Happy, Healthy New Year

Robin Strongin

In the spirit of President Elect Obama’s/HHS Secretary Designee Tom Daschle’s efforts to mobilize a grassroots “get out the health” series of house parties, I am re-posting my first Disruptive Women post:

My Top 10 Priorities for the Next HHS Secretary (NOTE: this was written prior to the selection of Tom Daschle–not surprisingly, I was holding out hope for a woman–no offense to Mr. Daschle):

The next Secretary of the US Department of Health and Human Services (DHHS) will have a plate that is not only full, but is overflowing. While all the political rhetoric is focused around access—health insurance for all—there are a number of other critical areas that need immediate attention as well.

Clearly there are many more than 10 priority areas. However, if I just so happened to find myself sitting across from the next Secretary of HHS, I would remind her (just indulge me on that) that she is the Secretary of Health AND Human Services—that for her to make a dent on the health side of things, she must take into account whether people have: the support systems they need, heat, a home, transportation, enough to eat.

Here is my list of the top 10 priorities, in no particular order:


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Reactions to the Congressional Budget Office Reports

Two reports recently released by the Congressional Budget Office, Key Issues in Analyzing Major Health Insurance Proposals, and Budget Options, Volume 1: Health Care, have dominated discussions this week.

Jane Zhang of the WSJ reported:

The Congressional Budget Office analyzed 115 options to change health care, some costly and others that would save the government and consumers some money.

Among the findings:

- If no changes occur, CBO says health care spending will rise to 25% of GDP by 2025 from 16% last year.

- If the federal government required all employers with more than 50 workers to provide insurance or pay a penalty, federal revenue would increase by $13 billion in four years and $47 billion over nine years.

- Allowing non-federal workers and companies to buy into the Federal Employees Health Benefits Program would cost the federal government about $2 billion over four years and $6.2 billion over nine years.

Ezra Klein explained the importance of these reports and the impact they could have on healthcare reform plans:

How do we decide how much a government program costs? It’s an essential question. Programs need prices, because the government has to produce a budget. But pricing legislation in advance is impossible… But you still need a number. So Washington operates amidst a tacitly agreed-upon imprecision. What the CBO says, goes. “In this town,” says Henry Aaron, a senior economics fellow at the Brookings Institution, “it’s not infrequent to hear people say it doesn’t make any difference what it really costs. It only matters what CBO says it costs.”

The books that the CBO released this week are essentially a guide to the CBO’s scoring process. They tell congressmen, in advance, how the Number will be built. The Wonk Room and The New York Times are focusing on the equations. But they’re not what’s changed. Rather, the difference is that Congress knows what they’ll be in advance. The scoring process will still be a minefield, but now legislators will have a map. There won’t be a situation analogous to 1994, when the White House was shocked by an unwelcome assumption and their legislation was mortally wounded by a staggering price point. Obama and his allies in Congress, along with Orszag’s help, will be able to build a bill able to survive the scoring process. They can, effectively, decide their own Number.


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Budget Outlook for Caregivers

Stephanie Mensh

When the Congressional Budget Office released their “Health Budget Options” report last week, I eagerly scanned through the tome for recognition and support for caregivers—like myself—of people with disabilities or chronic health conditions. We’re mentioned in a parenthetical in Chapter 10 on Long Term Care:

“(Much long-term care is provided personally by the family and friends of elderly and disabled individuals.)”

Earlier in the chapter, CBO points out that patient/family out-of-pocket spending accounted for 20% of the total long term care spending. While one-fifth of spending is a lot, I think it probably underestimates the full value of direct care provided by the family, purchases of needed non-prescription and non-reimbursed medical equipment and supplies, and lost income by the caregiving family members.

CBO does make some oblique references to the magnitude of unaccounted-for care in its discussion of the pros and cons of adding home-based care incentives to Medicaid—the dreaded “out of the woodwork” factor—the number of people they cannot count who might come forward for services and wreck federal-state budgets. (more…)

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Poll: The Next President’s Top Priority

A recent Washington Post-ABC News poll found that over three-quarters of Americans think Obama should make major reforms in our health care system, and a majority think he should start working on health care right after taking office.

What do you think? Share your opinions by responding to our poll:

Do you think making major health care reforms should be a top priority for Obama and Congress? Why, or why not?

View Results

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Weekly Roundup – December 19, 2008: ‘Tis The Season

The holidays are upon us, and we all know what that means for health issues — besides higher sugar and alcohol intake. That’s right, healthcare reform house parties! Check out the message from HHS Secretary nominee Tom Daschle below, and learn more about hosting or attending a healthcare community discussion over the holidays.

