Election End in Sight

And we're all holding our breath, trying not to jinx anything.

The campaign continues to be on everyone's mind, pepper everyone's conversation, and appear on all sorts of media. I think we're all ready to exhale, and hopeful for the best outcome for public health (you know who that is - I hope my in-laws are reading this...). Congressional staff continues to leave offices to work on campaigns.

The SOPHE/APHA meetings in San Diego were restorative - good to see friends and colleagues, get batteries recharged, new ideas and inspiring students and long-time leaders to learn from. It’s always a good recharge of batteries and sense of urgency of public health problems, listening for legislative policy solutions to some (and what I might be able to do), and the need for all to renew our efforts to address poverty, illiteracy, discrimination.

How proud I am to see former students in leadership positions, and new colleagues stepping up to new roles. It’s always great to see old friends and make new ones.

I had the chance to speak to the APHA board about the fellowship, and the benefits to me, public health and the Senate office. I would love to see the program expand, both in length and the number of fellows. My goal is to put my thoughts together for a practical article on what I've learned and how other public health workers, faculty and students can up their advocacy game.

I also had the chance to speak with the student caucus at SOPHE and the affiliate/section leaders at APHA about advocacy. We can certainly amplify our voices if we're speaking out (up?). My final presentation was on public health and the built environment, which has become one of my new passions.

Talking about advocacy reminded me that all of us need this preparation - in our courses, at our conferences, through the National Health Education Advocacy Summit [February 21-23, 2009 in Washington DC - http://www.healtheducationadvocate.org/Summit/he_advocacy_summit_2009_flyer.pdf], and with other opportunities - to remind us to respond to CapWiz alerts, call and visit our representatives, and mostly to pay attention, share our expertise, and hold our elected officials accountable.

In fact, the Robert Wood Johnson Health Policy Fellowship program is interested in public health professionals, so if you have any interest in being considered for a stint like mine on the Hill, their deadline is November 14th: http://www.healthpolicyfellows.org/.

Too much enthusiasm at the conference exhibit halls, as I ended up with too many handouts. This put my one checked luggage over the weight limit at the airport (I hate that – my valise, empty, feels like 20 lbs). I ended up having a third bag as carry-on, putting me over the limit. Thank goodness that Marc Zimmerman, despite back pain, schlepped my extra bag onto the plane as his, saving me potential embarrassment and a real dilemma (thanks, Marc!).

San Diego - gorgeous for the tourist: black ducks and brown pelicans, gardenia- smelling shrubs and birds of paradise as common as weeds, trolley to old town and SOPHE meeting, walking through Little Italy and Gaslamp districts, banquet at the zoo (and resisting sneaking onto the double decker bus taking the other party through the zoo on an evening tour), walking to the Midway aircraft carrier museum, and around the harbor parks, watching people, pets and plants. It was hard not to skip the sessions and play!

Meanwhile, in Washington DC the leaves changing, air is crisp, and I’m back to hot tea and oatmeal for breakfast, definitely a sign of fall.

So, remember to talk with family, neighbors and friends (or more), and VOTE!!

Coasting

Ah, while two weeks delayed, we are finally in recess. The members are in their districts campaigning for themselves and each other, so we're just writing speeches, catching up, organizing and preparing for next year. I'm researching the impact of the fiscal mess on health care agencies to identify possible legislative relief.

The Senate Banking Committee did just have a hearing, so a few members (including my boss) came in for the day. Senator Schumer, whose office is two doors down, gave a press conference right in the hall. Lots of cameras and reporters. Not a big deal anymore.

We still have occasional constituent and lobbyist visits. This is actually a good time to visit, as we can pay attention and use the data and suggestions for considering new policy. We're also catching up on our writing, the website, and capturing all of the accomplishments of the year.

I'm catching up on lunch and dinner with friends and colleagues, too, so that's fun. The U.S. Supreme Court has resumed its session for the year, so I hope to catch another case, if it works out. At the same time, the Capitol Visitor Center is being completed, and this week they took down those opaque fences blocking the view on the street. Now we see the outside of the Capitol in all its majesty.

We will have a lame duck session the week of November 11th, when new members get oriented, and committee chairs and leadership positions are selected. This week should be very interesting.

In the meantime, I've been job hunting and preparing for three talks at the annual health education and public health meetings in San Diego, CA next week. I've been back home for the holidays, catching up with family, friends, pets, and garden. That's a relief.

