleased with Orszag’s performance: “This closes one of the worst budgeting debacles in American history.  Orszag’s tenure produced the worst budget deficit of our time, the FY2010 budget with $1.3 trillion in red ink.  The budget process has gotten so bad that Democrats didn’t even bother to produce one for FY2011, the first time in decades that a House has failed to even propose a budget.” Morrissey isn’t optimistic about next year’s budget either, saying: “However, let’s not kid ourselves that Orszag’s departure will make a difference in budget problems, although it may at least bring a little more competence to the process.  The real problems with the budget come from the Democratic agenda of big-spending, big-government programs at the expense of taxpayers who will have to eventually foot the bill.  In order to fix that, we don’t need to replace Peter Orszag. We need to replace Nancy Pelosi, Harry Reid, and Barack Obama.”

Matthew Yglesias points out “it’s worth observing that this is a high-turnover job. Presidents Clinton and Bush managed to go through eight OMB Directors, one of whom only made it thirteen months.”

Newsweek’s Ezra Klein reflects on Orszag’s legacy: “On a policy level, Orszag was wildly, even improbably, successful. A bill was passed. The Congressional Budget Office, now under the watchful gaze of Doug Elmendorf, certified it as deficit-reducing. Orszag’s two top priorities—an independent commission empowered to aggressively reform Medicare and a tax on high-value insurance plans—survived the process. But on a political level, he lost the argument: polls showed that few Americans thought the legislation would reduce the deficit.”

The Washington Post’s Ed O’Keefe lists seven names he’s heard to replace Orszag, including former Clinton advisers Gene Sperling and Laura Tyson.

And Time’s Michael Scherer suggests another group of candidates to draw from: “But there is another, considerably less likely, direction the President could go. In the second half of his first term, President Obama will find that his biggest obstacle when it comes to the budget is Congress, which will be challenged to take on the radioactive political issues (social security, tax increases) that come with dealing with a government that is running deficits that the White House believes are unsustainable over the medium and long terms.

On Obama’s speech, Cato’s Michael Cannon writes, “In the upside-down world of ObamaCare, politicians can force health-insurance companies to spend more yet blame them when premiums increase,” and says the new rules amount to “price controls.”

Wonk Room’s Igor Volsky looks at the political strategy behind the remarks: “Obama is requiring insurers to accept new regulations that will increase their costs while warning them against raising premiums. The administration is hoping that today’s public scolding will shift some of the blame for the coming premium increases to insurers (where some of it rightly belongs) and encourage issuers to squeeze the providers, which is good for the whole system because it brings down costs. But I’m not sure what happens if they respond by simply passing on the increases to consumers. Unfortunately, the health care law does not give the federal government enough authority to actually prevent insurers from jacking up prices.”

Heritage’s Kathryn Nix continues her “Side Effects of Obamacare” series by writing about the Department of Health and Human Services’ missed deadlines for health reform implementation. Nix says, “No one will die because of these missed deadlines, but the trend is worrisome.  If HHS can’t get its act together for the simple, preliminary stuff, how will it do when it has to address complicated and weighty manners under deadline?”

And John Goodman links to a clever public service announcement for Father’s Day by the Agency for Healthcare Research and Quality.

The new regulations on which insurance plans would be considered “grandfathered” under the new health law has prompted diverse responses from bloggers. In addition, there’s a posting about the difficulty of using research to tailor Medicare treatments and studies on health sector productivity.

Health Affairs’ Timothy Jost, a legal scholar, takes a detailed look at the proposed regulations:

The regulations begin with the statutory principle that as long as an enrollee remains with a plan in which the enrollee was a member on March 23, 2010, the terms of that plan do not need to change to accommodate requirements of PPACA that do not apply to grandfathered plans.  Insurers or employers may add new benefits to health plans, change the terms of a plan to comply with state or federal requirements (including PPACA requirements that apply to grandfathered plans), voluntarily adopt consumer protections that they are not required to adopt, make modest adjustments in benefits or cost sharing, and — most importantly – raise premiums, without losing grandfathered status.  

Grandfathered plans may also add new family members or employees, and may be renewed.  Indeed, a grandfathered group plan could add new employees as existing employees left the plan, ending up eventually with no members who were enrollees as of the effective date, but still remain grandfathered.  The regulations, however, bar certain subterfuges that employers may be tempted to engage in to maintain grandfathered status.

Heritage’s Kathyrn Nix continues her “side effects of Obamacare” series with a look at the new regulations. Nix says, “The new regs will make it tough for a lot of those folks to hold onto their current plans, even though the Department of Health and Human Services continues to claim otherwise.  That because HHS is ready to revoke the ‘grandfathered’ status of existing plans whenever an employer makes what it deems to be a ’significant’ change in terms of coverage.  And the HHS regs show that common adjustments such as an increase in deductibles or co-pays or a reduction in benefits would be considered ’significant.’”

