Disruptive Women Archelle Georgiou was interviewed for the blog below, originally posted on August 21st on Big Think.  In order to be a patient advocate you need to be well informed of the issues, this post reminds us of that:

You may want to think twice before your next visit to the doctor’s office. According to Dr. Barbara Starfield’s now-famous study, iatrogenic deaths (those resulting from treatment by physicians or surgeons) are the third leading cause of mortality in the United States, resulting in the loss of 225,000 lives per year. Of that total, nosocomial (hospital-acquired) infections kill 80,000, physician errors claim 27,000, and unnecessary surgery results in 12,000 deaths.  

But iatrogenic errors aren’t the only reason people should avoid hospitals, says physician and health care administrator Archelle Georgiou. She tells Big Think that relying on doctors may actually shorten your lifespan. Georgiou bases this idea on her studies of the earth’s so-called “blue zones,” isolated communities around the world whose inhabitants live longer and healthier lives than the greater populace.

In the Greek blue zone, the island of Ikaria, inhabitants are more than 4 times more likely to live to age 90 than Americans are—yet there is virtually no health care infrastructure. Georgiou tells us: “There are no hospitals or major surgery capabilities…. People needing emergency care are transported by helicopter to Samos (a neighboring island), and all elective surgery is done in Athens.”

A procedure like an arthroscopy or a hysterectomy that would take 3-5 days in the U.S. consumes 3-5 weeks for Ikarians, who must relocate to Athens for the procedure and convalescence. Therefore, “their threshold for elective surgery is significantly higher than ours,” Georgiou says. The result is that people depend on themselves rather than doctors for non-life threatening ailments. And, knowing that health care is so inconvenient, Ikarians take greater care not to get sick—they eat a healthy diet rich in vegetables and exercise daily.

Our greater access to health care (discounting, of course, the millions of uninsured Americans) might make us more likely to live unhealthfully. “U.S. culture is steeped with a ‘find it and fix it’ mentality,” Georgiou tells us. Rather than try to prevent illnesses, we rely on our doctor’s ability to fix what ails us. And the result is that “we spend significantly more on health care than any other nation but without the benefit of improved outcomes or longevity.” In the U.S., our life expectancy is only 78, yet we spend 2.5 times more money per capita than Japan, the country with the highest life expectancy (82.6 years). One-half to one-third of the $2.2 trillion per year America spends on health care is simply unnecessary, says former AMA chairman Raymond Scalettar. (more…)

By Robin Strongin. Over the next several weeks Disruptive Women will be blogging about the various aspects of patient advocacy.  Then in September, we will disseminate an e-Book on the topic.  To get ready for this series, I invite your input; think about what patient advocacy means to you and share your stories with us. Please comment on this post to let us know what you think about the topic– its level of importance in health care and any questions you may have or experiences you are comfortable sharing.I hope you will join us in this very important dialogue.

Did you miss Disruptive Women bloggers Indu Subaiya, Jane Sarasohn-Kahn, Trisha Torrey, and Regina Holliday this week on the Real Women on Health! Radio series? Or did you hear them, but want to listen again? If so, you can listen to the podcasts now available.

By Val Jones. I received this press release today and was depressed by the prevalence of meritless lawsuits in this country. Most physicians (95%) are sued at some point in their careers, and as many as 90% of these suits are found to be meritless. If that doesn’t make you want to quit practicing medicine, I don’t know what does.

This kind of litigious climate definitely adds to my stress levels — and makes me fearful of caring for very sick and fragile patients who are likely to have poor outcomes, regardless of what I do. Many of my colleagues practice medicine with one eye always looking over their shoulder, wondering when that one bad apple will take them to court in an attempt at a financial windfall.

In Canada, those who bring frivolous lawsuits to court are responsible for all legal costs. I’d be in favor of having a similar process here to chill the medical malpractice frenzy that’s raising costs and driving physicians out of clinical medicine. Cases of true medical malpractice should be punished and patients’ rights protected — but when 90% of lawsuits are bogus, it’s time to fight back.

Here’s the AMA’s press release:

WASHINGTON – A new report from the American Medical Association (AMA) paints a bleak picture of physicians’ experiences with medical liability claims and bolsters the case for national and state level reform. A key finding from the report is that, among physicians surveyed by the AMA, there was an average of 95 medical liability claims filed for every 100 physicians, almost one per physician.

