According to Bukhardt and Nathaniel ‘s (2008) opinions which were based on Jean deBlois’ (1995) examining fundamental factors of “social consensus on the question of a right to basic health care for all persons, strength and energy of those who argued on behalf of individual rights and liberties over the needs of the community or the nation; unconstrained powerful interest groups; and little or no recognition that substantive reform required a significant challenge to the values that inform and drive health care”. (p. 391)
Indeed, we will face many challenges is we decide to provide health care access to all. However, it is possible to achieve this goal. We need cooperation within this nation, and people need to agree first on the same goals, national health access. As the case of Medicare and its passage and eventual absorption into our society and healthcare system demonstrates is that it is a long road that is not expected to be easy and even once passed, might already be outdated upon inception. With so much changing in healthcare, especially in terms of costs and insurance coverage problems, the only way to truly create a functioning and workable plan is to do so with immediacy in mind. In other words, it is vital to create a plan with the intention of full-scale implementation immediately.

Economic factors
“The iron reality of health care is that death is almost always the lowest cost outcome” (Moris, 2008, p.8) and unfortunately, this grim statement goes far beyond being a sad wake-up call. What is being suggested is that in this economy that is tied to problems with unaffordable healthcare and the national, private, and individual debt that arises from it, affordable and accessible healthcare has become a life-or-death proposition. In our economy, people are not just waiting to get healthcare or discussing the quality of what they get—they are having to decide between paying their bills to keep a roof over their head or die of a disease that has a proven cure or treatment. This is a sad state for not only American healthcare, but its related implicit statement about the true value of capitalism for the average citizen.. But does economic distress appears to be a valid excuse? “The Roaring Nineties were no table for waiting lists for $4,000 handbags and $44, 500 watches; 75,000 cars sold like hotcakes…As both wealth and poverty continue to rise, many of the most affluent have managed to escape with their capital gains intact”(Farmer, 2005, p.161). Our health care system is expensive, but still we do not see patients’ satisfaction, which is leading many to ask, where did the money go, and where the money will come from? As it stands, United States spend 1.9 trillion dollars annually on health care, and Chile spends 2.8 billion annually on same. However, we do not live longer or healthier than Chileans. Preventive care, electronic medical record, and many other ideas have been brought to allocate the cost in order to reduce potential expense in the future. One of the ideas is that advance practice nursing may be able to provide quality primary care where there is a shortage in primary care providers. The aging and unhealthy population influences both medicine and nursing practice.

-Political factors
Many proposals have been brought before the Congress in the last ten years although few have made any detectable difference in their aims to correct the current ineffective state of healthcare. President George W. Bush remained optimistic about market-based healthcare and made the suggestion that “market competition” would drive the cost of health insurance down, and everyone would be able to afford it. However, “free market” gave insurance companies the power to select criteria which are favorable to insurance companies only and not much negotiation is possible for people who are desperately looking for insurance. Some people suggested a system where national health would be funded by the federal government therefore, tax would have to be increased for this purpose, which naturally caused a great stir, even when it was clear that the market-based solution was no longer effective. Presidential candidate John McCain combined both market competition and tax on health insurance to formulate his agenda And Barack Obama has suggested to mandate businesses either to offer workers insurance or to pay a tax, and some very small businesses would be subsidized by the government. Again, there has been little agreement on any of these proposals and there is, as of yet, no synthesis of these ideas that appears acceptable. “As a recent Families USA report points out: With costs of health care coverage soaring, one aspect of health plan company expenses has kept pace: compensation packages for top executive. One has to wonder what, in addition to growing inequality, is being managed in this arena of for-profit health care”. (Farmer, 2005, p.173) There have been so many proposals; however, none of them will work if we don’t sort out the fundamental problems of this expensive system and cost distribution.

Providing national health care access encounters difficulties from a complex interest interaction within the society. Comparing both president candidates’ health care reform proposals, we can judge their fundamental beliefs in eliminating health disparities. According to Senator John McCain, “We have all tangled with the existing bureaucracy enough to know that such an approach would diminish, not improve, quality”.(Cutler and Wilensky, 2008, p.1537) He offered to eliminate current tax exclusion for employer-paid health insurance premiums and to refund tax credits ($2500 for individual and $5000 for families). Blumenthal, director of the institute for Health Policy, stated that President Eisenhower signed Internal Revenue Service regulations exempting from personal income taxation employer’s contributions to the cost of their employee health insurance in 1954, and 160 million Americans are able to obtain insurance through this policy today. He claimed that Senator McCain would end the exemption, and it will reduce number of employers providing insurance to their employees. Some argued McCain’s policy would reduce the quality insurance companies provided, since they all want to match the number of tax refund. Dr. Oberlander, an associate professor of social medicine and health policy and administration at University of North Carolina, claimed this exemption policy would leave uninsured Americans still uninsured. McCain would enhance market competition in order to provide better quality. In addition, Dr. Blumenthal, director of the institute for health policy at Massachusetts general hospital, argued that McCain’s policy on health care is no different from that provided by George W. Bush, and we know the result was not satisfactory. Obama stated that he will provide insurance to 47 million people currently uninsured and will reduce insurance premiums for individuals.