Summary: On March 5, 2009, Barack Obama convened a White House Forum on Health Reform in which the administration underscored its commitment to take on the nation’s crisis in its medical processes. A month later, on April 8, 2009, Obama acted again by establishing the White House Office of Health Reform. For perspective on these developments and what they mean to integrative practice, the Integrator turned to Wayne Jonas, MD, president and CEO of the Samueli Institute, where Jonas has led the development of the ambitious, and long overdue, Wellness Initiative for the Nation (WIN). In this invited column, Jonas notes shortcomings of current thinking and the pressing need for an “Executive office to focus specifically on developing policies and programs for lifestyle-based chronic disease prevention and management, integrative health care practices and health promotion.” This posting also includes the full Executive Order.
The White House Office for the Transformation of Medicine. The White House Office to Put Health Back into Health Care. The White House Office to Transform the Therapeutic Order of the Nation. The White House Office of Wellness.
While Barack Obama has plans to make a dent in the problems in the US medical situation, we don’t at this time see any overt movement toward these announcement of significant change. We do, since April 8, 2009, have, by Executive Order (see below and here), a new White House Office of Health Reform, and a website on the tops at healthreform.gov. We also have a director of that office in Nancy-Ann DeParle. (A New York Times article on DeParle’s appointment, which focuses on her industry ties, is here.)
But what will “reform” mean under Obama? The Integrator invited Wayne Jonas, MD, one of integrative healthcare’s top advocates in Washington, DC, for perspective. The Samueli Institute-led Wellness Initiative for the Nation stands out as a significant proposal which begins to have the ambition and reach to make a difference as we face the ravenous medical-industrial juggernaut. As Jonas writes, “what is meant by prevention is not always
clear.” By extension, what is meant by “reform” is also muddy.
Regarding Early White House Health Reform Efforts
Wayne Jonas, MD, President and CEO
The White House Forum on Health
Reform highlighted the commitment of the Administration to address the growing
health care crisis. By inviting a broad array of interested and influential
parties to the White House, the President and his senior staff were able to
feel and understand the call for reform coming from “the bottom up, from
all across the spectrum–from doctors, nurses and patients; unions and
businesses; hospitals, health care providers and community groups.” The Forum facilitated input from those parties which is recorded in a Report
available at here.
comprehensive lifestyle and
behavioral health care
beyond the current medical
system and will not be
addressed by increased
coverage and payment under
the current system.
While the President’s introductory remarks to the group are punctuated
with references to the “exploding cost of health care in America
today,” he also noted that there must be investment in prevention. What is often lost is the fact that what is meant by prevention is not always
clear. And, there are different types of prevention. Early disease
testing is prevention that is dependent on the medical system to deliver.
Smoking cessation, weight control and stress management are much more complex
behavioral types of prevention requiring, knowledge and education, community
and environment support, and personal responsibility. Effectively
implementing this type of comprehensive lifestyle and behavioral health care
goes beyond the current medical system and will not be addressed by increased
access, coverage and payment under the current system.
Without such a high level
commitment, my fear is that
efforts to create long-term,
sustainable health and wellness
will be lost in
the scramble to
preserve and expand access
to the status quo.
In the Wellness Initiative for the Nation (WIN), we call
upon the Administration and Congress to place high emphasis on prevention,
health promotion and integrative health care. True prevention and health
promotion require something different than just access to current
services. A new vision of health and disease based on the primary components
of health flourishing is required. WIN also emphasizes the essential step
of creating within the White House environment an Executive office to focus
specifically on developing policies and programs for lifestyle-based chronic
disease prevention and management, integrative health care practices and health
Without such a high level commitment, my fear is that
efforts to create long-term, sustainable health and wellness will be lost in
the scramble to preserve and expand access to the status quo. Without a
substantial wellness focus, the Nation will be destined to our system that
costs too much and is delivering less health and little care to fewer
Wayne Jonas, MD, President and CEO
Comment: My older brother once shocked me, when I was 19, by announcing that “your mother was not my mother.” Alas, he was making a point that his place in the family and mine, and changes in the woman who birthed us, led to very different mothering.
I think of this at this time when so many of us are thinking: Your reform is not my reform. Each of our varying roles in the huge business of healthcare creates variations on the reform theme. I share Jonas’ fears that without overt embrace of a “substantial wellness focus,” my reform will not have a chance to be nurtured. As you can see by the statement from Obama below in which he orders the formation of the White House Office, there is nothing here that announces anything transformative.
Jonas underscores that what we need, but have
not seen, is an executive level commitment which announces that “reform” will actually allow us to engage changes. Jonas’ WIN effort, and its call for visible commitment from Obama to prioritizing health and wellness, are all the more critical.
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
April 8, 2009
*ESTABLISHMENT OF THE WHITE HOUSE OFFICE OF HEALTH
By the authority vested in me as President by the
Constitution and the laws of the United States of America, and in the interest
of providing all Americans access to affordable and high-quality health care,
it is hereby ordered as follows:
Section 1_. _Policy_. Reforming the health care system
is a key goal of my Administration. The health care system suffers from serious
and pervasive problems; access to health care is constrained by high and rising
costs; and the quality of care is not consistent and must be improved, in order
to improve the health of our citizens and our economic security.
Sec_. _2_. _Establishment_. (a) There is established a
White House Office of Health Reform (Health Reform Office) within the Executive
Office of the President that will provide leadership to the executive branch in
establishing policies, priorities, and objectives for the Federal Government’s
comprehensive effort to improve access to health care, the quality of such
care, and the sustainability of the health care system.
(b) The Secretary of Health and Human Services, to the
extent permitted by law, shall establish within the Department of Health and
Human Services (HHS) an Office of Health Reform, which shall coordinate closely
with the White House Office of Health Reform.
Sec_. _3_. _Functions_. The principal functions of the
Health Reform Office, to the extent permitted by law, are to:
(a) provide leadership for and to coordinate the
development of the Administration’s policy agenda across executive departments
and agencies concerning the provision of high-quality, affordable, and
accessible health care and to slow the growth of health costs; this shall
include coordinating policy development with the Domestic Policy Council,
National Economic Council, Council of Economic Advisers, Office of Management
and Budget, HHS, Office of Personnel Management, and such other executive
departments and agencies as the Director of the Health Reform Office may deem
(b) work with executive departments and agencies to
ensure that Federal Government policy decisions and programs are consistent
with the President’s stated goals with respect to health reform;
(c) integrate the President’s policy agenda concerning
health reform across the Federal Government;
(d) coordinate public outreach activities conducted by
executive departments and agencies designed to gather input from the public,
from demonstration and pilot projects, and from public-private partnerships on
the problems and priorities for policy measures designed to meet the
President’s goals for improvement of the health care system;
(e) bring to the President’s attention concerns, ideas,
and policy options for strengthening, increasing the efficiency, and improving
the quality of the health care system;
(f) work with State, local, and community policymakers
and public officials to expand coverage, improve quality and efficiency, and slow
the growth of health costs;
(g) develop and implement strategic initiatives under the
President’s agenda to strengthen the public agencies and private organizations
that can improve the performance of the health care system;
(h) work with the Congress and executive departments and
agencies to eliminate unnecessary legislative, regulatory, and other
bureaucratic barriers that impede effective delivery of efficient and
high-quality health care;
(i) monitor implementation of the President’s agenda on
health reform; and
(j) help ensure that policymakers across the executive
branch work toward the President’s health care agenda.
Sec_. _4_. _Administration_. (a) The Health Reform
Office may work with established or ad hoc committees, task forces, or interagency
(b) The Health Reform Office shall have a staff headed by
the Director of the Health Reform Office (Director). The Health Reform Office
shall have such staff and other assistance as may be necessary to carry out the
provisions of this order.
(c) As requested by the Director, each executive
department and agency shall designate a liaison to work with the Health Reform
Office on improving access to health care, the quality of health care, and the
sustainability of the health care system.
(d) All executive departments and agencies shall
cooperate with the Health Reform Office and provide such information, support,
and assistance to the Health Reform Office as it may request, to the extent
permitted by law.
Sec_. _5_. _General Provisions_. (a) Nothing in this
order shall be construed to impair or otherwise affect:
(i) authority granted by law to a department, agency, or
the head thereof; or
(ii) functions of the Director of the Office of
Management and Budget relating to budgetary, administrative, or legislative
proposals. (b) This order shall be implemented consistent with applicable law
and subject to the availability of appropriations. (c) This order is not
intended to, and does not, create any right or benefit, substantive or procedural,
enforceable at law or in equity, by any party against the United States, its
departments, agencies, or entities, its officers, employees, or agents, or any
THE WHITE HOUSE
April 8, 2009.
for inclusion in a future Your Comments Forum.