Now that the mid-term dust has settled in Washington, D.C., thoughts turn once again to the issues before us. And one of those burning issues is the future of healthcare reform.

Healthcare reform was a factor in how voters cast their ballots, according to a new poll conducted by the Kaiser Family Foundation. And as you know, the mid-term elections left us with a divided government – the House is now solidly Republican, and the Senate remains in Democratic control. And, of course, President Obama is still the President of the United States.

The Kaiser poll showed that about 17 percent of respondents cited healthcare reform as one of their top voting issues, following the economy/jobs, party preference and voters’ views of the individual candidates.

But what struck me as even more interesting in the poll were the opinions on the future of healthcare reform. The respondents were sharply divided on how Congress should proceed on healthcare reform. Roughly 21 percent favored expansion of the reform law, 19 percent wanted the law to remain as is, and 24 percent preferred to see the law repealed.

I recently read in the Philadelphia Inquirer that one conservative commentator said the GOP strategy around reform is to “defund, delay and debunk.” Here at NJHA, we’ve long said that the Affordable Care Act isn’t a perfect solution, but that something must be done to reverse the spiral of rising healthcare spending, the growing number of uninsured and inadequate reimbursement for healthcare providers that threatens an access-to-care crisis.

But I’d like to hear where you stand on healthcare reform. Should we stay the course and see where it leads us? Repeal it entirely? Refine the law to correct trouble spots? Click below to weigh in – I’m eager to hear your opinions.

You can’t turn on a television news channel anymore without hearing a story about the latest poll numbers in key congressional races around the country. Who will win? In Nevada, Harry Reid or Sharon Angle? In Delaware, Chris Coons or Christine O’Donnell? There’s plenty of prognosticating on whether the House of Representatives will move from a Democratic majority to a Republican majority under new Speaker-hopeful John Boehner. Most pundits agree the House will move to a substantial Republican majority, while the Senate is projected to remain – just barely – under Democratic rule.

What will it all mean for action on Capitol Hill, and what will it mean for healthcare reform? First, it likely will mean gridlock with little meaningful legislation unless there is bipartisan support among both parties. I haven’t noticed much of a bipartisan spirit in D.C. lately, but that may change. Second, I think there will be action on deficit reduction. That’s an issue the American people feel strongly about, so I think the parties will agree to work on it.

As for healthcare reform, I think it will be tough for anything to proceed aside from minor fixes to the law. Why? First of all, it will be near impossible to get a repeal bill through the Senate if the predictions hold true. Second, President Obama will still be President, and he isn’t going to sign a repeal bill. Expect a veto of any bill that makes its way out of Congress, and neither house will have the numbers to override a presidential veto. Third, the law responds to genuine needs. We have 1.3 million uninsured residents in New Jersey alone, and the reform law is expected to provide coverage to about 923,000 people over a nine-year period. That’s a good thing. And finally, the law actually saves the government money through its provisions to increase efficiency. Repealing certain provisions may actually cost the federal government money. With the focus on deficit reduction, that will be a problem.

So my prediction is the reform law will remain largely intact, with tweaks along the way. Stay tuned to see if my crystal ball is correct.

Yesterday morning I awoke to the news that the six fishermen lost off the coast of Cape May were located, safe and sound, by the Coast Guard more than 1OO miles out to sea. Then later, as a I drove home from work, I heard the welcome news that the rescue process had begun for the Chilean mine workers who have been trapped 2,000 feet underground for 69 days. What wonderful news for the individuals rescued and their families, friends and loved ones.

It is gratifying to hear good news in a 24-hour news cycle filled with grim updates about the economy and political sniping. But there is another side to this story, and that is the countless hours, days and – in the case of the Chilean miners – months of work by countless rescue workers joining together for the long-awaited result as the whole world watched. The U.S. Coast Guard and all of those involved in the Chilean rescue did their jobs wonderfully, tirelessly and we thank them for being heroes each and every day, even when we aren't watching, and even when we aren't aware of the work they do.

My guilty pleasure during the work week is waking up and running downstairs to catch a half hour of the Morning Joe program on MSNBC before my husband and son wake up. I have watched the show for years. It provides thoughtful debate and dialogue and showcases numerous differing perspectives on an issue, which isn’t usually the case onmost cable TV news channels.

The show is led by host Joe Scarborough, a former Republican Congressman from Florida who gives a conservative but pragmatic viewpoint on the issue de jour. He’s joined by Mika Breznienski (yes, I had to look up the spelling), who gives intelligent commentary plus she sometimes acts as the Mom on the set when the boys get off subject. Add to the mix a wide range of guest commentators like Pat Buchanan, Harold Ford, Arianna Huffington and the guys from Politico.com (one of my favorite Web sites), along with Willie Geist, who has his own show – “Way Too Early” at 5:30 a.m. – and who also plays a key role. I watch them for normally a half hour. After that, the rest of the family wakes up and my son commandeers the TV to watch SportsCenter.

Obviously, I’m no casual observer of Morning Joe, so I was thrilled to learn that NJHA was able to get Joe Scarborough to be our keynote speaker at the NJHA Annual Meeting Jan. 14 in Princeton. I think he will be a great speaker, will be honest during Q & A, and since he will be unchecked by Mika, who knows what he will say? I encourage all NJHA members to consider attending. (Watch this site in the coming days for registration information.) This is our premier member event, where we will be installing our new Board chairman and other officers. It promises to be a great day.

We in the hospital community were disappointed by the recent ruling of a New Jersey appeals court in which a panel of judges decided not to rule on a case that centered on some very difficult issues regarding end-of-life care for hospitalized patients. It was a 26-page opinion that essentially said “the case is moot.” (As a lawyer I can appreciate why it sometimes takes 26 pages to explain a non-decision.)

Why are we disappointed? The medical community, along with patients and family members, need reasonable, responsible and compassionate procedures for the care of patients in their final days when further medical intervention would provide no relief or benefit. This lawsuit was filed against a hospital by a family member pushing for continued medical interventions for a dying patient. I sympathize with them, having seen similar circumstances in my own experiences. The hospital, however, thought it best to end those medical interventions because they didn’t meet medical protocols and were in essence doing little more than drawing out the patient’s death. These are difficult ethical issues that society must face as our population ages and technological advances can greatly prolong the dying process. In the end, the appeals court ruled that it didn’t have enough information to provide this much-needed guidance and encouraged the Legislature to take up this important issue.

Our goal as healthcare professionals is to provide the highest level of care that is medically necessary and appropriate, care that protects our patients from unnecessary pain and preserves their human dignity. These difficult issues will continue to confront physicians, patients and their loved ones until we honestly and sensitively address the conflict between the marvels of medical science and the natural limits of the human body and spirit.

This case has generated some spirited discussion on Web sites and news blogs. Some people have accused hospitals of wanting to deny care because of the cost to the facility. There is no doubt that medical care is costly. However, that is not what is at the core of this matter. This is a human issue, not a financial one. And the undeniable human reality is that sometimes more care is not better care. Sometimes, more care does not add to an improved quality of life. Sometimes, providing care is medically futile. It is a difficult issue for anyone to confront, and certainly a tough conversation to have with family members and loved ones. I know – I’ve been in the midst of such conversations with doctors, nurses and my own family members. It is never easy to hear, and it is never easy to have to be the one to decide. Difficult as it is, this conversation will have to continue in the public arena. In the meantime, make sure your loved ones know what you want – and what you don’t want – should you find yourself in such a situation. Make an Advanced Directive so your wishes are clear to your loved ones and your medical team.