Posts Tagged ‘health system’

Healthcare’s Best-Kept Secret: Nurse Practitioners

Thursday, August 13th, 2009

If healthcare reform is to successfully overcome the realities of Washington politics, there is one problem in covering the millions of Americans who lack insurance coverage – the physician shortage.  Currently, there is a 30 percent shortage of primary-care physicians, and with less than 10 percent of 2008 medical school graduates choosing that career track.  When Massachusetts enacted mandates for universal health insurance in 2006, the state’s primary-care physicians48019286 were overwhelmed.  A similar scenario could occur on a national scale.

Nurse practitioners — who have advanced nursing degrees, are licensed by the state and often are allowed to prescribe medications — may fill that void because they can treat and diagnose patients at less cost than physicians.  Medicare reimburses nurse practitioners at 80 percent of what they pay doctors for similar services.

Nurse practitioners are vital to healthcare reform because they focus on patient-centered care and preventive medicine.  The House of Representatives has listed nurse practitioners as primary-care providers on their healthcare reform legislation bill.  The profession lobbied intensely to include this legislative language so they can play an important role in a revamped health system.

“We seem to be healthcare’s best-kept secret,” said Jan Powers, health policy director for the Academy of Nurse Practitioners.  Although nurse practitioners typically have less medical education than physicians, they are well trained in skills such as bedside manner and counseling.  “In the United States, we are so physician-centric in our health system.  But it should be about wellness and prevention, not about procedures and disease management,” said Rebecca Patton, president of the American Nursing Association.

Healthcare Reform Will Not Mandate Rationing

Friday, May 22nd, 2009

Conservative columnist Charles Krauthammer’s negative assessment of President Barack Obama’s healthcare reform package is based on his belief that the plan is economically feasible only if that care is rationed.

180px-rationingboardnolavachoncTo quote Krauthammer:  “Rationing is not quite as alien to America as we think.  We already ration kidneys and hearts for transplant according to survivability criteria, as well as by queuing.  A nationalized health insurance system would ration everything from MRIs to intensive care by myriad similar criteria.”

Krauthammer’s personal preference is “for a highly competitive, privatized health insurance system with a government-subsidized transition to portability, breaking the absurd and ruinous link between health insurance and employment.  But if you believe healthcare is a public good to be guaranteed by the state, then a single-payer system is the next best alternative.  Unfortunately, it is fiscally unsustainable without rationing.”

Krauthammer is wrong!  In the United States, healthcare is rationed but it is according to your income and insurance status.  And for the 47 million Americans who don’t have insurance, we ARE already rationing everything, “from MRIs to intensive care (to use Krauthammer’s examples)”.  We have to accept that no matter what the system is that we adopt, that rationing will occur.  The issue is rationing that is unethical and doesn’t meet the mission of healthcare.  The way to mitigate rationing in a nationalized system may be to do what the British Medical Association has suggested, which is to define a set of core services – cardiac care, for example – -which may fall under the rubric of life threatening.  These would never be rationed regardless of who you are.  More elective procedures or non life-threatening procedures, on the other hand, would be rationed.  We can’t expect our health system to do it all and this seems a modest proposal.