French lessons: Leadership in Alzheimer's disease

It is impossible to forecast anything at the beginning of 2009 about health policy in general, or Alzheimer’s disease (AD) specifically, that is not both optimistic and cautionary. Our new President, Barack Obama, who spent the campaign energizing the nation about prospects for change, is hunkered down with advisors tackling our financial and economic crises and remapping the nation’s foreign affairs. But if the multiple plans for health insurance reform that have started appearing from Congress are any indication, we may well be in store for serious and sustained leadership on this front in the near term. However there is something very troubling about this new start on healthcare: it’s all become about paying for it. Somewhere over the past few months, it has become impossible – or at least it seems irresponsible – to think about healthcare in anything but monetary terms. How will we save Medicare and Medicaid? How will we fight profiteering within the insurance and managed care industries and move to reimbursement that covers more (all) of us? How will business owners, large and small, stay afloat while subsidizing employee health costs? How will American families manage our own stretched healthcare budgets? These are important, fundamental questions to be sure, especially given our domestic and global economic crises, and the burst of governmental spending to manage them. But shouldn’t we also be having a simultaneous discussion about prevention of illness and how to provide the actual care – how, in fact, to make the fruits of world leadership in medical research available to more Americans in the form of compassionate care? Before we close the patient file and move on to reimbursement exclusively, are there not other equally fundamental questions about our duty to care? Any consideration of this complex question—beyond one or two slogans in policy speeches—is now seen as frivolous