I'm beginning to believe that the best way to achieve true and lasting healthcare reform is to just get out of the way and let Baby Boomer women revolutionize healthcare. Baby Boomers as a cohort have been change agents for redefining the family, education, and work life, so why not healthcare as well? Boomer aged women are already--and will increasingly be--the majority on the front lines of formal and informal care. I certainly don't mean to denigrate the role of men in healthcare or to perpetuate some kind of bio-destiny argument that women are "naturally" supposed to be the caretakers in our society. But I do think our overwhelmingly male Congress would do well to better understand the role of--and listen more to--women, who will likely be the most impacted by these health reform policies.
A quick story. About 9 years ago, during my first attempt to get Intel to see the social need and business opportunity for innovating technologies for personal and proactive healthcare, I was struggling to make much headway. The demographic and economic numbers were startling to some of the executives I approached, and the logic of my arguments made sense to them. But they didn't seem to "get it" in their bones that there is a fundamental need for caregiving and personal health technologies at home. In one particular strategic discussion with a key Vice President who was skeptical and blocking my request for seed funding for a personal health lab, I showed several early concepts of caregiver assistance technologies, particularly for families dealing with Alzheimer's.
After my demo, he said, "It's kind of cool, but I just don't see why anyone would want this." It was clear I was going to be denied funding, and before I knew it, I just blurted out: "Can you get your wife on the conference call?" The room was filled completely with men--all were engineers and executives--and they stared at me as if I had leprosy. "Seriously, call your wife, let me explain the concept, and if she doesn't think this is compelling, then I'll stop pushing for it." He went along with the gag, and fortunately for me, his wife answered the call, listened to me explain the idea, and loved it. In fact, I couldn't have paid her for better comments as she said to her husband in front of the entire room: "Wow, honey, this is the first technology I've ever heard you talk about from your years of work there that I actually need...I could use that now for taking care of your mother....when can I try it out?" I won several executive champions that day as they went home and discussed what had happened with their wives.
I don't believe members of Congress or the technology industry are being intentionally sexist or blatantly dismissive of caregiving as "women's work." But we have to admit that this work--done primarily by women--is often invisible to politicians and tech executives, who by and large, are men who simply don't have the lived experience of caregiving to feel the need for new technologies, policies, and support for caregivers. Yes, I've met men who are exceptions (I work with someone who is an amazing partner with his wife as they care for their special needs daughter). But I've met many, many more husbands who aren't even aware of the amount of time, money, and sometimes suffering that their wives are doing to care for their aging parents.
So healthcare reform needs to orient to the fact that women are the primary careforce for making healthcare work smoothly across the continuum of care. In our Intel clinic studies, nurses prove to be the seemingly tireless orchestrators of the day-to-day healthcare experience for almost everyone--they are the glue that holds the healthcare system together. Most research on the topic confirms that around 94% of nurses are women--in most every part of the world--and most of those are "boomer" age or older. In our home studies, women most often serve as the primary health managers, information keepers, caregivers, and advocates in the family, whether or not children are present. There are many studies and statistics that show these gendered trends to be the norm (see the Family Caregiver Alliance summary, the National Family Caregivers Association summary, and the Kaiser Family Foundation Women's Health Policy page).
Congress needs to "get it" in their bones that we need a reform plan for training, sustaining, and growing a "careforce" of women (and men) that is ready to deliver 21st century care in some new ways. Healthcare reform without workforce reform--and without broader planning for developing a diverse, flexible careforce of paid professionals, new kinds of care workers, volunteers, and informal caregivers--won't solve the cost/quality/access problems we all face. Simply put, there won't be enough traditional nurses and doctors to meet the demands of the uninsured and the age wave using our institution-and-professional-centric system. We need something else.
As Clayton Christensen shows in his great book, The Innovator's Prescription, we need, among other things, to use disruptive technologies to skillshift--that is, move skills and expertise from higher trained professionals to less trained professionals to families and patients themselves--whenever safe and effective to do so. So much attention in the healthcare reform debate has focused on clinicians while glossing over how to better educate and empower consumers. AARP's caregiving study points out that more than 34 million Americans are providing informal (but often full time) care at this very moment--to the tally of $375B worth of care if we had to hire professionals to deliver it instead. Again, most of these are women, and few are given the support, respect, and tools to do those informal caregiving jobs. We need to be more conscious in our reform strategy about how to skill-shift many of the things that doctors and nurses do to this huge informal careforce.
So what are we doing in healthcare reform to support, sustain, and enhance the abilities of this often invisible, informal careforce to deliver better quality care at reduced financial and emotional costs? How can we further offload the expensive, institutional care settings and professionals by training and skill-shifting to families, friends, and patients themselves who have to become trusted partners on care coordination teams? How are we retraining medical professionals to use new technologies and build new relationships with this informal careforce to achieve better outcomes for more patients? In short, who will make up the careforce of the 21st century that anticipates the age wave and caregiving crisis we face?
Outside of some discussion of how to accelerate and give more incentives to students to go to medical or nursing school, especially in primary and geriatric care, there has been too little discussion of these kinds of questions by Congress and the media. President Obama is under attack this week for supposedly being callous and carefree about the unemployment crisis in America (see the NYT op ed by Bob Herbert). Healthcare reform offers enormous opportunity (and there is certainly enormous need) to put people to work. Let's solve one problem--stimulating the job market and the economy--by solving another: reforming healthcare. Perhaps if we could spend as much time as a nation debating ideas to develop this new careforce--and as much energy figuring out how to grow new jobs for the new healthcare system--as we are giving to Jon and Kate, town hall crazies, and Letterman's love life, we might well find a way out of this healthcare mess, stimulate the economy, and have better healthcare for all. And maybe we would be able get this done just in time for the Baby Boomers to play a transformative role once again in our society, as they demand, create, and live out new notions of what retirement, health, and being a "patient" really mean.
Next week I'll offer my top six ideas/answers to the careforce questions I posed in this entry. I want to do some more homework and thinking before I put them out here. And I'd love to hear your creative ideas on this topic here on the blog, if you are up for some homework yourself.