The Alliance for Health Reform has released the first chapter in the new edition of Covering Health Issues—an online guide to the major topics in health policy. From national health reform to local health disparities, each chapter provides readers with the basic facts, background on the issue, and overview of the likely policy debates.

The first chapter, written by our colleague Joanne Kenen, tackles the issue of health reform in its entirety. Kenen lays out likely policy debates, noting that "this time around, politicians and policymakers are talking about the intertwined issues of coverage, cost and quality." She provides an overview of the ongoing debates in each, while also addressing related reform issues such as public health and health information technology.

Congress is set to pass a $787 billion economic stimulus package—with more than a $130 billion in health-related funding. The House is expected to vote this afternoon, with the Senate scheduled to follow suit this evening.

Congressional leaders worked late into the night Thursday, to reconcile he House and Senate versions of HR 1. The conference report detailing the compromises in the final legislation is available from the House Committee on Rules. Just how late were lawmakers up hammering out the details? The 496-page pdf is filled with handwritten notes and last-minute edits.

In less than two weeks, on February 24, President Obama will address the Congress in what amounts to his first State of the Union. Health care, The Atlantic decided, couldn't wait that long.

Hosting a State of the Union for Health Care on Wednesday, the magazine brought together experts from across the health care spectrum to lay out where we are and where we need to go in the coming year.

In terms of where we are, much should sound familiar to our readers. Health care costs too much. It covers too few, and the care it does provide is too often mediocre.

As David Walker, President & CEO, Peterson Foundation, told the audience, health care is our nation's single largest fiscal challenge, with the potential to bankrupt our government and cripple our competitiveness. The fact that some 46 million are left without health insurance, Walker said, was shinola.

This post appears on the National Journal's Health Care Experts Blog where you can also see what other health policy analysts have to say on Health Information Technology.

The prospects for health reform in 2009 are still high, despite Senator Daschle’s withdrawal and the worsening economy.  In fact, the economic crisis has made the case for reform even more compelling.  Indeed, it is useful to remember that the health reform debate is far larger than any one man or woman and the underlying reasons for reform are unchanged. 

Gary S. Kaplan, MD is the Chairman and CEO of the Virginia Mason Medical Center in Seattle, Washington. In recent years, Dr. Kaplan has worked with local employers to control health care costs, while improving value. Dr. Kaplan is a founding member of Health CEOs for Health Reform and a leader in payment reform policy. Today, Dr. Kaplan shares Virginia Mason's story and why he believes every American can have access to high-value care at lower prices.

Collaboration Key to Affordable, Safe Health Care for All

By Gary S. Kaplan, MD

The numbers are staggering. Nearly half the $2.6 trillion in the U.S. health-care system is waste. Take a moment to let that sink in. More than a trillion dollars—that's 12 zeroes behind the 1—adds no value for patients and sometimes even causes harm.

At Virginia Mason Medical Center, we don't claim to have all the answers to this dilemma. But we have seen what's possible and are anxious to share our experience in improving care and reducing cost. It isn't going to be easy, but the result we think is achievable makes it all worthwhile: quality, affordable health care for all Americans.

It's been a tough year but many states have shown determination to make progress on health reform, even amid their economic challenges. State Coverage Initiatives, created by a partnership between the Robert Wood Johnson Foundation and AcademyHealth, recently released its "State of the States" 2009 report. Here's a brief overview of the findings:

Coverage Initiatives. Massachusetts is easily the most well-known. The only State to have implemented an individual mandate, it now reports that 97.4 percent of its residents are insured. Vermont has also made significant progress. Between 2005 and 2008, Vermont's uninsured rate dropped from 9.8 to 7.6 percent, and the goal is near-universal coverage by 2010. Even before yesterday's reauthorization and expansion of SCHIP, 10 States, particularly Iowa and New Jersey, were able to push forward on expanding children's enrollment in health care programs in 2008.

Michael Courtney was 41 years old when he was diagnosed with a rare form of lymphoma. It started on his tongue, but spread quickly. He has had radiation and chemotherapy. Treatment will continue indefinitely. So will his bills.

An auto mechanic, Courtney was hesitant about changing jobs because he didn't want to lose his health insurance. But a new employer promised immediate benefits so he took the job. He was even able to stay with the same insurance company that he had at his old job. But a month into the new job, he found that the new policy wouldn't cover his cancer for three months. His disease was a pre-existing condition. Already strapped with medical bills, he postponed treatment.

Courtney's story is one of 20 real-life experiences of patients that gives the human dimension to a new report by the American Cancer Society and the Kaiser Family Foundation released Thursday. Based on calls to the Cancer Society's insurance help line, the study called "Spending to Survive" concluded that after a cancer diagnosis, the financial implications may not be the first concern "but for many, it soon becomes one." Even people with health insurance face enormous financial obstacles to care.

Yesterday, President Barack Obama made a down payment on health reform signing the SCHIP law that extends and expands coverage for low-income children. Today, he makes a pitch for the next installment.

In a call to action in an op-ed in today's Washington Post, Obama outlines how the proposed economic recovery package is a not just a burst of short-term spending but a "strategy for America's long-term growth." Health care figures prominently. He writes:

In recent days, there have been misguided criticisms of this plan that echo the failed theories that helped lead us into this crisis—the notion that tax cuts alone will solve all our problems; that we can meet our enormous tests with half-steps and piecemeal measures; that we can ignore fundamental challenges such as energy independence and the high cost of health care and still expect our economy and our country to thrive. [...]

Every day, our economy gets sicker—and the time for a remedy that puts Americans back to work, jump-starts our economy and invests in lasting growth is now.

The progress towards national health reform hit a bump in the road when Senator Daschle felt compelled to withdraw as nominee for Secretary of Health and Human Services. Still, it is useful to remember that the health reform debate is far larger than any one man or woman and the underlying reasons for reform are unchanged and compelling.

• Our health system is on a trajectory that cannot be sustained. The costs of inaction are high and they will only rise over time. Families, employers, and governments are all threatened by rising health care costs. These trends will not change on their own. In fact, they will worsen. This issue is not going away and neither are the "strange bedfellow" coalitions of business, labor and consumer groups that helped make health care a decisive issue in the 2008 campaign.

For small businesses the economic hits just keep coming, and as the New York Times reminds us, the hardest hits are often from health care.

The Times' Kevin Sack profiles several small business owners faced with a difficult choice: cut health care benefits or close their doors. Amberly Allen, who runs her own direct-mail firm, spends 17 percent of her firm's payroll on employee health benefits. Thomas L. Fritts, who owns a sporting goods store in Illinois, saw his company's health care costs rise 30 percent last year while his business's sales plummeted 60 percent.

Small business owners are shifting a greater share of health care costs onto their employees. In the past two years, for businesses with fewer than 200 workers, the percentage of employees enrolled in a plan with an annual deductible of $1,000 or more jumped from 16 percent in 2006 to 35 percent in 2008. See the chart below from the 2008 Kaiser HRET survey: