By Diane Vines
Health care reform is currently a much-debated national issue that threatens to polarize the nation. Scaremongers exist on all sides of the issues. Town Hall meetings with members of Congress are increasingly volatile. Protestor groups have been mobilized and many are playing on the worst fears of groups such as the elderly who may be completely dependent on Medicare.
Many of us in health care recognize the complexity of the issues and the possible unintended consequences of the proposed actions; thus we are often torn between the many sides of the reform debate.
As a White House Fellow and assistant to a U.S. Cabinet member, I watched as the unintended consequences of education legislation unfolded and the costs of new legislative initiatives far exceeded the estimates. Although reform may be difficult, with about 46 million Americans and almost 20 percent of working adults ages 18 to 64 uninsured, it is essential to our nation's health that we find a solution to the health care crisis.
To truly understand the implications of the current proposals, it is important to place them in an historical context. Many of us in health care have been observing and participating in various reform efforts across the decades, from the development of Medicare to the development of managed care and other movements intended to increase the cost-effectiveness of care and, therefore, allow more people to afford insurance coverage.
The attempt to increase coverage or provide universal coverage is decades old including the essentially unsuccessful efforts by numerous Presidents from Teddy Roosevelt to Bill Clinton. Hillary Clinton took on health care reform as First Lady but failed to achieve it for many reasons including a secretive process that excluded all stakeholders. The effort was doomed from the start as it lacked credibility and viability.
There have been some successes along the way.
One president who was successful in increasing coverage was Lyndon Johnson, who presided over the establishment of Medicare and Medicaid. There have been successes in increasing the coverage for children both at the federal level and at the state level.
In light of this rather dismal record, President Obama felt he had to get the health care reform legislation through during his "honeymoon" period or legislation would be bogged down in debate and never be passed by Congress. We are seeing how correct that assessment was. As part of the compromises, there has been a subtle change in the language of reform in President Obama's speeches and meetings. The White House is now calling the effort "health insurance reform", not health care reform. With the sympathetic concern for ailing Senator Kennedy, the Senate passed a bill that requires Americans to have health insurance and initiates a government insurance program. The House introduced a scaled-back bill and the debate continues.
Rather than try to pass judgment on the various bills and reform efforts at the state and Federal level, there are some principles that any reform initiative should address. It should:
• Focus on health and wellness rather than illness treatment.
• Include support for self-care education for chronic disease management and wellness activities since a large part of the health care bill is spent on illness treatment for chronic disease complications.
• Provide for the portability of health insurance, such as when an employee changes jobs.
• Include insurance coverage for people with pre-existing conditions.
• Recognize the value of evidence-based complementary and alternative therapies already used by a majority of people in the U.S. as an adjunct to modern medicine techniques.
• Support the expansion and voluntary sharing of electronic health records.
• Include a plan to dramatically decrease the paperwork requirements so providers can focus on providing care, instead of completing duplicative forms.
• Include tort/liability reform, since many specialty physicians such as neurosurgeons and obstetricians can no longer afford to practice their specialty because of the high cost of liability insurance.
• Recognize the importance of research in the basic sciences, such as genomics, new therapies and drugs, since we are world leaders in the development of new drugs and therapies and this research won't happen unless companies can recoup their costs.
• Streamline the FDA approval process, allowing people to use drugs and therapies developed and tested in other countries without the lengthy U.S. approval process.
• Consider the impact of reform efforts on small businesses, since they employ about 90 percent of Oregon employees, area primary provider of health insurance coverage, and are the engine for economic recovery.
• Consider the need for health care workers, especially in rural areas and with vulnerable populations.
• Provide increased support for the free and federally-qualified community health clinics that have a proven track record in providing low-cost care to vulnerable populations.
For those of us who have worked with the underclass and vulnerable uninsured and underinsured, the national and state debates bring some hope for change, but we need to be involved and express our hopes and opinions to help these populations.
Diane Vines is a professor of nursing
