Tag Archives: UNC Health Care

Sunday in Musanze

St. John the Baptist Cathedral

St. John the Baptist Cathedral

Today we are in Musanze (formerly known as Ruhengeri).

We went to the early service (in English) at St. John the Baptist Cathedral. The Anglican service of Morning Prayer was very familiar, and all the songs were ones we knew. There were some other Americans and other non-Rwandans there as well.

After a break, I went back for a portion of the main service, which is in Kinyarwandan, the national language here. I did not understand a single word ? but the vibrant, enthusiastic service was really inspiring.

I was struck by how many young people there were ? in both services, lots of young adults and children. And especially young adult men ? noticeably different from many American churches, that lack them.

Kigali and Gisenyi

Will with people we met on the road

Will with people we met along the roadside

Today was a very good day.

We did several things to get settled ? changed money, got cheap cell phones, got our passes for the mountain gorilla tour (which we will do in a couple of days).

Then we went to the Kigali Genocide Memorial. It tells the incredible story of the 1994 genocide in very effective and moving terms. It is really impossible to do it justice in a short blog posting, but this country has been through horrific trauma, and is now making amazing progress in reconciliation and development.

Then we drove almost three hours to Gisenyi, which is on the shores of Lake Kivu, a huge, beautiful lake. There are a number of resort hotels there, and we went to a very nice one, and had a late lunch. It was magnificent — we sat overlooking the lake as we ate.

We are now in Musanze, where we will spend the next two nights. The town used to be called Ruhengeri.

Our day starts tomorrow with the early English service at the Anglican Cathedral, and then we will spend the rest of the day relaxing. The guesthouse has a pool and the weather here is great.

Then we set out early on Monday to see the gorillas.

Arrived in Rwanda

On the way here via Brussels, we got to spend an unplanned extra day in Belgium. Our plane flight was cancelled, and we had to wait a day for it to go.

Everyone was very kind to us ? they put us up in a hotel at the Brussels Airport, and served us great food.

We got to visit with several of our fellow pilgrims to Rwanda ? a couple from Little Rock on their way to visit their daughter who is working for an non-profit group in Rwanda, three college students who are going there to do volunteer work with another group for several weeks, a lady going home to Congo (she lives a five hour bus ride from Kigali, Rwanda), and an AIDS researcher who works in Rwanda. It turns out we know lots of people in common.

We arrived after dark this evening ? so have not yet seen much, but it is clearly hilly. After all, Rwanda is known as the Land of a Thousand Hills.
Tomorrow we visit the main genocide memorial and then leave the capital city to visit some of the outlying areas.

En route to Rwanda

Greetings from Brussels ? our son, Will, and I are on our way to Rwanda for a long-planned visit.

This will be the fourth of our international visits together, in which we combine our interest in global health with an effort to learn more about the world ? especially those parts which are far away from Chapel Hill.

Will Roper in the Brussels Airport

Will Roper in the Brussels Airport

In 2007, Will and I went to South Africa, Malawi and Zambia. We focused especially on the UNC Institute for Global Health and Infectious Disease work that has long been done in Malawi. We learned a lot, and Will got to work in an AIDS orphanage.

In 2008, he and I went to China, where we again met with UNC collaborators, particularly in the China CDC. And we got to take in some of the Beijing Olympics!

In 2009, Will and I went to Peru, with Drs. Luis Diaz and Doug Morgan, and we saw first-hand the work that they and colleagues are doing to advance our understanding of health and disease. This has direct relevance to our efforts in Latino Health in North Carolina. And we got to see Machu Picchu too!

This year it's Rwanda ? a small country in east central Africa ? with a troubled past, but an exciting present and future. The 1994 genocide in Rwanda is a major part of the history of the country, and we will be visiting genocide memorials and learning of the horror of what happened 16 years ago.

But we will also be learning of the widespread reconciliation work that seems to be bearing much fruit, and the rapid development of the country and its economy.

UNC does not yet have global health work in Rwanda, but I will be visiting with leaders in the Ministry of Health, and in the hospitals and medical school. I look forward to learning much about what others are doing in Rwanda, and to thinking about the further opportunities.

In addition, our church in Chapel Hill has a partnership with the Anglican Church in Rwanda, and our sister parish is St. Paul's Cathedral in Butare, Rwanda. I will be visiting with church leaders there and elsewhere in Rwanda.

All in all, we have much to learn and experience. It promises to be a great trip!

Much more to come.

Preventing Childhood Obesity

logo_letsmove

This week I have had some unique opportunities ? related to the growing efforts to do something about the epidemic of childhood obesity in our nation.

I have been asked to be one of the nine members of the inaugural board of directors of a new organization ? the Partnership for a Healthier America (PHA, http://www.ahealthieramerica.org/about/board.html). We had our first board meeting this week in Washington, DC.

This new group is designed to be a non-partisan, private sector effort to catalyze work that is underway across many public and private organizations. One of the partners we will be working with is the First Lady, Michelle Obama.