The Apothecary’s Avik Roy says “The government also provided a low estimate and a high estimate; at the high end, the report projects that 80% of small employers, and 69% of all plans, would lose their status by 2013.” Roy also points to another blog that suggests unions might be exempt from the grandfathering rules until their next contract negotiations.

Wonk Room’s Igor Volsky has a different take: “The new grandfathered rules wouldn’t prevent plans from changing. They would only discourage employers and insurers from stiffing beneficiaries with very higher costs and insufficient benefits or increasing costs and reducing benefits too quickly. To argue that grandfathering would force people out of their plans assumes that market forces aren’t already pushing people out of existing coverage or leading to significant cost increases and benefit reductions.”

And Dawn Horner of Georgetown University’s Say Ahhh! writes: “With the new rules in place, however, these millions of children and families will be assured that they receive the same protections under health reform as others newly signing up for coverage. Now that’s something to tell our grandchildren about!”

Elsewhere, Merrill Goozner looks at a Wall Street Journal report about research showing that Medicare could save up to $500,000 per year by changing beneficiaries’ drug treatment for macular degeneration. However, Goozner notes, “CMS will still cover [the more expensive drug] Lucentis after the ‘definitive’ trial results are published because it is prohibited by law from using comparative effectiveness research or cost-benefit analysis to make coverage decisions.”

The Association of Health Care Journalists’ Andrew Van Dam points to a new study from the Agency for Healthcare Research and Quality that he says is full of colorful graphs and attempts “to figure out where to put the blame for those in-patient cost jumps that occurred between 2001 and 2007 and thus divided the increases into four categories: Medicare, Medicaid, private insurance and payments from those without insurance.”

The Incidental Economist’s Austin Frakt looks at a new paper from economist David Cutler that found productivity growth in health care, education and other social services was negative betweeen 1995-2005.  Frakt reacts: “This is not a good sign. To have any hope of obtaining a reasonable return on our massive health care (and other social program) spending, we need productivity in the sector to grow, not shrink. If the 1995-2005 trend continues, we risk both the health of our economy and populace.”

And Greg Scandlen points to a new EBRI report on consumer-driven health plans that found enrollees had no statistical difference in self-reported health status from traditional plan enrollees.

A front-page New York Times story last week on the Dartmouth Atlas Project caused immediate controversy among many left-leaning blogs. Now, a few conservatives and libertarians have also weighed in on the debate.

John Goodman compares the debate to that over public education, and says:

I think the work of Elliott Fisher and Jonathan Skinner is very important. But behind the very public to and fro about their work is a very important policy issue that all sides allude to and none are confronting directly. To wit: Can we (meaning the government) use statistics on Medicare spending to force the health care system in general, and Medicare providers in particular, to deliver more efficient, higher-quality care?

The weight of the evidence I believe is fairly clear: No, we cannot. …

In general, a bureaucratic system is one in which normal market forces have been systematically suppressed. In such an environment, there tends to be a sea of (relative) mediocrity, sometimes punctuated by little islands of excellence. Further, the islands of excellence tend to be randomly distributed. They do not correlate with much of anything. This picture not only describes most public school systems around the world, it also describes most health care systems. (In fact, I can’t think of a single exception.)

The Apothecary and National Review Online posted a commentary by Avik Roy in which he suggests the debate “relates to one of the key justifications for Obamacare: that the rising cost of health insurance is largely due to the greed and incompetence of ordinary physicians, and that government alone can fix this problem. … It is about something more fundamental: Can government do a better job of managing medicine than doctors and hospitals can, or should the doctor-patient relationship remain sovereign? There is plenty of waste in medical care today, but the Dartmouth Atlas demonstrates that government is the problem, not the solution.” Roy gives a detailed rundown of flaws in the Dartmouth data.

Cato’s Michael Cannon says he “agree[s] with my left-leaning friends.  This was shoddy journalism.” Cannon goes on to note that free-market advocates shouldn’t run from the Dartmouth data because “[s]o long as the Dartmouth research holds up to scrutiny, advocates of free-market health care reform should embrace it, for two reasons. First, embracing reality is generally a good idea.  Second, the Dartmouth research makes the case for free-market reforms, and against the Obama-Orszag agenda.  The Dartmouth Atlas focuses almost exclusively on the Medicare program, where economists of all stripes acknowledge that government-imposed price and exchange controls, coupled with a lack of patient cost-consciousness, are the driving forces behind persistent excessive spending and a lack of focus on value. ”

Elsewhere, Boston Health News hosts a new “killer edition” of Health Wonk Review.

And a new nonprofit, nonpartisan organization focusing on free enterprise and led in part by James Capretta, a former official in the Office of Management and Budget, has launched a site called ObamaCare Watch.

