My Healthcare reform proposal

My Healthcare Reform
Proposal

I have been a registered nurse for ten years and a person with outspoken opinions for longer than that, so here are my health care reform ideas.

I believe that the infrastructure is one of the only things really worth keeping. I believe the health system in America is in need of total reform for it to serve all in need.

I will use one scenario of a patient type to show how my reforms would work. The ideas I will present will be based on this scenario but will apply to all in one way or another.

My mock patient is a 35 year old man with no health coverage offered at his place of employment, a small 6 person heating and Air Conditioning Company. His yearly income is 30,000 a year. He is married has one child and his wife is a clerk at a local convenience store making 18k a year. He is slightly over weight, eats a diet high in fat and low in fiber, the traditional American diet. He sees a physician only when he is ill and usually at the emergency room when he thinks he just can’t take it anymore. His blood pressure is slightly elevated; he has a family history of diabetes and heart disease.

1. Universal Health Care/ Affordable Insurance: Health insurance for all is where the process starts. It could be a single payer system or a hybrid of our current system. As long as all are covered and that coverage includes all aspects of care to include prescriptions. I believe the employer based health insurance system should be entirely scrapped and the premiums paid for by the states or the federal government. The personal financial responsibility would be based on a persons personal income and those below a certain income would be subsidized or receive free insurance. The premiums normally paid by business would have to be paid into the national health care pool that would provide the base asset pool for the program. Your individual premiums would continue to be removed from your check in the same manner that all other income based taxes are removed. We would all have the same insurance and there would be no difference in the programs for the rich or the poor. This would have to be federal law.
The insurance companies would still be able to make a profit but not what they have become accustom to. They would be required to compete for a given market and would be forced to promote prevention and healthy life style over denial of services to increase their profit margins.


2. Disease prevention: If disease prevention were the focus our healthcare system instead of the treatment of disease and symptom we could prevent many diseases from progressing and contributing to other costly conditions.
Diseases like diabetes and hypertension are chronic conditions that untreated lead to a variety of other costly and often deadly conditions like heart disease, stroke, peripheral vascular diseases, blindness, amputations, renal failure and many more.
We must first begin to promote this with a change in the way we pay our physicians. We should reward our physicians when they keep their patients healthy and for finding problems early when they are less costly to treat. This would require legislation to remove insurance barriers to physicians ordering test for their patients. I am not suggesting a return to fee for service but to a system that values health over short term profits. Our current system does not allow doctors the freedom to treat their patients as they see necessary. After all they are licensed physicians and are supposed to be qualified to make those decisions. I am not advocating for the removal of oversight but do not believe the best person to provide that over sight should be the insurance industry.

Looking at our patient he would have his hypertension treated and that treatment may help prevent his progression to costly treatment of heart, renal and other vascular diseases. The physician would have the tools available to monitor and treat the hypertension with the latest treatments available. The physician also understanding the effects of diabetes and his patients risk factors and could monitor and treat his patient if the disease is present or is found on regular check ups.

If his patient continues to be healthy and meets certain benchmarks then that physician would see and increase in his reimbursement and as a result of his practice would grow.
Many would ask then what will keep practices from refusing patients who are less than healthy and my solution to that issue is to tailor the benchmarks according to the patient’s baseline and accepted theory on disease progression when it is being effectively treated.

Some patients will be non compliant and will continue to work against the goals and measures needed to promote health and those issues would be taken into consideration. You can lead a horse to water but you can’t make it drink. I do not believe in utopia but I do believe that many people are willing to learn a better way and would take advantage of health care if it were available.


3. Inpatient Care: I have been a nurse at the bedside in acute care for ten years now with a brief period of my career as a nurse manager. I believe the greatest reform needs to take place in this arena. There are many issues that the current for profit system cannot solve on its own.

Nurse to patient ratios should be mandated federally and apply to both acute and long term care facilities. There are many ways that this can be done and what ever method is chosen it will require that we deal with increasing the number of nurses willing to work in the inpatient environment.

The studies have been performed and have all come to the conclusion that patients suffer and are more likely to die or end up with costly and debilitating complications due to high nurse to patient ratios. If the ratio of nurse to patients match the reality of the care needed by the patient then we can decrease the days a patient is in the hospital, maximize the patients possibility of return to their baselines and decrease the potential for long and costly treatments as a result of injury due to lack of care. We have failed to keep up with the survival rate of our patient population. Years ago the patient that is now on the medical/surgical floor was in the ICU and those that are now in the ICU were dead. With that said our current for profit system has failed to acknowledge that these patients now require more than they used to and that requires more nurses and fewer patients assigned to each nurse to maximize outcome.

The next issue is the freedom for nurses and other health care providers to report abuse and problems in our system without the threat of termination or reprisal from their employer. Nurses are not allowed to speak freely about the issues that face health care and I have experience the repercussions of speaking out for reform, first hand. Employee’s rights to organize should be strengthened by the formation of a national union for health care workers that promotes fairness in the work place that works for all.

Technology: The use of computerized records should be mandatory. Paper should almost be a thing of the past in a modern health care setting. We spend 40-50% of our time charting and documenting in redundant ways. Technology if used properly could in my opinion reduce that time in half. Physicians placing their orders directly into the patients plan of care instead of having it processed by two or three people would reduce errors in transcription that result in delayed treatment and medication errors that kill thousands of patients every year. Programs have the ability to check the medication against know allergies and to even assist nurses in their recognition of unwanted symptoms and interactions with other medications. We are not taking advantage of what’s available and people are suffering for that. These technologies are expensive but will pay for them selves over time and will decrease the likelihood of costly and potentially deadly errors.

The old timers and the alarmist who are resistant to technology should be helped to get over their fear or be left behind. My health information privacy is important to me and all measures should be taken to protect it. The ability for someone to hack into my information should not keep us from moving forward. I value my life more than I value the information about my life and it is my opinion that the health care system moving into this century out weighs the possible risk to my health information.



If just these reforms were made, I believe we would all be better off. I love my profession and my country and wish for the day that I can say as an American and a nurse that we value human life and that when it comes to the health of our citizens we believe all should be treated equally.