The big day is almost here… The House is voting on the health care reform bill. President Obama has been calling undecideds like Rep. Jason Altmire — and about 57,000 (of the 59,000) nuns in the country defied the bishops — stood up to the man — and sent a letter supporting the bill — calling it “the real pro-life choice” because it lets pregnant moms get prenatal care. (Talk about Disruptive Women!)

Yesterday we encouraged our readers to take part in the live video chat presented by the White House, during which HHS Secretary Kathleen Sebelius and Health Reform Director Nancy-Ann DeParle took questions about President Obama’s recent health care reform proposal.

Did you watch yesterday’s live chat? If so, what are your thoughts and reactions on what was said? What additional questions do you have for the President as well as the HHS Secretary and the Health Reform Director?

The following post originally appeared on The White House Blog. The Disruptive Women in Health Care blog encourages its readers to take part in the live video chat described below, which will take place today at 3:40 EST.

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The President has now laid out a path forward for health reform that  puts families and businesses in control of their own health care, reduces costs and the deficit, and incorporates new Republican ideas while still instituting fundamental protections again insurance company abuses.  He opened his remarks saying, “I want to especially recognize two people who have been working tirelessly on that — on this effort, my Secretary of Health and Human Services, Kathleen Sebelius — as well as our quarterback for health reform out of the White House, Nancy-Ann DeParle.”  We’re happy to have both of them in a live video chat at 3:40PM EST to take your questions on the President’s proposal.  Secretary Sebelius will also be meeting with insurance company leaders in the morning to get answers on the alarming premium hikes being ushered in on families across the country and will be able to discuss what she heard from them.

• Watch the discussion at WhiteHouse.gov/live
• Watch and join the chat through Facebook

In case you don’t have a TV in your office and weren’t glued to C-SPAN all day yesterday, we asked Disruptive Women’s Wendy Grossman to take a minute to recap a few of the highlights. She spoke with several Disruptive Women and had this to say:

Democrats: We want to get this done by the end of March. We have 9 out of 10 of your wish-list items. Let’s do this.

Republicans: No. We don’t like it. Let’s trash it and start over from scratch.

Democrats: Not possible.

Republicans: Seriously. Let’s start over. Clean page. Fresh slate.

Throughout the day, President Obama pointed out that people on both sides of the table want the same things. He gets letters every day from hard-working people who have lousy (or no) health insurance — people who are losing their house and going bankrupt to pay their medical bills.

He argued that his proposal and the bill that passed in the Senate at Christmastime wasn’t a “radical change” — most people who have health insurance now will still have it, it will just cost a little less. And people who can’t afford it, or who have pre-existing conditions — could get coverage.

While Republicans argued that folks are furious at the idea of Big Government stepping in and forcing people to buy insurance — Obama argued that he just wanted to make sure everyone could have it. The way the FDA makes sure meat isn’t poisoned or drugs won’t kill you. He said there ought to be a little bit of regulation — the same way doctor’s have to go to med school and pass board certifications before they can practice. He just wants to make sure everything is fair, and everything is safe.

At the beginning of the summit, Senator Harry Reid (D-Majority Leader) said, “If you have a better plan for making health insurance more affordable — let’s hear it.”

And the plan that was echoed over and over again is we don’t like this current plan, no one talked to us about it — we should have had this meeting nine months ago — let’s scrap it and do it again. Obama said he didn’t want to “pretend” like he was going to change health care reform and not actually do it.

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I was asked by Norweigan Public TV to do an interview on health reform.  “Happy to do it” I said as I asked for the questions in advance so I could be properly prepared. 

The very first one, Why don’t Americans think everyone should have reasonable health care (which, my interviewer-to-be noted, seemed very strange to Norwegians) was quickly followed by Why is this matter so controversial in the US? 

Oh boy.  This interview has the potential to be very short; that, or I hope my friend from Europe has a passport with some serious time left on it because explaining this thing we call US health reform could take a while. 

Would love your input.  How would you answer?

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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It could not escape notice this week that the Virginia state Senate passed legislation that would make it illegal for any government body to require individuals to purchase health insurance.  The bill is expected to be passed by the state’s House of Delegates and then signed into law by Governor Bob McDonnell.

Virginia is one of the first states to take such action, but it almost certainly won’t be the last.  According to the American Legislative Exchange Council, legislative measures or proposed constitutional amendments have been filed in 35 states to challenge the idea of health insurance mandates.

