Health Reform

I have a confession to make: I'm burnt out on health reform. I know, it's terrible since I'm getting a PhD on the politics of health services. I don't know everything about health policy, but I know enough to realize that the debate has been twisted and distorted tremendously by both sides. What a complex issue! Suddenly, health reform turned into a debate about abortion; what a mess. I'm also hoping that we can finally put to rest the idea that health reform is a government takeover, that is a real big stretch.

As you have probably heard, 60 Senators have supposedly agreed to support health reform (the cloture vote is tonight at 1am). Although a major breakthrough, there are still many hurdles that have to be passed before a passed bill arrives on Obama's desk. The biggest question will be what compromises will come out of the conference bill between the Senate and the House. Does anyone know if the conference bill needs 60 votes as well, or is that step automatically skipped?

Although I'm a bit burnt out, I will be really interested to see what happens at this point. I don't know enough of the details to know whether I would prefer the House version (which includes a public option plan) or the Senate version (which doesn't include a public option, but does include an opportunity to buy into a privately run plan that is monitored by the same people who monitor the plan for federal employees). Either one seems fine to me.

Have you read David Brooks' latest column on health reform? I think it's one of the most balanced (brief) discussions I've seen. I agree with a rebuttal I read elsewhere that his arguments against reform aren't really that strong, but I still think people have some legitimate concerns.

Lamaze International

I was recently quoted in a parent.com article about our experience taking Lamaze-certified prenatal classes before Olivia's birth and the way it helped us feel prepared. Here's the link to the full article: http://features.parents.com/natural-birth-methods.html

Here's my quote:

“When my wife, Sarah, and I had our first child we felt we were in many ways better prepared than most. I was working on a master's degree in public health and she is a registered nurse. However, we had a lot of questions about pregnancy and the birth process, and we wanted to be able to make informed choices. Thus we signed up for and attended an eight-week childbirth preparation class with a Lamaze Certified Instructor.

“This instruction gave us more confidence in my wife’s body and ourselves. During labor, many things our Lamaze Instructor taught us were useful, such as the labor position my wife used: on her hands and knees. We were taught that she should move around and be in positions that were the most comfortable for her. My wife refused to have continuous fetal monitoring because she found labor so much more painful on her back. We also stayed home longer, because I felt more confident supporting my wife through early labor and thus she was never confined to a bed.” —David K. Jones, husband to Sarah Sacuto

Phish Fall Tour

It's so great to have Phish back! Here's a couple clips from one of their recent shows at MSG in NYC (no, we didn't make the trip). The above clip is the Rolling Stones song "Shine a Light," and the below clip is of their song "First Tube," (also from one of their MSG shows).




Sarah and I did get to the first show of the tour in Detroit (my 19th and her 2nd Phish shows). Thank you to our babysitters who made the evening possible! Here's a brief clip of the jam after the song "46 Days." There's nothing like the light show at a Phish concert!

Comments on public option

There have been a few interesting comments made in response to my post on the public option a few weeks ago. Thank you for your perspectives! I think the two Jeffs have posted very valid criticisms of the public option and it's kind of refreshing to be having the debate on this level instead of the death panel level. It's obvious now as I reread this post that I was swept up in the moment and wasn't thinking through all the examples perfectly clearly. Unfortunately there is no real good parallel withthe health care industry. The imbalances are so severe that it really doesn't seem like a market to me. In that respect, I think it's interesting/ironic that this is the main selling point used by democrats - that it will create competition for private insurance companies who often otherwise have none. Despite the irony, I still think it would be a good step.

As far as I can tell, this debate centers on two issues: 1) what is the role of government, and 2) is health care a right or a commodity. If you are skeptical of government's ability to solve problems and think of someone's ability to have quality health care as a commodity in the same vein as someone's ability to buy a nice house, then you are understandably opposed to the public option. If you think government is the ideal way to solve societal problems and you feel so strongly that everyone should be able to buy a nice house that you're willing to have the govt spend tax money on it, then you probably don't think the public option is enough.

