After decades of failed attempts at healthcare reform, it seems that real change may finally be on the horizon. A new Administration -- elected by a landslide on a promise of change -- is about to take the helm in Washington.

Healthcare is "not something we can put off because we are in an emergency (but rather) part of the emergency," President-elect Obama declared the December morning I sat down to write this column. That same morning, he officially nominated healthcare reform advocate Tom Daschle for the Health and Human Services Secretary's post.

Since the November election, support for healthcare reform has continued to gain momentum, even in sectors previously opposed to reform. In the last few weeks alone, two of the nation's leading heath insurers' trade groups promised to support guaranteed coverage -- despite preconditions -- if universal coverage were mandated. Sen. Max Baucus (D-MT) released a comprehensive plan for mandated, universal coverage that would place greater emphasis on prevention and care coordination. A bipartisan group of 14 senators led by Ron Wyden (D-OR) endorsed a bill calling for affordable and "portable" healthcare coverage for all Americans. And the insurance industry and business groups joined unions and nonprofits in discussions about fundamental changes in the healthcare system.

These are heady times. But we still have a very long way to go. Despite the president-elect's assurances, not everyone in Washington agrees that the nation can afford to significantly expand health coverage in such difficult economic times. And timing isn't the only issue. Coming to a consensus as to how, exactly, to structure healthcare reform, and how to finance it, won't be easy either.

On the campaign trail, president-elect Obama called for many reforms that ring true to AGS' values. These include: initiatives designed to move us toward universal coverage; efforts to repeal the ban preventing the government from negotiating lower prices for medications for the Medicare prescription drug plan; eliminating the drug plan's "donut hole" coverage gap; placing greater emphasis on prevention and investment in research (including stem cell research); and supporting care coordination, long-term care reform, the medical home model, and stepped-up efforts to train much needed healthcare workers. Different interests, however, will have different agendas. And different approaches to reform will create different winners, and losers.

Because so much is at stake, it's vitally important that AGS continue to advocate for policy change that will enhance care for older Americans. In fact, we're already stepping up our policy advocacy efforts. AGS' leaders, staff and Public Policy Committee members are actively working with WolfBlock, our Washington consulting firm, to educate Congress and advocate for our priorities in the Capitol. We made several trips to the Hill this fall and have contributed to several pieces of legislation, including Sen. Herb Kohl's (D-WI) recently proposed "Retooling the Healthcare Workforce for An Aging America Act of 2008." This timely legislation would significantly expand education and training programs to address the serious and growing shortage of geriatricians and geriatrics healthcare professionals, and better prepare other healthcare professionals, direct care workers and family caregivers to care for older Americans.

As I discussed in my previous column, the series of articles about the geriatrician shortage that appears in October's Journal of the American Geriatrics Society includes the results of a recent Association of Directors of Geriatric Academic Program (ADGAP) survey. The survey asked the directors of U.S. geriatric academic programs how to best deploy available geriatricians in light of the shortfall. Their answer: given the shortage, geriatricians should focus on the most complex and most vulnerable older adults. Now we'd like to know what you think. So, in early 2009 we're fielding a survey to the full AGS membership, asking your opinion on this pressing issue. We hope you'll take the time to respond: It's crucial that AGS fully understand its members' views of these and other matters to effectively advocate for policy that supports their interests.

Since this is my last column as AGS President, I'd like to thank all of our members for their support of and involvement in the Society and its efforts to ensure all Americans access to quality healthcare. I'd also like to extend a special "Thank you" to AGS' committee and SWAT team members, who have contributed countless hours to multiple initiatives. Thanks to these efforts Congressional staff have begun to see AGS as a valuable resource.

I also want to single out our many committee members and members at large for an extra "Thanks" for the tremendous contributions they continue to make. They provide outstanding expertise and enormous investments of time -- all with an upbeat and magnanimous attitude. A special "Thanks" also goes to all the AGS staff, who have been so helpful to me this year, and every year. They are a talented and dedicated group. Our senior leadership deserves tremendous credit for excellent financial management in very troubling times. And I'd be remiss if I didn't thank the executive committee and the Board, as well, for their contributions and sage counsel. Thank you all.