The Users' Guide to the Health Reform Galaxy

Swine Flu: Testing Our Readiness

(Today's post comes to us from Jeff Levi, Executive Director of Trust for America's Health.)

As the first swine flu cases were diagnosed in Mexico, health officials all over the United States leapt into action.  This is the test that they are always preparing for.

As the flu spread, public health professionals have been actively tracking the cases, working to contain the disease by treating areas where the disease is most concentrated, dispensing antiviral medications from the Strategic National Stockpile, and letting the public know how to protect themselves and when to seek treatment.

How to package the evidence for health reform

by Brian Quinn

Over the last few months, every day seems to bring a new journal article or report with the intent of informing the health care debate.  The releases usually are featured in an e-mail alert that breathlessly touts the importance of the new study's findings for discussions on issues like coverage expansion or payment reform.  Most of the research is top-notch and contains key insights that could help policy-makers.

And they're off!....

By Mike Painter

Help me out here.  I'm trying to reconcile several recent experiences.  I just returned from a wonderful visit with some dear family members in another state.  Interestingly, my 13-year-old nephew spent a great deal of time during our stay with either (1) his nose in his iPod Touch or (2) his thumbs flickering out text messages on his cell.  It was nearly bewildering--and don't get me wrong, I'm not a technophobe--actually, I proudly consider myself a bit of a gadget freak.  It's just disconcerting for someone of my generation to witness how engaged other generations are in new methods of communicating.

Filling the glass all the way....

By Andy Hyman

Is the glass half-full or half-empty?  Are you an optimist, or a pessimist?  I can give you a different answer to these questions depending on the topic, current events, and what I've had for breakfast on any given day, but I've chosen to take an optmistic view of one thing:  that health reform is possible, and that all who are busily working on health reform legislation in DC, right now, have learned their lessons from the early nineties collapse of the Clinton health reform effort.

Prevention and public health, here's why.

I've gotten some interesting thoughts on prevention and community health, as these topics relate to health reform, from two RWJF staffers who work on these issues, and I decided to try and stitch together these thoughts into one blog entry.  I did this because I thought the reform-minded amongst us might appreciate a little thought-packaging assistance.

What if payment reform could actually work?

(This post comes to us from Francois de Brantes, CEO of Bridges to Excellence, who is leading a demonstration of a new approach to paying for health care)

For the past few years, the state of Massachusetts has received a great deal of attention for having the audacity to not wait around for national health reform and, instead, trying for universal coverage and better health care on its own. And now, in the middle of this experiment, we’re gleaning a few valuable lessons already from that state’s experiences. First, health care coverage reform is possible; and second, coverage reform cannot be sustained without payment reform. Adding millions more Americans to the rolls of the insured is morally and ethically the right path for the country, but it will only be sustainable if we progressively replace the basic fee-for-service payment system. A few months ago, the governor of Massachusetts, Deval Patrick, launched a new commission on payment reform and charged them to find solutions that would address the seemingly unstoppable increases in health care expenses, because the state cannot afford the rising level of subsidies it must deploy to keep the newly insured covered.

Beyond building a better mousetrap

 By John Lumpkin

I just purchased the new Kindle device.  I like to try new technologies with the understanding that they may not yet be perfected, but still I want to see for myself whether the new technology, however flawed it may still be, solves a problem.  In the case of the Kindle, for example, I tested it to see whether I could more easily read a book using the Kindle while on the exercise bike, instead of struggling to turn the pages of a fat paperback or hardcover book.

The answer, by the way, is "yes."  Score one for this particular technology.

Making health reform simple

The title of today's blog entry is a bit misleading--health reform is not simple by anyone's definition of the word.  But today, I just had to pause and admire people who, if they can't simplify health reform, can at least make it, and all of the related issues, more understandable for more Americans.  For a moment, let's set aside the tinges of mistrust that usually show up in polling when people are asked about the insurance industry, writ large.  And let's set aside our differences about which reform approaches we support, and why. 

Saving the safety net

(This post comes to us from Sara Rosenbaum of George Washington University)

As Congress and the White House work on Act III of health reform (following the SCHIP bill and the relevant provisions of ARRA), one question receiving little attention as of late is how reform efforts will affect the health care safety net.  And step one in answering that question depends on how willing we are to explicitly acknowledge that the health care safety net exists, and what purpose it serves, for whom, and why.

Come On, Is There Really a Nursing Shortage???

 by Susan Hassmiller

Health reform policies that aim to increase coverage must also address the long-term capacity of the nursing workforce to provide high-quality care. Nurses are the largest segment of the health care workforce; they’re the professionals who spend the most time providing direct care to patients. Nurses are indispensible to patient safety, and the current shortage (and it’s growing, with a projected shortage of 500,000 nurses by 2020) threatens the quality of care that patients receive.

What feels different about health reform, now.

A lot of people have been saying that health reform in 2009 sure feels a lot different than it did back in 1993.  I can't confirm this, because in 1993, I was working at an nonprofit organization in New York (criminal justice and sentencing policy) and only dimly tracking the doings in DC around health care.  (I was in my twenties, after all--barely sentient in policy years.)

Now, I work at an organization that lives, breathes, eats, and sleeps health reform.  It's what we've always done, but there's renewed energy and urgency to all of the goings-on this year.  And since I wasn't quite there for health reform in 1993, I've got to rely on the hearsay about what feels different. 

Health. It's not just one thing. It's a lot of things.

--by Jim Marks

As a person who trained and practiced as a pediatrician, several careers ago, I am never going to dump on the importance of getting good health care.  It is my fondest hope that health care reform can happen so that everyone can get the health care they need.  But at the same time, the course of my life has taught me that there are so many other things that determine how healthy a person is--and that overall, we Americans are not doing so well.

An App Store for your EHR? Why Not?

(This blog post, contributed by Steve Downs, can also be found on Pioneering Ideas)

Up on the Project HealthDesign blog, Lygeia Ricciardi calls attention to Ken Mandl and Zak Kohane’s perspective article in the New England Journal on the need for a flexible information infrastructure in health care. In the article, Mandl and Kohane offer a simple prescription – that the infrastructure be designed as a platform upon which many competitive, substitutable applications can be offered. They cite the Apple iPhone as an example where this has worked successfully:

“The platform separates the system from the functionality provided by the applications. And the applications are substitutable: a consumer can download a calendar reminder system, reject it, and then download another one. The consumer is committed to the platform, but the applications compete on value and cost.”

Covering Americans: it sure still matters to us. It always has.

--by David Morse

Last week was Cover the Uninsured Week.  This is the seventh consecutive year that RWJF has helped pull together a week of activities--media, research releases, you name it--dedicated to promoting the cause of the uninsured in America.  Despite the 1,110 events that took place around the country, and the more than 900 media hits, we're far past gloating about these successes (even though they always make us feel good), because we know this:  the overall number of uninsured Americans is still unacceptably high--46 million, at last count--and it's proven a bear of a number to push downwards.  So we thought it appropriate to reflect a bit on where RWJF has been with coverage, and how we've looked for signs of hope along the way.