The New York Times recently reported on Health Reform Private House Parties. At this particular party, the participants easily sided with the angels: health care is a right, insurance should cover everything and coverage should be available from government and businesses. There, that was easy. Bet they had a nice time.

Partygoers were not asked for solutions and the devil is always in the details, so let’s use my favorite – flu shots.

First, the New York Times reported that party participants quickly agreed that “…health care was a right…” It makes me wonder; if health care is a “right,” what of “responsibility”?

- If I have a “right” to flu shots to help prevent flu disease, do I have a “responsibility” to get them to protect myself, reduce my medical care costs, improve economic productivity and protect others around me?
- If I don’t get the shot, infect others and cause them to be ill, am I responsible for the cost of their care?
- If others I infect miss work, am I responsible for the cost of temporary workers or losses incurred by their employer? Am I responsible to the government for the loss in taxable productivity?
- What if they die as a result of the flu I transmit to them? Am I culpable?

Second, participants also agreed “…that insurance should cover ‘everything,’ not just some services….”
- If a flu shot is covered and I choose not to get one, should I be required to pay for any doctor visits and medicines I need?
- Should my employer have the right to charge me for the temporary help that might need to be hired to replace me on the job?
- Should Uncle Sam have the right to tax me for earnings I would have made if I had been on the job?
- Should the cost of something so reasonably priced be covered for everyone? Really, I mean everyone? Even the wealthy who can well afford the cost?

Third, participants agreed that “…coverage should be readily available from the government, as well as from employers….” They agreed that individuals and businesses should have to pay a “small health care tax” to fund care.
- Who are they kidding, “small health care tax?” Have they looked at cost projections lately?
- And what about non-coverage barriers? Coverage is only one barrier to care. Ask those in rural areas, anyone not fluent in English or medically literate.

And yes, I’m still harping on flu shots. The season is not nearly over and there are plenty of doses left to protect the nation from the $87.1 billion – or more – that flu could cost us this winter.¹

1. Molinari NA, Ortega-Sanchez IR, Messonnier ML. The annual impact of seasonal influenza in the US: Measuring disease burden and costs. Vaccine 2007;25:5086-5087.

The following post appeared last week on the Get Better Health Blog:

President-elect Obama and Secretary of HHS designate, Tom Daschle, invited concerned Americans to discuss healthcare reform in community groups across the country. My husband and I hosted one such group at our home in DC yesterday. Although we had been instructed to compile a list of compelling stories about system failures – instead we decided to be rebellious and discuss “what’s right with the healthcare system” and compile a list of best practices to submit to the change.gov website.

The event was attended by a wide range of healthcare stakeholders, including a government relations expert, FDA manager, US Marine, patient advocate, health IT specialist, transportation lobbyist, real estate lobbyist, health technology innovator, Kaiser-trained family physician, medical blogger, and EMR consultant. Here is what they thought was “right” with the healthcare system: (more…)

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:

(more…)

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.

(more…)

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:

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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.

(more…)

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.
(more…)

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.”

(more…)

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…)

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.
…
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.)

(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…)

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…)

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…)

Guest post from Donna Barnes

Chronic disease prevention presents an obvious opportunity for health care reform. The platforms of both Senators McCain and Obama note the potential savings—in dollars and lives—that can result from preventing chronic illnesses. However, by focusing exclusively on chronic disease, we miss an opportunity for prevention of a common cause of death that takes as many lives as Alzheimer’s disease and causes ripples throughout American families and communities.

What I am talking about here is violent death—among others, homicide, suicide, child abuse, and domestic violence that takes lives. Recognizing the growing damage from violent death and recognizing that it can be prevented—just like countless medical conditions—is critical.

(more…)