This is a significant problem for the future of health reform.  One of the most popular components of the health reform bills that have passed both houses of Congress is the provision that removes pre-existing health conditions as a barrier to purchasing health coverage.  Even in our fractious society, there is virtual unanimity around the idea that having an illness shouldn’t leave individuals and families without health insurance and subject to financial ruin.

But we can’t enact that essential reform unless we also take steps to ensure that there is an individual responsibility to have health coverage.  Just as our property insurance system would collapse if individuals could wait until their house is on fire to buy a homeowners’ policy, so would our health insurance system be unsustainable if the healthiest among us could opt out until we became ill and needed an insurance plan to cover their expenses.

Understandably, lawmakers, in a challenging political environment, would love to pass laws making insurance companies issue policies to all comers, but they’re reluctant to impose health insurance mandates on their constituents. This, however, is a case where you genuinely can’t have the dessert without the vegetables.

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With all the hand wringing about health care costs, it is possible to cut costs without harming patients. Even better, costs can be reduced while making patients better off. Here’s how.

An unspoken truth is that three kinds of medical treatment are provided in the U.S. The first is treatment whose benefit is unquestionable. Surgery to treat a ruptured appendix is an example. Without it, death from life-threatening infection is almost certain. The life-saving medical care being rendered to earthquake victims in Haiti is in this category.

A second type of treatment is provided when uncertainty exists about benefits and risks. Doctors and their patients must balance the benefits and risks. The recent mammogram controversy fits into this gray zone.

The third type of treatment is when the possibility of harm exceeds the possible benefit. A panel convened by the Institute of Medicine years ago called it “overuse”. This is the subject of my new book, The Treatment Trap.

Health care tests and treatments today are like the colors of a traffic light. Life-saving treatments flash green. Where uncertainty exists, the light flashes yellow. With overuse, the light flashes red and tells us to stop.

We don’t stop at red lights in health care. In fact, we run right through them. In a survey conducted by the American College of Physician Executives, eighty percent of physicians who responded said they were very concerned or moderately concerned about their physician colleagues overtreating patients to boost their income. Fifty-four percent said they were concerned about their peers admitting patients to a hospital to increase their bottom line. The survey respondents are in leadership positions in hospitals, medical practices and other health care organizations.

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President Obama had this to say about health reform during his State of the Union address to Congress this past Wednesday:

“…if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. (Applause.) Let me know. Let me know. (Applause.) I’m eager to see it. Here’s what I ask Congress, though: Don’t walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. (Applause.)

Let’s get it done. Let’s get it done. (Applause.)”

What do you think will happen to health care reform after the State of the Union?

A: I am pumped. They’re totally going to get it done. Now!

B: This is going to be a nightmare. He asked for people to bring him better ideas — and that’s going to take another, like, eight years to get every idea organized and heard.

C: Fast track it!

D: I don’t know. I don’t really think anything is going to happen.

E: Other thoughts?? 

Do you have “a better approach” to health reform than we’ve seen so far?

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 we all know, children can’t speak for themselves, but if they could, they’d probably point out the obvious: they need more attention.    There have been some great strides over the years and some compelling examples such as those shown in Bill and Melinda Gates’ Living Proof project and the Measles Initiative.  In the recent installment of Raj Shah, the new USAID Administrator, he touts the progress that his new agency has already made in preventing unnecessary deaths.  He is pragmatic and encouraging as he also says that much more should be done.  To save more lives, we need to make sure the US investments are there. Look at the numbers: More is needed to ensure two leading childhood killers are addressed.  More global funding is needed for new vaccines such as pneumococcal and rotavirus vaccines offered through the GAVI Alliance to prevent much of the disease in these at risk children.  Vaccines can’t do the whole job, so inexpensive treatments such as antibiotics or oral rehydration therapy are also needed along with training of health workers to prescribe or education of parents to seek care – certainly not impossible, but requiring some effort and focus.

Now is the time to speak up and insure that the right investments will be made.  Please Call to USAID to take action on pneumonia and diarrhea.  You can submit a letter to Dr. Shah both welcoming him and asking for him to speak up for children.  Visit: http://www.change.org/actions/view/call_to_usaid_to_take_action_on_pneumonia_and_diarrhea.

Disruptive Women is thrilled to announce our January Man-of-the- Month, Greg Simon, Senior VP of Worldwide Policy at Pfizer.

