Health Care Reform: What Is Our Problem?

Bradley-Springer, Lucy

doi:10.1016/j.jana.2009.09.002

« Previous Next »Journal of the Association of Nurses in AIDS Care
Volume 20, Issue 6 , Pages 421-422, November 2009

Health Care Reform: What Is Our Problem?

Article Outline

Health Care Reform as Prevention
Fear and Loathing
An Opportunity
References
Copyright

You can always count on Americans to do the right thing

—after they've tried everything else.

—Winston Churchill, 1944

I have a friend who recently retired. He had worked for more than 20 years as a clinician for a well-known health care system. During his employment, he and his family had health care coverage from the agency where he worked. His coverage included everything from emergency care to primary care to specialty provider consults. In the past several years he was diagnosed with high blood pressure, elevated cholesterol and lipids, and a torn rotator cuff. His coverage provided surgery, medications, therapy, and education. It helped him get his health in control and he is now considered to be active and healthy: he swims, he bikes, he takes his medications, and he watches his diet. He is currently using Consolidated Omnibus Budget Reconciliation Act (COBRA) rights to continue his health insurance, but he has been notified that when that runs out, in less than 18 months, the health care system that has covered him all of these years will no longer insure him. He is being dropped because of pre-existing conditions. These are the same conditions he developed while employed by this agency and which—with the expert care he has received—are now under control.

When he told me his story at dinner one night, I said, “And that's why we need health care reform.” I said it with a bit of trepidation because we had not discussed politics before and I didn't know his stand on the issue. But more importantly, I was concerned that strangers in the crowded restaurant would hear; the news had been filled with stories about angry protests in health-reform focused town halls around the country and I did not know how my opinion would be taken. Although my friend agreed with me, I have to be honest: My friend will not lose health care coverage. He had a good job and was well paid. He has his savings. He will buy health insurance because he knows the problems that can develop without coverage. His premiums will be exorbitant, but he will pay them, and he will eventually take advantage of Social Security and Medicare. He will not become one of the 46 million uninsured Americans who do not have access to routine health care (Kaiser Health News, 2009).

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Health Care Reform as Prevention

There are some things I just do not understand. I do not understand why the federal government does not support needle and syringe exchange programs (NSEP) and I do not understand why people do not want health care reform. I think these issues are similar in a number of ways, but the main connection is prevention.

The primary goal of NSEP is to prevent transmission of blood-borne diseases. The goal of accessible primary health care services is to prevent disease or, if that is not possible, to diagnose the problem early enough for conservative—and affordable—treatment. A syringe costs about 15 cents; a liver transplant or life-long HIV treatment will reach into hundreds of thousands of dollars. The cost of providing help to quit smoking is nothing compared with the cost of treatment for cancer or emphysema. The cost for treating high blood pressure is much less than for treating a stroke. You get my point. Health Care Reform is harm reduction.

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Fear and Loathing

Many people cannot see the benefits of harm reduction or will simply refuse to consider it, which is a big problem. These are the people who use the fear, anger, and misinformation that lead to those angry protests. I have listed some examples below.

Some people object to including illegal immigrants in a universal health care program. I would rather diagnose and treat everyone—regardless of immigration status—for tuberculosis than risk being exposed while I am shopping. Treating one case of tuberculosis can save countless pain and suffering, not to mention the millions of dollars needed to find exposed people, get them tested, and provide care.

Some people object to a provision that would reimburse providers for having end-of-life discussions with their patients. People who trade in fear have said that this provision will generate “death panels.” As you know, we are already required to ask end-of-life questions when patients are admitted to the hospital. I remember the first time it happened to me. I was going to have outpatient surgery and was shocked to be asked what should be done in case things did not go well. These discussions ought to be so routine that people are not shocked when they happen. I, for one, will save the system a lot of money when my time comes because I do not want to endure heroic and futile measures.

Some people object to “socialized medicine.” I'm not sure I have a completely clear understanding of what socialized medicine is, but I know that what we currently have does not work. Too many people slip through the cracks in the current system. Too many people have inadequate care. Too many people suffer needlessly. And too many people use too much of our limited resources by showing up in the emergency room too late for life-saving treatment. As Tom Daschle said recently, “The status quo is unacceptable” (Health Care Debate on Meet the Press, 2009). President Obama's initial reform program included a publicly funded option for health insurance, which is under attack as I write this editorial. I hope that the President's provision remains in the final legislation because it upholds a primary aspect of the American economy: competition makes the players work hard to provide the best product for the best price. We need the option of a public plan to make reform work.

Some people are concerned about the cost, and I cannot say I disagree with them. It is scary to hear the numbers that are being publicized. However, I keep reminding myself that it will be so much worse if we do not do anything. Just think, if President Clinton had been successful in reforming the health care system during his presidency, we would already be 10 years into a more equitable, effective, and cost-saving system. Without reform, costs will continue to escalate, people will continue to be dropped from their plans, and millions will go without health care. We cannot afford to delay any longer. Health care reform is an investment in the future.

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An Opportunity

Atul Gawande (2009), a surgeon from Boston, wrote, “… we are witnessing a battle for the soul of American medicine” (p. 8). In that article, Dr. Gawande said that insurance companies currently pay physicians for how much they do rather than how well they do it. They also pay physicians as individuals. He made the point that—if we actually want a system of care—we should reimburse care teams that work together for the best quality outcome for the patient. Health care is complex, and no profession or individual has all of the skills needed to provide comprehensive care to a patient.

I feel the need to amend Dr. Gawande's statement because I believe that what we are really witnessing is a battle for the soul of American health care. Health care is what nurses do. Nurses are key team members and they need to stand up and be counted. Health care reform is good for the public health and it provides an amazing opportunity for nurses to be recognized as the expert and essential care providers that they are.

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