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Forums open up debate about health system reform

Washington -- President Obama's effort to engage Americans in discussions about national health system reform reached a new phase with the conclusion of five regional health forums and another smaller gathering near the White House. The invitation-only, two-hour forums were attended by a few hundred people each, including lawmakers, physicians, executives and others from a variety of backgrounds. White House staff moderated the forums, which were held between March 12 and April 6 in Dearborn, Mich.; Burlington, Vt.; Des Moines, Iowa; Greensboro, N.C.; and Los Angeles. State medical society representatives and others who attended the events said they were a useful way to let people speak their minds about problems with the U.S. health system and the potential for positive changes. They said the regional events began with a video statement from Obama followed by statements from the host governors and moderators, then time for audience members to speak and ask questions. "It was valuable in the sense that this is clearly a more transparent process than we had in the early 1990s," said Paul Harrington, executive vice president of the Vermont Medical Society, who attended the forum in Burlington on March 17. That event drew people from Massachusetts and New York as well and touched on universal coverage, preventive care and health care quality, he said. The Los Angeles forum, held on April 8, was mostly scripted, with the moderator calling on specific people to get their views and just one spontaneous question from the audience, said Jeffrey Luther, MD, president of the California Academy of Family Physicians. Still, he said it was a good chance to network with others involved with health care. "It was invigorating for those who were there," Dr. Luther said. The comments at the regional forum in Dearborn were "all over the place," reported Michigan State Medical Society President Michael Sandler, MD. "There were some patients who wanted single payer. There were some legislative and hospital types who wanted more efficiencies in the system." Many of the key local health care players attended the event and were allowed to share their expertise, he said. "The value was that people were allowed to give their input." Nancy-Ann DeParle -- director of the White House Office of Health Reform -- hosted a smaller forum with about 30 health care representatives on April 8 at the Eisenhower Executive Office Building, adjacent to the White House. The same day, Obama issued an executive order formally creating the office headed by DeParle. It will be in charge of implementing the executive branch's health reform policies across federal departments and agencies. DeParle led the April 8 discussion and asked attendees for opinions. "It didn't really take much to get the conversation started," said Ken Thorpe, PhD, professor of health policy at Emory University and executive director of the Partnership to Fight Chronic Disease. DeParle also moderated three of the regional forums. Participants in the Washington, D.C., gathering -- including representatives from pharmaceutical companies and health plans -- appeared to agree on the need for universal coverage, better preventive care and payment reform, Thorpe said. But they differed on the methods needed to get there. The executive branch outreach is probably not over, Thorpe said. He anticipated that the White House would hold more small health reform meetings in Washington, D.C. In addition, several members of Congress, at the request of the White House, hosted discussions in their districts and states during their two-week holiday recess. On April 1, DeParle also met with American Medical Association President Nancy H. Nielsen, MD, PhD, and Rebecca J. Patchin, MD, chair-elect of the AMA Board of Trustees, to discuss health system reform. Obama's push for public participation began before he took the oath of office. The president's transition team asked Americans to hold community discussions on health system reform, then report the results of those discussions. About 3,200 groups did. Summaries of the comments submitted as well as videos of four of the regional forums are on the Dept. of Health and Human Services reform Web site (www.healthreform.gov). Robert Blendon, ScD, a professor of health policy and political analysis at the Harvard School of Public Health, said Obama is trying to keep health system reform near the front of peoples' minds at a time when the economy is dominating the news. But these events weren't designed to get into the thorny details of negotiating legislation or answering tough questions, he said.
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