Greg has served as a senior congressional staff member in both the House and the Senate, was the chief domestic policy advisor to Al Gore, and is past president of Faster Cures.

And now, Greg is Senior Vice President, Worldwide Policy, Pfizer Inc. As such, he leads a global team of professionals in a number of areas including (1) worldwide government policy (2) science policy (3) economic policy and research and (4) international policy.

At the moment, Disruptive Women was interested in his role advising Pfizer’s CEO about the company’s involvement in health care reform.

Greg shared a DVD of a recent speech he presented at a Pfizer legislative conference. In a 25-minute talk we saw why he’s so good at enacting legislative change — he exudes energy and enthusiasm—and he cares about patients. As a motivated, savvy policy and legislative expert, when he talks, you just feel like the right changes are going to be made. Soon.

“Healthcare reform should be about patients,” he told the audience.

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The following post by Liz Scherer, Principal of Digital Copy, LLC, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Liz Scherer is a digital copywriter, health reporter, medical writer, marketing and social media consultant, blogger and women’s health advocate. With over 25 years experience in the healthcare arena, Liz has worked in the private and public sectors on behalf of web-based and traditional science publishers, public relations and advertising agencies and non-profits.

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There’s an elephant in the room: band-aids.

Poverty and its relationship to the provision of and access to healthcare is a global problem. This month, esteemed Disruptive Women in Healthcare bloggers and guest posters are writing on this critical issue with a unique look at the problems abroad. Yet, this has prompted me to look within, for if we can’t address our own problems, how can we possibly be successful at addressing problems outside our immediate borders?

It’s no secret that the divide in the U.S. comes down to socioeconomic status. And while our representatives in Washington continue to battle it out to devise a healthcare reform bill that, for all intents and purposes, may ultimately serve the power lobbies more than the public, a significant proportion of our population is being pummeled into submission with powerful drugs.

According to an article in the New York Times, children from poor families receive antipsychotic medications four times as often as those from wealthier families. What’s more, it appears that these children are likely to receive a prescription for less serious conditions than would commonly prompt a prescription for a wealthier child. The divide: Medicaid versus private insurance.
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The following post by Glenna Crooks, PhD, founder and President of Strategic Health Policy International, Inc, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Glenna Crooks solves some of the toughest health care problems of our times by distilling chaos and complexity into recognizable and easily digestible, action-oriented insights. Her clients, businesses and governments around the world, have used her Centricity Principle™ approach to create successful organizational, national and global transformational strategies.

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It has been long recognized that the growth of a nation’s economy improves the health of its people.

The converse is also true. Improving health is an economically wise and productive investment.

In fact, that’s the reason that health systems were established – by the King and the employer – documented as far back as 4,000 years ago.

There is good news to today’s world: a positive cycle of gains in both health and economic security occurs as either one is improved.^[1]

Have we taken the value of health for granted? I think so and find that especially the case among those of us in the health community. We talk endlessly about improving health outcomes as if those outcomes were an end in themselves. We have fallen victim to the notion that health expenditures are a cost, rather than an investment. We have forgotten our origins in economic growth and security. We have set our sights too low.

It’s high time we set higher goals. Disease creates barriers and slows progress towards economic status and security. As health improves, people experience both immediate and long-term economic benefits. Individuals become more productive; they enhance not only the quality of their lives but their capacity to enrich economic well-being.^[2] “Health is an economic engine.”^[3] This is true not only for individuals but also for families and societies.

World Health Organization (WHO) and World Bank benchmark reports outline the relationship between good health and economic development; good health is not only a means to reduce poverty, but also a means to accelerate national and personal economies.^[4],^[5]

• Individual health increases personal productivity and earnings. Extending healthy years of life increases the number of working, income-earning years. Healthier workers are more productive economically during their working years as well.
• Good health reduces the funding required to treat disease, allowing people and nations to invest in other needs.
• A healthy population encourages foreign investment, technology transfer, and facilitates access to global markets.^[6]
• Healthy children are more prepared for school, miss fewer days of school, attend school for more years, and learn more while in school.  In addition, longer life span is associated with more years in school and each year of schooling results in a 15% higher starting wage and a doubling of the rate of subsequent salary increases.^[7]
• Natural resources previously inaccessible due to disease (e.g., agricultural acreage unusable because of malaria) are made available for production and farming.^[8]

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