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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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 had the opportunity yesterday to attend the Forum on the Future of Nursing: Community Health, Public Health, Primary Care, and Long-Term Care, which was hosted by the Institute of Medicine and the Robert Wood Johnson Foundation as part of a series those organizations are conducting. Following the conclusion of the series, a committee convened by the IOM will issue a report on elements such as:

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I just stumbled upon a really interesting article published in the Online Journal of Issues of Nursing (under the auspices of the American Nurses Association), and wanted to share it on this forum. The authors (three nurses and one MPH/MBA) set out to discuss how process innovation is crucial to health care practice. It is always invigorating to know that these conversations are happening around the country. The article highlights several specific examples of how innovative practices are being constructed and implemented. There seem to be concentrations of innovative energy in the Boston area, already a hotbed of medical, scientific and health-related activity, as well as within the Kaiser Permanente system. Related, also worth reading is a recent article in the NY Times Magazine about the fascinating work going on at Intermountain Health.

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I was taken aback at how difficult it was to gain access to primary health care when I moved to the United States in 2005.  Even in the self-described "Health Care City"  of New Brunswick, NJ-- home to Johnson & Johnson's headquarters, the Robert Wood Johnson Hospital system & St. Peter's University Hospital-- booking time with a medical doctor in a pinch was always a challenge.  Parents who've needed a prescription on a weekend, or desperately wanted to ensure that a cough was 'just a cold,' can surely identify with this experience.

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Independence Blue Cross announced this Fall that they are discontinuing their Special Needs Plans for persons who are dually eligible for Medicare and Medicaid and their low-fee plan for other low-income Medicare beneficiaries.  Why?  They say the reimbursement rates from Medicare are not sufficient to provide case management, managed care, prescription drugs and additional services.  As many as 40,000 individuals in Southeastern Pennsylvania are affected by this and we just learned Aetna is also pulling out of the market.  While Aetna currently only has about 1,000 beneficiaries in its plan, all low-income beneficiaries will have fewer options as they choose new plans or return to traditional Medicare.  And, since IBC is by far the largest provider, the two remaining providers in the market will be taking on a particularly large burden.

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In the face of regional and national acute primary care physician shortages and steady reductions in the number of physicians who are willing to accept Medicaid and Medicare, it is unclear whether our existing primary care system will be able to meet the needs of an Obama administration universally-insured nation. In addition, health care delivery is strained under tremendous pressure from the demands of chronic health issues, downward trends in third party payments, and while insurance coverage will address some of these issues, many of these problems may persist even if universal insurance coverage is achieved in the United States. So what else needs to happen to make healthcare reform a success?

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