Sunday, November 23, 2014

The Thankful List 2014...

I have been neglecting this blog recently. Actually, I think this is the longest I've ever gone without blogging. There are good reasons--ranging from vacation/conference to choir rehearsals.  But now I'm back to blogging.  With Thanksgiving a few days away, it seems appropriate to once again (yes, I did this last year) make a health/health care/health policy thankful list:

1.  Politicians who aren't afraid to stick their necks out on health issues:  I'm thinking of Sen. Sanders and his colleagues who are digging deep into the mysteries of sharp increases in generic drug prices, but certainly there are others out there who truly care about health and health care policy, and are willing to lead the way.  There are even a few who put health and health care before partisanship.  It would be nice if there were more, but we should be thankful for those who do exist.

2.  Writers who inspire and provoke us on matters of health:  Nicholas Kristof, Atul Gawande, Elisabeth Rosenthal, Eric Topol, etc.  When their words flow across the page, they wake up our brains and serve as an impetus for ideas and activism and change.  Again, it would be nice if there were more writers who truly understood health/health care/health policy, but there are definitely enough for whom we can and should be thankful.

3.  Advocates whose words, whether spoken/written/Tweeted, make a difference by swaying politicians or leaders, raising awareness, or igniting passion.  All of us have the ability to be health/health care/health policy advocates, so we can include ourselves and our friends and colleagues in this category.  A special level of thankfulness goes to those advocates who always speak out loudly and consistently, who can rabble-rouse when the rest of us cannot.

4. Doctors and hospitals and insurers that put patients before profits.  Truly caring for and about patients, charging reasonable and transparent prices, maintaining broad provider networks. 

and my personal list item:

5.  Mentors, teachers, and role models:  I've had so many over the years it's hard to count.  The lessons they've taught me guide the professional and volunteer work, and the advocacy, I do every day.  I'm so lucky--and so thankful.

Tuesday, November 11, 2014

Dear Politicians...

Last week we had elections, and since then there have been predictions and speculations galore about what the newly elected politicians are going to do and what they should do. Each TV news network, each political analyst, each newspaper...all have their own ideas and opinions.  And naturally, I have my own opinions about what should happen in terms of health policy. If I were going to share those opinions with political leaders, both newly elected and veteran, these are (a few of) the things I'd say:

1.  Please don't try to repeal the ACA.  The law passed, it was upheld by the Supreme's the law of the land.  There have been more than enough repeal attempts, and they haven't worked.  And rather than taking partisan aim at certain little parts and picking it to pieces, work together--yes, with members of the other party--to devise solutions to the parts that are problematic.  Because it's not perfect. 

2.  Tackle the big issues, the expensive issues--where you can do something tangible and get a lot of bang for your buck.  Join with Senator Sanders to investigate and reduce rising generic drug prices--which would save patients, hospitals, and insurers money (yes, this might mean governmental price controls).  Pass a national law to address balance billing in emergencies, following in the state of New York's footsteps.  This would simplify bills for patients, and significantly reduce financial burdens.

3.  Realize that gun violence is a public health issue, and treat it accordingly...with sufficient dedicated research funding, with sensible policies and laws, etc.  Guns kill both Democrats and Republicans.  They don't discriminate.  And please, enough with the state laws like that in Florida that say doctors can't ask their patients about guns in the home.  Let doctors do their jobs the way they're trained to do...let them take thorough histories so that they can provide appropriate, tailored anticipatory guidance...guidance that in this case could save lives. 

4.  Remember that health and health care are not partisan issues.  We're all going to get sick, we're all going to need care. Examples from your own parties:  both Bill Clinton and Dick Cheney have had significant heart problems.  They've needed acute care, routine care, preventive care...heart disease didn't care whether they were Democrat or Republican.  Same principle applies to the rest of us!  Illness and accidents and injuries don't discriminate based on political party.  Thus, our entire health policy enterprise shouldn't be rooted in partisan battles.  The focus should be on health policies that create and support a health system that can meet all of our needs.

(Note: I say #4 often in some way, shape, or form--but political leaders somehow just don't get it, so I keep saying it like a broken record)

Thursday, November 6, 2014

What now?

I count myself lucky, amidst all the recent overly partisan politics, to have been awed and inspired--x3, within the past month.  Twice from the pages of books...Nicholas Kristof's and Sheryl WuDunn's A Path Appears, and Atul Gawande's newest masterpiece Being Mortal.  And once live...when Shiza Shahid spoke about her journey from a childhood in Pakistan to Stanford to the businessworld to running the Malala Fund  (a fund named for Malala that helps provide money for Pakistani girls to be educated).

The two books and the live speaker have been pretty amazing and inspiring.  There's just one problem.  What am I supposed to do with all of this?  I feel like little Alice in the children's book Miss Rumphius, The little girl talks about her plans for being a grown-up...where she's going to live and where she's going to travel.  Her grandfather says to her that all that is well and good, but she must do something else--she must make the world a more beautiful place.  Little Alice has no idea how to accomplish that task.