VP Cheney was in the George Washington University Hospital (one block from my studio) the other day, on the same day as my farmer's market. Sure, he's fine, but the descending media scarfed up all of the apple cider and other goodies, leaving little for us late-working residents...

Tomorrow, a friend and I will be canvassing in Virginia for the presidential campaign. Down here, that's pretty much all that's talked about. This debate, that dinner, the jokes on SNL; it's all consuming. For many reasons, I'll be glad when it's over, and fingers crossed for my desired outcome.

Senate Banking, Housing and Urban Affairs Chairman Chris Dodd (D-Conn.) said Tuesday that the Senate will likely return for its November lame-duck session to consider an economic stimulus package and other proposals to tighten lending regulations.

It would also include unemployment benefits and government funds for infrastructure projects, as well as additional aid for residential mortgages, student loans and credit card debt, and a last attempt this session to address some of the worthy bills that Sen. Coburn still has a "hold" on.

And please, remember to VOTE!

Exhale

With the media finally covering the story, with its many angles and impact on the credit, housing and business sectors, what can I say that you don't already know? If only we had such energy and attention to health coverage, the environment, housing, education or energy; call me a dreamer.

So what did it look like from our end? After the UC (unanimous consent agreement) for naming post offices, etc, I've heard that "Harsh necessity is the midwife of progress." Somehow this doesn't feel like progress as much as an arm sling. The Senate added many of the legislative initiatives it hadn't reached a 60-vote threshold on previously, such as mental health parity, low-income energy assistance, and other worthy measures.

Lots of procedure, what gets a voice vote, who gets to introduce amendments, and how much time each party has to speak. Most dramatic of all was 99 senators in the chamber, voting by voice from their desks! You never see that! Wow! And an overwhelming vote to pass "H.R. 1424 as amended."

Again with the House vote, we watched the House floor split screen with the stock exchange floor, but everyone was confident this time that the House would pass the bill. Still much media attention, cameras taping Senator Dodd coming out of his car in the morning in front of the Dirksen Senate Office Building, and anyone else they can recognize.

People are talking about what they heard on NPR that morning, everyone looking for information and explanation as we follow not only breaking news of what's happening, but what it means, how to explain it to constituents, and composing floor statements and press releases. Many late nights two weeks in a row for the members and staff responsible for banking issues.

And now we're more worried than ever that there won't be the financial resources or political will to spend any money to fix the health care crisis. With the Deficit Reduction Act requiring Medicare and Medicaid cuts (e.g., physician reimbursement and other fiscal economies), next year might be even harder than this one. Julie Rovner of CongressDaily writes that: The current financial crisis has basically doomed prospects for health reform next year, no matter [who gets elected president]. Now we're hoping for modest reforms, such as expanding the role of community health centers, requiring Medicare providers to accept electronic payment, and other smaller-scale changes.

Other changes are noticeable now. First, the huge exhale from the staff and members that most of the legislative business is completed, although I suspect not with the outcomes desired. Many, many good bills were left on the table, and most of the federal budget just continues, rather than gets increased or evaluated.

There will be a "lame duck" session the week of November 17th. Many newly elected members come in then for their orientation, and committee and chair appointments need to be made.

Now it's denim and a slightly shorter workday for everyone. I did see my first mouse in the Metro, scamper across the platform at Metro Center; yikes!

The fountains are already turned off in front of the Library of Congress, and the Supreme Court has started its next work session. The helicopters overhead have become routine, as is knowing that it's not for reporting traffic but more likely carrying the Vice President (Marine One) to the Pentagon or his office in the Eisenhower Executive Office Building (EEOB), next to the West Wing of the White House. And in the evening, it's likely to be POTUS returning to the White House. In fact, I've heard two so far tonight as I write! I can watch out my window as they fly over the Watergate and across the Potomac.

Different choices now at the Farmers' Markets with the fall harvest in, and I'm scouting out my favorite apple, the Macoun. Lots of fall festivals and activities in and around the District, so lots to do.

And it's also time for my favorite activity, job hunting! Here we go again! I'll look both on and off the Hill, and in my home state, and see what comes up. Wish me luck!

Wow Redux!

Staffers say this is probably the most drama they ever remember on the Hill. We've never had more calls to the office. Staff and members are listening to the media and constituent input to get a pulse of how the country feels. Members voting against leadership direction, sometime even against their own instincts.

I wonder how clearly this complex situation has been explained across the country. I'm concerned that the public and even the media don't understand the potential impact of the "bailout", "buy-in" or whatever it's named (and clearly labels matter) on "Main Street" as well as "Wall Street." We're all connected here, just like our environmental actions on the planet and our economy.