First Lady Michelle Obama, courtesy White House

First Lady Michelle Obama, courtesy White House

The First Lady is the Honorary Chair of PHA, and the Honorary Vice-Chairs are former Senator Bill Frist (a Republican) and current Newark Mayor Cory Booker (a Democrat).

PHA intends to work closely with the First Lady's initiative, Let's Move! http://www.letsmove.gov/

While we were in DC this week, the PHA Board met for almost an hour with the First Lady and her key staff.

It is clear that she is deeply involved with and passionately committed to this initiative. She talked about what it means to her ? not only as first lady, but as a mother of two young daughters.

I was really impressed by Michelle Obama. Her grace, poise, intellect and beauty were striking.

What was also striking ? as I have told others afterwards ? is how tall she is! Coach Hatchell would have been glad to have her on the team!

There is surely lots more work for many people and organizations to do to turn around the epidemic of childhood obesity ? but I was pleased to have these inspiring experiences this week.

Stay tuned!

Health Reform ? hurray

This week will long be remembered as a momentous time in American health policy and politics.

President Obama signed the landmark health reform legislation and the Senate seems poised to complete the complicated process with passage of a reconciliation bill making a number of changes in the earlier law.

I have long worked for far-reaching overhaul of how we finance and deliver health care in America, and I celebrate this major accomplishment.

We are all hearing several narratives from different quarters ? that predictably conflict:

After decades of trying ? by Democrats and Republicans, far-reaching health reform has passed into law.

This is a major victory for a more compassionate and communitarian society.

President Obama and his party can be proud of their leadership on achieving this.
This legislation gives the federal government a significantly greater role in directing the American health care system.

Republicans will campaign against a government takeover of health care, and they could see major electoral gains this fall and in 2012.

Will it work?

Can we afford it?

Each of us will choose which of those and other narratives to emphasize.

I am very glad it passed, even with its flaws and other consequences that we don't yet know about.

On the whole ? we badly have needed to cover the uninsured ? and this legislation, when implemented, will do that in a big way. The fact that not everyone will be covered is surely true ? but this is a major step in the right direction.

As the head of a major public safety net institution, I am very concerned about the proposed cuts in Medicare. I have to believe, and I do, that these will not occur ? to anything like the extent promised ? because of the predictable push-back of seniors and health providers.

So what that means is this will add hugely to the federal budget deficit ? not a happy prospect, to be sure.

I continue to believe that our nation must press ahead with additional health system reform, that delivers quality care at much lower costs. We can do that ? but it will stretch us like nothing we have ever done before. Just like this process has challenged our political system.

Here at UNC we are dedicated to reform, and we are determined to be a leader ? creating a new model for organizing and delivering care.

So … Health reform has passed … With much more to come! I believe we will be arguing about all of this for months ? indeed for years to come.

Stay tuned!

Unexpected turn in health reform

Health care reform just took a dramatic and unexpected turn.

Only a few weeks ago it seemed that the Congress was about to complete action on a fundamental overhaul of health care financing and delivery in America, and send this legislation to President Obama, so that he could sign and complete his top domestic policy priority before his first State of the Union Address.

But . the special election in Massachusetts, to fill the seat held for decades by Senator Edward Kennedy – astounded the nation and upended the plans for health reform. Scott Brown was elected – the first Republican to hold this seat since 1952!

This surprising election had many ramifications – but two were uppermost – the Senate Democrats now number 59, no longer can they end a filibuster and have their way; and elected officials around the country, especially Democratic House and Senate members, were asking themselves if they should back away from health reform, lest they suffer the same fate.

For a few days, there were several creative scenarios debated – ways for the Congress still to get health reform done quickly. However, now it seems that has quieted down, and it looks like this will be dragged out much longer.

Will we ultimately see big time health reform this year? I wish I were more optimistic – but I think the chances are now much less than 50-50. As I have repeatedly said – in this blog and elsewhere – we badly need to overhaul how we pay for and deliver health care, so that we cover the uninsured, do so at lower cost and with consistent quality and safety.

It is more likely now that we will see some more modest reform of health insurance, some expansion of Medicaid, and the launch of some demonstration projects for delivery reform. Those are not insignificant – we need to do them, but the disappointment is palpable. What could have been was much more.

My short-term prediction is that health reform will go quiet for several weeks – as the congressional leaders try to work out a smaller package behind the scenes. They will bring it forward only if and when they have it worked out and they are confident that they can get it done.

Once again – stay tuned. Maybe much longer.

Health Reform in 2010?

There are two weeks left in 2009, and there will be lots of holiday interruptions so the huge efforts to get agreement on a formula for national health reform, and push it through the Congress will surely go over into the New Year.

Each day seems to bring additional twists and turns to the tale one day our hopes are dashed, then the next day we learn of a new proposal which seems to have merit and support, then someone shoots it down.

