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Nancy Pelosi and the Center for American Progress think so. During the recent health care summit, House Speaker Pelosi 's argued in favor of health care reform since it could create up to 4 million jobs in the health care industry and the private sector. Her reasoning is based on a Center For American Progress study that establishes that the cost of providing health insurance is a deterrent to hiring for many employers (especially small businesses), thus if insurance costs were lowered, more empoyers would be able to afford to provide health benefits and hire more employees.

Check out CAP's State by State Job Creation Estimates here and share your thoughts with the Policy 2.0 community.

Over the last few weeks I have talked to several primary care physicans throughout the country about increased burdens associated with the field, and the one thing that comes up in every single conversation is the need for RVU payment reform.  Currently, physicans are paid or reimbursed for their services based on a Relative Value Unit (RVU) system, which assigns a service code and a unit value for hundreds of medical services that physicans perform.  Unfortunately, this system has been designed to undervalue or completely ignore an entire range of primary care services and care coordiation,

Interested in an indepth look and history of RVU's? Click here.

There is little hope at increasing primary care access if we are unable to attract quality physicans to the field. Reforming RVU payments to adequately reimburse primary care physicans for the care they provide is essential to decreasing the compensation gap and increasing the number of primary care phyiscans nationally.

The Center for American Progress released a new health care report with a lot of bright ideas for approaching shortages in the health care work force. Understanding the impact that a primary care practitioner shortage will have on our nation's health care, Closing the Health Care Workforce Gap calls for reforms to federal workforce policies such as:

• Creating a permanent National Health Workforce Commission to better align federal payment policies for health professions;
• Support for health care workers in high-need specialties and underserved areas;
• Reform the training of health professionals to grow our health care workforce.

You can read the full set of recommendations by downloading the full PDF of the paper here.  Although these are great ideas for federal reforms, it is important to look beyond federal legislation to changes that can be made to optimize primary care practice models to continue increasing health quality outcomes and make primary care as equitable as speciality practices.

You can check out some of the highlights from the Bipartisan Working Group discussion on primary care to get an idea of where some of the most influential stakeholders in health care reform stand on the issue.

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Teach For America is on the tip of my tongue again (love it or hate it, it does have an annoying way of staying there, doesn't it?) with two big stories. The first is a new study examining the civic activity of TFA corps members, and the second is a big wet kiss from The Atlantic (which it deserves for getting anywhere on figuring out what pre-service indicators are worth worrying about for new teachers).

The Atlantic story is a high profile spotlight on what we already knew - TFA focuses on recruiting corps members with a proven track record of significant accomplishments and leadership. This, along with a relentless focus on improving and ambitious goals for students, helps some TFA corps members achieve remarkable gains in student achievement. The work that Teach For America has done to track its teachers and connect these characteristics to student achievement is absolutely critical. It's also work that states and districts should be doing more (as recommended in "Policy 2.0: Using Open Innovation to Improve Teacher Evaluation Systems." Here's hoping they follow suit.

The second story is about a new study out of Stanford looking at the civic engagement levels of TFA corps members (here's the NYTimes, you can read an abstract and purchase a PDF of the study here). The study found that "graduates" who completed their two years of teaching had lower rates of civic participation than "non-marticulants" (who were accepted but didn't teach with TFA) and "drop-outs," who didn't complete two years of teaching. The headlines about the study are giving Teach For America a bad rap - as Eduwonk points out, all three groups of accepted applicants had high rates of civic engagement when compared to the general population.

Doug McAdam, who authored the study, has also looked at civic engagement of participants in the "Freedom Summer" of 1964 in Mississippi and found the opposite - those participants continue to be involved in activism in later years. Freedom Summer is a fascinating foil for Teach For America, with more contrasts than similarities. It's interesting that Wendy Kopp suggested this study, and I wonder if she's surprised by the results.

Either way, the "burnout" factor comes up in an interesting way in both stories. The first is in The Atlantic piece's introduction to Steven Farr, a TFA alum who rejoined the organization to try to identify characteristics of effective teachers. Of his own time in the classroom, he says "I was not the teacher I want our teachers to be." "Burnout" is also suggested as a contributing factor to low rates of civic participation among TFA alumni in the Stanford study. Anyone who has spent time teaching in our worst schools can tell you that failure, despair, and chaos are part of the learning process. How we react to failure could be an interesting part of the puzzle.

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An interesting article from Health Leaders Magazine Online poses the question: could specialists be retained to fill gaps in primary care? The article proposes that we could ease the burden of the primary care shortage by retraining specialists to fill gaps in primary care. They argue that reforms targeting the primary care pipeline will take several years to take effect, thus there would be a quick turnaround with specialists since many already have a foundation in primary care. Here's an excerpt:

However, as the article also points out, taking on more preventative services and care coordination is only worthwhile for specialists if the change were to increase their profits, which in my opinion, completely defeats the purpose. The end goal we're working toward is to increase the availability of primary care services for Americans and increase health quality outcomes and value-- objectives that have historically been linked to primary care not speciality care.

Do you think an initiative to retrain specialists in primary care would lead to increased access to much needed primary care services and still lead to higher quality and value outcomes?

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Paul Krugman, from the New York Times thinks so, and he also thinks we can expand coverage AND still cut costs in health care. In the current haze of health care legislative pessimism, most people view these concepts as a dichotomy, rooted in the notion that an expansion of health care coverage would translate into a complete financial collapse of our health care system, but CMS projections don't support this assertion:

Ok, so really- how does providing everyone with health care curb costs? Here's one take on it:

- Patients seeking care without medical insurance turn to the nation’s “Health Care Safety Net”, which is defined (not ironically) by the American College of Emergency Physicians as “providers who have a legal mandate/mission to offer medical care to all patients, regardless of their ability to pay.” This includes emergency departments, community health centers, public hospitals, and charitable clinics.

- According to an ACEP survey released in March 2003, emergency physicians estimated that one out of every three patients they personally treated were uninsured.

- Many of the nation's uninsured delay needed care and live with serious medical conditions because they do not have affordable access to health care when they need it and only turn to the "health care safety net" when their conditions turn dire, and unfortunately, expensive.

- 55% of emergency care goes uncompensated and hospitals and physicians shoulder the financial burden by incurring billions in bad debt.

- Outpatient care, including same-day hospital vists (aka, ER visits) is by far the largest and fastest growing part of the US health system, accounting for $436 billion or two-thirds of spending expected and 40% of health care spending.[i]

In short, my point is that by extending coverage to the uninsured we'll be cutting some of the 40% of health care spending being used to provide them with care, which is one of the major causes for the cost problem.

However, what happens if the CMS and CBO projections are wrong? Should there be a failsafe mechanism that requires the private industry to cut costs by a certain amount over the next ten years or an independent commission will intervene?

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[i] McKinsey Global Institute, Accounting For The Cost of US Health Care: A New Look At Why Americans Spend More, November 2008

ED has released the list of states who have submitted "intent to apply" letters for the Race to the Top fund, part of the American Recovery and Reinvestment Act. Which states are on the list? It might be more important which ones are not. Alaska, the District of Columbia, Maine, Maryland, Michigan, Mississippi, Montana, Nevada, North Carolina, North Dakota, Oklahoma, Rhode Island, Texas, Vermont, and Washington have not submitted letters of intent. More fun with the list to come...