health insurance traveling while

It is hard to believe that I have been working in Washington, DC, for almost five months. The position I have requires long hours, and those who are permanent staff assure me that those hours are going to get longer.
I am now used to my daily routine of getting up by 5am to work on my own research, followed by taking care of my daughter Sarah, and then heading out the door by 8:30. The day ends when the deadlines are met or 6pm, whichever comes later. Often it is later.

I commute to and from downtown by metrorail and love it, except of course for the occasional "rider delay," which generally means being standing shoulder to shoulder for 40 minutes or so as the train slowly makes its way through the tunnels. I'm afraid that even though my driving skills are pretty good (thanks to those MN winters), I couldn't stomach having to deal with the stress of driving here during rush hour. I really do love my ability to walk out my apartment building door and head into the metro station entrance.

The past five months have given me an education on how policy is made and the interplay of politics with policy. So much is about interpretation and timing. There is also a lot more spinning than I ever imagined. This week I will be concluding my work on preparing the Economic Report of the President and I am happy about that. It is a long process with several rounds of edits from a long list of agencies. Even though it was a lot of work, I enjoyed having the opportunity to read about topics that are outside my immediate interest areas. I am grateful that I have only health care and entitlement programs to worry about. I am looking forward to seeing the Oval Office and meeting the President when he signs it.

We have now entered the period of transition. Practically speaking, that means that we have to prepare ourselves for the fact that we will have two new Members and a new Chair (Dr. Roemer from Berkeley is Obama's selection). It also means that many of those with whom we work outside of CEA will move to other jobs in government or the private sector, and so new relationships will have to be made. Finally, and perhaps most distressing, everything on our computers (email, documents, etc) and our hard copy files will be archived. In many ways, it is like writing the final paragraphs of a novel and then immediately diving into the next one.

Whether you are on Wall Street or Main Street, this was a very tough week! There is a real sense of urgency here, as though a clock is ticking and the longer this takes to broker a deal, the higher the probability of a worse, longer-term economic slowdown. While some of the Council staff are heavily involved in the "rescue plan" legislative activity, many of us simply learn about the issues via the lunchroom table and the media outlets used by the general public. Of course, probably not too many in the general public have their boss going on CNBC in the morning, as happened earlier in the week.

There have been lots of other tasks keeping us busy, most notably work on helping to formulate the US response to a recent OECD document on the need for health care reform and other matters. There is also some new interest in Health Savings Accounts, and health insurance markets more generally. The Kaiser Family Foundation Survey came out this week. The good news is that businesses continue to offer health insurance at roughly the same rates as last year. The bad news is that premiums continue to rise and so do cost-sharing provisions at the point of utilitization. When you sit down and look at the numbers, it is mind-boggling to think we spend more than 2 trillion dollars per year and that providing health care coverage for a family is over $12,000 per year. We need to be addressing the cost and affordability issues.

Hopefully, next week will be a bit less stressful on everyone.

Yesterday the Commerce Department and Census released the latest statistics regarding income, poverty, and health insurance. One statistic caught a lot of folks by surprise --- the number without health insurance declined to 45.7 million from 47.0 million in 2007. Interestingly, the first question asked by the press was "what caused the number to fall?" The answer: increases in public insurance -- Medicare, Medicaid, and Military health insurance. Employer-sponsored insurance declined ever so slightly in the past year, while individual health insurance is at an all time low, covering just 8.9% of the population. It will be interesting to see how this outcome gets spinned as health care reform heats up again in the near future.

As for having some fun in Washington, DC, this past weekend Craig and I visited the Newseum, which is located right behind the National Gallery of Art on the Mall. If you like journalism and current events, this is a fun experience. They even have a 4D short movie experience that combines history and entertainment all in one.

The month of August is fairly quiet in Washington, DC. Congress is in recess and many in the Administration are traveling or on vacation. For me personally, it means that I am more likely to get a seat on the Metro going and coming from work and it also means that the pace is slightly more relaxed. This week I had the chance to learn a little history. On Thursday, I toured the Eisenhower Executive Office Building (EEOB). Located on 17th and Pennsylvania, this structure was built between 1871-1888, and housed the State, War, and Navy Departments originally. While the building is still used extensively by the Executive Office of the President (EOP) for conducting day-to-day business, including many of the meetings in which I participate, there are parts that have been under restoration. This week they opened up the Secretary of War's office suite, which had been under restoration for a number of years. It is magnificent in terms of its decoration -- gold leaf, ceiling stencils, and marble. The ceilings also contain glass jewels or rondels. In the suite, they had many war-related items on display -- from canteens of soldiers in the Mexican-American War to a World War I solider's epilets and helmet. This history tour also included some modern events, such as walking through Nixon's second office during his administration and learning about the bowling alley in the basement. And yes, it is still used today by staff!

It has been a fairly quiet week, as members of Congress are in their districts or on vacation and many senior leaders in the Executive branch are traveling.

This week was spent researching and writing on two main topics: (1) PEPFAR and (2) Health Information Technology.

PEPFAR is the Administration's global health initiative to combat HIV/AIDS in 14 countries, mostly in Sub-Sarahan Africa. This legislation was first authorized in 2003 and re-authorized a few weeks ago. While small in size relative to domestic programs, it is quite significant in terms of targeted foreign aid to combat a specific health problem. Initial evaluations of PEPFAR have been positive with some concerns regarding how budget allocations were tied to specific approaches for prevention (e.g., the "ABC" approach - Abstinence, Be Faithful, and Correct Condom Use). Overall, the assistance has been effective in providing antiretroviral drugs to those infected and helping to care for children orphaned as the result of their parents dying from the disease.

The other key topic of the week was HIT. We really don't know that much in terms of the magnitude of the savings and/or productivity gains that might result from broad IT implementation in hospitals and physician practices. There is a great CBO report that summarizes what we know and what we don't. It also pokes some big holes in the RAND study that provided politicians with the magic number of $80 billion per year in savings if IT was fully implemented and had interoperability. The key message from that report is that estimates rely on assumptions and that anyone who uses numbers ought to be very careful about interpretation.

The learning curve for any new job is steep, but this one is particularly so. It has been awhile since I have had to walk through security to get to my office, and where I am working, we actually have two sets of security.

On my first day, I was escorted to my office. On my desk was a large stack of supplies, an employee manual, and a large stack of forms to fill out. I was told to please start reading. By noon I had my computer identification and by 2pm