1. Humphrey, Carolyn J. MS, RN, FAAN

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The recent debate in Congress over the Medicare Prescription Drug Bill has caused the media, our elected representatives, and all Americans to again focus on coverage for one part of our population on one area of healthcare-prescription drugs. Admittedly the cost of prescription drugs and the ability of certain groups to choose between food, rent, heat, and the necessary medications should concern us all. Even "middle income" citizens who have a drug benefit often pay thousands of dollars a year for medications which, in this economy, impacts on an income that has been fixed for quite a while. Tidbits of information about our patchwork healthcare delivery bombard us daily. For example:


[black small square] Approximately 41.2 million Americans were without healthcare coverage in 2001. This resulted in the U.S. spending approximately $35 billion per year to provide uninsured residents with medical care, often for preventable diseases or diseases that could be treated more efficiently with earlier diagnosis.


[black small square] A sustained economic recession and escalating health insurance premiums could raise the number of uninsured to 51.2-53.7 million in 2006. This represents an addition of at least 10 million Americans to the ranks of the uninsured (NCHC, 2003).


[black small square] Most states have decreased Medicaid health coverage for women and children.


[black small square] Medicare pays generously for cardiac care in hospitals resulting in physicians and hospitals scrambling to build new cardiac centers, doing special surgeries and adding "room service" to compete with their cardiac competitors.


[black small square] While the cardiac business is booming, payments for psychiatric care, preventive screenings, and case management are being severely scaled back.



In a recent New York Times article, Reed Abelson stated:


"Medicare-which pays for some $100 billion of inpatient hospital care annually, and sets the pattern for many private insurers as well-is not the sole driver of this investment. Health executives say that Medicare's payment system for hospitals, with its emphasis on procedures and its weak ties to the actual costs of providing care, exerts a strong influence on which medical needs in a community are met."


This statement only reinforces what those of us who've been patients in the "system" worked as professional caregivers in the "system" and who've tried to push prevention to the system's payers and designers have known all along-the "system" is badly broken.


Unfortunately, neither political party has developed a plan that addresses the bigger problem of delivering healthcare to the U.S. population. Instead, the "system" keeps being legislated one piece at a time. We should pressure our representatives, senators, and presidential candidates to address core issues such as drug costs, insurance and HMO profits, equitable access to care, and the ineffective and inefficient model of care focused on illness.


You have a choice-you can be the passive victim of change or work to affect it. 2004 presents an opportunity that is knocking-let's answer, and answer loudly!




National Coalition on Health Care (2003). Home page. Retrieved November 25, 2003 from [Context Link]


Abelson, R. (October 26, 2003). Generous Medicare payments spur specialty hospital boom. New York Times.