The report has data not available anywhere else, including information on medical liability claims’ impact by age, gender and practice arrangement for physicians. Highlights in the report include:

- Nearly 61 percent of physicians age 55 and over have been sued.There is wide variation in the impact of liability claims between specialties. 

- The number of claims per 100 physicians was more than five times greater for general surgeons and obstetricians/gynecologists than it was for pediatricians and psychiatrists.

- Before they reach the age of 40, more than 50 percent of obstetricians/gynecologists have already been sued.

- Ninety percent of general surgeons age 55 and over have been sued.

“Even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence what specialty of medicine physicians practice, where they practice and when they retire,” said AMA Immediate Past-President J. James Rohack, M.D. “This litigious climate hurts patients’ access to physician care at a time when the nation is working to reduce unnecessary health care costs.”

The number of medical liability claims is not an indication of the frequency of medical error, as the physician prevails 90 percent of the time in cases that go to trial. While 65 percent of claims are dropped or dismissed, they are not cost-free. Average defense costs per claim range from a low of over $22,000 among claims that are dropped or dismissed to a high of over $100,000 for cases that go to trial. This leads to increased costs for physicians and patients.

“The AMA supports proven medical liability reforms to lower health care costs and keep physicians caring for patients,” said Dr. Rohack. “The findings in this report validate the need for national and state medical liability reform to rein in our out-of-control system where lawsuits are a matter of when, not if, for physicians.”

The report includes data from the AMA’s 2007-2008 Physician Practice Information survey of patient care physicians and other sources.

Originally posted on Better Health  by Disruptive Women Val Jones on August 3rd.

By Santi Bhagat, MD.  It seems that children with chronic medical conditions and disabilities (CMCD) just disappear into thin air when they grow up.  No-one tracks these young people, so we have no idea what happens to them.  We don’t know if they have insurance and doctors; are sick and in emergency rooms; go to school and have jobs; and/or live independently and have social lives. It is estimated that 600,000 young people with CMCD enter adulthood every year, into a system devoid of any supports and services, a system that is completely unprepared for them.  

To help improve things for children with CMCD as they transition into young adults , Physician-Parent Caregivers (PPC), is launching EMERGE–a new campaign  next week…stay tuned…I will be blogging more about that in the coming weeks.  

In the meantime, I would like to introduce a special PPC young adult leader, Amy Long.  Amy is one of America’s 8.2 million amazing young adults with CMCD who push through barrier after barrier and never give up on their dreams.  Amy gave me permission to share her first person account of what it is like to be a young adult with a chronic medical condition.  She calls it, the Google Circus.

GOOGLE Circus

Five years ago, I aged out of my pediatric skeletal dysplasia clinic (a place for kids with bone diseases).   I will never forget my first two adult medicine experiences….The first happened late one Fall evening. 

I was in college dorm my senior year and I woke up  from a late afternoon nap with a terrible headache, flashes of light and floating dots in my vision. I have a rare connective tissue disorder and form of arthritis called Kniest Syndrome that puts me at risk for a detached retina.  The flashes of light and floaters are common symptoms of retina disease.  Retina detachment is only fixable in the first 24 hours. I immediately called Student Health who told me they could get me into see an eye doctor next week.  I tried to explain that I couldn’t wait that long but no one seemed to take me seriously. All the doctors had left for the day. I called a friend and we drove the Emergency department.

We arrive. I spell Kniest no less than 3 times for the tirage nurses. They lead me back to the eye exam room and leave the door open with my chart hanging there. The doctor grabs my chart, starts to come in, looks at my file. His eyes widen and he backs out of the room. Through the open door I watch him try to Google Kiiest Syndrome.  He flips through the links and then finally after five minutes comes back in and sheepishly asks me, “So what exactly is going on?” I tell him, yeah I have a migraine-like headache, and I am seeing stars. I have a collagen disorder that causes high myopia and thus very fragile retinas. “Yes, yes, how exactly do you spell your condition?” I spell Kniest 2 more times.  I then watch him turn around and type Kniest Syndrome into Google. (more…)

By Robin Strongin.

