However, Dr. Antos, a scholar in health care and retirement policy at the American Enterprise institute, argued this promise seems to be too ideal to be true. It did not take into consideration real underlying issues with health care. “Failing to address the perverse incentives that drive health care spending inexorably upward, making insurance unaffordable for millions and shaping (or misshaping) the practice of medicine” (Antos, 2008, p.1648). He further argued Senator Obama’s “play or pay” may prevent employees from getting raises due to the employer having to offer the health plan. Also, it may induce inflation, since businesses will have to raise prices in order to balance their cost. Senator Obama also offered creation of a new national health insurance exchange that would offer choice of private insurance options to uninsured individuals and small businesses. He also would like to regulate all private insurance plans to end risk rating based on health insurance. “Conservatives have long argued that Americans need a choice of health plans. The Obama plan accepts this idea, but minimizes the competition among insurers that makes choice matter”. (Antos, 2008, p.1649). Obama’s emphasis is also on prevention and public health. Further, he would accelerate adoption of electronic medical records. However, Dr. Cohen and his research colleagues stated “Our findings suggest that the broad generalizations made by many presidential candidates can be misleading”. They argued the cost of prevention and public health would not be lower than what we spend right now. There are many ways to allocate cost in order to provide national health access. Further investigation is needed whether preventive health care is cost-effective or not. Yet, ethical consideration has always to be involved in the decision making.
Nursing and health care to all
We, as health care professionals, have the moral obligation to have compassion and commitment to persist on eliminating disparities in health care. We commit to American medical practice ethical principles of beneficence, nonmaleficence, justice, and respect for autonomy. I remember patients who lack proper insurance and the abilities to take care of themselves properly and were forced to make the decision between living daily and living at all. I see communities where fresh vegetables and fruit are unaffordable, but are being substituted with fried chicken and canned food. I remember patients telling me they had chest pain for many months and are afraid to see doctors since they “cost too much”. Medicare and social security are challenged by its funding. Dental care has become unimaginable to many Americans, and healthy white teeth became a sign of belonging to a certain socioeconomic class. There were homeless persons who came to the hospital extremely ill, and also some of them use the hospital as the safest shelter. The medical cost is extremely high and leads to a very odd phenomenon: people who can afford to pay are forced to pay extremely high price in order to compensate for people who cannot afford to pay.
Life expectancy in this country is 77 years, and it is 75 years in Chile. Medicine in Chile lacks advanced technology, yet Chileans live as long as Americans. Why? Based on the opinion of New York University’s annual students visiting to Chile, the community health was well organized in Chile, and each community clinic has access to the detailed health information on every resident in the community. Many people could have avoided complications or chronic diseases if they had opportunity to perform physical check up regularly. When doing discharge teaching, I focus on how important it is to take medication on time and its side effects, but I often hear patients telling me that they are not going to follow my instructions because the drugs are too expensive and they are not going to get my prescription filled anyway. Indeed, I feel the need to address the issues and difficulties my patients encounter. How do we regulate insurance and drug companies? The reasons of why so many people who are underinsured must be related with the reasons of uninsured. Leaving market on its own, as it is now, and hoping that will take care of itself is hardly an option, otherwise there will not be close to 70 (47 uninsured and 16-20 million underinsured) million suffering. Nurses are close to patients, we have an instinct to sense our patients’ feeling. In turn, patients are usually being honest to us. It is not surprising that patients more readily admit their weak points to us than to physicians.
However, Nursing is in invisible in the public, and indeed nursing is counted as the 75th of political action among all professions. Insurance and drug companies’ commercials are everywhere in the mainstream media. They advertise how important and how effective they are, but fail to mention what is the cost. Physicians are working closely with these insurance and drug companies. Physicians may get rewards from the drug companies if they prescribe a certain drug manufactured by a certain company. It is all about market. According to Farmer (2005), professor of medical anthropology at Harvard Medical School, “What happens when health becomes a commodity and doctors conduct “commercial transactions” with patients, in a climate where managed care corporations are the providers?…business ethics do not translate well to medicine”.( p.162)
Further, Farmer (2005) took a quote from New England Journal of Medicine, “there is no longer a role for non-profit health plans in the new heath care environment”, and he argued this “new health care environment has, of course deep cultural resonance with the affluent, in egalitarian society from which it springs. Supporters of medicine for profit do not hesitate to class their endeavor as part of American Way: Freedom of choice is valued more highly than equality of outcome, and….our commitments to beneficence are limited, as reflected by the absence of a constitutional right to receive welfare services. These we take to be the broad moral assumptions of American health care policy”. (p.163)
We, nurses, need to advocate for national health access, and we are the best candidates to speak out for our patients. A profession of a nurse is a sensitive one, and we feel the inequality sharply. Our professional knowledge motivates us to fight against injustice. However, nurses seem to be very busy following “doctor’s orders” and can only feel sympathy about patients. Many physicians expressed their doubts in Nurse practitioners’ knowledge and competence in performing primary care. “I worry that further expanding fully independent role for nurse practitioners in primary care will be an irreversible step that we may regret”. (Kassirer, 1994, p. 205) In an UK study done by Wilson et al. (2005), 25 primary care physicians were interviewed. Physicians showed concerns about threats of social and financial status, and they claimed nurses are not intelligent enough to perform a complex task. However, it is nurses who do the health promotion, follow up the immunization, conduct community visits, and minor illness consultations on a regular basis. These are basic and the most important needs for public. If the nurses do not care about whether or not health care should be provided to all, nurses would still be seen as “doctors’ maids”. If we lose the compassion to advocate for patients, and we would no longer be independent professionals. Instead, nurses would become profit-seeking business persons. However, Nurses should never lose focus on reasons why they have chosen this profession.