Meanwhile, four issues dominating discussions around the web this week are the future of the FDA, the new Nursing Home Compare rating system and web site, physicians and health IT, and of course, healthcare reform issues.

At the Center for Medicine in the Public Interest DrugWonks blog, Peter Pitts shared his recommendations for reforming the Food and Drug Administration:

I was honored when the Obama FDA transition team called and asked for my advice on how the incoming administration could make the agency a more robust and forward-looking regulatory instrument.

My suggested areas of focus are

  1. A strong, science-based FDA
  2. The Reagan/Udall Foundation — a Partnership of Unequals
  3. Clarity vs. Ambiguity
  4. Information Management
  5. Food Safety and Security
  6. Risk Communications
  7. The Drug Label and the “Safe Use” of Drugs

There are, obviously, many, many other important issues … and I look forward to working with the transition team to ensure that the new commissioner can hit the ground running… And kudos to the Obama transition team for reaching out to a wide variety of groups.


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Actively Dying Continued

Meryl Bloomrosen

Having received the diagnosis of stage 4 pancreatic cancer dad decided that his remaining days should be oriented toward providing him comfort rather than treatment. I had not heard the term (actively dying) before dad was admitted into inpatient hospice. It was a brief stay following his collapse at home. It seemed that he would have preferred and felt safer and more secure to stay longer; perhaps it was the supportive listening and personal care and attention they provided. Or the three meals a day he could have (if only he had an appetite). Or the audiences who came into his room and listened to him conversing fluently in various languages.

But the staff said that he was not yet “actively dying” and there was little (no?) need for him to remain on the inpatient hospice. Yet seeing the sad and fearful look in his eyes, the physician quietly mentioned that perhaps he could remain on the unit one more night. So he stayed another night and then we finalized the plans and arrangements for him to go home with round the clock home health aides.


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Comparing Comparative Effectiveness: One Step To Saving Costs

Randel Richner

Thursday night on NBC nightly news, Dr. Tim Johnson said “we’re paying for treatments that have never been proven to work” presuming we’re wasting dollars on dubious medical innovations. He described this within the context of the Obama administrations’ announcement of Tom Daschle as the new Health Care Czar who may establish an independent health care board isolated from health care lobbying “interests” and prioritizing US government spending. Within this context, it will likely adopt some process of comparative effectiveness to evaluate health care interventions. Stuart Altman recently said, “we need to move aggressively forward to develop the capacity of this country to do effective comparative research…the nation cannot afford healthcare that is not supported by evidence of sufficient benefit”.

But what really is comparative effectiveness? Comparative effectiveness in the context of health is as old as “medicine itself”, an implicit and explicit comparison of one medical technique to another. If the intervention works (i.e., understanding positive and negative impacts on patient outcomes), than one may translate this into “economic effectiveness”, or “cost-effectiveness” metrics. In our quest to assess value of medical interventions based on meaningful clinical outcomes, decision makers are using a number of well-established academic methodological approaches.

Is this new? No.

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Reactions from the Web: Tom Daschle for HHS and Health Reform

It’s official: President-elect Obama announced in Chicago last week he will be nominating former Senator Tom Daschle for Secretary of Health and Human Services — and as director of the White House Office of Health Reform. The President-elect also announced his pick of Center for American Progress Senior Fellow Jeanne Lambrew as Daschle’s deputy director. (Official announcements from the transition team: the press release with the President-elect’s prepared remarks, and the blog post, with photos from the event.)

At the National Journal Lost In Transition blog, Mary Gilbert explained:

Daschle, in his new dual role, will be responsible not only for crafting a health care plan but also for implementing it. Calling him “one of America’s foremost health care experts,” Obama claimed that Daschle’s knowledge of health care policy and extensive legislative experience make him uniquely suited to steer an effective reform package through Congress. As “the original no-drama guy,” Obama said, Daschle is also someone who can be trusted to use the HHS Department to implement the new policy on the ground.

Pressed by a reporter on how he plans to pay for an overhaul of the health care system, Obama spoke about first cutting costs and then finding ways to make the system pay for itself over the long run, though he was short on specifics. He stressed, however, that fixing health care must be “intimately woven” into his team’s overall economic recovery plan. “We can’t put this off because we’re in an emergency,” he said. “This is part of the emergency.”

From Sarah Rubenstein on the WSJ Health Blog:

For his part, Daschle, who will also head up a new White House office dedicated to health reform, emphasized that this won’t happen behind close doors. (See our post from earlier today.) “We’re going to bring the American people into this conversation and make health-care reform an open and inclusive process that goes from the grassroots up.”


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Who will be most disruptive in 2009?

Robin Strongin

Definitely the word of 2008.
Along with change comes disruption.
This is a great time to roll out our new addition to the Disruptive Women blog – a weekly poll.