Paul F. Levy, Disruptive Women’s June 2010 Man of the Month, was appointed President and Chief Executive Officer of the Beth Israel Deaconess Medical Center in Boston in January 2002.  BIDMC is one of the nation’s preeminent academic health centers, providing state-of-the-art clinical care, research, and teaching in affiliation with Harvard Medical School.  Previously, Mr. Levy was the Executive Dean for Administration at Harvard Medical School, where he was responsible for administrative, budgetary, and facility issues, as well as community and governmental relations.  He was also involved in coordinating collaborative ventures between HMS and its affiliated hospitals.  Before joining Harvard Medical School, Paul Levy was Adjunct Professor of Environmental Policy at MIT, where he taught infrastructure planning and development and environmental policy for seven years.  Mr. Levy has served as Executive Director of the Massachusetts Water Resources Authority, Chairman of the Massachusetts Department of Public Utilities, and Director of the Arkansas Department of Energy.

Ever since I created the Disruptive Women in Health Care blog, I wanted to meet Paul Levy.  Who was this guy who boldly started blogging when most executives in health care either didn’t know what blogging was or were frightened by legal into thinking that blog was a 4-letter word?  His blog, Running a Hospital, is “a blog started by a CEO of a large Boston hospital to share thoughts about hospitals, medicine, and health care issues.”

I recently spoke with Paul and the first thing I asked him was Why Blog?  Here’s what he had to say:

Why did you decide to blog?  Was there one incident that propelled you, an aha moment, or had you been thinking about it for a while? Paul simply said, “It was a lark.”  He explained that in August ’06 he was reading a New York Times article about how executives don’t blog.  “Being a contrarian, I started blogging.  It was an excuse to learn.”  Paul mentioned that the Boston Globe took notice, wrote about his blogging and then it was “off to the races.”  He added that he’s obsessed by blogging…in a good way.  “It helps consolidate my thinking.”

As you reflect back over your years of blogging, what have you learned? “I hadn’t realized the power of blogging until I actually did it.”  He gave me an example: One of his top priorities at BIDMC is a major emphasis on quality and safety, eliminating preventable harm.  Paul experimented by using his blog to publish infection rates and clinical outcomes. “I didn’t worry or think about how unusual it was—I just did it.” [Pretty disruptive of him—I knew I liked this guy]. He discovered that the blog served as “an incredibly powerful, transformative management tool.”  The blog became the vehicle that allowed everyone in the organization to see the data, to see how they were doing.  An audacious goal was established, and the blog enabled everyone in the hospital to track progress. According to Paul, publishing the data on his blog helped foster the desire to meet the goal.  “The approach was well received and appreciated. And, it created no legal problems.”

Since last week’s Health 2.0 conference in Washington DC was fresh in my mind I asked Paul, What do you think of the blossoming Health 2.0 phenomena…what is it’s promise and what work needs to be done? He once again stressed that the value of Health 2.0, and social media in general, lies in the ability of these tools to provide a way for people to share and exchange data, information and ideas. “They support a community of interest.”

We talked for some time about how unfortunate it was that health care companies, particularly those in the life sciences, fear they will be criticized—or worse, if they take the social media plunge.  We also agreed that the real power of these tools reside in patient advocacy—enabling people to actively participate in their own health.

I have to ask—health reform—as a veteran of the Massachusetts experience, what do you think about where we are and where we are headed? “Massachusetts is prologue for the country as a whole.  We certainly had a head start with reform, likewise with the cost implications.  We are working through all that.”  Paul stressed to me that the costs were under-estimated in the law and the delivery system is still a mess.  He doesn’t see the government fixing that. “We won’t improve the delivery system by government fiat; it has to come from the profession.”

Any words of wisdom to share as we conclude our conversation? “Please, be disruptive… disruption and imagination are the driving forces for change.”

By Rebecca Camp. AUSTIN, TX– Today’s SXSH conference (South By Social Health) saw many successful, multi-disciplinary approaches to weaving together new media and health care. I was bothered, however, by a theme that’s becoming increasingly common in the health care conversation: patients treated as consumers.