The shouting war over health reform’s effect on the budget got a little louder today when the director of the Office of Management and Budget, Peter Orszag, pushed back at conservative bloggers who are saying federal officials were disingenuous about the real costs of the law.

First, let’s go back in time….just a little:

Last week, Congressional Budget Office Director Doug Elmendorf posted on part of a presentation he gave to the Institute of Medicine on health care and the deficit.  Elmendorf wrote, “In considering the opportunities for achieving that reduction in spending growth, there are grounds for both optimism and pessimism. On the upside, there is considerable agreement that a substantial share of current spending on health care contributes little if anything to people’s health, and providers and health analysts are making significant efforts to make the health system more efficient. On the downside, it is not clear what specific policies the federal government can adopt to generate fundamental changes in the health system.”

Conservative commentators quickly focused on the downbeat assessment. Heritage’s Conn Carroll, who initially blogged about Elmendorf’s report last week, returned to the subject today, saying: “now that Obamacare has become (hopefully only temporarily) the law of the land, the CBO is singing a slightly different tune.”

Orszag posted a defense on his blog today: “CBO Director Doug Elmendorf recently gave a presentation on health costs and the fiscal outlook.  Doug concludes that the federal budget remains on an unsustainable course even after enactment of the Affordable Care Act, and I wholly agree with him.” But he goes on to add “The new law incorporates the most promising ideas from economists and leaders from  across the political spectrum to control health care costs.  As I have written before, this includes the vast majority of the options CBO itself suggested for reducing long-term health care cost growth.  And we now have a variety of new institutions that will be devoted to guiding policy toward higher-quality and lower-cost outcomes”

Elsewhere in the blogosphere, Health Beat Blog’s Maggie Mahar reviews an update of Philip Longman’s book on the Veteran’s Affairs health care system.  Mahar writes: “In other words, reformers don’t have to start from scratch. The VA already has laid out a roadmap and it would be happy to share the comparative effectiveness research that it has gathered with the rest of the nation. We don’t have to look to Europe to find examples of systems that work. I believe that studying care in Europe can be extraordinarily useful, but on the phone, Longman confided that, as a young journalist, he was told, “Never start a sentence, ‘In Sweden, they . . .’”  Americans are more likely to be persuaded by home-grown solutions.”

Cato’s Michael Cannon has a different take on the VA — pointing to reports of problems with the system.  Cannon says, “ObamaCare will produce similar horrors, and for the same reason: all economic systems serve the people who control the money.  Under ObamaCare and the VA, patients don’t control the money.  The government does.”

Talking Points Memo created an interactive map of what they’re calling the “Shadow Congress,” or former members of Congress now working as lobbyists in Washington, D.C.  TPM counted 172 “shadow members.”

Hot Air’s Ed Morrissey responds to reports that parts of Canada may privatize some health care services, saying, “That does prompt a question, though, on whether a little privatization is possible — a question that the US is considering in the opposite direction.  If Canada will no longer cover some of these necessary procedures, it will have to allow for insurers to sell policies to cover the costs … If Canada allows that, why wouldn’t Canadians want to get insured for other issues as well?  And if the electorate gets health-care coverage in a more rational and accessible manner than they do now, why would they tolerate government control in the future?”

On the Health Affairs Blog, legal expert Timothy Jost writes about new requirements for nonprofit hospitals under the health overhaul law. Jost says the requirement “crowns a long-standing campaign by Senator Charles Grassley to increase the accountability and ‘charitability’ of tax exempt hospitals.”

David Catron on the American Spectator calls Donald Berwick, President Barack Obama’s nominee to lead the Centers for Medicare and Medicaid Services, “a blinkered ideologue with an abiding admiration for Britain’s National Health Service (NHS), and the significance of this for the future of U.S. health care can hardly be overstated.”

Wonk Room’s Igor Volsky writes that the National Federation of Independent Business is having trouble getting other business groups to join in a lawsuit seeking repeal of the new health overhaul law, saying: “Small businesses may not be overly enthusiastic about the new law — given the misinformation about the law and the complexity of the measure, that’s not surprising — but they would be foolish to join a frivolous lawsuit that cuts them out of negotiations with HHS about any new regulations.”

Dylan Matthews, guest-posting on Ezra Klein’s blog, notes that abortion rights groups are lobbying in support of other reproductive health issues, like mandatory coverage of birth control pills.  Matthews says: “Abortion rights groups seemed to be caught unaware when the Stupak amendment initially passed the House, and while some organizing occurred afterward, the damage was done. It should have served as a warning against future complacency, one Planned Parenthood at least seems to be heeding.”

The New Health Dialogue’s Meredith Hughes looks at a Commonwealth Fund report on community health centers. Hughes says the report recommends these centers “need referral partnerships with hospitals, increased health IT capacity, and to adopt the qualities of patient centered homes. As we move forward in building and improving our community health center infrastructure, it’s important to keep these qualities in mind.”