“[T]here are those who say we cannot afford to invest in science, that support for research is somehow a luxury at moments defined by necessities.  I fundamentally disagree.  Science is more essential for our prosperity, our security, our health, our environment, and our quality of life than it has ever been before.”  These were the words of the President in a speech delivered at the National Academy of Sciences earlier this week.  He went on to set a goal for the US to increase investment in scientific research and development to 3% of the gross domestic product.  Previously, I have discussed this administration’s commitment to science and science education.  I’d like to include a presentation I made a few years ago on the crisis in science, technology, engineering and mathematics (STEM) education and the importance of a robust science sector to a strong economy.

by Clay Bennett

Tell me me what you think. Was the previous administration antagonistic towards the science, research and development sectors of the American economy? I’ve already voiced my opinion of the matter in a previous post. Please leave me a comment (or send me an email, if you prefer) to tell me why you agree or disagree with me.

Subscribe to enBloom

ARRA and You (Part II). Statistics serve only to confirm what we instinctively already knew, the Executive Order of 2001 which banned funding for embryonic stem cell research did not reflect the will of the people. (see fig. 7-18) Though we live in a representative democracy, the ignorance and fears of the minority should not overrule the cautious optimism of the majority. My biology background taught me that correlation does not suggest causation, but during 2002 when about 35% favored this research and nearly 50% opposed it, I’m nevertheless, tempted to surmise that the American people second guessed themselves, “perhaps the President knows something I don’t,” they mused. By 2004 however, public opinion had decisively migrated back in favor of supporting this kind of medical research. So the scientific community and the majority of the broader public alike, breathed a collective sigh of relief with the signing of an Executive Order that reverses the ban of federal funding for embryonic stem cell research. The President stated,

“…the potential [embryonic stem cell] research offers is great, and with proper guidelines and strict oversight, the perils can be avoided. That is a conclusion with which I agree. That is why I am signing this Executive Order, and why I hope Congress will act on a bi-partisan basis to provide further support for this research.”

It is the hope of future legislation combined with the Executive Memorandum directing the head of the White House Office of Science and Technology Policy to develop a strategy for restoring scientific integrity to government decision making that go further to prevent future challenges of this kind.

In conjunction with initiatives of the stimulus package (ARRA 2009), the new research agenda should indeed go a long way towards the recovery of the economy.

The changes that the Obama administration is bringing to biomedical research don’t end with this critical executive order. For the first time in the history of the National Science Foundation’s Survey of Research and Development Expenditures at Colleges and Universities (initiated in 1972), in a two year period (2005-7) federal funding decreased when adjusted for inflation. Combine this with a decreasing trend in federal share of overall research and development dollars spent. In light of these statistics, the $8.2 billion allocated to the National Institutes of Health for extramural research via the ARRA is a logical decision, to say the least. While $800 million will be targeted to priority research areas through Challenge Grants (more on this later), another $1.1 billion is allocated for Comparative Effectiveness Research (more on this later). Anyone who wants to deny that science research and biomedical research, in particular are not significant sectors of our economy is simply fooling themselves (further explanation to come). In short, the President has opened a new frontier (by expanding embryonic stem cell research) and provided the funding with which to explore it, responsibly and ethically. All in less than 40 days in office.

I have laid the foundations in this post to for the impact of the ARRA on the health and research sectors and on you. In the following weeks look for posts expanding on:

• Employment, Economic Recovery and the Research Sector
• Challenge Grant Research Priorities
• Comparative Effectiveness Research
• Preventive Health Interventions
• HITECH Act

Sources:

“A debt of gratitude to so many tireless advocates” at The White House Blog on March 9, 2009. http://www.whitehouse.gov/ blog/09/03/09 /A-debt-of-gratitude-to-so-many-tireless-advocates/

American Recovery and Reinvestment Act: Comparative Effectiveness Funding. March 2009. http://www.ahrq.gov/fund/cefarra.htm

Federal Policy. In Stem Cell Information. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2009 [cited March 16, 2009] Available at <http://stemcells.nih.gov/policy/ defaultpage>

