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:

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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.
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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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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.
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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

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

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

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

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

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

(Read Barnes’ essay here.)

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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.

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…)

Sarah Palin makes me angry. She claims to represent families with special needs, but I can’t point to much that she or John McCain or 8 years of George W. Bush have accomplished to earn this claim. From my vantage point as a caregiver for 20 years to my husband, Paul, who became disabled at 36, and—full disclosure—as a Democrat, I believe that the government has a responsibility to provide for people with disabilities and chronic health problems, and their families. We need creative, supportive, innovative leadership to lift up the hopes and futures of these citizens.

My husband Paul had a ruptured brain aneurysm, resulting in a stroke that left his speech severely impaired and his right arm paralyzed. Over the years, we have met many other people and their families who are coping with significant disabilities. I can tell you that the number one trend in recent years is the decrease of, and lengthened waiting lists for, the services that these families rely on—health insurance coverage, Medicare, Medicaid, vocational rehabilitation, special education, transportation, and much more.

I’m all for personal responsibility, and I can assure you that families like mine take on a tremendous amount of responsibility. But it’s really hard to fight back and conquer impairments when you can’t get the basic rehabilitation and training you need.

Besides being responsible for the decline of services (not to mention research budgets), the current administration, through the waging of war in Iraq, has created a whole new generation of people with disabilities, such as the mild (often not recognized for some time) to severe brain injuries caused by road-side bombs.

I would like to hear Palin and her supporters explain exactly what the Republicans have done and plan to do to help people with disabilities aspire to and acquire a good job, a fulfilling life, and independence. We need more than a friend in the White House. We need advocates who will make a real difference.