When a company follows capitalistic principles, the goal is to increase value by offering better services at a lower price. The company strives to improve their bottom line by offering more value than their competitor, in an effort to put their competitor out of business. Offering good customer service complements this strategy. In industries other than health care, the result is a benefit to the consumer: quality products and service at a lower price. Southwest Airlines, for example, employs a very effective social media presence. They respond to complaints tweeted by customers, which is has garnered the company praise in addition to a loyal customer base. But does this consumer-centered strategy translate to health care?

Mayo Clinic is held as a model for value in health care, but attributing their success to “consumerism” is off-base. The new media strategies being presented by health care institutions at SXSH essentially boiled down to damage control by tending to disgruntled Twitterers, and analysis of the types of complaints being registered. Though claiming to be influenced by social media mavens at Mayo’s Rochester flagship, the strategy is misguided and far removed. Mayo Clinic works because of a philosophy of care that puts the needs of the patients first—which does not equate to reactionary PR moves on social media sites. Absolutely nothing about their strategy distinguished it from other industries—and in the context of health care, replicating the strategy of Southwest Air and its ilk borders on insulting. Mayo Clinic avoids the noisy Twittersphere when addressing something as important as patient care; when a complaint is registered, that’s what their specialized center for patient service is for. Their Sharing Mayo Clinic blog allows a community of patients, staff, and families to form, which anticipates service problems before they even occur. This is the absolute obligation of companies in charge of delivering health care to a society.

My issue is also a philosophical one.

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Disruptive Women welcomes Personal Trainer Morris White as our February 2010 Man of the Month.

A personal trainer for 22 years, Morris White has both men and women – and even children as young as 12 – as clients. He helps them with basic fitness, sport-specific fitness and self defense. He also trains people with special needs, including those with disabilities and eating disorders, and those recovering from a stroke and heart attack.

In his own life, he is a power lifter and a practitioner of Kung Fu, Yoga, desert hiking and survival quests and sustainable healthy living. He is currently working on a fitness community site.

I can vouch for his impact. I’m now in my third year with him, with regular work outs at 6 AM. The benefits have been worth every trek to the gym in those before-dawn hours.

Morris, I’m pleased to have the chance to talk about fitness with you. It’s an important topic, but rarely addressed in this blogspace. How did you get started training?

There were three very influential men in my young life. It was the 1970’s. My Father was a pharmacist and successful businessman who took me to monthly Toast Masters meetings and had me working in the pharmacy on weekends. He taught me the importance of physical poise and presence. One of his business partners was a Physical Therapist who mentored me in anatomy and exercise, from him I learned about anatomy and body mechanics At about that same time, I was introduced to Kung Fu by my best friend’s Father who was a Master of the art.  Kung Fu combined all the earlier lessons and helped me to develop my personal philosophy on holistic personal training.

Those were the years of my greatest lessons.

I attended Temple University but my advisors could not grasp what I wanted to become and what I wanted to do with my life. The usual response was, “So, you want to teach phys ed?” No.

From there to the gymnasiums I went, working under different titles until personal training evolved and became popular.

 What about fitness and training makes it your passion? 22 years seems a long time.

Seeing my mother die at young age and my father debilitated primarily by an unhealthy lifestyle, has made me even more intent to give meaning to my existence by living and enjoying life to its fullest and helping others to do the same through fitness.  The bonus is that by helping others achieve their personal goals, I get to meet great people that, in turn, enrich my life through their collective experiences and wisdom.

How do you approach training?

My philosophy of training is:

• Safety first. You should never be harmed or injured in the course of training.

• Strict, proper form. The best form produces the best, most efficient results.

• Keep moving. A body in motion tends to stay in motion.

Follow those rules and you’ll keep at it, making progress. You’ll avoid injuries and won’t suffer any set-backs in your workouts. You’ll also see results and be able to have an increasingly better quality of life. Even if you’re already fit, you’ll see improvements.  As I like to say to my clients, “one foot in front of the other and you’ll get where you’re going,”

Oh, and one more thing, never imitate what you see others doing in the gym.  So many people do their exercises incorrectly. Others may do an exercise properly but their routine may not fit your desired goals.  Always consult a professional about a new exercise or routine.

Do you have any dramatic examples of client improvements?

I could tell lots of stories of women who come to prepare for their weddings. They’re motivated for sure. Believe it or not, they’ve bought dresses three sizes too small and now need to fit into them. Plus, the regular workouts really help them with the wedding-planning stress.