NIH’s Role in the American Recovery and Reinvestment Act (ARRA). In From the Director. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2009 [cited Saturday, March 16, 2009] Available at <http://www.nih.gov/about/director/ 02252009statement_arra.htm>

National Science Board. 2006. Science and Engineering Indicators 2006. Two volumes [Electronic Version]. Arlington, VA: National Science Foundation (volume 1, NSB 06-01; volume 2, NSB 06-01A). Available at<http://www.nsf.gov/statistics/seind06/>

National Science Foundation, Division of Science Resources Statistics
Universities Report Continued Decline in Real Federal S&E R&D Funding in FY 2007. Arlington, VA (NSF 08-320) [August 2008]. Available at <http://www.nsf.gov/statistics/infbrief/nsf08320/>

Subscribe to enBloom

by M. Wuerker (in Politico March 5, 2009)

Many stakeholders and special interest groups may become uneasy as the Administration makes progress towards reforming health care. Considering the current state of the system, can we really make things worse or is there nowhere to go but up? Leave me a comment and tell me what you think about this week’s satire feature.

Subscribe to enBloom Where You’re Planted

Melody Barnes, Director of Domestic Policy during the White House Forum on Health Reform (photo by Pete Souza)

ARRA and You (Part I).  The “fierce urgency of now” is the concept that President Barack Obama used to explain why he would run for president. Yet it can also be used to characterize his motivation and subsequent actions in the push to reform health care.

With the new legislation, American Recovery and Reinvestment Act of 2009 coverage for millions was protected or extended.

1. Health insurance coverage for 7 million Americans was extended via insurance premium assistance for COBRA benefits.
2. Families are no longer in jeopardy of loosing current benefits from Medicaid and CHIP due to $15 billion in Federal Medical Assistance Percentage funding allocated to states.

Without pause, the President continues to move forward his agenda for reform. The release of a budget blueprint, proposes a $634 billion reserve fund to extend coverage to some of the 47 million Americans who are currently uninsured. “This is the first step towards getting health care reform done this year,” White House domestic policy adviser Melody C. Barnes told allies on one conference call. “We can’t underestimate the importance of rallying around this budget. It serves as a footprint for something bigger.” In contrast, others express doubts about the prospects for overhauling health care. For example, Sen. Mike Enzi, the senior Republican on the Senate Health, Education, Labor and Pensions Committee stated, “It needs to be done up front and quickly. I’m not so sure that we haven’t already lost that, with so many other things coming in and weighing us down.” As was the case in bringing a stimulus package into law, it appears the President will remain undaunted and continue to seize the opportunities created by environment, his political capitol, his strategic leadership and timing to accomplish the essential goals of his health agenda:

1. providing affordable, comprehensive and portable health coverage for every American;
2. modernizing the U.S. health care system to contain spiraling health care costs and improve the quality of patient care; and
3. promoting prevention and strengthening public health, to prevent disease and protect against natural and man-made disasters.

As he so aptly noted in his address to a joint session of the Congress,

“[Health-care costs are] one of the major reasons why small businesses close their doors and corporations ship jobs overseas…This is a cost that now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. ….Given these facts, we can no longer afford to put health-care reform on hold.”

So it is no surprise that on the following Thursday, March 5 the administration convened the White House Health Reform Summit. The event sought to convene the varied stakeholders in the health care reform debate and ultimately, get buy-in. The President stated, “I want to be very clear, at the outset, that while everybody has a right to take part in this discussion, nobody has the right to take it over and dominate.” Participants included leaders from the (American Medical Association) AMA and other medical specialty societies; trade groups for drug makers, insurance companies and hospitals; CEOs of companies including Pfizer and General Mills; advocacy groups such as the American Heart Association and American Diabetes Association; and unions such as SEIU and the Teamsters.

Lawmakers also met on Thursday as they have been given the task of working out the details and writing the actual legislation around several key principles set forth by the President:

• maintaining choice of insurance and doctors,
• ensuring affordable coverage,
• protecting Americans’ financial health,
• investing in prevention and wellness,
• improving patient safety and quality of care.

