HEALTH REFORM: A Reporter's Guide to Covering Health Issues

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.

QUALITY: On-the-Job Training Lowers Turnover Rate of Nurses

After decades of letting newly-licensed nurses sink-or-swim on the job, some hospitals are finally tossing their new nurses a life preserver. The goal is both better quality care—-and fewer newly-minted nurses who quit.

 According to the Los Angeles Times, a recent national study found that one in five newly licensed nurses quit within their first year of work. This is not what we need given our nursing shortage. Peter Buerhaus, of the Vanderbilt University Medical Center, told the LA paper that we could have a shortage of 500,000 nurses by 2025, due to increasing rates of retirement and the demands of the aging baby-boom generation. This shortage too comes at a time when nurses may actually have a larger role to play in a reformed health where we place more emphasis on primary care, care coordination, and management of chronic diseases.

QUALITY: Comparing Perspectives in Comparative Effectiveness Debate

The New York Times' Robert Pear examines the content and contentiousness of the comparative effectiveness provisions of the $787 billion stimulus package.

HR 1 provides $1.1 billion (pdf starting on page 156) to AHRQ, NIH and the HHS to evaluate the relative effectiveness of different health care services and treatment options. The goal is to create a process of funding and disseminating comparative effectiveness research that is transparent, professional and free from conflicts of interests. As the Dartmouth Atlas' Elliott S. Fisher, MD, tells Pear, the funding would be used to try to answer questions such as:

Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of "talk therapy" and prescription drugs to treat mild depression?

QUALITY: A State of the Health Care Union

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.

HEALTH REFORM: Prospects Remain High for 2009

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. 

VOICES OF REFORM: Collaboration Key to Affordable, Safe Health Care for All

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.

IN THE STATES: Yearly Check-up for State Reform Efforts

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.

QUALITY: Radiation Variation

Ever worry about standing too close to the microwave as it works its magic for you in the kitchen? Or maybe think that you spend too much time on your cell phone? Sure, neither give off a ton of radiation in a single dose, but sometimes you might wonder what's safe?

That leads us to a big story that broke this week about computed tomography (CT) scans. According to a JAMA piece, published by researchers from Germany and the Mayo clinic, patients who receive a single heart CT scan are exposed to the same amount of radiation they'd receive from 600 chest X-rays. That 600 is a median figure; patient weight, heart rhythm, and length and type of scan affected the amount of radiation. Some patients received more, some less.

While a dosing algorithm called "electrocardiographically controlled tube current modulation" reduced radiation by about 25 percent in about three-quarters of patients, another technique called "sequential scanning" (according to Bloomberg, it's when the CT scan of the heart is done in pieces, with the X-ray on for a brief part of each scan) reduced the dose of radiation by 78 percent. But it was only used six percent of the time.

HEALTH REFORM: A Presidential Call to Action

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.

HEALTH POLITICS: Daschle Out, But Health Reform Still In

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.