But the one client and story that really inspired me was a 280 lb sedentary banker who lost the weight and became a marathon runner.

As he became physical healthier, his self-confidence and self-esteem also improved.  This newfound self-respect gave him the strength to not only run a marathon but to walk right out of a less-than-supportive, troubled relationship and climb the corporate ladder to a promotion.

(Laughing) Of course, I cost him lots of money – he kept having to replace his wardrobe as his body changed.

Have you ever seen anyone who did not see an improvement in working out with a trainer?

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Probably the thousands of nurses who have been following this case were encouraged to read the press report of its outcome:

“Texas jury finds nurse not guilty for reporting a physician for unsafe practices.

It took the jury less than an hour on February 11, 2010, to return a not guilty verdict for the nurse, Anne Mitchell, of felony charges of “misuse of official information,” for reporting a physician to the Texas Medical Board for what she believed was unsafe patient care.

Since news of the criminal indictment – and Mitchell’s being fired from her job – first spread through the nursing community, nurses across the country have followed developments. Labeling the criminal indictments “outrageous,” an outpouring of support – and financial contributions to the Texas Nurses Association Legal Defense Fund – has continued.

According to a New York Times article on February 9, the prosecutors claimed that Mitchell intended to damage the physician’s reputation when she reported him to the Texas Medical Board, which licenses and disciplines doctors. Mitchell explained that she felt an obligation to protect patients from what she saw as a pattern of improper prescribing and surgical procedures – including a failed skin graft that was performed in the emergency room, without surgical privileges.

Conflicts of interest seemed to be part of this case with allegations that this case was, in part, a result of the local sheriff being good friends with, and a former patient of the physician, and bending the rules to protect his reputation.

A number of nurses who had previous worked at the same Winkle County Rural Health Clinic testified in court that they left the clinic because of their concern about the care provided by the same physician that had never been addressed. The case is no less perplexing as to why Mitchell was even indicted – all witnesses (even the state’s) have agreed nurses have a duty to report unsafe care.

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Immediately after the snow stopped falling in Washington DC this week, another news story took DC by storm–the resignation of Billy Tauzin, effective June 30th.

Mr. Tauzin’s departure comes at a critical time for those involved with health reform efforts, not to mention PHRMA’s own thick portfolio of issues that include patents and trade, the economy, taxes (think offshore), and shrivelling pipelines, just to name a few.

The job pays well, but the applicant will surely inherit a daunting to-do list.

Job Qualifications

It’s a given that she would have impeccable bipartisan connections at the highest levels of government (both here and abroad); a robust rolodex full of private sector titans and Wall Street mavericks; a keen understanding of marketplace complexities (both here and abroad); superior people skills (it can be a b*tch managing those board room egos); not to mention a thorough grasp of and respect for the unique political and policy complexities that define health, health care, and innovation.

But that won’t  be enough.  I would love to see the next CEO take some bold action and harness the power of e-patients:  increasingly, patients (e-patients and their e-caregivers) are hungry to engage in participatory, user-generated health care, often referred to as Health 2.0.  Kaiser’s Dr. Ted Eytan explains it this way, “enabled by information, software and community that we collect or create, we the patients can be effective partners in our own health care and we the people can participate in reshaping the health system itself.”[1]

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I’ve grown weary of the public continuing to rate nurses as the most trusted profession (annual Gallup polls every year of this decade except 2001 when fire fighters understandably led the ratings), only to have leaders in health care agree but ignore us.

The Robert Wood Johnson Foundation released a Gallup poll that surveyed over 1500 opinion leaders in health care, including government officials, health care and insurance executives, and university faculty.

The survey found that:

• Doctors (54%) and nurses (42%) are the information sources about health and healthcare in whom opinion leaders have a great deal of confidence.
• Government (75%) and health insurance executives (56%) are viewed as most likely to exert a great deal of influence on health reform, compared to only 37% for doctors and 14% for nurses.
• 51% say nurses have a great deal of influence in reducing medical errors and improving patient safety
• 18% say nurses exert a great deal of influence on increasing access to care, including primary care.
• 39% say nurses will not have much influence on reforming health care over the next 5 to 10 years, compared with 10% of MDs.

