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Inauguration 2009: Perspectives On Health Reform

January 17th, 2009

The imminent inauguration of America’s first African American president, Barack Obama. The sharpest economic contraction since the Great Depression. In nominal terms, the biggest federal budget deficits and highest debt in history.

To this short list of improbabilities, welcome and not, dare we add another — the prospect of health reform? As President Obama prepares to take office and engage with the 111th Congress, the United States seems closer to broadening health insurance coverage and making other sweeping changes than at any time since 1994. Hence, this package of Health Affairs Inauguration Perspectives. Call it our bipartisan way of honoring one of our greatest achievements as a republic: the peaceful transition of government, and the embrace of a new day.

Whether members of Congress or business leaders, the authors of these Perspectives are unanimous: the status quo in health care is unacceptable, and changes must be made. Yet the writers also differ in various respects. Some favor proceeding boldly, and others favor caution. Some endorse particular bills or policy initiatives; others point to broad-brush changes to build a foundation for ongoing transformation.

We receive critical reminders that health care isn’t everything, and that addressing conditions that affect the social determinants of health matters, too. Nor should U.S. health or health care be our sole preoccupation. The administration of George W. Bush made large and lasting contributions in the field of global health, and the Obama administration can and should build on these to deepen America’s commitment to improving health worldwide.

These authors will not have the last word on any of these topics, as the months to come will bring many more in the pages of Health Affairs. We hope you enjoy this symposium. Let the festivities begin.

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2 Responses to “Inauguration 2009: Perspectives On Health Reform”

  1. Kellyann Curnayn Says:

    I am disappointed to see there has been little activity to this article. “Leaders lead to the extent that they are role models for the change they aim to make and the values they aim to instill”. Tom Peters.
    The quality of care in the United States continue to go down as can be noted by preventable errors and hospital aquired infections. Medicare estimates it spends 20 Billion a year on hospital aquired infections. With that said Department of Health and Human Resources has spent a great deal of time and money to address this issue. We are all looking for available money to help ‘fix’ things. 20,000,000,000 billion spent on infections. Yet Nurses still have no say on the flows and processes that affect their work environment. Charting has been placed at a higer value then the care of the patient and every one wonders why the quality of care has gone down!!!

    Basic care and proper hand washing would bring down HAI. Those that talk about quality of care are not close enough to the patient to serve as a role model. Reform will only occur when those who implement the care are involved in the ‘necessary’ process flows and policy changes. Address the simplistic problems and then maybe the complex problems won’t seem so complex.

  2. tricketts Says:

    Research in Health Care Can More Directly Stimulate the Economy and Add Jobs if it is Conducted in the Community.
    Thomas C. Ricketts, Ph.D., M.P.H.
    The University of North Carolina at Chapel Hill
    There are proposals to, as part of the second tranche economic stimulus program, invest heavily in health research. Part of the extant proposals would support research into health service delivery including comparative effectiveness research. This proposal is one of many mechanisms to stimulate employment and economic activity. This will serve as one way to push money into the pockets of working Americans but it depends on the ability of the current research infrastructure to absorb and usefully spend that money in a relatively short term.
    Experience suggests that the current research capacity would not be able to quickly make use of a very large infusion of funds using its normal mechanisms of planning, deployment, analysis and reporting. There is simply too long a led time under current procedures using traditional means. There is a way to quickly absorb the funds for research and one that would more directly put the funds into the pockets of working people and that is through what is often called “community based participatory research.” That is a process whereby the subjects themselves and the communities that are being examined take part in the research development, the data gathering even elements of the analysis.
    This type of research can be done in communities with local recruiters and coordinators hired to facilitate and operate the process. Many tasks can be devolved to relatively untrained individuals or programs quickly developed to train participants. These programs and projects can be fielded in relatively short order to implement fairly complex projects by following the lead of already successful community based projects. In North Carolina, we have had what is called the Johnston County Project which made use of local coordinators, data collectors and community panels that were used to assimilate and reflect on the data.
    This community-based approach is more appropriate for some types of research questions than others For example, understanding what constitutes appropriate access to health care services; or why individuals choose one service or practitioner or hospital over another. These types of studies can easily make use of locally trained and employed people who can conduct surveys, organize focus groups, and help interpret data.
    Even clinical questions that revolve around compliance and individual and group behavior can be facilitated with this form of research. The response to various types of cancer treatment that depend on patient choice of modality can be examined in the community. The many proposals for behavior modification in preventive medicine and general prevention programs require many subjects using many optional approaches.
    Taking this idea one step further, we can use the funds to field an update to the Rand Health Insurance Experiment and make use for the stimulus funds to directly pay for care in experimental groups or to subsidize options of blended payment and services mix.
    It would be a shame to spend the funds on questions and projects that do not answer the most pressing questions that face us as we consider health financing and health delivery reform. It would be even more of a shame if we did not allow ourselves to learn as much as we can when we spend the money. We can use this opportunity to learn as well as stimulate the economy in a way that touches far more than the research establishment.

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