Please note: This week’s roundup is abbreviated due to the holiday.

There has been a great deal of buzz over President-Elect Obama’s choice of Melody Barnes for Director of the White House Domestic Policy Council, as ThinkProgress reported Monday. (You can also check out the official Obama-Biden Transition Team blog post.) Before taking an advisory role on Obama’s transition team and campaign, Barnes held the position of Executive Vice President for Policy at the Center for American Progress. Also, from 1995 to 2003, Barnes served as chief counsel to Senator Ted Kennedy. Many have suggested that Barnes’ primary focus in the new Administration will be on health care policy, given her record on health care issues and the President-Elect’s stated domestic agenda priorities. Noting Barnes’ record at CAP, Ezra Klein wrote:

Barnes has been one of the chief architects of CAP’s domestic policy program, and in that, she’s created a formidable and decidedly impressive organization.

At The Field, Al Giordano commented on Barnes’ record as an “unabashed progressive,” and on what her role in the Obama Administration will include:

Barnes will coordinate the mega-board of the Cabinet secretaries of Health and Human Services, Justice, Labor, Education, Housing and Urban Development, Commerce, Energy, Treasury, Agriculture, Transportation, Interior and Veterans Affairs. Basically, she’ll be domestic policy czar.
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1993. Want to get an idea of how progressive she is? Read this: In January of 2007, prior to President Bush’s state of the union address, Barnes wrote this essay for the Washington Post, What a Progressive President Might Say…

(Read Barnes’ essay here.)

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I was recently called an “audist” by a sign language interpreter on my staff, and believe me, it was not a compliment. Audism is a term used to describe attitudes and actions by people in the hearing world that oppress those who are Deaf. Audism, like racism…judges, labels and limits…The belief is that hearing people feel they are superior to Deaf because they can hear. It might be because I am Jewish but words that end in ISM such as anti-Semitism, racism, sexism and now AUDISM are words that are powerfully repugnant to me.

I told the interpreter that I wanted to share a story with her. A long time ago I had an assistant who I was very fond of, and she, me. One day an elderly Jewish lady, whom I’ll call Mrs. Goldstein, had an appoinment to purchase hearing aids. When she left without purchasing them, Katie, my assistant, asked “did Mrs. Goldstein try to Jew you down on the price?” What was so upsetting to me was that she had absolutely no idea that what she was saying was offensive, bigoted, insulting and just plain ignorant. I explained that to Katie and vowed to myself that I would help teach her the truth…it is the only way to combat prejudice.

I asked my staff person to help me in the same way. I am not an audist…but I may occasionally say things that might make it seem, out of ignorance that I am. Rather than make derogatory comments I asked her to take the time to educate me. I am very open to listening and learning.

When I was at Pfizer, I worked with colleagues at NHGRI and FNIH to form the Genetic Association Information Network (GAIN) — a public-private partnership that encourages industry and academic collaboration to better understand the genetic basis of common disease.

At the final GAIN analysis workshop earlier this month, we were given the chance to review data generated over the last two years, including disease studies of psoriasis, depression, schizophrenia, diabetic nephropathy, and bipolar disorder. It was exciting to see that each study identified important regions of the genome associated with these diseases. Unfortunately we also learned that neuropsychiatric diseases remain a challenge as the search for genetic variation and diseases is hampered by the complexity of the phenotypes involved, as well as the apparent diversity in genes which contribute to the diseases.

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Today is Public Health Thank You Day, honoring legislators, researchers, government agency employees, and other professionals who focus on community-wide health. Take a look at profiles of public health heroes, and spread the word!

Health Care America Now started running a new ad in an “attempt to influence the political commuity to help push the president-elect’s vision of health care reform once he takes office,” as Sam Stein reported for the Huffington Post:

Health Care for America Now is out with a new advertisement Tuesday morning that makes clear that Obama will be held to the health care reform promises he made while on the campaign trail.

The spot, airing in Washington D.C., uses an October speech by Obama on health care as a way to set the ground rules for his forthcoming administration.

Here is the new Health Care for America Now ad:

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November is National Family Caregivers Month, designated by the government to recognize the efforts of spouses, children, and other family members in giving free care to loved ones struggling with chronic health needs. The impact of caregiving is significant—billions of dollars of uncompensated care, billions of dollars of lost productivity, and increased stress-related health conditions among the caregivers.

- 17% of family caregivers are providing 40 hours of care a week or more.
- The value of the services family caregivers provide for “free” is estimated to be $306 billion a year. That is almost twice as much as is actually spent on homecare and nursing home services combined ($158 billion).

As a caregiver and a health policy expert, the statistics that were the most painful to learn:

- 22% of family caregivers say they need help communicating with physicians.
- 50% of caregivers reported that different providers gave different diagnoses for the same set of symptoms and 62 % reported that different providers gave other conflicting information.
- Over 40% of U.S. primary care physicians think they don’t have enough time to spend with patients.

