The Commonwealth Fund and Harris Interactive have a new poll out on health care, showing 80 percent support for fundamental change or a "completely rebuilt" health system. The poll differs a bit from some surveys we've seen with its emphasis on how people get care, not just how it should be financed. The survey of 1,004 adults found that people across income brackets have difficult getting timely, efficient and well-coordinated care. And the frustration is not only among the uninsured.

Eight-of-ten adults (81percent) who were insured all year and nine-of-ten (89 percent) who were uninsured at some point during the year called for fundamental change or complete rebuilding. Although there's a widespread perception that patients demand unnecessary tests and procedures and things they saw on TV or heard from a neighbor or stumbled across on the Internet, this survey found that many people thought they were getting unnecessary and duplicative care. One-of-three adults said they had experienced inefficient or unnecessary care in the past two years.

Disease management is catching on in Kentucky, or at least advocates hope it will. The Louisville Courier Journal's Stephenie Steitzer reports that the Bluegrass state is stepping up efforts and outreach to get eligible state employees and retirees with chronic conditions like diabetes or heart disease into disease management programs. PricewaterhouseCoopers estimated that the state could save up to $10 million in just one year with a relatively modest enrollment increase. One challenge is logistics. The Employees Health Plan covers 260,000 people—current and retired state and local government workers, teachers, community college employees and their dependents—who are scattered in many locations. But the PWC study said the savings could hit $10 million by getting just 2,000 of the 40,000 with chronic diseases into programs. Right now only 600 are participating, illustrating the problems that the state has had moving people into both disease management as well as wellness programs, including weight loss and smoking cessation, since introducing them in 2006.

When was the last time you walked from home to the market? The hardware store? Your office? Can't remember? Your subdivision may be a few decades too young.

A study to be released in the September issue of the American Journal of Preventive Medicine (and cited in today's New York Times), found that people who live in older neighborhoods appear less likely to be overweight. The key is walkability. The researchers surveyed more than 450,000 residents of Salt Lake City, UT—examining which communities' environments encouraged residents to drive less and walk more.

According to lead author Dr. Ken. R. Smith, from the University of Utah, each extra decade in a neighborhood's age corresponded to a 13 percent drop in the risk of obesity for men, and 8 percent for women. Not only did old neighborhoods have better, tree-lined sidewalks, they also have places to go —parks, schools, and restaurants. As Dr. Smith says, most people "want something to walk to."

Throw another log on the burden of chronic disease fire:

About one-in-three working age Americans without insurance has at least one chronic illness, according to a new study published today in the Annals of Internal Medicine (abstract) and picked up in the New York Times.

Examining data from the National Health and Nutrition Examination Survey, the authors found that in 2004 (the latest year of the study) about  11.4 million, of the 36.4 million uninsured Americans between the ages of 18 and 64 were chronically ill.

The prevalence of chronic disease among the uninsured shouldn't surprise many, considering the CDC estimates that 133 million Americans suffer from at least one chronic disease. For a quick refresher on who is uninsured, check out New America's policy brief.

The study's more valuable contribution is demonstrating the significant barriers to care faced by chronically ill uninsured. Compared to the chronically ill with insurance:

Remember Phys. Ed? Or recess? You know, that chance to run around during the school day and burn off steam -- and calories?

Well, Congress seems to have been doing some remembering too.

During the last two weeks, Congress heard quite a lot about childhood obesity. The Senate HELP committee had not just one, but two hearings. Doctors, public health experts, economists, and community activists substantiated the fact that one in three of America's children can be defined as obese, and described the immense economic and logistical burden this will place on our already strained health system. On a more encouraging note, several witnesses described initiatives where these challenges are being successfully addressed. For example, the Central Connecticut Coast YMCA has added more subsidized after-school programs that encourage physical activity; provided a service that lets people order fresh fruit from their local YMCA; and have "Y" board members get involved with local building commissions and school boards—getting their communities to recognize the value of sidewalks and P.E.

You hear a lot of talk in policy circles about disease management of chronic conditions, and we're all for new models of effective, coordinated care. But even if we figured out the perfect way to treat chronic diseases, it won't do much for uninsured people who can't get this wonderful new care. As a new study by the Kaiser Family Foundation shows, there are a lot of people who fall into that category. The number of working age adults with major chronic conditions grew by 25 percent during the ten years from 1997 through 2006.

The study by Catherine Hoffman and Karyn Schwartz, on the Health Affairs website, found that this group experienced access problems both based on their insurance status, and because of cost.

Its hot. Its sticky. And in the southern United States this summer, more than 30% of adults are considered to be obese—with Mississippi topping the leader board. This according to CDC estimates reported yesterday by the Associated Press. The study—a random phone survey conducted last year—was published in the CDC's weekly Morbidity and Mortality report. According to CDC experts, the South has higher obesity rates than the rest of the country in part due to high levels of poverty, specific demographic groups that call the South home, and traditional southern eating habits.

Mississippi has had the highest obesity rates in the country since 2004, as well as having rates above the national average for heart disease and stroke—two conditions thought to be closely linked to obesity. These conditions also see higher rates among rural residents and black women, two demographic groups which the South has high concentrations of, and two groups which are more likely to be living in poverty.

More gloom and doom on the health care economics and fiscal sustainability front. Or, choosing a more cheerful perspective, more great incentives for fixing our health care system.

The GAO in a recent report to the Senate Finance Committee added its voice to the Washington choir (in which CBO chief Peter Orszag and Fed chairman Ben Bernanke are the star soloists) warning that we are on an unsustainable fiscal path, and "over the long term, health care spending is the principal driver." That "we" is a big "we"—federal, state, and local governments, as well as the private sector. Like other top government agencies and experts, the GAO has recognized that the challenge is not merely demographics. Yes, with the Boomers retiring, we will have more older people, and older people develop health problems. But it's how they use costly (and sometimes unnecessary) health services, what the GAO calls "increased costs per beneficiary" not just sheer numbers of people that counts.

Who knew that prenatal care could be so much fun?

"Centering Pregnancy" is a prenatal care model that brings together a group of about 10 pregnant women who are having their babies at around the same time. The women meet throughout their pregnancy for about 10 shared prenatal sessions that usually last an hour and a half to two hours. Each also gets a quick individual checkup in a discreet corner where any medical problems that need more thorough or more private follow-up attention are identified.

MedPAC's big June report is out, and it's full of big June ideas. Really big ideas. The panel, which advises Congress on Medicare policy, outlines (not all for the first time, but more emphatically and comprehensively) a lot of ideas for changing a lot more than technical fixes to fee scales and payment rates. MedPAC is ready for the whole enchilada (or whatever the geriatric equivalent would be. Chicken dumplings?) in reshaping the system so that it is both higher quality and more cost-effective. The nonpartisan panel of experts wrote:

Fundamental changes are needed in health care delivery in the United States and in Medicare. ... Recent studies show that the U.S. health care system is not buying enough of the recommended care, is buying too much unnecessary care, and is paying prices that are very high, resulting in a system that costs significantly more per capita than in any other country.

Medicare does more than take care of the elderly and disabled. It sets patterns and models for much of the U.S. medical system, affecting how hospitals function and doctors practice. It also costs a lot. The commissioners stated further: