Health care reform and welcome back students

Health care reform — another chimera?

Note: I wrote this Saturday, August 15th. When I got the papers Monday morning, front page articles splashed the news that President Obama might be willing to support a health reform plan without a public plan. It’s a huge change, but one that might make the legislation more palatable — or not. Saturday, it seemed that the whole thing was unraveling. So I wrote…

A lot of people all over the country are talking about what kind of health reform package we will have. I am an optimist on most things. When it comes to health reform, my optimism is shaded with deep concern. The igniting of extreme passions (illustrated by the appearance of guns at health reform rallies), especially on the part of anti-health care reformers, is causing me to worry that, yet again, health care reform will be just another chimera, a vision and dream deferred. Each time health care reform seems breathtakingly close, fear-mongering drowns out rational voices. I spent a few hours in the Atlanta airport last week and found myself speaking back to Lou Dobbs (on CNN) as he authoritatively spoke one mistruth after another about health reform. There was no one answering him but me — mostly under my breath.

The problems with our health care non-system have been catalogued — more than 47 million Americans uninsured, great disparities between those who are minority and those who are not, access problems, waste, geographic mal-distribution of health care, uneven quality of care, and health outcomes that, for many indicators, are worse in the US than in other countries. As Gawande, Berwick, Fisher and McClellan wrote in the New York Times August 13th, “So we are trying to decide if we are willing to change-willing to ensure that everyone can have coverage.” In 2009, we should conclude that we are willing to ensure that all Americans can have health care coverage.

There are many good analyses of the current bills. The bills have many common themes — guaranteed issue, administrative simplification, some but not all cover preventive services, transparent purchasing marketplace, minimum benefit package, individual mandates in some but not all plans, health care delivery reforms, workforce reform (includes public health), and allowable services dependent in part on comparative effectiveness. There’s a lot more, but these are some of the common elements. There’s no discussion of tort reform, but that needs to be fixed.

John Oberlander, PhD, Associate Professor of Health Policy and Management at our school, is one of the most astute commentators about health reform. Here are some links to his recent articles.

There’s no perfect system, but we can do better. We should do better.

Welcome back students!

I look forward to meeting our new students and talking with those who are returning. I love the fact that the sounds of students have begun to replace the sounds of silence in our atrium. Wishing you all a great year!

Happy Monday, Barbara

• Learning from Failure in Health Care ReformPicking the Right Poison — Options for Funding Health Care Reform, N Engl J Med 360:2045, May 14, 2009 Perspective

• Great Expectations — The Obama Administration and Health Care Reform
  N Engl J Med 360:321, January 22, 2009 Perspective

• Health Care and the Recession, N Engl J Med 360:e5, January 22, 2009 Perspective

• The Partisan Divide — The McCain and Obama Plans for U.S. Health Care Reform, N Engl J Med 359:781, August 21, 2008 Perspective

• Health of the Nation — Coverage for All Americans,N Engl J Med 359:777, August 21, 2008 Perspective

• Presidential Politics and the Resurgence of Health Care Reform, N Engl J Med 357:2101, November 22, 2007 Perspective