It's time to get serious. I know, it may not be fun, but our healthcare system is slowly collapsing and I am concerned that if we don't create change now, it's going to be much more dire in 5, 10, or 15 years from now.
Truth be told, I am a nurse and have been for 15 years; before I was a nurse, I was a health educator and before that I was a candy striper and the daughter of an RN. So I have been around and involved in healthcare for sometime. Besides also being a consumer of healthcare services, I teach graduate nursing students healthcare policy and economics. I have written several published journal articles on the nursing shortage and nurses' lack of voice in the larger healthcare arena. Nurses are the largest number of healthcare providers in the USA and yet we seem to have the least input into the reform process and our own future workplace endeavors. I belong to my professional organization(s), and I would like to see every nurse step up and make his or her voice heard. Nurses are still trained to be somewhat passive and often they are made to feel powerless in both the academic and workplace arenas. Nurses are not offered adequate education around the political process until graduate levels of education, an academic level that most nurses will not pursue.
In 2001 when I graduated from my Masters of Science in Nursing from the Cal. State System, I was named "graduate nursing student of the year". <pat on the back>. I mention this because at that time I gave a speech to the faculty and a few other health science students entitled "20/20 vision in nursing". My point was that we need to look toward the future and create plans for transformation, but we also need to realize that, as we get closer to that once far-off-future, the view, the vision, and the perception will change. We then need to adjust our plans and create more and new transformational processes, as the future vision becomes today's reality.
So... my point is that while healthcare reform is on the legislative blue plate special menu of the day, most of the endeavors in this area seem very "near sighted". The legislators are not considering long-term implications and visions for what healthcare needs to look like both now and in the future.
Here are some of my thoughts on how we should proceed:
1. Calm the hysteria. I am a little shocked that folks are so resistant to change. Far too many people are living in fear of the changes in their own healthcare coverage in order to create a more viable, sustainable, and accessible system. I have had my facebook friends mention that they feel these moves will be from a socialist agenda and that Armageddon is right around the corner from that, "just as it says in Revelations".
The truth is that our healthcare outcomes are poor; for instance, when we look at prenatal care, we rank 26th in the world, behind Cuba at 25th (see world health organization for more healthcare rankings where we look quite dismal). For all of our technology that we use in providing prenatal care, women and children are suffering more here then in many other countries.
Fears of rationing of healthcare are also naive and unjustified. For instance, our renal failure outcomes are behind those of Canada, yet Canada spends far less on these applicable treatments; and they "ration", as they do not provide dialysis for elderly folks with new onset renal failure. Yet if one had renal failure, one would statistically live longer, and likely have a higher quality of life, by receiving care in Canada over the USA.
Additionally, healthcare is already rationed by both the government systems and insurance companies. Kaiser is especially adept at providing preventative care for young folks.
2. We need to send a clear message that the current system is not sustainable and if action is not taken soon, the consequences will be grave. Individual folks are so clingy to their own right to healthcare as it is now, that they can't seem to realize that at any point they could be denied or lose coverage for a variety of reasons; we have an epidemic of denial. We need to let folks know that change means growth in new directions and that we have plenty of good, successful healthcare models to look toward to create some sort of hybrid system where everybody is covered, and everybody pays in. We do not need to have a "free system", but we do need to have an accessible system.
There is something twisted about the absurd for profit insurance company profits and folks need to realize that they are already paying a high price for healthcare. A CEO of an HMO can profit as much in a year as it would take to cover all of the children's healthcare costs in the state of California. I personally think this is absurd and this sort of approach is more likely to lead to "end-of-the-world" scenarios then a sustainable healthcare system will.
Fully one-third of our healthcare costs are spent on administrative fees and if we can create a more standardized and centralized reimbursement and billing system, we can likely bring those costs down to a more reasonable 5-10%.
3. We need to educate folks on various healthcare models that do work; in Switzerland one has a choice of non-or-minimal-profit insurance providers and if one is dissatisfied with the care or coverage, one can switch providers without being denied and without a raise in premiums. In the Netherlands, healthcare coverage is mandatory and they use a hybrid system of both private and public systems. The private health plans are competitive and the average person pays around $150/ month for coverage, with children under the age of 18 receiving free care and government subsidies provided for those of lower income. There are many solutions to our issues and many challenges we must face, but it is hard to believe that we can't use resources to come together and create visionary change.
4. As mentioned previously, we need to have a vision for how to create a sustainable future for healthcare. If we move toward mandated or universal coverage of some kind, many changes will need to take place.
*Hospitals will have to close and there will be larger regional medical centers, perhaps with outlying urgent or emergent care centers. Hospitals will be more like ICU settings. Uncomplicated births and most deaths will generally take place in the community setting. Outpatient surgery will be more of the norm.
*Care will need to take place in community settings and public and community health efforts will have to be better funded in order to provide preventative and primary care.
*We will need more doctors and advanced practice nurses, but their educational backgrounds will have to change as well. They will need to be trained on developing caring relationships and supporting folks in creating healthy lifestyles. We will need more faculty members at our institutions of higher learning, who are ready to create new curricula to adapt to this change.
*Health education, self-health responsibility, and creating healthy lifestyles will have to become the norm. We need to have less reliance on expensive and often dangerous medications and technology, and more reliance on individual's self-health and healing efforts. We need to better explore and implement alternative modalities and support people in eating healthy and getting adequate exercise. This needs to begin as educational efforts in our school and community settings. Nurses are prepared to offer support in this area and could prove to be key resources for this type of transformation.
*We need to change our cultural fear of death and dying; the majority of one's healthcare expenditures across a lifetime are spent at end-of-life, and often on futile care efforts. Death is inevitable and we could learn from those cultures that practice and prepare for the process.
Many changes need to take place, but they can be gradual versus quantum and the shift toward self-health responsibility and some autonomy around one's health status are values aligned with our founding father's vision of life in the USA.
Secretagentwoman is signing out for now, though I likely will have more thoughts in this area to be shared soon.