If you missed the live coverage on CSPAN, you can find a summary and important document links at the White House blog and continue to follow the entire process of health care reform at the newly launched HealthReform.gov. Opponents to the progress of health care reform will have take notice of “the fierce urgency of now” momentum and perhaps much more are already on the President’s side. Regional White House Forums on Health Reform are currently under way to expand upon what was gained at the White House forum.

Sources:

Obama Has Big Challenges In Overhauling Health Care {Obama Has Big Challenges In Overhauling Health Care (2009, February 21) [Electronic Version]. The Washington Post} and Obama Proposes $634 Billion Fund For Health Care {Connolly, C. (2009, February 26) Obama Proposes $634 Billion Fund for Health Care [Electronic Version]. The Washington Post, A01} and Brown, CB. Obama wants Congress to Weigh In (2009, March 6) Politico, p. 3 (Volume 3: Number 24)

Subscribe to enBloom Where You’re Planted

Health and the 44th Presidential Administration (Part III). In three nearly back-to-back announcements, President Obama is working prodigiously to fill his leadership roster for health care. Of course, the most newsworthy was his selection of Kansas Governor Kathleen Sebelius as Secretary-designate of the Department of Health and Human Services (HHS). The White House Office of Health Reform, however will be lead by Nancy Ann DeParle who headed up the Center for Medicare & Medicaid Services during the Clinton administration. The administration may deem DeParle, a Beltway-insider, as having a greater amount of political clout to handle what is sure to be high-stakes negotiation within the White House Office of Health Reform. Both women have a depth of experience in health care financing and health insurance, a stakeholder group incidentally with a powerful voice in previous rounds of the health reform debate.

The Office of National AIDS Policy is set to be led by Jeffrey S. Crowley. With a background in public health, Crowley will bring the appropriate knowledge for managing the health of populations and the dynamics of epidemics in leading the effort to set an appropriate national policy. He will also serve as a member of the Domestic Policy Council. The President stated the following:

“In [AIDS and disability policy], we continue to face serious challenges and we must take bold steps to meet them. I look forward to Jeffrey’s leadership on these critical issues.”

Mary Wakefield has been appointed Administrator of the Health Resources and Services Administration (HRSA). President Obama made the following comments regarding her appointment:

“As a nurse, a Ph.D., and a leading rural health care advocate, Mary Wakefield brings expertise that will be instrumental in expanding and improving services for those who are currently uninsured or underserved. Under her leadership we will be able to expand and improve the care provided at the Community Health Centers which serve millions of uninsured Americans and address severe provider shortages across the country.”

For even more insight into this health braintrust, check out what’s on the bookshelf (a widget to the right) featuring books and articles with references and contributions from these political appointees. Several leaders are now in place and not a moment too soon. With the American Recovery and Reinvestment Act of 2009 now signed into law and the more recent unveiling of the budget proposal for 2010, there is plenty of (health care) work to be done.

Sources:

Sebelius at HHS at the White House Blog and Administrator of HRSA Announced and Obama Names Head of AIDS Policy Office and Obama Picks Kansas Governor Sebelius as Health Secretary – washingtonpost.com.

Subscribe to enBloom Where You’re Planted

Health and the 44th Presidential Administration (Part II). The New York Times editorial is believed to have crystallized the issues of the current political climate and helped former Senator Tom Daschle choose to remove his name from further consideration and confirmation as Secretary of Health and Human Services.

Despite Daschle’s legislative policy expertise and significant history working on health policy issues, his work at Alston & Bird, LLP (though not as a registered lobbyist) and the mounting opposition from Senate Finance Committee Republicans may have ultimately proved an albatross to great to bear. Perhaps, it is ironic that the very attributes that would suggest former Senator Daschle would be a tremendous asset to shepherding and ultimately passing health care reform in America (ie. legislative policy expertise and significant familiarity with policy and industry stakeholders) is also the gauntlet that forced the President’s nominee and friend to fall short of the new ethical standards placed upon this administration.

What does this mean to the average health consumer?