I come down somewhere in the middle on both of these issues. I am cautiously optimistic that the government can play a positive role in alleviating suffering and helping people create opportunities and take advantage of them. But I share some of the concerns expressed by my friends that I don't think a "government takeover" of the health care industry would solve the problems. As much as I love Canada and admire aspects of their system, I don't think it would work in the US right now and I am glad we're not going that route. Although not specifically stated in our constitution, I lean closer to viewing health care as a fundamental right that everyone should have access to as opposed to strictly viewing it as a commodity. Just as I don't think everyone has a right to own a very nice house (to the degree that the government should give everyone a four bedroom home), I don't think everyone has a "right" to get as much health care as they want. But I do think everyone should have access to some basic level of services at an affordable price.

With this frame in mind, I think the public option is a good compromise solution that deserves a chance. There is no reason to trust the insurance companies will help keep costs low and provide some basic coverage. The fact that they're increasing their prices so dramatically right now because of fear of health reform strikes me as circumstantial evidence that they are committed to doing their job - maximizing profits. Believing that health care is more a right than a commodity, I don't think it's wise to completely rely on companies whose job is to make money by denying just enough services. I think a non-profit option should be included.

All that being said, I'll be honest (since I'm more an academic than a politician) that I understand the concerns expressed by the Jeffs and am sympathetic. I don't think it will be perfect and I don't think it will solve all the problems, and it won't do as much as it's advertised to do. I think it's better than the status quo and I'm afraid that without the public option we're much more likely to end up with the status quo. Even still, if the public option gets defeated from the final bill, I still really hope that the other reforms are passed and implemented.

Public Option

Heather Graham's sex appeal and the public option: effective?

AL East Champs

It's been a pretty long time since I've had something exciting to say about the Yankees, but as September turns into October I'm feeling optimistic for the first time in many years. As you probably know, over the weekend the Yankees clinched the division by sweeping the Red Sox at home. The question now is who they'll play. If Detroit holds on, then it's possible I'll get to see the Yanks in my new backyard during the first round. I love this video, showing the team in a fun mood last night as they gave Pena the silent treatment after he hit his first career home run. It seems like it's much easier to have fun when you're winning.

8 Years Later

For a week I thought about what I'd want to say on my annual post about 9/11 (can you believe it would have been my 5th year?). Ultimately, the most interesting thing I have to say is that I didn't really have anything interesting to say. Some might see that as emblematic of how quickly we've forgotten the dangers we face and how horrible 9/11 really was, but I see it as a healthy part of the healing process. I didn't feel compelled to search youtube for the worst videos I could find or revisit the photos. I didn't feel the need to cry this year. Even still, the subject almost surprised me in how it found its way into the talk I gave at church on Sunday (in our church, members take turns giving 15-20 minute lectures/sermons on various topics. Each person gets an opportunity every couple years depending on the size of their congregation). I shard my mom's axiom that "only good comes from God," to make the point that God doesn't cause the tragedies in our lives to teach us a lesson, although there are lessons to be learned in each tragedy and He is able to help us learn them. To some this might seem like splitting hairs, but it's an important distinction that liberates me from wanting to blame God for the bad things that happen to me.

If you're interested, you can read my previous 9/11 posts here: 2008, 2007, 2006, 2005.

Pres. Obama's Speech

After reading and watching the speech this morning, I thought Pres. Obama did a great job last night before Congress. I wish I could have watched it with some of my conservative friends so I could have heard their response. My experience has been that once I explain in simple terms what Pres. Obama is actually proposing (compared with what his opponents say he is proposing), they are generally impressed and seemed confused that there is so much controversy. As the President clearly said last night, in no way is he proposing a government take over of the entire health care industry. A Canadian-style single payer system would not work in America. What we want is choice and competition. What Democrats are proposing is that one of these choices include an insurance plan that would receive initial support from government funds but would otherwise be self-sufficient and paid for by premiums. First of all, despite what you'd think from watching Glenn Beck, a majority of Americans actually supports a public option. Even still, some very smart friends of mine have expressed concern that private companies couldn't compete on an even playing field with a government plan and that government would be overstepping it's bounds. I have four responses that usually alleviate these concerns:

1) Are you opposed to state-run public universities? Of course no one is. They provide a fantastic education at a fraction of the cost. Yet those who choose private universities are free to do so. Are you opposed to using a government run mail system to deliver your packages? Often it's cheaper, though you do have the option of using UPS or Fedex to take advantage of their particular services. Not only is there enough room for these private companies, but I suspect that their prices are lower because of the competition with the public company. As a result, consumers are better off.