Nothing new here to most nurses. We continue to have to be vigilant about whether nurses are included at decision-making and advisory tables, as speakers at national and regional conferences on quality and safety in health care, and on boards of health-related organizations. The next time you’re in a meeting on health care, look around the table and ask whether nurses are included — and not just a token RN. If they aren’t, ask why not and call for RNs to be appointed. Organizations and the nation are missing out if we don’t all change our expectations about who is at the table.

Healthcare (insurance) reform has passed in the Senate and final negotiations are happening before it moves on to the President’s desk for signature. While the legislation is not perfect – in fact some would say far from perfect – it is a piece of legislation that is very much in keeping with our American philosophy, our constant pursuit of progress and change.

As the late Senator Kennedy’s career on Capitol Hill demonstrated, change is usually incremental, usually negotiated and usually compromised. But at the end of the day, change usually amounts to progress.

I see tremendous progress, too, as I look back on a decade’s worth of work to promote access to affordable quality health care using nurse practitioners in the role as primary care providers, thereby alleviating the burden on a strained primary care system.

We’ve come a long way regionally and nationally. The fact that we as a country are always striving to improve our path is what most invigorates me as a relatively new American. Our pursuit of progress is never ending, but it is what sets us apart from most countries in the world. We know our work is never done. As we enter a new year and decade, we always should remember that what makes us different from most people and countries in the world is that we have the freedom to purse progress and make change.

This health insurance reform bill is not the end all or be all, but it will help make affordable health insurance available to more than 30 million Americans who have been without it. Furthermore, the legislation contains many provisions for others who fall through the cracks and will need additional care and support.

That’s progress for individuals, families and America, as Walt Disney would have said. And not until you take a ride on the Magic Kingdom’s The Wheel of Progress will you truly appreciate how important it can be to take even a small step in the right direction.

Happy New Year! And a toast to a New Decade and our new Pursuits of Progress for individuals, families, and our country.

As this first full term at the Johns Hopkins Bloomberg School of Public Health has unraveled, I see how much they were prepping us during summer term.  My days have been filled with work, outside activity, caffeine, and a test of how long I can go without sleep and still be productive—similar to what I imagine the days are like for most of the Disruptive Women in Healthcare!  Classes this term included biostatistics, evolution of infectious diseases, program planning for health behavior change, health policy I, and public health economics seminar.  I chose the more rigorous biostatistics course (and will take others throughout the year) in an effort to become more quantitative and enhance my ability to analyze and conduct cost-effectiveness studies and economic evaluations in particular.  The course has its challenges, and there are certainly days when I wonder if I should have taken the other class, fondly known as “baby stats” to fulfill the requirement.  Health policy I: the social and economic determinants of health has been my favorite class, because not only have I learned about what the name of the course suggests (and health disparities is of great interest to me) but also how to develop a conceptual framework for a health policy problem and how to write testimony in an effort to get such an issue on a policymaker’s agenda.

In between classes, I have busied myself with all that the MPH program has to offer outside the classroom, as there is no shortage of activity competing for students’ every “free” moment.  For instance, I am part of a monthly health disparities journal club and am working with a professor on a book about Taiwan’s national health insurance system.  I am also now VP of Communications for Students Promoting HEalthcare REform (SPHERE), an organization spanning the school of public health and school of medicine whose goals are to assure that every person in the United States has the right to affordable, high-quality healthcare and to educate the Hopkins community.  So far the organization has had one event this year in which we heard from a panel that included representatives from Kaiser Family Foundation/The Commonwealth Fund, Johns Hopkins faculty, and local news radio, on the state of play in health reform.  We will be having other health reform educational events throughout the year and one major advocacy event in the spring.  As VP of Communications, I will be promoting events at the school, updating and enhancing our website, and possibly forming partnerships with other similar, local student groups.

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As an insurance broker in the metro Washington DC area, I have been in the trenches of selling, and advocating for our customers for their small group health insurance, disability programs and life insurance plans for over 17 years.

Needless to say, it has been maddening in the last five years to watch rates rise and our customers get increasingly frustrated with the system. I spend my days arguing with insurance companies about what they will cover and what they won’t — and I’m consistently amazed that these large firms often don’t have a handle on the benefits they provide in their policies. To say the right hand doesn’t know what the left is doing is a dramatic understatement.

