Nurses Rising

Nurses are legion. We populate almost every corner of the healthcare industry, and we are the largest segment of the global healthcare workforce. In terms of hands-on care, we're at the bedside, in the home, caring for residents of long-term care facilities, taking care of schoolchildren, ministering to the dying, and tending the wounded on the battlefield. Like I said, we are legion, and our importance to society cannot be underestimated.

Book Review: "The Real Healthcare Reform"

Note: As with all of my book reviews here on Digital Doorway, I received no payment for this review other than a copy of the book from the authors in order to expedite the review process. 

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According to Linda Leekley, BS, RN and Stacey Turnure, RN--the authors of "The Real Healthcare Reform: How Embracing Civility Can Beat Back Burnout and Revive Your Healthcare Career"-- incivility "infects" healthcare workplaces in epidemic proportions. Based on that premise, the authors maintain that it is through embracing civility that true healthcare reform will take place.

The Burden of Medical Bills

A recent study released by the CDC (and reported on Medscape and other sites) states the blunt fact that 20% of American households have difficulty paying their medical bills. And the National Center for Health Statistics states that 1 in 5 Americans has lived in a family that could not pay its medical bills in the last 12 months.

Chronic Disease and Optimism for the Future

A recent press conference sponsored by the Partnership to Fight Chronic Disease (PFCD) revealed a startling statistic: chronic disease costs the American taxpayer more than two Wall Street bailouts per year. (To listen to the press conference or download a transcript, click here.)

According to PFCD, 45% of Americans live with a chronic illness; poorly controlled asthma sends 5,000 people to the ER every day; and obesity rates of American teenagers has tripled in the last 20 years.

Perusing the PFCD website, it's obvious that there is a great deal of optimism being verbalized vis-a-vis the opportunity that Barack Obama and his administration have in terms of addressing chronic illness and health care reform. Improvement in the management of chronic illness is seen as a clearly bipartisan issue by many in the know, and a number of members of Congress are apparently already preparing policies vis-a-vis these issues in advance of Mr. Obama's inauguration and first 100 days of governance.

In terms of technological advances, there are many policy-makers and consumers who are calling for a national Electronic Medical Record (EMR) that will streamline information, track prescription drug use and medical visits, as well as allow more continuity of care. This type of system would also allow for easy access to immunization records, would simplify facility-to-facility patient transfers, and facilitate care of patients who have moved or who need health care while traveling. Furthermore, chronic disease care could also be greatly enhanced by such centralized record-keeping, providing crucial financial and medical data about the overall state of American health---and its medical management. While pundits (justifiably) worry that a government-run EMR could raise Orwellian privacy concerns, perhaps some type of third-party oversight could assuage such fears as the project moves ahead.

Obviously, something needs to be done to address the state of disarray in which we find health care in America. We are less healthy, more obese, taking more chronic medications, and experiencing greater levels of stress than ever before. Sadly, 40 million of us are still uninsured (a pathetic statistic which I am apt to belabor ad nauseum here on Digital Doorway), and the percentage of us suffering from chronic conditions such as diabetes and heart disease is currently rising.

As 2009 beckons, the Obama-Biden transition team is revving its engines and preparing for an all-out attack on the American economy, including the economics of health care. In my virtual peregrinations, I am seeing that a great deal of optimism is being expressed vis-a-vis the future of health care and chronic illness management in the United States. As the economy inevitably rises from the ashes and financial stability returns to the markets, many feel that the health care
infrastructure will also revive itself with government-funded resources aimed at curbing chronic illness and improving public health. As a newly-minted Public Health Nurse, I am quietly joining that chorus of optimism, and will do my best (from my lowly municipal position) to support those valuable and forward-thinking efforts.

The Obama-Biden Health Care Agenda

The Obama-Biden Transition Team is requesting that all interested citizens pay a visit to the transition's website, Change.gov, and voice ideas and concerns regarding American health care and health care reform. By clicking here, you can go directly to the web page dedicated to the health care agenda and submit your opinions and views.