2) I support a public option because I believe it will lower costs and increase access. Have you ever considered the job of an insurance company? They make money by not paying for services. Plain and simple. This requires tremendous administrative costs and overhead to deny claims, sometimes with disastrous consequences for people whose health care is delayed (as described early in Pres. Obama's speech). I have met many people who work at insurance companies, including some very powerful CEOs and I do not think they are bad people. They are businessmen and women who are doing their job to maximize profits. This is their legal responsibility to shareholders and their primary concern. In principle I am ok with that, but I would love to have an insurance option that operated as a not for profit with the mission of providing care instead of making money.

3) Let me say this third point carefully: A public option is nothing like socialism and not even close to a government takeover of health care. According to Pres Obama's speech, the CBO estimates that only 5% of Americans will sign up. But, if it does work well, and some people switch over from their private plans, that is fine with me. If everyone decided that the US Postal Service provided vastly superior service to UPS or FedEx, and these companies did not innovate, reduce costs, or improve services to compete with the public option, why would we want to protect their profit margins? I don't think we would and I don't think we should in health care either. Put another way, I think the strangest argument I've heard against the public option is that it will work so well that no one will want a private plan. I am not THAT optimistic about the plan, but if it does, why stop it?

4) Finally, I generally don't like to insert religion into these kinds of debates, but it's worth mentioning a scripture that has helped shaped my feelings. It describes a society using its prosperity to ensure that everyone was cared for. "And thus, in their prosperous circumstances, they did not send away any who were naked, or that were hungry, or that were athirst, or that were sick, or that had not been nourished; and they did not set their hearts upon riches; therefore they were liberal to all, both old and young, both bond and free, both male and female, whether out of the church or in the church, having no respect to persons as to those who stood in need," (Alma 1:30, Book of Mormon).

Obama before Congress

I am so relieved August is over and Congress is coming back into session so we don't have to keep hearing about these town halls in which moderate Senate Democrats are threatened with the judgment of God for wanting to increase access to affordable health care. Pres. Obama is scheduled to speak before a joint session of Congress next week to advocate a more detailed approach. Is it just me or does this sound a little like 1993 when President Clinton spoke to Congress in September of his first year to resurrect support for dwindling support on health reform and shift focus away from the economy. Although I support the creation of a public option, I hope President Obama doesn't wave his pen and threaten to veto any bill that doesn't not include it (that didn't go too well for Clinton).

Historic Win Against Spain

Last night the US Men's Soccer Team pulled off what might be considered one of the biggest wins in American soccer history. Having won the tournment for all North American, Central American, and Carribean countries last year, the US earned the right to play in this exclusive competition against the winners of each other continent, including Brazil, Spain, Iraq, Egypt, New Zealand, and world cup winners Italy.

The US got walloped by Brazil and Italy in their first two matches of the group phase, and to advance to the semi-final they needed the near impossible task of winning their last game by at least three goals and having Italy lose by at least three goals. Amazingly, the impossible happened as US beat Egypt 3-0 and Brazil beat Italy 3-0. Their reward was to play Spain, currently the highest ranked team in the world; a team that hasn't been beaten in over 35 matches, a period spanning multiple years. Once again, the US team did the impossible, beating Spain 2-0 with a gritty effort from many players, including important saves by Tim Howard in goal. Now it's on to the final against either Brazil or South Africa. No matter what, this tournment has to be considered a success for the US, a great preparation for next summer's world cup. It would be a mistake to get to confident however, as we did get trounced on pretty badly by Brazil and Italy.

Health Reform

Watch CBS Videos Online

I don't think this was the most accurate or informative video I've ever seen on health reform, but it did feature a good quote from Jonathan Oberlander, a professor from my master's degree at UNC. I was his research assistant for a year and provided support for a couple papers published in Health Affairs on which he was kind enough to acknowledge me, including "The Politics Of Paying For Health Reform: Zombies, Payroll Taxes, And The Holy Grail," and "Beyond Incrementalism? SCHIP And The Politics Of Health Reform."