I am one of the first to admit that something needs to be done. Last fall I hosted the DC Health Summit and brought together some of the country’s top health insurance executives, doctors, politicians, hospital administrators and business people into one room to discuss what might be done to fix the system.

An Obama spokesperson was one of our speakers — and today I continue to stand behind the president’s goal to accomplish health care reform, and do it as soon as possible.

As the debate has unfolded, however, it has been suggested that health insurance brokers be eliminated from the mix. Obviously, this potential threat is unnerving, but if you consider the possibility on a more global level — it simply doesn’t make sense.

Here’s why: If we have a government option in health care reform, over a short period of time, it will likely crowd out the private sector. If private health plans are squeezed out of the market, it follows that insurance agents will be as well, and that would be a major loss — not just for my firm, but also for every American who currently relies on their broker to explain their benefits and advocate for them when there is a problem.

I believe it is critical that the broker not be categorized as an administrative cost — especially as those costs are the biggest target in the reform packages. We also want to make sure Congress doesn’t do anything that removes us from the system, or removes the value that we know we add for the customer.

So let’s consider the doomsday scenario for brokers.

If the current threat comes to fruition and brokers like myself are put out of business, I’m certain there will be a consumer advocate of some sort under any new model that is adopted. Like with many government-run programs, will these be poorly trained people be truly knowledgeable about how the system works? Will they be advocates for their customers? Will they have the time, resources, or incentive to spend five hours on the phone in a day — as I often do — arguing for a patient’s health insurance rights?

Not likely. Indeed, odds are good that we’ll end up with internet-based FAQ pages filled with complex explanations. I can foresee the day when trying to understand your health insurance benefits will resemble trying to understand how to do your taxes. Will we look back on these days as the good times for our health insurance benefits?

Needless to say, I believe strongly that brokers are an important part of the health care system. I hope to have the privilege to continue to do my job for many years to come.

Those who have spent their careers in the trenches of healthcare and are now reading the uncertain headlines in the news each day and fearing for the future of healthcare, fear not! There are fresh crops of enthusiastic students, eager to make a difference and keep the ball rolling in the quest to improve healthcare, sprouting up in graduate programs starting across the nation this summer.

Having started the Johns Hopkins Masters of Public Health (JHSPH) program in July, it has been a thrilling month and will no doubt be a fast year with many choices to make for classes, volunteer opportunities, and research projects. The plethora of options was described by one former student as “going to the grocery store when you’re hungry.” Not to mention, each student shopping in the “grocery store” is a Type A overachiever with diverse interests and remarkable accomplishments under their belts. It is no exaggeration that it is difficult to get a seat in the first few rows of the lecture halls—it is just that kind of crowd.

Each day has been a new adventure with exciting speakers further energizing us and spurring new thoughts and ideas, laying the groundwork for our future studies this year. Countless fliers for seminars to attend cover the bulletin boards week after week, and we each have several hundred courses for credit from which to choose during our 11-month program.

As the summer session comes to a close and I find myself in the throes of final exams, I not only have learned the principles of epidemiology and environmental health but also have taken away several overarching lessons with widespread implications:

• Change is possible, even if the odds are against you. Dr. D.A. Henderson, former Dean at JHSPH, spoke to our class about the global campaign he led to eradicate smallpox in the 1960s when no infectious disease had ever been eliminated on such a large scale.
• Even if wide scale change is not immediately plausible, something—no matter how small—can still be done. For instance, Howard County, Maryland took it upon itself to help its own uninsured residents by launching the Healthy Howard Access Plan to provide basic health services to those unable to obtain or afford health insurance.
• The American people can successfully unite to affect healthcare change. Polio: An American Story (required reading for incoming MPH-ers) by David Oshinsky, a Pulitzer Prize-winning historian, depicts the true story of Americans coming together despite socioeconomic class or political party to find a vaccine for polio.

Needless to say, with just one term under my belt, the JHSPH motto “protecting health, saving lives—millions at a time” doesn’t seem such a far-reaching feat after all. This thinking that is shared with my classmates is proof that midterms and finals have not tarnished our raring-to-go attitudes or deflated our ideas and dreams about improving the health and lives of many. And hopefully knowing this will help some of my more seasoned colleagues out there rest assured and sleep a little easier.