Although political campaigning is seemingly endless, right now we're in the thick of the 2012 elections. Politicians from all "sides of the aisle" bombard us with messages and pleas for change, for the status quo, or for commitment to an as-yet undefined program. As they did 4 years ago, the economy and healthcare continue to make headlines although in different ways. In 2008, the economy was about to begin its free fall into the "Great Recession" and Obamacare was simply a plank in a political platform. Today, the U.S. economy is making slow, positive improvements, and the Affordable Care Act has survived constitutional challenges in the Supreme Court.
For nurses, economic gains mean that our job markets and salary structures are less uncertain, that increasing numbers of nursing students will matriculate in the coming years, and that perhaps more of us may seriously consider retiring soon. All "good." The changes that will result from reforms in healthcare-funding, insurance coverage, pay for performance, increased public reporting of outcomes-are not so clearly "good."
Both political parties continue to debate the merits and limits of reform. Both still debate the issues of access to care, Medicare and Medicaid funding and reimbursement, provision of preventive care, possible limits to end-of-life care, and the individual consumer's, and his or her employer's, role in managing and coordinating his or her own care. Voters will again have to weigh their options, the implications of their choices, and the potential impact on their health and their finances. As nurses, we choose for ourselves and our families and for the patients for whom we care. We care for some of the most vulnerable individuals in this country, so our political choices affect their priorities and needs as well. We will again have to evaluate the merits, strengths, limitations, and practicality of the proposed reforms. We make choices not only from a personal viewpoint but with a professional bias. How we think about and make choices for or against healthcare change have consequences for others.
Whatever vision of healthcare we carry with us, we should again consider the following overarching concerns:
* Care should be integrated and coordinated.
* Access to high quality care must be universal.
* Benefits should be comprehensive and include preventive services.
* Health literacy will be essential to successful reform
* Costs must be transparent.
* Research should focus on both outcomes and efficiency.
* Nursing education and practice must move away from "tradition."
Choice is not always simple or straightforward. It can be hard. We sometimes rue today's choices. However, having options remains a positive. How you choose is personal, but take a stand and make a choice.