So how likely do I think significant health reform is to pass this year? This was a topic of conversation at the PhD recruiting day I attended at Berkeley, and I seemed to be the most optimistic at the table. Everyone else put it between 10-30%, though I said somewhere closer to 50%. That was in March, what do I think now? Believe it or not, I still think the chances are pretty good. The big question is how you define “significant.” My opinion is that the best reform will include a requirement that everyone purchase health insurance (similar to requirements that everyone with a car purchase car insurance) and the creation of a new public plan which will be allowed to compete with the current private plans. The health insurance industry obviously likes the first idea but hates the second. I agree with Nobel Prize winner Paul Krugman’s recent column that insurance companies have understandable concerns about a public option, but I think that Americans should have more options, not fewer. If a public plan is able to deliver better care at a better price, private companies will have to become more competitive. As Krugman describes, companies that are already innovative should do just fine while it will be the inefficient companies that don’t survive. It might be that these companies will ultimately outperform the public option and be a more attractive option anyway. I’m perfectly happy to let the market sort this out, though I think it makes sense to let the government become a player.

The politics of the current reform debate are fascinating. The House this week came out with a bill crafted by the Chairman of three powerful committees (including Charles Rangel, who I interned with a couple years ago), which contains an individual mandate, a public plan option, a new agency to regulate insurance, closes the Medicare Part D donut hole, expands Medicaid, and increases Medicare reimbursment rates. Sen. Max Baucus (D-MT) is essentially taking the lead on the Senate side to forge some type of compromise with Senate Republicans. I think this is a worthwhile endeavor that could strengthen the final product, but I share the concern of many that seeking compromise will ultimately weaken the reform so that it doesn't please either the left or the right. The pieces of the puzzle are in place so that Senate Democrats can get this through without worrying about a filibuster, but hopefully they won't have to use this budget reconciliation option.

My Prediction: The House passes the more aggressive reform including a public option while the Senate passes a compromise package that includes insurance cooperatives instead. What happens as the two bills are hashed out in conference is anyone's guess. Given the results of a recent poll in which 72% of Americans (including 50% of Republicans) favor a public option, and that 57% would be willing to pay higher taxes to provide coverage for all Americans, it seems reasonable to guess that the House version might win. Of course I'm getting way ahead of myself. Any health reform bill getting out of committee would be a historic accomplishment in its own right.

Way behind...

I apologize that this is going to be one of those posts that you see all the time on people's blogs about how it's been way too long since they posted:

It's been way too long since I seriously posted on this blog, which is too bad because I've had a lot of fun doing it over the past 3 years. In my defense things have been pretty busy lately. The following is just a brief summary of some of the things I've been to in the last few months, in addition of course to all the wonderful adventures that come with having a one year old, which you can read about at http://www.sacutojones.blogspot.com/ :

1) Graduation




In May I officially graduated from the University of North Carolina with a Master's of Science in Public Health degree, meaning that until I finish my PhD in a half decade or so, my name will always have the letters MSPH after it. I really loved being at UNC and find it hard to believe we've left and won't be living there anymore (you never know, right?). Chapel Hill is such a fantastic city and it was a ton of fun to be living in the south for the first time. If you're ever there, you have to get BBQ from Allan and Son's; it's my personal favorite. The graduation festivities were a ton of fun, especially because my mom received her doctorate on the same day, coincidentally from the same department of the same school. For what it's worth, my classmates named me "most likely to become a professor." I'll take it.


My actual program was wonderful, mostly because of the fantastic faculty who consistently went above and beyond to serve as mentors and friends to all of us. Maybe it's just because my undergraduate experience set a low bar, but I've found UNC to be such a supportive and user-friendly place without sacrifice any of the academic energy you'd want at a top-notch university.

Of course it was a blast to be there when the Tar Heels won the basketball national championship. There's nothing quite like the way UNC treats basketball and I'm glad I'll get to have this allegiance for the rest of my life.

