By Joanne Warner
There's a technical word for policy concerns and debates like health care reform. They are called "squishy" issues - hard to frame, complex causes, conflicting assumptions and sweeping consequences. Here's where we find ourselves - surrounded by the rhetoric of a squishy issue that is central to the health and the fiscal condition of our country. Our best response is to stay informed, be engaged and avoid the cynicism that can come from watching a messy process.Some personal reactions: • Gratitude to President Obama for raising health care reform as a priority. It was neither safe nor predictable. • Appreciation for those who are proposing ideas and furthering the debate. Squishy issues need visionaries with thoughtful, strategic ideas. • Disapproval for those who are infusing fear or untruths to shape public opinion or championing only the status quo when change is needed. • Grief that the valiant voice of Ted Kennedy has been silenced in this crucial debate.Our health care system is broken because it cannot deliver consistently on the three pillars of system excellence: access, quality and cost. Tinkering at the edges of a fragmented structure will not provide the reform needed to improve our nation's health. We need access that is not linked to employment; that was a dubious idea instigated when salaries were stalled but the benefit of health care could be bought for a trifling cost. No longer true. Preexisting conditions, unemployment and family mobility all render this relationship flawed. We need a quality system that is judged by health outcomes. Where in this debate is the concern about improving the health of our nation or our robust longevity? Too much health care is driven by impulses or habits and not focused where the greatest outcomes could be achieved. The incentives built into the system often reward behaviors other than cost-effective, proven strategies. We need a system that prioritizes primary care, prevention and education around healthy choices, as well as using great biotech and pharmacological innovations.The cost of our system threatens more than our health, contributing to family bankruptcies and corporate solvency. The financial and demographic assumptions that drive our health care are outdated. We need to build a new system that uses our public money on fewer interventions proven to be effective, and allow families to spend their discretionary money as they please. Where does UP nursing fit in? Each of our programs contributes uniquely. Our undergraduate program prepares nurses with twin goals of (a) serving competently and compassionately within today's system and (b) envisioning and creating a better system. They learn that nursing and health care are political, using the classic definition of politics as influencing the allocation of scarce resources. We focus on political competence to engage in political dialogue and use policy as a tool for health promotion. Our graduate program creates masters level Clinical Nurse Leaders with a skill set to lead at the point of care with a strategic view of the care "microsystem." They have been called "disruptive solutions" in health care - just the kind of voice needed in reform and redesign of care.Our Doctorate of Nursing Practice prepares nurse practitioners (NPs) to give primary care to families. I envision a major role for NPs in a redesigned system giving cost-effective, preventive care and managing both chronic and acute health issues. All our UP nurses are "difference makers" in this time of health reform.Years ago, Uwe Reinhardt, a Princeton policy guru noted that the US health providers and consumers would be happier with a single payer system and that we didn't have the political will to make it happen. Let's prove him wrong by muddling through this squishy problem to an improved system that focuses on health, wisely allocates resources and demonstrates a sense of social justice and altruism equal to the nobility of our country. Joanne Warner is Dean of the School of Nursing