To launch our new poll, we are asking for your feedback:

Who do you think will be most disruptive in 2009, as health reform takes center stage? Why?

View Results

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The New Kid on the Online-Healthcare-Discussion-Community Block

The Obama-Biden Transition Team website has been generating a great deal of discussion for its innovative approaches and potential effects (or lack thereof) on key aspects of federal government policymaking. The recent Join the Discussion: Healthcare feature on the Change.gov blog stimulated a 3,701-comment-conversation about important health care issues.

But wait! There’s more!

The video response from former Senator (and head of the Obama healthcare transition team, at least until his HHS nomination is announced) Tom Daschle and Laura Arnonson (Obama healthcare policy team member) regarding the healthcare discussion generated over 4,400 comments since Tuesday afternoon — and counting!

Open, extensive conversations about healthcare issues and policy ideas are obviously very near and dear to our heart here at Disruptive Women. But what impact, if any, do you think the Change.gov approach will have on healthcare reform? What are your reactions to Daschle and Aronson’s video response to the blog comment discussion?

Here’s the video from Daschle and Aronson:

Over on his Washington Monthly Political Animal blog, Steve Benen noted the historical significance of the Change.gov blog, even though “the idea of setting up a website and accepting public comments doesn’t sound especially revolutionary” at first glance:

Historically, government-related sites have avoided public comments. The medium was about one-way communication, not two. To this extent, we’re already seeing the beginnings of a significant shift. George W. Bush ran an operation that stifled dissent and kept opposing viewpoints as far away from policy makers as possible.

On the ZDNet Healthcare blog, Dana Blankenhorn considered how the President-Elect’s effort “to drive the health care debate, from the bottom up” might affect the health care reform process, especially considering “how policy debates typically play out”:

Interest groups lay down markers, then go into small meetings and hash something out, which goes to Congress in order to die. The question is whether the Internet will be allowed to break through this.

The question is whether ordinary citizens who are not inclined to support the new Administration will participate, or whether they will rely on top-down organizations to oppose it.

On Covering Health, Ed Silverman reacted to the blog discussion and video response from Daschle and Arnonson, which, he explained, reviewed “a couple of key issues and the overall response to their effort”:

To be candid, there wasn’t much said that we don’t already know. Daschle, at various turns, says things such as, “We need to really put the emphasis on prevention” and later, “We need to contain costs.” To be fair, the willingness to engage the public in this way is worth noting. After all, when was the last time that HHS Secretary Mike Leavitt deliberately spoke to Americans by way of YouTube? Send us a clip if you have one. Meanwhile, Daschle promises more online discussions are forthcoming. (more…)

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The Medicalization of Life

Ruthann Russo

The phrase, Medicalization of Life refers to “society’s growing trend to classify more and more life problems as medical problems” and treating those problems with pharmaceutial or surgical intervention. Many advertisements describe how to treat problems like restless leg syndrome, sexual dysfunction and insomnia with a physician visit and a prescription drug.  These are examples of medicalization of life issues today that, 20 years ago, we did not even have a medical diagnosis for, let alone a treatment.  Determining the proper level of medicalization involves asking questions such as, when does a deviation from normal need medical intervention? and, what are appropriate alternative treatments?  Medicalization speaks to an issue of fear – fear that society continues to lower the bar in defining what is a disease and in need of medical treament.  Achieving a balance in the growth of medicalization requires a group effort:  proactivity on the part of the patients, open mindedness from treating physicians, and information, education and research support from the government.

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Yin Yang of Healthcare

Sharon Terry

Transforming health through genetics. That is the mission of the organization I lead – Genetic Alliance.  Almost 5 years ago I took on the leadership of this organization.  I had some strong inklings at the time, about transformation, about health.  While I was developing Genetic Alliance’s path to transformation, both internally and externally, with some phenomenal colleagues, the world around us was changing in similar fashion.

I sometimes see genetics as a leading edge, a knife that is cutting through the old, crusty, barriers.  It does this perhaps because it is new, but after leading with the novel edge, it has a great deal more punch.  I believe it will be an innovative disruption (a la Clay Christensen) because the health care system will not be able to adjust enough to fit its value inside the system (or lack thereof).

Starting with the power of understanding family history (still perhaps the most powerful genetics tool) to the sophistication of personalized medicine (using genetics and genomics to tailor diagnosis and treatment), genetics and genomics will both buoy and stress an overstressed healthcare system.  It is time for change.  It is in the works, on the drawing tables and in people’s hearts and minds. (more…)

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  • December 1st, 2008 Giving Thanks for $1,000 Flu Shots
    By Glenna Crooks