I know it's cheesy, but here's a video someone made about the tar heels winning:



2) Michigan

Chapel Hill was wonderful and although it was hard to turn down their offer to stay for my doctorate, I decided it was time for a new experience. I was also privileged to have the choice to go to Berkeley, and although that was also extremely hard to turn down, it became clear to me that the University of Michigan will be the best fit for me academically, culturally, "weatherly," and provide the kind of lifestyle that my family is looking for at the moment. There is a great group of 2-3 other students who are studying political science and public health in a way that I didn't find at any other university in the nation and I'm very excited to be joining them. In a year I will formally apply to also be a part of the political science, one of the top two or three in many rankings, including the categories of most interest to me.

I am also very lucky to be receiving a nice financial package which will cover tuition, fees, health insurance for my entire family, as well as provide a monthly stiped just big enough for us to survive on. I've only been in Ann Arbor for about 30 hours and Sarah has never been, so in some ways it feels like a leap of faith, but we haven't heard anything that wasn't extremely positive. The same was true going into Chapel Hill, and the same process of studying, praying, visiting, and talking to others worked out well for us then, so we're confident now. Being out of the country is making it difficult to find an apartment, so we've decided to go with student family housing like we did at UNC. It won't be quite as new and nice, but will be very comfortable. We'll essentially be in a 3 story town house with bedrooms upstairs, living room and kitchen downstairs and a full basement. After a summer in a small studio apartment in France it will feel like total luxury!

3) Active Living by Design



Around midnight of their last meeting last June, the Chapel Hill Town Council officially appointed me to their advisory board charged with encouraging physical activity. Our decision to move to Ann Arbor cut what would have been a 4 year term to just 1, but I'm so glad I did this. I've worked to support a lot of people in advancing their ideas and opinions, it was fun to have a seat at the table and share mine. It was also a great experience to learn of the frustrations that come with trying to accomplish something within a local government context. Everybody I worked with was incredible and the committee is accomplishing some important goals, none of which I can take much credit for. The first picture is a few of us at Town Hall after receiving a proclamation ready by Mayor Foy proclaiming October 2008 to be Go! Chapel Hill Month. I wrote a series of articles in the local paper on the subject. During my time on the board there were 3 high profile pedestrian deaths in Chapel Hill and 1 in neighboring Carrboro. Two of these happened on roads I regularly jog and 1 on a street I regularly drive. I happened to be near one of the scenes shortly after it happened and watched with horror as the helicopter made the short trip to the hospital. It was the experience of serving on this board that really solidified my interesting in providing access to safe facilities for pedestrians, joggers, and cyclists. This topic developed into my master's paper which in turn is developing into a manuscript I'm working on for publication, as well as research I am currently doing in northwestern France.



4) NCIOM

During the final year of my master's degree, including the entire preceeding summer, I worked as the Jim Bernstein Health Policy Scholar at the North Carolina Institute of Medicine. In some ways this was a glorified title interns received for a few years, but I felt privileged to receive scholarship money in honor of a man dedicated to improving health in North Carolina. I was able to work on a number of important issues while at the NCIOM, including writing chapters on physical activity and the provider work force. I played a role in the publication of multiple reports, including the recent report of the task force on substance abuse, the task force on prevention, and the task force on transitions for people with developmental disabilities. I also wrote a number of pieces for the North Carolina Medical Journal, including this summary of resources on patient advocacy which came out in the latest issue. I must admit it's kind of cool to see 3 or 4 entries under my name "Jones DK" in pubmed. Even still, I will probably best remembered by the IOM staff for covering the IT issues during last years annual meeting in which Uwe Reinhardt spoke to hundreds of us in NC by videoconference. It was a somewhat stressful assignment but we pulled it off. I'm going to miss everyone I worked with there; thank you!



5) Visa for France

This story certainly deserves it's own post, but I'll try to succintly hit the main points. Last summer I met Antoine Flahault, director of L'Ecole des Hautes Etudes en Sante Publique (the French School of Public Health) and over time he invited me to come to France for the summer. I've been working with the HR and International Relations department at L'EHESP since last fall to get all the paperwork straightened out for me to receive a visa and be able to come, etc. They have been absolutely wonderful, but of course it came down to the wire and threatened to not get done in time. Few things stress me out more than visa and immigration issues, but that's a whole other story.

