Thoughts on Health Care Reform

As boxes and arrows and words scribbled in chalk rapidly took over the board, I was once again struck by the same uneasiness I had been feeling for a while whenever the topic of health care reform came up: will we be changing anything at all?

We were drawing a diagnostic tree in class, pinpointing potential causes behind the discrepancy in what the U.S. pays per capita and our health outcomes. Words were scrawled hastily across the board as we brainstormed – lack of fee for service, fragmented financing, lack of access. I want these words to be huge, bright, flashing neon signs in the face of U.S. citizens. But they are getting buried – buried in rhetoric, in scare tactics, in sensational statements instead of an articulation of the facts.

The fundamental misalignment of incentives at every stage of the healthcare system – specialists being paid far more than general physicians, physicians being paid for quantity instead of quality, patients not seeing the true costs of procedures and medications due to insurance coverage – is not what the health care debate seems to be about. The absurdity of inequalities in health – by socioeconomic status and by race, among other things – is not what the health care debate seems to be about. The structural, environmental, and societal factors that combine to make us unhealthy are not what the health care debate seems to be out.

Insuring everyone is important, but we must consider – what does having insurance mean? Having insurance doesn’t change the fact that some people can’t get out of their sprawling suburbs without a car. Having insurance doesn’t change the fact that some neighborhoods are incredibly unsafe. Having insurance doesn’t change the fact that some people’s nearest hospital is miles and miles away, understaffed, and underfunded.

While I am incredibly, incredibly grateful to all those who are working to change our system for the better – including so many here at our school, as well as President Obama and his administration – if the health care debate thus far is indication of what the health care bill that eventually passes will look like…I have to wonder, will we be changing anything at all?

[Disclaimer: I am not as pessimistic as all that makes me sound – I firmly believe that public health can improve things, and I do think health care reform will change some things (and that having health insurance changes some things!), just not enough things or to an adequate extent. And I’m not at all arguing against taking quick action on health care reform. Best case scenario – the voices of public health experts and others get heard, and we get a bill that, though far from perfect, actually addresses some fundamental problems and affects some real change. Some of the bills under consideration now do address at least some fundamental issues, despite the lack of focus on these issues in the debate, and for that I am very grateful! Worst case scenario (assuming a bill passes) - a bill, any bill, would serve as a starting point – if we can change something about health care, it is no longer untouchable, and hopefully iterations in the future will bring us closer to the kind of health outcomes our country should have. ]

Vinu Ilakkuvan
ScM Candidate 2010
Society, Human Development, and Health

Comments?

Protect Insurance Companies PSA from Will Ferrell

So, what is YOUR opinion?

Rallying for Health Care Reform

My apologies for such a late post; however, given the increasing momentum for health care reform in the news and media I feel it is still timely and appropriate. It's great to see the HSPH community getting involved with health care reform and rallying around this important cause! Below is a post from a fellow student, and first time blogger, Alana Wooley:

September 11, 2009
An estimated one thousand people came out to the Boston Commons on Labor Day for a health care reform rally hosted by Organizing for America, the Service Employees International Union (SEIU), and other labor unions and health care reform advocacy groups.  Speakers included Massachusetts politicians (several of whom may be vying for the late Senator Kennedy’s vacant Senate seat), Boston politicians, labor union leaders, physicians, and community members personally affected by a lack of or inadequate health insurance coverage.

Many attended the rally bearing homemade signs iterating the urgency of health care reform.  Some signs read: “Help make America as healthy as insurance profits,” “The health of the people is the highest law of the land,” “Public option means affordable health care,”  “Health care is a human right!”  In addition, signs and speeches called for health care reform honoring the late Senator Kennedy’s cause.

Rally participants ranged in age, race/ethnicity, physical ability, and social class – chanting at times in favor of health care reform and applauding politicians who articulated their support of a public insurance option.  Representative Stephen Lynch, who supports health care reform, but does not support the public option, received loud boos from rally participants, often drowning out his speech.  Chants that circulated among rally participants included “What do we want? – “Health Reform” – “When do we want it?” – “Now!” and “Public Option! Public Option!”

In addition to showing support for health care reform, rallies such as this one also sought to visibly demonstrate the number of people who support healthcare reform, with the intention of eclipsing the famed town hall objections that have often been featured in the media.

Alana Wooley
ScM Candidate, 2010
Society, Human Development, and Health
Harvard School of Public Health
awooley@hsph.harvard.edu 

Sights of Kenya

Here are some of the pictures I took during my internship with Aga Khan Foundation Community Health Department in Mombasa, Kenya. Some pictures from Nairobi are included as well.

In addition to my work at the health department, I often visited an orphanage for children below the age of two years-- just in case you are wondering who those adorable kids are.

Enjoy!

Bolanle Bukoye
ScM Candidate, 2010
Global Health & Population
Harvard School of Public Health
bolanlebukoye@gmail.com

The Journey so Far!

A year ago I was getting ready to leave my job in the trauma center where I had spent the last seven months as a medical officer sewing up people who had sustained wounds from assault or road traffic accidents and resuscitating people who were unfortunate to be victims caught up in the crossfire between rival militant gangs or armed robbers in one of the states in the Niger Delta. I was embarking on a new phase of life. It was a relief to leave the streets of the Niger Delta for the more peaceful streets of the Federal Capital territory. It was one major reason I was leaving but the other was to change my focus and steer me away from other distractions to proceed along the path of Public Health. I had spent one year of the compulsory youth service in the Northern Part of my country and had gone on medical outreaches were I was the only health worker seeing close to two hundred patients over a two day span. This was when I began to realize that my love for surgery would take back seat to a public health pursuit.

