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Better health policy -- and a healthier America

IU faculty members in computer science, law, applied health science, public affairs and medicine make suggestions for using technology to empower people for better health, focusing on the "process" of health care reform, shoring up the nation's public health (and not just health care), making contraceptives available through insurance, and looking to Indiana as a model for electronic health information.

Kay Connelly

Increased efficiency is NOT the solution; improving America's overall health is what's needed. Technology has the potential to revolutionize health care. While I applaud your focus on using technology to streamline health care processes, making electronic patient records a reality in the next five years, I encourage you to consider how technology can not only assist in managing our medical records, but be used to improve our health. Simply put, no matter how much more efficient we make it, our health care infrastructure cannot keep up with the demand caused by an aging population and the dramatic increase in chronic conditions. Instead, we need to focus on how to make people healthier.

There is a move in the research community to looking at how technology can be used by patients to better understand, manage and improve their own health. Technological advancements allow us to record a host of everyday, health-related information, from how much exercise a person gets in the course of a day, to how socially isolated an elder living alone may be. This information can help people and their loved ones better understand the health implications of their lifestyles, assisting them in making small health-related changes in behaviors that have a large impact on their long-term health. From preventative applications targeting the obesity epidemic that encourage teenagers to be more physically active, to state-of-the-art sensing technologies embedded in elders' homes to help them live independently in their homes for longer, technologies focusing on the patient have the potential to reduce the overall burden on our health care system because people are healthier!

To realize this vision, we desperately need to dedicate funding for a joint program through the National Science Foundation and National Institutes of Health that will specifically look at how technology can be used to empower people to improve their own health.

Kay Connelly is assistant professor of computer science at IU Bloomington and associate director of the Center for Applied Cybersecurity Research. Top

Eleanor Kinney

Eleanor Kinney

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Eleanor D. Kinney

Take care with the process of health care reform. As a health law professor with expertise in administrative law, I would advise you, Mr. President, to be careful about the "process" you use to develop and implement health reform. You should consult with everyone with an interest and ensure that policy-making processes are transparent and accessible. It was process and politics that killed the Clinton health reform initiative of the early 1990s -- not the reform strategies.

Good luck with your health reform initiative. The American people really want health reform and they need it, too.

Eleanor D. Kinney is the Hall Render Professor of Law and co-director of the William S. and Christine S. Hall Center for Law and Health at the IU School of Law--Indianapolis. Top

Lloyd J. Kolbe

Improve public health, not just health care. An economic crisis and a health crisis simultaneously afflict our people. They threaten our daily lives, our children, our nation. These crises critically are synergistic. By 2008, we paid $2.4 trillion for health care, or 17 percent of our gross domestic product (GDP) -- 75 percent of that amount to treat largely preventable chronic diseases. We now spend four times more on health care than on defense. By 2016, we'll pay $4.3 trillion; 20 percent of GDP for health care.

We can't pay for health care in 2008; we certainly won't be able to pay for it in 2016. Worse, U.S. businesses won't be able to compete in a global economy with businesses in other nations that have healthier workforces, and pay less for worker health care. Though the U.S. spends a greater amount for health care than other nations, we rank 26th in life expectancy at birth, 32nd in infant mortality, and 35th in child mortality.

Yes, we need health care reform for our nation to assure everyone can receive health care; just as every other industrialized nation, except the U.S., assures. But health care reform only will offer means to pay for health problems that will increase in number and cost, especially as our population ages. It will not appreciably reduce costs. We urgently need public health and health care reform -- combined together -- if we are to reduce ever increasing costs of health care.

Why? Public health programs markedly can prevent unnecessary suffering, illness, disabilities, medical care costs and deaths; yet they remain desperately underdeveloped. How can we develop them? I encourage you to consider Blueprint for a Healthier America: Modernizing the Federal Public Health System to Focus on Prevention and Preparedness (2008), proffered by a broad group of our nation's brightest.

Lloyd J. Kolbe is associate dean for Global and Community Health, professor of Applied Health Science, School of Health, Physical Education and Recreation, IU Bloomington. Top

Nicole Quon

Nicole Quon

Nicole C. Quon

Require health insurance to cover contraceptives. Mr. President: Most insurance companies offer coverage for prescription drugs, but many insurance companies deny coverage for contraceptives. Twenty-seven states require insurers to cover Food and Drug Administration-approved contraceptive drugs and devices, but 19 states allow some employers and insurers to opt-out. These inconsistent laws mean that many women who have health insurance are forced to pay out-of-pocket for their contraceptives.

An annual supply of contraceptives typically costs less than $500, but systematically excluding a class of legal prescription products is unfair. It is unfair for women who rely on these products for family planning, and it is especially unfair to low-income women. There is precedent for this type of federal insurance regulation. In 1996, Congress passed mandates for coverage for maternity care and mental health services. The scope of the mental health provision was expanded in 2008. A bipartisan coalition of senators and representatives has introduced legislation since 1997 that would force insurance companies to pay for contraceptives. You were a co-sponsor of this legislation in 2005 and 2007.

Studies have documented that companies that add contraceptive coverage save money from unintended pregnancies. Why have we been debating this policy for a decade? The evidence is clear: mandating insurance coverage for contraceptives would save money and address an important women's health concern. I urge you to include family planning services as a key component of your health system reform plan.

Nicole C. Quon is assistant professor, School of Public and Environmental Affairs, IU Bloomington. Top

Marc Overhage

J. Marc Overhage

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Dr. J. Marc Overhage

Look to Indiana as a model for electronic health information. President Obama, I encourage your administration and congressional leaders to consider Indiana's health information exchange as a model for the rest of the country -- providing the basic health IT infrastructure that provides value now and is critical to realizing the potential that electronic medical records and other IT components offer.

The Indiana Health Information Exchange has best demonstrated the power of an economically sustainable, patient-centric database and its positive effects on patient care, and we are 'shovel ready' to move health information technology forward, including health information exchange and other components of whatever comes out of the stimulus package being considered by Congress.

Indiana is one of the national leaders of a secure, effective health information exchange network. Our model works, and privacy and security are imbedded into the DNA of our platform. IHIE was launched five years ago by Indiana's major health care providers, payers, physicians, public health officials, and business and community leaders and builds on the Regenstrief Institute's legacy of developing and promoting health information standards and the use of health information technology to improve care.

The Indiana Health Information Exchange, in conjunction with the Regenstrief Institute, securely connects 39 hospitals, 10,000 physicians and more than six million patients and delivers clinical information instantly to where it is needed. Our community (not one organization) has established stringent rules to protect patient privacy while allowing information to be used as effectively as possible for patient care.

The American Recovery and Reinvestment Act of 2009 has the capability to provide funding to support the development of community-based health information exchanges. This will be a critical and timely step toward achieving a truly reformed and effective health care system. We need -- and we can achieve -- full connectivity among the providers, physicians, payers and patients, each of whom has a vital stake in advancing the cause of better health for all Americans. A secure, community-based system, like ours in Indiana, can provide a crucial step toward delivering on the promise of health IT.

Dr. J. Marc Overhage is professor and Regenstrief Chair at the IU School of Medicine. He also is CEO of the Indiana Health Information Exchange. Top