Substantively, the elements of the Obama health plan will not change as the remainder of the President’s braintrust for health remains in tact. If former Senator Tom Daschle were the heart of that effort, then his former co-author, Dr. Jeanne Lambrew is (if at least in part) the brains of the effort. Only time will tell as elements of health reform begin to make their way through the legislative process if there exist another health care champion with the political moxie to accomplish what the Clintons could not back in the 1990’s—reform America’s health care system.

Read:

Editorial – The Travails of Tom Daschle – NYTimes.com.

Subscribe to enBloom Where You’re Planted

Source: Jim Wilson/The New York Times

Last Thursday, in a press conference from Chicago, President-elect Obama’s announcement of former Senator Tom Daschle as designate for Secretary of the Department of Health and Human Services was of little surprise. This has been speculated upon and anticipated for weeks since the election.

The announcement of more significance was the formation of the White House Office of Health Reform. As Director of this new office, Senator Daschle will have dual posts in the new administration. Dr. Jeanne Lambrew, a health policy expert will serve as the Deputy Director. Establishing an Office of Health Reform within the White House suggest the President-elect fully comprehends that the magnitude of the task of reforming America’s health care system is greater than that which can be met by the handful of individuals who will serve on his Domestic Policy Council. And, as the name reveals, these individual are responsible not simply for health care but all domestic policies. Obama stated, “[Daschle] will be responsible not just for implementing our health care plan — he will also be the lead architect of that plan.” Hopefully this newly formed Office of Health Reform will be used to formulate strategy and inject continuity and integration into a process—legislative policy-making—which by its very nature is incremental and piece-mill. I believe such coordination and systems thinking is essential to the successful reform of health care in America.

The Obama brain-trust for health policy also includes Daschle staff alumni Mark Childress and Bill Corr each formerly having served as Cheif Counsel and bring a wealth of legislative experience to this endeavor. Experience that will be highly valuable in shepherding reform legislation through Congress. Subject matter experts include Dr. David Cutler, a health economist, Dr. Nicole Lurie, a physician-scientist noted for her research in the areas of health care disparities and public health preparedness and Dr. Jonathan Moreno, a bioethicist. Together with Dr. Lambrew, these experts have proposed linking medical payment to improved health care outcomes (and not simply the medical intervention), emphasis on prevention, and coordinating care through disease management programs as key goals for health care reform. Each of which is difficult to attain in the absence of an integrated health care delivery system. (More on the details of the Obama health plan and further integration of the system to follow in Part II of this post).

Watch the press conference

Read a transcript of the press conference

Additional Sources:

Change.gov:

Department of Health and Human Services Team Leads

Health Policy Working Group

Lembrew, J. “Dear 44: Take a Pragmatic Approach” Politico.com posted July 7, 2008.

Lowenstein, R. “The Quality Cure” in The New York Times Magazine. March 13, 2005.

Earlier this week, President-elect Obama announced former Senator Tom Daschle as his designated nominee for Secretary of the Department of Health and Human Services. This Washington Post article discusses the dual role Daschle will serve not only as top administrator of the executive branch health care programs and services but also as the lead architect in the reform of the system as well. This is an enormous task, to say the very least. Yet it is one that the President-elect has identified as being a key element toward our economic recovery.

During the press conference Obama states, “Now, some may ask how, at this moment of economic challenge, we can afford to invest in reforming our health care system. Well, I ask a different question — I ask how we can afford not to.

Right now, small businesses across America are laying people off or shutting their doors for good because of rising health care costs. And some of the largest corporations in America — including major American car makers — are struggling to compete with foreign companies unburdened by these costs. Instead of investing in research and development, instead of expanding and creating new jobs, our companies are pouring more and more money into a health care system that is failing too many families.

So let’s be clear: if we want to overcome our economic challenges, we must also finally address our health care challenge.”

Sources:

HHS Will Be Shepherding Health-Care Reform – washingtonpost.com.

President-elect Obama Nominates Senator Daschle as Secretary for HHS, press conference transcript

UPDATE February 3, 2009: Former Senator Tom Daschle removed his name from further consideration for confirmation as Secretary of Health and Human Services amid criticism surrounding delayed payment of taxes in excess of $100,000.00 and the perception of ethical impropriety due to his former work with health care industry clients at the firm Alston & Bird, LLP.