A few weeks after Congress authorized $700 billion to "rescue" our struggling financial institutions, a colleague said to me, "Well, there goes any hope for health care reform after the election." But is that true?
The following are likely scenarios because of the now-global economic crisis.
The ranks of the uninsured will increase. According to the Bureau of Labor Statistics, September's unemployment rate was 6.1%-the highest it's been since 2003. And it's likely to continue to rise as layoffs extend beyond Wall Street. Carol Raphael, chief executive officer of the Visiting Nurse Service of New York, said her organization, already grappling with a growing number of patients without health care coverage, is having to increase its charitable care.
People will delay primary care and forgo prescription drugs. This means their illnesses will worsen and they'll rely on crowded EDs. In a July survey of consumers by the National Association of Insurance Commissioners, 22% said they were seeing their physicians less often, and 11% said they were cutting back on prescriptions.
The health care industry will tighten its belt. On October 15 the New York Times reported that hospitals were also facing a credit crunch. Some were halting construction projects, and downsizing was likely to follow. Redesigns of nursing units to make care more efficient are being abandoned or delayed. Cutbacks in Medicaid funding and in profitable elective procedures may force hospitals to close.
The nursing shortage will ease-for now. As early as May 7 the Wall Street Journal reported that nurses who had retired or left the field were returning to help their financially strapped families. But returning nurses or those who put off retirement may not be able to handle the rigors of bedside nursing. Institutions will need to better modify work assignments to suit aging nurses.
Linda Burnes Bolton, chief nursing officer at Cedars-Sinai Medical Center in Los Angeles, told me recently that nurses were requesting more work hours and she was particularly troubled by "the number of new grads who can't find jobs." Health care organizations may seek out lower-paid workers, even though research shows this kind of belt tightening will jeopardize clinical outcomes and may not save money (see "Nurse Staffing and Patient, Nurse, and Financial Outcomes," January).
The economic challenges we face can be a strong impetus for reform. But it won't happen if we see reform as simply financing health care as it is today. We need to explore what health care should be and what our priorities are. Although I believe health care is a right, I'm not willing to pay for every 90-year-old to have an artificial heart. At the recent Nursing Management Congress in Las Vegas, Nevada, I spoke to a group of nurses about how we waste money on overscreening and overtreating instead of focusing on behavioral changes, such as diet, that promote health. I saw heads nodding throughout the audience. Nurses know we don't have cost-effective systems of care; they see the waste in health care every day.
After a season of campaign speeches on how to pay for health care, with Barack Obama poised to assume the presidency, it's time to change the conversation. It's up to every nurse to help our policymakers, communities, and workplaces turn this economic crisis into an opportunity for true health care reform. Yes, we need to find ways to ensure coverage for all. But it's also time we changed our views of what health care means during this time of economic crisis. We need conversations about priorities, such as the need for supportive end-of-life care rather than futile high-tech care, and about promoting health by coaching patients to make lifesaving-and money-saving-lifestyle changes.