The featured highlight address at the opening session of the Families USA conference is by Nancy Pelosi, Congress’ first woman Speaker. In person, Speaker Pelosi clearly comes across as a brilliant and warm woman, a friend of Families USA, and she was introduced as a champion of social justice and equality in the 110th (2007) Congress, passing the first minimum wage increase in a decade and making college more affordable for working families. While I’m not certain this is true, I heard comments beforehand that this speech was slated as a major health care policy statement by the Speaker.
In it, she succinctly laid out several core principle of her view of reform.
"I want to start by talking about something that we all agree on: that everybody in America has a right to quality health care. But what is it that this health care should look like? What are the principles that this approach should have?"
Along with other familiar voices like Maggie Mahar and Ezra Klein, I’m in DC today writing from the Families USA Health Action 2008 conference. Families USA is a progessive (liberal) consumer advocacy organization dedicated to universal coverage, driven by mobilizing the nation’s passionate citizen advocates. I am here at their invitation, but I should note, as an objective observer, not necessarily a cheerleader for the approaches advocated here. My perspective will undoubtedly be colored by my own experiences and realizations working on the dynamics of reform.
The idea that citizen involvement can drive meaningful change was a core theme of the conference’s opening speaker, Senator Blanche Lambert Lincoln, the senior senator from Arkansas. She serves on the Senate Finance Committee, which has oversight of Medicare, Medicaid, SCHIP, and other health care programs. She was a champion of the SCHIP reauthorization bill, and advocated for small employer health care purchasing pools.
Several events and trends emerged over the last year that will reverberate throughout the health care
marketplace in 2008 and going forward. While none of these dominated the trade press like some other issues – electronic and personal health records, RHIOs, the evolving labor shortage, pay-for-performance reimbursement – these manifestations of change are occurring in the marketplace as well as through policy, and are moving health care forward in fundamentally positive and far-reaching ways.
Health 2.0The most significant for the long term in terms of its capacity to change how health care works is the Health 2.0 movement, which Matthew Holt and Indu Sabaiya have played a central role in facilitating and explaining. In some ways, Health 2.0 is simply a continuation of what has come before: companies creating new value through information and connecting with customers over the Web. Health 2.0 takes this approach into every area of health care data, often driven by companies outside of or at the margins of health care, who have no financial stake in perpetuating inappropriateness and waste, and who see an opportunity to make money by rationalizing the system.
Our good friend Bob Laszewski is host of this edition of Health Wonk Review, which consistently displays a collection of the best, most insightful health care writing around the Web. Maggie Mahar and yours truly are represented from THCB. Drop by Health Policy and Marketplace Review for Bob’s thumbnail sketches of each column. Indulge yourself for a half hour and read them all. It reminds you how dedicated and superbly thoughtful our colleagues are.
I was on the phone with my good friend Bill
Bestermann MD yesterday. Dr. B, a preventive cardiologist who is
passionate about the underlying mechanics of cardiovascular disease and
the horrific toll the American diet and lack of exercise is taking on
everyday people, lives in spectacularly beautiful, rural Kingsport TN.
He told me he was driving through town, channel surfing on his radio,
and he happened upon the station that broadcasts information for the
local schools. They were announcing the menu in the school cafeterias.
He said it was appalling. "Honeybuns and processed foods. It was all
the stuff I tell my patients to avoid."
Now that health care reform is once again an active, visible issue in state governments and the presidential campaigns, the ideas are flying fast and furious. Predictably, some ideas are better than others.
Now and then, amid the stories of financial conflict, medical errors
and political intrigue that so often undermine health care, comes a
story of the miraculous, where patients in impossible conditions not
only survive, but thrive, due to the skill and resources of many
dedicated clinicians, due to luck and due to who knows what
extraordinary circumstances that are still beyond our understanding.
On December 7th, Alcides Moreno and his brother Edgar, window washers,
fell 47 stories down the side of the Upper East Side apartment building
they were working on. His brother was killed instantly, but Alcides
survived, consuming 24 units of blood and 19 units of plasma. In a
coma, he went through 9 orthopedic operations, and then amazingly – I’m
not making this up – awoke on Christmas Day.
incredible still, Mr. Moreno is now on a path to full recovery, at
least from the looks of it, walking and talking as he did before his
fall. This has prompted Dr. Philip Barie, the chief of the Division of
Critical Surgery at the hospital where Mr. Moreno is being treated to
comment, “If you believe in miracles, this would be one.”
The final bill had 12,000earmarks,
testimony to continuing special interest domination over the public interest. Everyone facing
a cut got a reprieve, but all the same issues (and cuts) will be on the
table in the near future. Here’s one of Bob’s summary paragraphs.
Late in 2008, the docs will be facing
a 15% Medicare fee cut on January 1, 2009, SCHIP will be out of money a
few months later on March 1, 2008, the extra payments to Medicare
Advantage plans will present the same plump target, and we will know
who won the November elections.
So the cuts were held off. Nothing really changed. And once again,
our Congressional representatives on both sides of the aisle made
decisions that accrued much more to the interests of their contributors
than those they claim to represent.
Of course, many readers are aware that Paul has made news by establishing a blog called Running a Hospital. I think he’s probably taken some good-natured ribbing by his more straightlaced colleagues. But I admire that fact that he’s broken the bounds of decorum and speaks openly about the many tremendously difficult issues that face hospital executives.
In the world of health reform wonks – the writers on this blog qualify in spades – all eyes
are on California at
the moment. His Republicanism notwithstanding,
Governor Schwartzenegger has developed a generous $14 billion bill that
would extend universal coverage to all Californians by 2010.
that the plan is set, the special interests are lining up. Most of the
health care groups – the physicians, hospitals, the health plans (with
the interesting exception of Wellpoint) – are supportive, fully aware
that if more money can be found for health care, they’ll be the
recipients. Also in the mix are two prominent unions: SEIU (the Service
Workers’ International Union) and the American Federation of State,
County and Municipal Employees. They are both key supporters, each with
health care workers who would benefit from the deal.