As many of the more than 400 folks at this year's Midyear Meeting came into the ballroom of the Westin Hotel for the closing session, the scroll from scotusblog.com was being projected onto a giant screen in the front of the room. It was pretty tense before the ruling came down; folks were standing around in groups, staring at the screen with the worried looks of parents whose daughter just left for the prom. Let's just say it was nerve-wracking.
Then the blog scroll popped up: "The individual mandate survives as a tax." And the crowd goes wild. And I mean wild. Even our very own Dr. Benjamin was seen wiping tears of joy from his face. It was a very good day for public health.
So, as you could imagine, it was a little hard to herd hundreds of jubilant public health practitioners to their seats to begin the closing session, but Dr. Benjamin managed to do it. Lisa Simpson, president and CEO of AcademyHealth, then came to the lectern to begin moderating a discussion on the "Path to the New Public Health."
First up was Lydia Ogden, director of the Health Reform Strategy, Policy and Coordination Office at the Centers for Disease Control and Prevention. She began by noting that the forces that drive change in the health care system aren't going away. Such forces are synergistic, she said, with the first being demographic changes. For example, between 8,000 and 10,000 people turn 65 years old everyday in the United States and that will happen every day for the next 18 years — "that's a profound change," Ogden said.
Another force of change will be the growing federal deficit, she said, noting that the feds borrow 41 cents of every dollar they spend. In turn, Ogden said this is one of the most fundamental questions we need to ask ourselves: Is what we're about to do worth borrowing 41 cents plus interest?
Looking ahead she said it's critical that public health and clinical practitioners not only partner, but take the time to better understand each other's work and challenges. To illustrate her point, she told a little story. Imagine public health came to you and said it wanted to marry health care. But because the two were pretty ignorant of each other, you'd have some qualms as to the longevity of the partnership. The moral: "If you want to be understood seek first to understand," Ogden said.
"One size won't fit all but if we keep focusing on our differences, we won't be able to learn as efficiently as we need to," she said. "Let's evolve and let's do it together."
Arkansas Surgeon General Joseph Thompson, director of the Arkansas Center for Health Improvement, began his time at the lectern with a Supreme Court-induced "WHOOP!" Then he asked the audience to join in with their own "WHOOPS" and they happily obliged.
Thompson said he never uses the term "public health" outside a room of fellow public health practitioners. For those outside the field, the term can come with too many preconceived notions. People, he said, may simply tune you out. But that doesn't mean people don't want to get in on the public health game, even if that's not what they call it.
"We have new players who are thinking about denominator medicine," Thompson said. "We don't need to argue about whether it's public health."
Lastly, Thompson called on those in health departments that provide direct clinical services to start learning how to bill for those services. He said it'll be next to impossible to maintain such services just with state funds — to have a viable financial future, we need to figure out how to bill.
Session speaker Cara McNulty, senior group manager at Target Corporation, said the company has a direct interest in the health and well-being of its more than 350,000 employees. In fact, McNulty said Target brought her onboard specifically to take on that issue. Her role, she said, is to look beyond health care and insurance plans to how to engage employees in staying healthy and happy. Like Thompson, she doesn't use the term "public health" when working with employers because they simply don't know what it means, she said. Instead, she keeps the conversation focused on improving the health of employees, which also improves the bottom line for employers.
"When working with employers, we need you to talk with them about policy, systems and environmental change," McNulty said. "Health isn't our primary business and we need your partnership."
Unfortunately, McNulty said she's never had someone from the local health department approach her about partnering, which she called on session attendees to start doing — "there's a huge opportunity to work with employers...if we're not all working collectively then we will never achieve population health."
"Be very clear in your language," she said. "Help us understand what you're trying to achieve because, believe me, as employers we want to improve health."
Then it was back to the news of the day, the 5-4 Supreme Court decision upholding the Affordable Care Act. (Though the court did rule that states can't be forced to participate in the law's Medicaid expansion and that Congress does not have the power to punish states that don't participate by withholding existing Medicaid funds. The court did, however, rule that the Medicaid expansion is constitutional.) Gene Matthews, with the Network for Public Health Law, called it a "breathtaking day." Still, many attendees as well as APHA's Dr. Benjamin cautioned against sitting on our laurels.
"We can take a victory leap but the fight and battle continue," said one attendee.
To see what others in the public health and health care arenas are saying about the ruling, visit APHA's Public Health Newswire.
And don't forget to register today for APHA's 140th Annual Meeting from Oct. 27–31 in San Francisco. This year's Annual Meeting theme is "Prevention and Wellness Across the Life Span."
See you next time in the City by the Bay!
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