My new job had the rather long and clumsy to explain title of Emergency Preparedness Doctor. I was to be responsible for monitoring outbreaks in the North Eastern Part of the country acting as a liaison between the local Health authorities in the different states and my organization and carrying out exploratory missions when there were cases reported (I worked for the French Section of Medecins Sans Frontieres).

When I first saw the job advertisement it had on it a caveat- Traveling 60% of the job, do not apply if not willing to travel, for me it was not a deterrent but a welcome home sign for one thing I do love is to travel! (Don't ask me where I have been, for many of the places I have traveled to are on the pages of books and my mode of transportation is my mind:)



Thus I started my trips round the North Eastern part of the country, many of the states were places I had been to when I was five for my parents took my twin and I on a trip round Nigeria and they form my early memories. But this was a whole new world for me for I now had the capacity to form more tangible memories.

My first job was as a doctor in a post measles malnutrition center, I had been employed at the end of a measles outbreak so I was sent to the field to see how a malnutrition center was being run, then I made some trips to some other states to monitor reported cases of cholera and then this year I spent most of my time working during the big meningitis outbreak. My last job before I left was to conduct a Nutritional Survey with my colleagues. All these activities took place in different states and most times I was on the road for long periods of time. It was fun to work and travel at the same time and I usually took pictures of the scenes along the way.


It was fun while it lasted and I am at the school of Public Health hoping that the journey will be even more fruitful than my past experiences. Looking forward to having a lovely time with everyone.



Olaoluwatomi Kehinde Lamikanra

MPH Candidate, 2010
Health Policy & Management
olamikan@hsph.harvard.edu

[The faces behind the numbers...]

Scenes around Mission Hill taken by A. A. Babar

Every time I see someone digging through our trash, I am struck with a mixture of shame, awkwardness, empathy, and perplexity. A mixture dissolved in irony.

There are homeless people all over the world—people whose survival is a daily struggle, people who do not have food nor water, people whose lives are vulnerable to all sorts of physical and mental harm. But here, in Roxbury—just a hop, skip, and a jump from some of the world’s greatest educational institutions, hospitals, developments—it seems to be such a contradiction to witness such immediate poverty in the midst of such wealth.

I witnessed this semi-collision of worlds a few days ago, when dignitaries—namely the Presidents of the United States—sat together to commemorate the legacy left by Ted Kennedy in the Basilica just a few blocks down. Although I have lived in Roxbury for only a year, I was struck for one of the first times with a certain sense of pride to be a part of a community where something seemingly quick and powerful happened within such diversity. Diversity of power, skin-shades, wealth, and experience.

It reminds me why I’m here in the first place, burying my head in numbers, formulas, words I can not/nor care to pronounce. I guess you could say that I am one of those “social epi” people out to “bridge the gaps”. While the books guilt-trip me into reading just one more page, I am obligated to also take my head out of the sand, and to open my eyes to see the life that is happening all around me.

To ignore the faces behind these numbers drowning in statistical vacuums would be fatal. We owe it to those who have fought before us--some silently, some loudly--proclaiming the need to address the disparities between rich and poor. Between black and white. And between the powerful and powerless.

Amenah A. Babar, MPH
SD Student
Society, Human Development, and Health
Co-Editor in Chief

HSPH Students Attend Town Hall Meeting on Health Care Reform

On Wednesday night, a group of 15 Harvard School of Public Health students crossed the river to be among the estimated 3,000 audience members at Senator John Kerry's Town Hall meeting in Somerville, MA. The atmosphere at the town hall stayed respectful for most of evening as Senator Kerry made his case for health care reform.

In his first public appearance since Senator Kennedy's funeral on August 29th, Senator Kerry spoke of how the two shared many ideals and fought to win the same battles. However, he expressed hesitation that the public health insurance option, a signature piece of the HELP committee's bill in the Senate and Senator Kennedy's final reform push, was politically feasible. 

As a physician, I have been keenly following the debate over health care reform for many months, and I was disappointed by the defeatist tone Senator Kerry used when discussing the public option. Nonetheless, Senator Kerry expressed to the largely sympathetic crowd that he believes meaningful health care reform will be passed in 2009. 

Paul Kokorowski (MPH-CLE, '10) said, "After hearing Senator Kerry speak, I am confident that a reform bill will pass. However, I am concerned that costs may not go down or that all Americans won't be covered."

Sylvia Thompson

MPH Candidate, 2010

Global Health & Population

Harvard School of Public Health

sthompso@hsph.harvard.edu

Welcome Back!

Classes began today for Harvard students from Longwood to Cambridge. While many students, including me, are still figuring out what courses to take for the next 8-16 weeks, I sense a lot of energy and excitement brewing around campus. This is a historic moment for those of us in public health. I am reminded of this constantly by the announcements in the daily Student News about town hall meeting road trips and rallys to discuss health care reform, as well as the frequent headline stories of the Boston Globe and New York Times.

I am certain that health reform will be a topic in many of our classes (whether taken here or at the Kennedy School), and I hope that this blog can inspire and be a forum for student-led discussion.

There lots of new faces at HSPH who will likely contribute great ideas, experiences, and lessons to the classroom discussions here at school. I hope that this blog can be a forum that expands the classroom beyond Kresge and FXB and makes them available for a wider audience of people interested in public health at Harvard.

So I pose this question to you (whomever you are...)

What are you looking forward to this year (or semester) at HSPH?