They say health care is recession-proof. But, that's not exactly the case. The health and human services sector has proven to be both recession-resistant and a recession laggard. And—if U.S. governors are right—the start of the ‘recession’ in the health and human service sector will begin on July 1, 2011. The fiscal year that begins in July will be “the most difficult to date,” according to a survey of 45 states released at the winter meeting of the National Governors Association.

States must find a cumulative $18.8 billion to balance their budgets in remaining months of the current fiscal year, and in fiscal 2011, an estimated $53.6 billion in shortfalls awaits, according to the survey. For governors, Medicaid is one of the top budget issues. Medicaid spending for fiscal year 2009 was $335 billion, an increase of 7.8 percent over the previous year. Enrollment increased 5.4 percent in fiscal year 2009 and will grow 6.6 percent in fiscal 2010. Additionally, 3.3 million more people were enrolled in Medicaid in June 2009 compared to the previous year—the largest one-year increase to date.

If you haven't started your management strategy for this time of economic freefall, now is the time. For starters, employ a three-prong recession management strategy consisting of short-term cash management, business development, and preparing for the post-recession marketplace.

For more, check out:

• Prepare for the Emerging Post-Recession Marketplace: Five Management Best Practices for Organizational Sustainability
• Anticipating Emerging Post-Recession Market Models: Consumer & Payer Demands for Behavioral Health & Social Services

Emily Friedman, in her recent piece “Almost Paradise” featured in Hospitals & Health Networks, gave a great history of Hawaii’s efforts to establish and maintain universal health coverage for its residents (it ranks second among the states in terms of population coverage). And, while the history was fascinating in terms of its magnification of the issues being discussed today in Washington, Ms. Friedman’s “ten lessons learned” were even more compelling for thinking about our current reform efforts:

1. Every state is unique. Whatever the health care reform prescription coming out of D.C., if it is a ‘national’ as opposed to state-based approach, variation at the state level is key to long-term success.
2. The right people have to be in the right places at the right time. To get big initiatives passed, alignment behind core tenets is necessary in several sectors of government. Given the current state of certain parts of the U.S. Congress (the ‘just say no’ contingent), this is problematic—it’s hard to figure out what they would support.
3. The political, economic, and cultural environments have to be right. Passing an expansion of health care coverage is difficult now given the economics. The proponents need to do a better job of making the case for expansion of health care coverage in the current context.
4. Having a predominantly nonprofit health care sector helps. In Hawaii, at the time that health care reform was passed, the health care sector was predominantly non-profit. In the current debate, there has been no end of the controversy about the role of for-profit sectors of the U.S. health care system.
5. If costs are not controlled, nothing will work in the long term. If costs keep on escalating, there is no coverage program in the world that can continue to function—public or private, employer-based or individual.
6. Mandates help but are difficult to enforce. Whether mandates to purchase insurance or mandates to provide coverage or mandates for taxation, mandates are easy to pass and hard to enforce. Complete compliance can never be assumed.
7. Truly universal coverage is impossible to achieve. "Universal coverage" is a great goal but a practical myth. Some small percentage(5% is a common figure cited by scholars ) of people participate, even if the coverage is free.
8. Providers can (or will) absorb only so much loss. There is much discussion about the end of fee-for-service and moving risk to provider organizations. This is a great potential model but cannot be the only cost containment measure.
9. Don't underestimate your opponents. Those who oppose an idea are generally more fervent than those who support it, especially when the benefits will largely go to people other than themselves.
10. All situations change over time. Flexibility needs to be built into any health care reform initiative. Accommodation of change (financial, political, technological, etc.) are necessary for health policy initiatives to last.

I recently presented at a state behavioral health association meeting where, to put it mildly, the execs in the audience thought my five-year projections were a bit 'wild'. I heard many comments like, "That will happen eventually, but certainly not in five years…"

But even my view of the future of the health and human services field was given a 'big shock' by the remarks of Google CEO Eric Schmidt at the Gartner Symposium/ITxpo in Orlando. Mr. Schmidt was asked to answer the question, "What will the Internet look like five years from now?" Here are a few of the trends he is working into the five-year strategic plan for Google:

• The next five years will outstrip the factor of ten that we now know as Moore's Law—computers’ capabilities will be doubled (speed, storage, reduced cost, etc.) in five years—and not ten
• Within five years, there will be widespread broadband access well above 100MB in performance—in other words, super-fast bandwidth for real time audio and video communication
• Distinctions between TV, radio, and the web will go away—facilitated in part by inexpensive, fast broadband access
• Real time user-generated information on the web will increase—also facilitated by inexpensive fast broadband access—and the will be including it in search results, and more critical, in ranking
• Web users will expect to jump from one application to another seamlessly (much like today's teenagers)—and will demand applications that permit this
• Five years from now the Internet will be dominated by Chinese-language content.

What does it all mean for our field? I don't know yet, but our team at OPEN MINDS is working on the answer to that very question. Stay tuned.

Want a quick summary of the 564 amendments offered to the Senate Finance Committee to 'fix' the Baucus bill?

Timothy Noah and Chris Wilson of Slate.com have done just that. The actual amendments are all described on the Senate Finance Committee's Web site. Unfortunately, they're scattered among six PDF files, and navigating them is a nightmare.

Slate's Chris Wilson assembled all these amendments into a single spreadsheet that can be sorted according to sponsor, party, budgetary offset, and whether the amendment in question addresses insurance coverage, reform of "delivery systems," or financing. (Note: You may need to log into Gmail to view the sortable spreadsheet. A low-fi version is also available.)

Hope you have is much fun with this as I did!