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Category: Health

It’s All About Choices: A Nurse’s View of Health Reform

| July 31, 2009

If health care reform is enacted—and if it works to lower costs and keep Americans healthy—nurses will be a large part of the solution, argues the author. Trust her: she’s a nurse.

When President Barack Obama appeared in the Rose Garden on July 15, 2009, to continue to stress the urgent need for timely passage of health care reform, there was a reason he was flanked by some of the biggest names in nursing today. No other profession is more trusted than the nursing profession, at least according to Gallup’s Most Trusted Profession poll, which nursing has “won ” for seven consecutive years.

At the president’s side were, among others, Dr. Mary Wakefield, the administration’s highest ranking nurse, and Becky Patton, American Nurse’s Association president. The message was clear—for decades nurses have consistently advocated for affordable, quality, equitable distribution of health care services for all Americans. And while much of the health care debate has focused on major stakeholders such as physicians (largely via the AMA), the insurance and hospital industry, labor unions and to a much lesser extent, the health care consumer, it is nurses who can and will be an essential aspect of any health care legislation that seeks to provide cost-saving, quality care, particularly to America’s most vulnerable populations.

Nurses are in a unique position to attest to the consequences of how today’s current health care market has privileged expensive, acute treatments over more cost-saving models that focus on disease prevention, health education and screening. While much has been made of the plight of the country’s almost 50 million uninsured, less has been made of the growing number of under-insured people, who can no longer afford even their employer-based plans or find that their health care needs are not being met despite their current coverage.

While some naysayers would like to cast any real attempt at true health care reform as anti-market or anti-business, make no mistake: competition among coverage providers has been acknowledged time and time again by nursing advocacy groups as essential to providing quality services at lower cost. The issue nursing has with the current system, however, is one of logic. It simply makes no sense to have a system that purports to be patient-centered while the primary gatekeepers to health care access—insurance companies—compete to insure the healthiest among us at the expense of the sick. This is why any health care reform must include a strong public insurance option that allows individuals to choose between the public plan or a private alternative depending on which they believe, based on their own individual circumstances, is best suited to their needs. This is why the current "compromise" legislation emerging from the Senate Finance Committee, which abandons the public option in favor of insurance reform, is unacceptable and must be remedied prior to final passage and signing by the president.

It is the opinion of most, if not all, major nursing advocacy groups and professional organizations, that anyhealth reform proposal that does not include a strong public option, is not really true health care “reform” in any meaningful sense of the word. And I say “strong” because, as we listen to the pundits, special interests, the media and the politicians spin their own proposals, the general public should not be faulted for being totally confused. Most of the above groups have been attempting to sell as a “compromise” their version of a public option—a bipartisan-sounding gimmick that maintains the current status quo by not really changing all that much of anything.

Politicians and health care stakeholders refer to these proposals in various terms—the “trigger” plan, the quasi-public option, the “weak” plan and on and on. But make no mistake, from the perspective of most nursing advocates, none of these plans are adequate to achieve the overlapping goals of cutting health care costs, increasing quality, providing a safety net to the uninsured and underinsured, focusing on disease prevention and streamlining health care delivery. In other words, don’t believe the hype.

Among the various plans being proposed, from a nursing perspective, none offers more promise than the one recently put forth by Senator Ted Kennedy and the Senate’s Health, Education, Labor and Pensions (“HELP”) Committee, the Affordable Choices Act. What makes this plan stand out is its recognition of the importance of a strong public option combined with a focus on cost-saving preventative health care services, some of which could be provided by Advanced Practice Nurses (“APRN”) in nurse-managed health clinics. Such clinics not only provide cost-effective, patient-focused, primary and preventative care, they help deal with the very real problem of physician shortages, particularly in rural and other under-served areas of the country. The purpose of utilizing APRNs in any model of health delivery has never been to supplant the physician’s role, but rather to supplement it. The nursing profession has long maintained that any meaningful health reform must not only deal with quality and cost but also with solutions to physician and nursing shortages, and the Affordable Choices Act does just that.

The need for true, meaningful health care reform has never been more urgent. Luckily, we have a president who demonstrated in the Rose Garden on July 15, 2009, that he understands that any real health reform, which has patients, and not profit, as its primary consideration, requires not only the participation of nurses of all backgrounds at every stage of the reform process but also at every stage of its implementation.