Public health education--at least the one I got--instills a "save the world" mentality and desire.  Granted, this is tempered by the hard numbers and sensible logic of epi and biostats, and by the bounds of health policy, but it's there.  It has been a driving force behind much of the work I have done since graduating, in some way, shape, or form.  Kristof's book is full of the "save the world" mentality from a different angle...implementing and spreading health and education programs supported by evidence, give to fiscally responsible charities, etc.  Gawande's book is "save the world" in terms of changing paradigms around old age and endof-life.  And Shahid's speech about her work with the Malala Fund was pure go out and "save the world."

One month filled to the brim by two fabulous books and a powerful speaker. Lots of good info, lots of exhortations to "save the world" and make it a better place...but, to paraphrase Miss Rumphius, what exactly am I supposed to do make the world a better place?  How I am supposed to use the MPH after my name and the education and training behind it, to make the world a better place?  What am I supposed to do, both professionally and outside of work?  Particularly in the current political environment?

Plenty of awe and inspiration...but what now???

Monday, October 27, 2014

Faith Renewed...

I was aimlessly procrastinating, scanning a website someone had mentioned, and suddenly I saw public health on it.  Less than five minutes later, I had managed to scan that and a few other sites, and my faith was completely the health advocacy power of faith groups and organizations.  I'm seriously impressed, and wondering how I--as someone who attended a college that has church connections and and has spent some time in churches since--was unaware that such advocacy existed.

I mean, I knew churches sometimes did things in their communities around health issues, and that many denominations have spoken out in favor of organ donation.  I knew from an obesity project that some churches had fairly major interventions in exercise and after school programs to get kids moving, and healthy coffee hours.   And I knew that some churches fund and support free clinics and other health care organizations.

What I didn't know was just how strong some faith groups' advocacy voices have been around health care justice and health care reform.  There's a big, bit group (click here if you want to see a long list of all their members) called "Faithful Reform in Health Care" that has an explicit vision of a system that is inclusive, accessible, affordable, and accessible.  Hmm, those words sound very similar to ones many of us in public health and health policy use!  Individual faith groups/denominations have also called out loudly and clearly for health care justice and reform.  I know I'm skipping over many, but I'm purposely limiting myself to three here, or this list could go on an on (and perhaps it will in another blog post):  
  • the notoriously socially liberal Unitarian Universalists have an entire section of their website dedicated to health care issues, and advocate at the national and state level for change.
  • the United Church of Christ also offers lots of information on its website, including specific advocacy info on issues such as Medicaid expansion and on the Supreme Court decision on contraception. Yes, these issues really do appear on a denominational website.
  • The Evangelical Lutheran Church in America (ELCA) issued a statement way back in 2003, that advocates for changes in structure and funding to increase access to care, for equitable access to care for all, for a more coherent system, for public health funding, etc etc.
Wow.  These denominations and faith groups, at state and national levels, are issuing strong calls for change in public health/health policy jargon.  They are doing health advocacy, plain and simple.  And I would bet that many of us who work in health care and public health and health policy, who advocate for increased access to care and for Medicaid expansion and for health system changes, have no clue that these denominations and faith groups are advocating for the same things we are.  I certainly didn't.  I'm feeling pleasantly surprised. And pretty clueless.  And perplexed.  If the denomination has called for health care reform so strongly at the national level, how come the subject never arises on Sundays in church?  How come equal access to care, health care justice, and a moral imperative for health coverage never come up?  I'm not expecting a sermon on the merits of the ACA, but it would be nice to at least know a denomination's stance on health care reform.

Suffice it to say that my random Internet surfing just opened my eyes and renewed my faith in the advocacy power and potential of faith organizations and denominations around health care, public health, and health policy.  

Sunday, October 26, 2014

November 4...

It's dawning on me that November 4 is a really big day with major public health and health policy implications, for our state and for our nation.  Oh yes, in case you don't know, it's Election Day.

In some of our states, this means a chance to elect new governors...possibly governors who view the ACA and Medicaid expansion more favorably.  This part I already knew.  There may be other important electoral offiecs to be filled that could impact public health and health policy as well in some places.  

What I didn't realize--because, I admit, I haven't been paying enough attention to national politics of late, is that some legislators, and legislator-hopefuls, still are dead set on wrecking havoc with the ACA.  It was comforting to hear Sara Rosenbaum, a health policy guru say in print. that an ACA repeal is unlikely.  It was worrisome to read her quote that ACA changes are likely depending on who controls the Senate.


It is scary to me that certain leaders, and leader-wannabes, still cannot accept that the ACA is the law of the land.  It passed, and our Supreme Court upheld it.  What more do they need?  And no, like most laws, it isn't perfect.  I'll be the first to say there have been glitches and challenges...the federal enrollment website,  provider/insurer networks that don't match contain both clinic providers and their traditional admitting hospitals, and more.  In an ideal world, our leaders--and leader-wannabes, would focus solely on fixing the problems.  Not on repealing the law, not on implementing their partisan ideological ideas about parts of the law...but on fixing things so that all Americans--whether Democrat or Republican, would have the best chance at affordable, comprehensive, high quality health care and health coverage.  

My hope for November 4, at state and national levels, is that we elect sensible and visionary leaders.  Leaders who make decisions regarding Medicaid expansion based on evidence and data, and based on a vision of healthier states.  Leaders who realize and accept that the ACA is the law.  Leaders who are committed to making it work, to fixing what's wrong, to maintaining what's good.  Leaders who understand that first and foremost, health and health care and health coverage shouldn't be partisan issues, because they affect every single American.