Communication is such an issue that the National Family Caregivers Association (the source of these statistics) chose as the topic of their first two national teleclass/webinars, “Communicating Effectively with Healthcare Professionals.” In addition to learning how good communication can facilitate optimum health care and how to prepare for doctor office visits, the classes also featured how to:

- Distinguish between different styles of communicating with healthcare professionals
- Compose assertive messages for communicating in healthcare situations
- Be prepared for and cope with an emergency room visit.

I’ll be celebrating National Family Caregivers Month by reaching out to other family members and friends about effective communications with their physicians and other healthcare professionals.

More details and resources for caregivers are available on NFCA’s website at: www.nfcacares.org, and the National Alliance for Caregiving at www.caregiving.org.

We have all seen the disturbing headlines of economic failures, bailouts, corporate bankruptcies, and massive layoffs. Economies around the world are slowing down. We also see the continued and raging debates over health care costs, delivery and quality as healthcare organizations and providers fight to reduce or control costs while delivering quality health care and attracting a qualified workforce. Whatever the reasons, there is a growing shortage of clinical, health, and allied health workers. Factors cited as contributing to the shortage include an aging workforce; high retirement eligibility; difficulty in recruiting and retaining workers; lack of educational, training, and retraining opportunities; high vacancy rates; high turnover rates; lack of opportunities for career advancement; low pay; and/or increased work load demand.

Recently, increased attention (and resources) has been placed on deploying new clinical technologies, devices, and treatments. Initiatives and advances include automated solutions for electronic health and medical records, bio-surveillance and disease reporting, public health monitoring, electronic prescribing, clinical decision support, personal health records, home health monitoring, and remote consultations. As the demand for and ability of these technologies to improve patient safety and quality grows their adoption will (hopefully) be more widespread. Yet, these technical advances also contribute to the workforce shortage because of the growing need for educated and trained personnel to develop, maintain and use these applications, products, and systems. (more…)

Given the historic opportunity to lead the nation as it transforms to a nation that is about to become a majority of current minority populations, President Elect Obama and his Transition Team, announced this week, should consider identifying a diverse leadership among the political appointees in the health related positions–not just HHS, VA, DOD, but at the White House-–to develop a realistic transformation in the health care reform policy making process. There is a critical need to consider health care reform that allows the health system to become more responsive to the new America with cultural competence and literacy as well as including issues based on the social determinants of health. The President-Elect plan for access to care and quality health care that addresses health disparities is a vision needed sooner than later in order to prepare for the changing population. And of course, the health of minority women and their families needs to become a priority item as the policy making starts after January with the attention to helping them through SCHIP, Medicaid and Medicare.

Senator Max Baucus (D-MT) issued a “Call to Action” on health care reform this week, unveiling what he calls a “blueprint” for ensuring all Americans have “quality, affordable health care.” (Here’s the official press release and executive summary from Sen. Baucus’s office.)

Sen. Baucus’s proposal has drawn both praise and criticism, but more importantly, it has stimulated a great deal of substantive discussion about our health care system, the need for reform, and potential solutions.

On her blog, Health Beat, Maggie Mahar called the white paper “shockingly honest”:

In his clear-eyed summary of the problems in our health care system — and his candid description of the obstacles — Baucus makes it clear that overhauling the system, and providing healthcare for all will probably require more than one piece of legislation. As he puts it, “The solution will demand time and attention to make sure that we get it right.”

Wall Street Journal health blogger Jacob Goldstein pointed out similarities and differences between the Baucus and Obama health plans:

[The Baucus plan] has a lot in common with Barack Obama’s plan, and at least one major difference: It would require everyone to buy health insurance… Obama says all children should be required to have health insurance, but has not supported a mandate for adults.

Both the Obama and Baucus plans would offer government-backed plans to more citizens, and would bar insurers from denying coverage for people with pre-existing conditions.

Over on his New York Times blog, Paul Krugman hailed Sen. Baucus’s move as “big news” signaling a “reasonable chance” for universal health care to be enacted in 2009:

One of the key questions about the new Democratic majority was whether Congress would try to play it safe, backing down on big ideas about reform, especially on health care…

But now Max Baucus — Max Baucus! — is leading the charge on a health care plan that, at least at first read, is more like Hillary Clinton’s than Barack Obama’s; that is, it looks like an attempt at full universality.

On Daily Kos, in agreement with Krugman, mcjoan commented:

That this is coming from cautious, conservative, DLCish Max Baucus does indeed mean, as Krugman says, that it’s looking much more likely that we have universal health care enacted in the next year. (more…)

So-called “medical homes” are finally receiving national attention from the Centers for Medicare and Medicaid and foundations after their purported inception over 30 years ago by pediatricians (home care nurses have been coordinating health care for people with chronic illnesses for more than a century). But we’re about to make the same mistake that we’ve made in developing other approaches to improving health care nationwide—we’re medicalizing it, instead of focusing on health.

