This is a shout out to some cool people and a group from which I have lately been drawing a bit of inspiration and hope. What’s cool is that they just forge ahead despite the absurdity and craziness that seems to surround us at every turn. As I sometimes struggle with cynicism or feelings of hopelessness about the state of the world (often as a result of just hearing the news), I find it helps to remember some newly emerging organizations, right here in our city. They seem optimistic and determined despite what happens in Washington, Wall Street, Harrisburg, Philadelphia City Council—and a whole bunch of other places.

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Even though the ink is barely dry on the new health care reform law, much analysis has already been printed and broadcast.  So, while my opinion is not unique, I would like to add my voice to those who celebrate this sea change in our nation’s approach to health care by making insurance coverage near-universal and beginning the process of reforming insurance regulations. However, we must continue to have patience and perseverance. This is a beginning and not an end. Change in human service, economic, technological and regulatory systems on this scale, not to mention the necessary changes in attitude and behaviors within the health care industry and in the general population, will take a lifetime. We must be prepared and committed to creating incremental changes, experimentation, research, training and technical assistance, and advocacy to expand access (beyond insurance), improve quality and outcomes, and reduce costs (i.e., significantly improve the cost benefit of our investment in health care). And, we must integrate investments in our public health infrastructure with our investments in health care strategies if we are truly to improve the health of populations.

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In 1997, the U.S. unemployment rate had fallen to a 27 year low of 4.9% and McKinsey’s coined term of “War for Talent” described the challenges that organizations were expected to have over the next 20 years  with attracting and retaining staff. Fast forward to 2010’s global unemployment situation and many wonder if the “War for Talent” is still relevant.

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The health reform debate is over—sort of. Thank goodness the President was able to sign into law a version of health reform that has enough going for it that it feels like a positive development. That may sound like a lukewarm endorsement. For someone who in his heart of hearts wanted single payer and at the very least a strong public option, my “endorsement” does come with a partial lack of enthusiasm.

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There are more than 46.3 million Americans who are uninsured.¹ In the five-county region of Southeastern, PA, Philadelphia County has the highest uninsured rate at 14.1%, with the other counties uninsured rates ranging from 5.9% to 8.0.²  Uninsured status is a barrier to accessing and receiving care within the healthcare system.³  Persons of uninsured status often lack access to preventative and wellness screening; are sicker at diagnosis; and have poorer health outcomes than insured persons.⁴  The healthcare crisis in the United States offers healthcare professionals opportunities to creatively address the needs of the uninsured or underinsured.

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In discussing older adults and health reform, I operate from a couple of basic assumptions. It is a GOOD thing that we now live longer, and to a major extent, healthier lives than any previous generation of Americans. For this we can thank improvements in public health, medical care, pharmaceuticals, and knowledge about diet/exercise as well as Medicare first enacted in 1965. And let’s not forget a generally robust economy over the last 60 years.

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I am in Washington, DC this weekend for the annual American College of Nurse Practitioners policy conference. As you might guess, health care reform is a big part of the agenda. Many are disappointed that reform has not yet been achieved, and are unsure what the next steps are going to be. We heard a troubling statistic about how many Americans are forced to declare personal bankruptcy as a result of health care related costs. That and any number of other stats should be enough to encourage any of us to put aside our political disagreements and come to together to make something happen. I don't think anyone (or at least no one that I know) would contend that the legislation that was working its way through Congress was a perfect solution. But what is troubling is the extent to which its demise appears to be a function of politics more than true philosophical concern for its potential impact. For instance, consider that the individual mandate was actually originally, in the early 90s, a creation of the Republican party (see this piece from NPR). However, once the Democratic party adopted it as a cause, the Republicans rather suddenly and completely opposed it. And both sides are guilty of such partisanship. It's very discouraging, even for a dedicated policy wonk. It's one thing to disagree based on actual principles. It's another entirely to disagree just because your party affiliation dictate that you do so.

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The Philadelphia Social Innovations Journal is an exciting new venture. It is a timely initiative to identify and promote creative thinking, and hopefully, the implementation of really good ideas in public policy.. All of those involved want to better serve our city, our region and the millions of people who live here. So far, however, one of the largest and fastest growing segments of our population has been missing from the discussion. I am referring to our older adults, our seniors, the elderly—or whatever the term du jour is for those of us who can remember exactly what we were doing the day John F. Kennedy was shot.

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Toyota has long been the gold standard among business world thought-leaders for how it has managed to exemplify a seemingly impossible collection of achievements: optimal efficiency, optimal quality, and optimal profit. As it turns out, Toyota's seemingly impossible success may be turning out to have been actually impossible. Without commenting too deeply on the issue, because I don't know enough about it to come to any reasonable conclusions, it appears as though something in their famously regimented production and control systems fell by the wayside. With Toyota's image terribly tarnished for years and years to come, what companies do you think might take up the place at head of the line for quality and accomplishment? What do you think are the likely lessons to be learned from this experience?

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Did you ever watch those science fiction movies where someone goes through a black hole ending up in an alternative universe where everything is reversed? That’s a little bit how I felt when I woke this morning and found out that a republican had won Ted Kennedy’s senate seat in Massachusetts. My initial reaction was one of shock and awl. Why?... How could this happen?... Massachusetts hasn’t had a republican senate since 1979 and the last time a republican held this particular seat was 1953. It’s a bit like the New York Yankees loosing to my brother’s old tee ball team.

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