With all of this I continue to believe that we will ultimately get large scale legislation passed and signed, and that it will overhaul our national health care system in substantial ways. And to be sure, we badly need to do this as a nation.

For months, one of the sticking points has been whether the legislation would establish a new public plan for health insurance that would give real competition to private health insurance. The theory has been that this would lower overall health care spending over time. The proponents of the public plan have criticized private health insurance loudly, and have heralded the public plan as the right idea for the future. Supporters of the public plan have tended to be from the left side of the political spectrum progressives as they are often called. But the notion of an effective alternative to private health insurance has been a popular notion with a broad array of citizens private insurers don't poll well these days.

But this fall the criticism of the public plan has centered on the idea it will simply add cost to an already very expensive health system, without really restraining spending much at all. And the Senate seems to lack the 60 votes needed to break a filibuster and pass the public plan.

Last week Senate Majority Leader Harry Reid came up with a new idea dropping the public plan altogether, and substituting for it a new idea (which has been around for decades). This new / old idea is to allow younger Americans to buy into the Medicare program so that people who are age 55 to 65 could join Medicare, with subsidies for those who cannot afford it on their own.

For a day or two it seemed that this might be a way around the impasse, but now some moderate Democrats have criticized this as being even more liberal than the public plan.

Who knows how this will turn out? We have many more twists and turns to navigate.

My prediction remains this will happen, meaning major health reform legislation will pass, in the early part of 2010.

The New Yorker magazine

The New Yorker magazine

For the first time, in addition, it seems that a growing number of legislators, policy wonks and pundits want actually to overhaul the health care system in some fundamental ways.

In this spirit, I recommend an article in last week's New Yorker magazine by Atul Gawande.

I believe he describes well the challenges we face in actually improving America's dysfunctional health care system.

Debate over mammograms reveals need for confidence in health care

This week we have had a disquieting reminder of one of the challenges we face in overhauling health care in America the public are deeply distrustful of experts.

The US Preventive Services Task Force an appointed body of leading clinicians and scientists issued a new recommendation of when women ought to have mammograms. Because it differed from what had previously been the advice, and especially because it differed from what millions of people thought they knew to be true the new guidelines were roundly criticized and scorned. By week's end, the USPSTF had tried to clarify what they were saying, and then the US Secretary of Health and Human Services asked the American people to disregard the recommendations altogether.

Not a pretty sight, especially for those who believe that we can improve care and make it more efficient and effective by carefully targeting what is done for individual patients.

I am one of those true believers in health services research and guidelines for the delivery of care comparative effectiveness research, as it is called these days.

I don't know what the right advice is for women regarding mammograms. But one thing I do know if this whole effort is going to work, we have to get to a place where the public has confidence in the experts else we might as well quit trying.

Maybe this is all due to our American individualism or maybe it is because so many of us learned to question authority. Whatever the explanation, it is not helpful to our efforts to construct a more rational health care system, guided by rigorous research and the consensus of the leading scientists and clinicians.

Until we solve this conundrum, we might want to slow down on our promises of health cost savings from comparative effectiveness research.

Senate Finance Committee Chair unveils his plan

Last week, President Obama spoke to a joint session of Congress about health reform, and polling afterwards has shown an upturn in support for him and for his recommendations for overhauling health care in America.

Today, Senator Max Baucus, the chair of the Senate Finance Committee, unveiled his long-awaited proposal. I continue to believe the SFC will be the main focus of congressional action on this very important issue. Click here to download a pdf version of the proposal.

The Baucus plan is still being analyzed by all the pundits and policy wonks I plan to write soon about its details. But based on the summary I've read, I like it. I believe it is a serious effort to deal with the big issues we face in an honest fashion.

Our concerns about the cost of care, the lack of access due to uninsurance and the quality and safety of health care in America are very real and they deserve to be faced and dealt with in a comprehensive fashion. The American people know that a lot is up for grabs, and they want this done right.

On September 17th, I will be part of a press conference at the National Press Club in Washington, DC. Several of us will be speaking on behalf of a much larger group of people who have worked on these issues for a long time researchers, clinicians and other leaders. This group from across the ideological spectrum is urging the Congress and the President to work together to make the most of this opportunity to put right some basic problems in our health care system.

Here is a link to the letter and a partial list of those of us who have signed it: http://www.healthreformusa.com/petition/index.php

Also, the leaders of the four medical schools and academic medical centers in North Carolina have come together to put forward our recommendations on health reform. Drs. Victor Dzau from Duke, Paul Cunningham from ECU, John McConnell from Wake Forest and I wrote a letter, which we sent last week to Senator Kay Hagan and Senator Richard Burr.

We believe that the academic medical perspective on health reform is important to the national effort but it is especially important in North Carolina, given our major role in research, teaching the future health workforce, and caring for so many of our most vulnerable citizens. We will be working together to articulate these issues and concerns over the coming weeks.

This major national debate is now at full stage but it will go on for a while yet. In football terms, I'd say we are mid-way through the third quarter now.

Stay tuned much more to come.