Medical homes are proposed to be primary care practices where people can get help with coordinating their care, particularly for chronic illnesses. The U.S. health care system emphasizes specialty practice rather than primary care. It’s one of the reasons why we pay more than any other nation for health care but have outcomes that lag behind those of even moderately developed nations. If I have diabetes and heart failure, I go to one specialist for treatment of my diabetes, the cardiologist for my heart failure, the gynecologist to get my annual GYN exam, a podiatrist, a retinopathist or ophthamologist, a dentist who may prescribe medications before and after procedures, a shrink to help me cope with this mess, and possibly others to screen my various body parts for myriad diseases. Each is prescribing medications that may interact in adverse ways. In fact, I may end up with a costly hospitalization because of these adverse effects. No one knows all of me or focuses on my overall health—unless I have a primary care provider who can oversee all of these specialties, follow all of my treatments and medications, and coordinate my care. (more…)

Like many Americans, I am still trying to wrap my mind around the shifts and changes wrought in our country on November 4, 2008. We will all be at it a while, I think. One dimension haunts me as a nurse: we elected a president who calmly stated “I think health care is a right”.

As a young nurse I repeatedly tried to understand why education, fundamental K-12, was considered a given in this country, yet health care was something one not only had to negotiate for but indeed was being systematically subjected to the vagaries of markets, profit motives, shareholder demands, and the overt “rankism” of our society. (more…)

One task for the new administration will be to turn our healthcare rights into reality. Just as he was able to unite us on election night, President-elect Obama should unite us all through equal rights in healthcare. In America, healthcare is only considered a “right” for certain classes of individuals, including those over 65, those with certain diseases, and those with either enough money or not enough money. However, once you become a patient, regardless of your ability to pay, you have additional rights guaranteed to you – at least on paper. And yes, because we are America, our rights come along with additional responsibilities as well. Problem is, it’s not clear that we are even all aware of these rights and responsibilities. A good place to start is by communicating and informing.

Our healthcare rights are published in the Patient’s Bill of Rights and Responsibilities, but even this did not happen until 1998. The bill gives us the right to accurate and easily understood information to help us make informed decisions about our healthcare. We also have the right to choose our provider, access to emergency services, care without discrimination, privacy, speedy complaint resolution. We also have the right and the responsibility to be a full partner in our healthcare decisions. The bill also states that patients must also take greater responsibility for maintaining good health.

While the Obama administration has a long road ahead in many areas, including healthcare, we all have a key role to play as well. If we go back to the original objectives of the Patient’s Bill of Rights, it may provide both us, as healthcare consumers, and the new administration some initial guidance. The original objectives of the bill were to:

· Strengthen consumer confidence by assuring the healthcare system is fair and responsive to consumer’s needs

· Encourage consumers to take an active role in improving and assuring their health

· Reaffirm the importance of a strong relationship between patients and their healthcare professionals

· Reaffirm the critical role consumes play in safeguarding their own health by establishing both rights and responsibilities for all participants in improving healthcare status.

Being a disruptive woman in health care feels very different today than it did yesterday.  I am shocked at the difference.  I did not expect it.  Even while I knew that the election would be significant, I could not have predicted the seismic shift within me, my family, my friends and my organization.

Yesterday, I would have written about the wonderful sense of camaraderie I feel with the other disruptive woman in this blog and beyond.  I would have written as someone in exile, who must fight the revolution to be heard, to make a difference.  I would have written feeling very much ‘other’-ed by the mainstream structures in health.

I imagine that this grew out of being the mother of two kids with a rare condition that the world might never recognize as important, or work to mitigate, except for the work our disease advocacy organization has done.  One could postulate that the other-ness was a product of being a fish out of water in the health care community – I come to it simply as a consumer, no science degrees, no elected career in this field – simply the mission to ‘transform health through genetics’ – the mission of Genetic Alliance, of which I am a part.  I knew some of my otherness was a result of feeling that the current administration doesn’t care about health care the way I think it should. (more…)

Dear President-Elect Obama,

Congratulations on your historic win. As we emerge from the first decade of the 21st century, I agree with your campaign message that there is great opportunity for change and the ability to harness new ways of looking at existing problems to propel us forward as never before. As President, you will have many complicated issues to address and manage, both foreign and domestic, more so than perhaps any incoming President in the history of this great nation.

Despite a lengthy campaign that covered so many issues, I am still left with this huge question, “How will we manage healthcare going into the 21st century?” Having practiced emergency medicine for 17 years, I know the shortcomings of our employer-based healthcare insurance system and our inability to address the under-insured.

Having also been in the health IT field for many years as a CMIO, I have also know the challenges of implementation cost and difficulties with EMR adoption from an organizational and clinician perspective. In my more recent role as a vendor, I speak daily with customers who have spent millions deploying transactional systems yet cannot get the data they need for quality improvement, cost analysis and business intelligence. (more…)