By now you know all of this already. Everyone's been getting as much as information as possible about what the best solution is, how the market would react to different solutions, and who supports different scenarios. Lots more posturing, guessing, candidates suspending (?) campaigns, flying in, being told to go away, and then the big vote on Monday.

We're watching the House floor votes come in, and on another tv screen we're watching the floor of the NY Stock Exchange. Then the tv station split screens, to the House floor! Everyone's watching the vote, watching the Dow, watching the vote, watching the stock market. We're all guessing who's the NV (no vote), and then the measure gets defeated! What an unexpected outcome! Now we're wondering personally what to do with any money we may have in a retirement account in the stock market (sell? sit tight?).

Then the spin. Blame it on the WH (White House) for not alerting Congress weeks ago about the magnitude of the risk. Blame it on Paulson and pals, for refusing to show up for hearings planned by Congress. Blame it on the Speaker for her speech (she must have more persuasiveness than I thought, if Republicans would change their vote just to spite her, and therefore, the nation). Blame it on the House "whips" (I still hate that term) for not counting their votes accurately (supposedly leadership knows how the vote will come out before hand, or they won't call for a vote on a measure they think will be defeated). Blame it on the greed of executives, on the subprime mortgages, on people taking on more risk and debt than they can afford. Whomever!

Regardless, it's down for the count. The Senate breathed a short-lived sigh of relief, as now they wait for the next proposal from the House. Remember that all spending bills originate in the House and then go to the Senate, so while we're still thinking about solutions and in negotiations with the House, the ball remains in their court.

In the meantime, people can't get credit for mortgages or college. Businesses can't get credit for payroll or expansion. One trillion dollars "evaporates" and other countries scold our leaders for putting personal ambition above altruism. As if our morale standing in the world wasn't scarred enough right now.

I think the whole country needs Rosh Hashanah, where we stop working, ask and pray for forgiveness, think about how to make ourselves and the world whole, and breathe deeply.

If we can think a bit further upstream, remember that the leading cause of people losing their homes is lack of health care/insurance. I would have hoped that improving access to health services could have been seen as part of a longer-term solution. And if housing were more affordable, maybe more people could hold onto it, and wouldn't be in a position of losing a roof over their heads. Where's the social justice in our solutions?

And when will we make a big investment in alternative energy/fuels to kick-start our economy, and make a big investment in health promotion/disease prevention, and keep people healthy and productive? Why isn't this obvious? And the long-term savings in these approaches could cover the "pay for" required with new spending bills (not to increase the deficit, new spending needs to find an offset in savings to be budget neutral).

And even before this mess, Congress was thinking about how to accomplish health care reform next year. According to Anna Edney from the Washington Journal:

Senate Democrats are bouncing around the idea that, come next year, when they attempt to overhaul health care, they might resort to a filibuster-proof process to steamroll Republicans and pass legislation.

Senate Finance Chairman Max Baucus mentioned the possibility of using reconciliation as a way to maneuver around opposition. "The preference is to do a major bill without reconciliation, that's the preference." Baucus said. By including reconciliation instructions for healthcare changes in next year's budget resolution, Democrats would need just 51 votes to pass legislation, rather than the 60 needed to overcome a filibuster, could limit debate and narrow the scope of potential amendments.

Republicans used the approach to pass President Bush's tax cuts during his first term.

But experts say there are some hurdles for Democrats if they want to use it to revamp the healthcare system. One is that because it is a budget process, reconciliation is limited to legislation that has a fiscal impact, and many healthcare policy changes might not fall into that category.

Democrats wanted to use reconciliation to pass children's health insurance legislation two years ago, but hit a wall because it did not meet the fiscal implication requirement.

Baucus said health care is losing some ground as a pressing issue as economic crises, higher gas prices and climate change battle for the attention of lawmakers and presidential campaigns.

Reconciliation also is limited to legislation that does not increase the long-term deficit. Experts said this means health reform either would have to be permanently paid for or sunset in 10 years.

While reconciliation instructions for committees must be included in the annual budget resolution, an expert said lawmakers could change the rules.

Lawmakers typically begin drafting the budget resolution in March, leaving little time for Democrats to negotiate with Republicans on a possible health reform compromise before they have to decide if they will include reconciliation instructions in the spending outline.

Baucus said he plans to release a white paper next year that will outline basic goals for health reform.

So there you have it, just another quiet week in Congress. L Shana Tova.