To receive the necessary visa I would need to make an appointment and drive to the French consulate in Atlanta, Georgia, more than 6 hours away to hand them my application. Of course, I couldn't do that until I received a document from the city of Rennes saying there is a qualified position available for me to take. That couldn't happen until I had a contract from the school signed by me, UNC, and the French consulate. In other words, I had to receive a document from France, which I signed and sent to the consulate in Atlanta, had them send it to me, so it could be brought to an official in Rennes. Once approved, these documents were then sent back to me so I could present them in person in Atlanta. It is bureaucracy at its nuttiest.

I finally received the necessary papers, made my appointment and drove to Atlanta. It was actually a pretty nice trip in which I stopped for BBQ along the way in Greenville, SC. I got to ATL that monday evening and killed time by running and working on my papers. My appointment wasn't until Tue afternoon so I spent the morning touring the Jimmy Carter Library which was a lot of fun. I finally made it to my appointment only to be told that the consulate only processes my type of visas in the mornings. "Only in the mornings?!?!" Despite pleading my case and giving the whole sob story about leaving behind my daughter, etc, it turned out there really was no way to process my kind of visa in the afternoon. Of course I couldn't get an appointment for the next morning, but he said to come early and be willing to wait and he'd try to squeeze me in. I left feeling like crying, but had to buy a change of clothes instead! I showed up the next day well before anyone who works at the consulate and was grateful the same man was there and called me up to the window first. He took my papers, went to the back room to make photocopies and came back with a silly grin on his face. The wall of bureaucracy broke down and he said "You'll never believe this, but it turns out that France changed their law last night so that someone in your situation doesn't need a visa." WHAT!?!?!?! "Are you a student?" Yes. "Will you be there less than 90 days?" Yes. "Are you American?" Yes. Then you don't need a visa. Wow. So just like that, after months of paperwork, 3 days wasted in Atlanta, including 13 hours of driving, and it turns out I didn't need a visa! My brother in law's wise advice was to be sure they didn't change the law again before I left! Well, I'm here and everything went well. They didn't even ask me a single question at the border. The guy just took my passport and stamped it. Even still, I'm glad I did everything I was supposed to do, even if that happened to change while I was in the process of doing it!

6) Phish

Like I've posted before, I thoroughly enjoy the group Phish and am very excited they're touring again this summer. I'm sad I won't able to catch any of their upcoming shows but am so glad I spent the $ (yes it wasn't cheap) to see one of their shows in Hampton, Virginia last March. Here's a couple brief clips to give you a taste of how insanely fun that show was. Imagine being in about the 15th row during this madness. If you don't have the patience to watch the whole thing, fast forward the first clip to about the 2 minute mark. The second clip was not shot by me but was about where I was standing and gives you a feel for how intense it is to be on the floor of a Phish show, as well as the creative improvisational skills of the band and their lighting guy Chris Kuroda.








7) Running

I've decided to start training for another half marathon and am loving it. I am still not that fast but it feels great. I am targeting a race in eastern Michigan in late September and am already actively training, running 5-6 times per week. More on that some other time.


8) Traveling

During the last few weeks I have been to a number of incredible places, including Atlantic Beach NC, London UK, Paris, Rennes, and Toulouse. I'm a bit burnt out on traveling and look forward to being somewhat stable (although I am traveling to Toulouse again this weekend to pick up my wife and daughter and bring them back to Bretagne with me. While in London I toured Stamford Bridge, the stadium of the football (soccer) team Chelsea. I am not a Chelsea fan in particular (Liverpool!) but thoroughly enjoyed the tour. Here's my video of the route the players take from the locker rooms to the pitch (field).

9) L'EHESP

I am finally situated at L'Ecole des Hautes en Sante Publique in Rennes (in Bretagne in northwestern France). I am very happy to be here and am extremely grateful for everyone that has gone so far out of their way to make my visit pleasant. More about that and what I'm doing here in a later post.

Phish at Phenway

BATTER UP: PHISH HITS FENWAY from Phish on Vimeo.

Phish is playing more than 20 shows this summer, but I won't be able to attend any of them because I'll be in France until August, and then too broke after that!!

Timelapse: Franklin Street after the victory from The Daily Tar Heel on Vimeo.

A time-lapsed video of the intersection of Franklin St. and Columbia St. in Chapel Hill after UNC won the national championship in men's basketball last night.