Anyone who’s responsible for juggling a personal or household budget knows the pitfalls of taking on too much debt. Unfortunately, the federal government has found itself in a situation where our national debt is growing out of control. Public policymakers have indicated that we have much work to do if we want to stabilize the debt at 60 percent of the gross domestic product by 2018.

I’ve discovered an interesting online resource called “Stabilize the Debt: an Online Exercise in Hard Choices,” which is offered by the Committee for a Responsible Federal Budget (CRFB), a bipartisan, nonprofit organization committed to educating the public about issues that have significant fiscal policy impact. (Here’s the link: http://crfb.org/stabilizethedebt ) The “Stabilize the Debt” simulator was designed to demonstrate how budget choices affect debt held by the public in the medium- and long-term. It illustrates the tough choices that will have to be made to achieve a goal of stabilizing the debt at 60 percent of GDP by 2018. This goal is a recommendation of the Peterson-Pew Commission on Budget Reform in its report, Red Ink Rising. The CRFB, which runs the Peterson-Pew Commission on Budget Reform, receives significant funding from the Peter G. Peterson Foundation and the Pew Charitable Trusts.

I was recently asked to complete the exercise in making hard choices. The budget simulator walks you through different budget options for reducing the debt that include increasing revenues and/or decreasing government spending. The objective of the exercise is to make choices that stabilize the debt at 60 percent of GDP by 2018.

Try it. See what hard choices are on the horizon for public policymakers. It won’t be easy, but it is something we must undertake as a nation.

A federal judge in Florida ruled today that the Affordable Care Act (a.k.a national healthcare reform) is unconstitutional. He sided with 26 states that filed a suit challenging the law’s authority to require individuals to purchase health insurance. One other court in Virginia had reached the same conclusion, while two other federal district courts have upheld the new law. What does this all mean?

Well, tonight we will listen to Fox, CNN and MSNBC speculate, but what it really means is that the constitutionality of the new law will have to be determined by the highest court in the land, the United States Supreme Court.

While the appeals proceed, N.J. hospitals will continue to care for all the uninsured who come to them for care, regardless of their ability to pay. We have to under New Jersey state law, and we want to because it is our mission.

A new year brings a new list of changes heading our way under the federal Affordable Care Act. NJHA’s Healthcare Reform Resource Center www.njha.com/reform details the new provisions of the federal healthcare reform law that take effect in 2011.

This year ushers in the beginning of $4.5 billion in Medicare cuts for N.J. hospitals over the next 10 years – hospitals’ very generous contribution to try to insure more Americans and make our healthcare system more efficient and affordable. Other providers such as nursing homes and hospice also will experience funding cuts.

Other key changes for the new year include:

• Added funding for community health centers
• Payment bonuses for primary care physicians to help address primary care shortages
• Redistribution of training slots for medical residents – again, an attempt to help ease certain physician shortages, and
• The first incentive payments to healthcare providers that achieve new thresholds in the use of electronic health records.

Next year promises to be a fascinating one in Washington, D.C. Despite some deep partisan differences, it appears that both political parties agree on at least one thing: the need to focus on reducing the federal budget deficit. And that’s quite a feat, given that we now have a divided Congress – the House being a Republican majority, and the Senate being a Democratic majority. Many are predicting gridlock as a result.

Of course, you can’t think seriously about reducing the federal deficit without looking at the Medicare program – it’s a major part of federal spending. One of my favorite Web sites from the Kaiser Family Foundation displays an excellent side-by-side comparison of the six (yes, six!) different deficit and debt reduction proposals in terms of the Medicare program. None of them have broad-based political support, but the concepts will begin to find their way into various proposals. One thing that I would ask public policymakers to remember as they mull over these changes is that the hospital industry took $155 billion in cuts over 10 years to achieve national healthcare reform. For New Jersey’s hospitals, this translates into $4.5 billion in Medicare cuts over the next decade. We must tread lightly when it comes to further Medicare reductions. Hospitals already “gave at the office” in 2010 – and will continue to give over the next 10 years. If we want to ensure future access to good quality hospital care, we must find other funding sources to donate to deficit reduction.

People ask me why I blog. I sometimes ask myself that very question (always after beating myself up for not writing more often). The reality is, I blog for several reasons. Number one: More people are getting information from the Internet and social media. Second, it's a simple and inexpensive way to communicate and reach broader audiences than ever before. Third, it offers interactivity – a way for readers to respond and create a dynamic conversation. It is, after all, called social media. And finally, the traditional news media, especially local TV news and newspapers, sadly don't have the resources to cover healthcare the way they used to. Don't get me wrong. I LOVE newspapers, and unlike some national figures I can actually tell you which I read daily. But NJN is the only news channel that I receive that really covers New Jersey news.

So to answer that initial question: I blog to share information and perspective on the important healthcare issues that affect us all. We're also on Twitter, and I invite you to follow us at "NJhospitals." Of course, there are numerous additional opportunities in the social media space – Facebook, You Tube, Linked In and many others. If you've gotten this far, you're clearly a reader of blogs. So I'd really like to hear your opinion: How do you like to receive healthcare information online, and where should we go next? The possibilities are truly limitless.