The Obama-Biden web page discusses health care in this manner:

"On health care reform, the American people are too often offered two extremes -- government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.

"The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

"Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options."

Allegedly, the plan would:

• Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
• Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
• Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
• Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
• Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees' health care.
• Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
• Ensure everyone who needs it will receive a tax credit for their premiums.
• Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.
• Require hospitals to collect and report health care cost and quality data.
• Reduce the costs of catastrophic illnesses for employers and their employees.
• Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.

I am personally dubious that insurance company practices can be sufficiently reformed to prevent abuses. I am also dubious that such a ponderous system administered by both the federal government and employers will not prove incredibly complex and difficult to manage for employers, government officials, insurers, providers, and consumers alike.

In terms of the plan, I would also like to see the following:

• details regarding a more robust national plan of preventive health care initiatives
• sufficient funding for public health initiatives
• sufficient funding for emergency preparedness and the national Medical Reserve Corps
• a comprehensive plan to decrease the nursing shortage, including grants and loan forgiveness
• a plan to assuage the nationwide shortage of primary care physicians
• a plan to create an Office of the National Nurse

Despite my reservations, doubts, and dubiousness, it is indeed exciting to see a new administration apparently dedicated to transparency, as well as the active participation of all Americans in the process of change that is underway.

Meanwhile, I am willing to suspend my disbelief, listen to the conversation, join in on the conversation when I have something useful to say, and watch as the story unfolds. These are exciting and nerve-wracking times, and I do indeed hope that the change that has been promised will indeed be delivered. Until that time, patience is one virtue we will all need to put into practice.

Obama, Daschle and Healthcare

It is now confirmed that Barack Obama has asked former South Dakota Senator Tom Daschle to serve as the administration's Secretary of Health and Human Services. While the nominee has already undergone a rigorous vetting process by the Obama transition team, he will of course face a Senate confirmation hearing after the President-Elect is inaugurated on January 20th. I will venture a guess that Daschle will be handily confirmed by the Senate, and I imagine that he is already setting his sights on a broad plan of action. Whether that plan leads to successful change in the healthcare trenches remains to be seen.

Meanwhile, a powerful bipartisan group of senators met in the offices of Edward Kennedy (D-MA) today, at the behest of Senator Max Baucus (D-MT), to begin shaping potential Democratic legislation vis-a-vis broad healthcare reform.

With 15% of the country's GDP going to healthcare and the number of American uninsured (estimated at 40 to 47 million) expected to rise as layoffs and unemployment increase in response to the economy, the stakes are high for meaningful healthcare reform.

We all know we can do better. In terms of healthcare access, funding and quality of care, the World Health Organization has ranked the United States as 37th in the world. Concurrently, our ranking in terms of infant mortality and life expectancy also continue to plummet when compared with other nations. These statistics bear out the widely accepted notion that the enormous per capita expenditures on healthcare by the United States government have fallen far short of their potential, and many other countries have somehow managed to produce far better results utilizing a percentage of what we spend here.

The battle regarding the potential benefits and pitfalls of universal healthcare is on. Yesterday on Digital Doorway, I pointed readers towards an excellent website where the arguments for and against universal government-sponsored healthcare is being argued quite cogently. This nationwide conversation will only intensify, and it remains to be seen how the Obama administration will rise to this Herculean challenge.

I am personally and professionally invested in the developments vis-a-vis healthcare reform in the United States, and I assume it will be years before we know the true successes or failures of President Obama's efforts, with support from Tom Daschle and other key players (not to mention the input of the American people, if it is heeded amidst the noise).

These next months and years will be an interesting affair, and great grist for writers, bloggers, healthcare policy professionals, pundits, and ordinary citizens alike. Meanwhile, as the conversation and debate rages, the statistics related to the uninsured and underinsured will certainly worsen. We can only hope and pray that a truly remarkable (and successful) solution is indeed within reach.