The Need for Health Care for All

Trajectory of the system
We are in an aging society, but we cannot afford a “sick” aging population. Promotion of a healthy lifestyle is the key. Many argue that preventive and public health would not reduce the cost of health care. On the other hand, not everyone needs to have colonoscopy. We need health promotion and disease prevention focusing on individual sensitivity and specificity. For example, we do not need to perform Pap smear on female above70 years old. The cost of duplicate medical tests performed on patients due to the lack of electronic medical record exceeds our savings on preventive care. “Think globally and act locally” would be the right approach if we really want to cut the expense. For example, strong researches proved that many cholesterol lowering agents can reduce the risk of coronary heart disease (and deaths as a result of it) by lowering cholesterol level. However, people who lack insurance coverage would not know their cholesterol level and would not benefit from this drug. These people may end up in coronary related crisis, and may require much more expensive medical intervention. Statistically, chest pain is one of the leading reasons why people visit Emergency Rooms. Monitoring cholesterol and providing cholesterol lowering agents could be a cost effective solution to the problem. On the other hand, Telemetry monitoring and open heart surgeries are not. Health promotion and disease prevention will most benefit a middle age adult, but most of them are excluded from Medicare program. Providing national health insurance would give patients and advance practice nurses more autonomy. According to Gunderman (1998), “What is medicine about? Is it about maximizing the incomes of physicians or health care organizations? Do patients and their suffering exist in some fundamental sense for the benefit of the physician, the hospital, or the stockholder?” (Farmer, 2005, p.175). The sick and the poor are around us, but the world goes on as if nothing happens. However, the society is responsible to protect the most vulnerable of its members. The government, insurance companies, and health professionals have even greater moral obligation to do so. We are responsible to let people have reasonable insurance premium cost, to subsidize insurance to those without, to provide quality preventive care, to promote healthy diet, and to assist them in taking medication responsibly. We need an urgent resolution of health access, and a step into a long term planning at the same time.

-The impact
Some think that providing national health access is not so urgent, but any delay with handling this issue may result in this problematic system becoming too difficult to fix. This country and the entire world are likely to face a long term financial depression and rise of unemployment rate. There is a possibility that uninsured people will increase to 50 million. Who will need health care, who will pay for it, and when is a life worth preserving? Nursing is under the “cost” section in the accounting book of most health institutes. Unlike physicians, they are seen as asset which can generate revenue. Hiring one more nursing staff means increase to the cost of the institute. Who will sense the nursing shortage if the environment is under economic crisis and also with a weak health care system? Some may want to cut down the nursing staff not only in the hospitals, but also in the communities. Fewer nurses and more patients will translate into worst practices. There will be fewer funds to support nursing education, and fewer advance practice nurses. It will leave us worse than today, since it will permit inequalities as the nature of the society. There have been too many excuses and it will continue if we let people to rely solely on the market. The sick and the poor are invisible in this capitalism web. However, they are not just being denied a certain social economic status, but the very right to live. Who will save ants’ life in a forest fire?

The role of NP
Nurse Practitioner approach is a long-term view, since Nurse Practitioners are able to provide a well managed health promotion, disease prevention, and primary care. Nursing education has solid training on ethical decision. Nursing profession is based on high moral integrity, sensitivity, compassion, and caring. Nurses also tend to feel responsible to empower their patients’ autonomy and are willing to be their advocate. There are random controlled trial researches concluded Nurse Practitioners’ care increase patient satisfaction. We need advance practice nurses to provide a better quality patient care, and make sure our profession and our patients are not blindly controlled by the insurance, pharmaceutical companies, and physicians’ interest.

Ethics and follow up
The difficulties of providing national health insurance are also facing the ethic question of “distributive justice”. As we are facing the economic crisis, providing health care to all will not be just one decision. It will require wise decisions about distributive justice. There are many questions need to be answered: How does the government react to policymaking based on limited resource? How do the insurance companies provide adequate services if they are taking high risk? How can nurses provide quality care if the nursing shortage will be even worse than now? There are different opinions as to whether providing health care to all is necessary or not. Interests of different stakeholders become one of the difficulties while we are trying to provide either national access or coverage health care. According to American Nurses Association, , nurses commit to code of ethics that we practice compassion, promote, advocate for, and strive to protect the health, safety, and rights of the person, and preserve integrity of the profession. Providing light and clean water sounds so obvious, but most of us do not realize that this society still needs to work on providing fundamental health care. We, nurses, work as partners with vulnerable; we have moral responsibility to be their advocates. Public ignores the importance of primary prevention and community health while we are worried about the medical expense and growing number of uninsured people visiting emergency rooms. “First, research has shown that physicians are poor predictors of which patients will comply with prescribed regimens. Second, those least likely to comply are usually those least able to comply” (Farmer, 2005, p.165). Why does health care to all matter? We, nurses, practice one of the fundamental ethic principles: distributive justice. Who are we to decide whose life should be saved? “The countless people whose life course is shortened by unequal access to health care are not topics of discussion. To hear dead silence in the realm of medical ethics, you have to look at access for poor people, especially, those who…can be hidden away” (Farmer, 2005, p.174). We need the ability to track records of the vulnerable part of our society through Center of Disease Control and Center of Medicare Service. We can also follow up on the plans offered by insurance companies. We, nurses, should keep being involved with our association and always speak out on the problems in the industry that need to be addressed. Both general public and the government need to hear our voice, since this is the voice for the vulnerable. Dr. Martin Luther King said “Of all the forms of inequality, injustice in health care is the most shocking and the most inhumane” (Farmer, 2005, p.173). I believe advance practice nurses have the ability to enhance these responsibilities and ethics. We, nurses, are willing and dare to save ants’ life from a forest fire.

Follow up Specific Source of Information:
Closely follow up with Center for Disease Control and Prevention; we can monitor the epidemiology of the disease and the comparison with previous status. The CDC maintains several departments concerned with different population and disease. It provides health professional a great tool to know how our patients are really doing. CDC website also has the health status of each neighborhood. This information is particularly helpful while we plan health education to our patients, since we have the background of susceptibility of certain disease in certain area. Second, Department of Health website provides information of insurance programs. It will serve health professional a great source to follow whether any changes will benefit our patients. Department of Health also provides information of the quality of each health institute. We gain knowledge about which institute has better infection prevention or which institute provides adequate teaching to patients from this website. Nurse Practitioners need to advocate for our patients and we need to continuously demand evidence-based information. Last, we need to monitor how the newly elect president selects his political team, and we can predict how incremental or dramatic the health policy change may be. It is crucial, since Nurse Practitioners will speak up for any inadequate plans. We are the frontiers to protect the benefits of our patients.

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