More than 48 million Americans live without health insurance coverage. They are people we all know. They are our neighbors, friends, and family members. Some of them have been my patients. For years, they’ve been forced to make tough choices between getting the medical care they need and paying the rent. They’ve gone without preventive care, missed annual check ups, and skipped medications.

 For more than 40 years, the Robert Wood Johnson Foundation has been working to ensure that all Americans have access to affordable, stable health insurance coverage. Now, thanks to the work of so many committed organizations and individuals, we have an opportunity to come closer than ever to achieving this goal.

RWJF President and CEO Risa Lavizzo-Mourey took part in a panel discussion at Tuesday's Clinton Global Initiative meeting in New York, and that was quite an honor. But, she writes in a recent blog post on the professional social networking site LinkedIn, the highlight of the day was what happened after the panel discussion: a presentation by presidents No. 42 and 44—Bill Clinton and Barack Obama. The two leaders delivered a clear explanation of the Affordable Care Act (ACA), and its implications for the future of the country.

And what they explained, Lavizzo-Mourey adds, was incredibly helpful, as the two presidents cut through all the background noise surrounding this clearly polarizing issue.

Health care spending is a drag on the economy, and the two presidents drove home that point. All of that spending has a measurable impact on everyday economic life, Lavizzo-Mourey says, affecting even the cost of a new car. For every new car built by America's iconic auto makers, Ford and General Motors, she writes, you can add to the price tag $2,000 in hidden health care costs. Lavizzo-Mourey concludes: "It is critical for our nation's future economic wellbeing that we fix health care."

The law in its current incarnation probably isn't perfect, Lavizzo-Mourey admits, but it's here, and we'll learn how to make it better. "The ACA is one of the most important pieces of legislation to come out of Congress in a generation," Lavizzo-Mourey writes, "and if history is a guide we know the law will be further refined and improved once its impact can be discerned."

That said, she adds: "I’m looking forward to going back to the Clinton Global Initiative a few years from now to talk about the good we can do for people with the money we once spent on health care."

PBS NewsHour videotaped the exchange. It's available below. Lavizzo-Mourey recommends you watch it. And you can read the transcript here on Politico.

How do you turn an idea into something bigger? It's necessary, but not sufficient, to start with a good idea, of course. But it also takes a community of supporters—people willing to step out of their busy day-to-day, and contribute time and brainpower to turning that idea into something closer to reality.

That was the goal of the first Flip the Clinic workshop, held in mid-September at the Foundation’s headquarters in Princeton, N.J. We invited 15 amazing thinkers and doers from various perspectives—doctors, nurses, patients, policymakers, entrepreneurs—and asked them to spend a full day (and then some) helping us turn the Flip the Clinic idea into something substantial, or at least substantiated.

The idea was to get some honest feedback on whether the idea has legs, and some expert input on where it might go. The result, by all measures, exceeded our expectations. Not only does the Flip the Clinic idea seem to meet a clear and broad need for new thinking about health care delivery, but it may just offer a necessary inspiration for doing some hard but necessary work in changing it.

“Pay no attention to the man behind the curtain! The Great and Powerful Oz has spoken!” 

In some ways, our health care system has traditionally functioned much like the fantastic land of Oz depicted in one of my favorite movies.  Consumers and purchasers are expected to be passive consumers, doing what they are told and paying whatever price is levied based on a high degree of trust and limited information. This model seems increasingly ridiculous. We now face an urgent need to improve the quality and efficiency of our health care system.

But to do that, we need information, a lot of information. Health professionals, purchasers, consumers—basically anyone who comes in contact with health care—need timely, accurate, comprehensive information on cost and quality if they are to make smart decisions. Without such information, not even a wizard could do the trick. But right now, such information is usually unavailable, or, when it is accessible, too often indecipherable. In fact, the Institute of Medicine estimates that $105 billion is wasted every year in the U.S. because of a lack of competition and excessive price variations in health care, and a lack of information on the price of health care services plays a large role in this waste.

An old joke has it that the doctor’s pen is the costliest technology in medicine, since money typically flows where physicians’ prescriptions and other orders decide that it should go. As a result, influencing these decisions is key to achieving the Triple Aim of better health and health care at lower cost.

But what’s more likely to influence doctors: external factors, such as bonuses for improving the quality of care, or internal factors, such as appealing to their sense of altruism or satisfaction with their work?  In other words, carrots, sticks, or something altogether different—what Daniel H. Pink, author of Drive, calls “our innate human need to direct our own lives, to learn and create new things, and to do better by ourselves and our world”?

• Health insurance for many individuals that is cheaper and better than what’s available now.
• More competition among health insurers than ever before.
• Partnerships between health plans and providers to deliver care at affordable cost.

These developments sound like the dreams of health reformers that fueled passage of the Affordable Care Act. But they’re proving to be reality now in many states—particularly in the 17 jurisdictions (including the District of Columbia) that are creating state-based health insurance exchanges, or “marketplaces.”

That’s the conclusion that emerges from analyses of the states participating in the Robert Wood Johnson Foundation’s State Reform Assistance Network. Housed at Princeton University’s Woodrow Wilson School, the program provides technical assistance to 11 states implementing coverage expansions under the health reform law.

“Speed kills,” warns the traditional highway sign about the dangers of haste and traffic deaths. Now, we know that stress kills, too.

Toxic stress, at any rate. The human body’s response to normal amounts of stress—say, a bad day at the office—is likely to be brief increases in the heart rate and mild elevations in hormone levels. But a toxic stress response, stemming from exposure to a major shock or prolonged adversity such as physical or emotional abuse, can wreak far more havoc.         

In children, science now shows that toxic stress can disrupt the developing brain and organ systems. The accumulated lifelong toll of stress-related hormones sharply raises the risk of chronic diseases in adulthood, ranging from heart disease and diabetes to depression and atherosclerosis.

Thus, the message from a panel of experts to the Robert Wood Johnson Foundation’s Commission to Build a Healthier America was at once simple and challenging: Create a healthier environment for—and increase coping mechanisms and resilience in—the nation’s most vulnerable and stress-ridden children and families.