1. Carroll, Susan V.

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Choice can be defined as a thinking process in which we judge the merits of multiple options and then choose one of them on which to act. We make dozens of choices every day-what to eat, what to wear, which patient to assess first, which beeping/buzzing piece of technology to troubleshoot first. Some choices are simple, straightforward. Others are much more complex. But even as we make difficult choices, most of us regard having choices as positive; making choices is one way to maintain control in our lives.

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Every 4 years, Americans make a choice that has enormous implications for us as nurses and the patients and families for whom we care. As we prepare to again choose a president and other elected officials, we have the opportunity, and the obligation, to turn a new page on healthcare politics and policies and rethink the ongoing debates regarding universal health care, healthcare costs, and the initiatives that will keep us healthy in the future. Millions of Americans today are either uninsured or underinsured. Healthcare costs continue to escalate so that healthcare premiums have risen 4 times faster than wages during the course of the last 6 years. As a nation, we spend too little on prevention and public health at a time when the population is aging, many children are inadequately immunized, and the number of individuals with chronic disorders such as diabetes, heart disease, stroke, and Alzheimer disease increases steadily.


As we listen to campaign promises and begin making decisions about our political choices, nurses should consider not only our own needs but those of our patients. Both political parties have made public their vision and plans for healthcare policy. Change is a buzzword in both camps. However, the ways in which this change will take place vary. For example, controlling healthcare costs is a critical element in the changes proposed by both parties. Plans include shifting the responsibility for purchasing health insurance from employers to the individual market. This is in contrast to providing a national health plan that is all-inclusive and would provide assistance to individuals who wish to participate in private or government-supported health plans. One party's proposed plan stresses the individual consumer's role in managing his or her own coordinated care; the other supports the individual consumer in navigating managed care.


Whatever vision of healthcare change each of us embraces, we need to consider the following broad needs:


* All Americans should be eligible for health care and disparities in care must be eliminated.


* Benefits should be comprehensive. Our neuro-science patient population needs acute care, rehabilitative care, long-term care, home care, and respite care that encompasses physiologic and psychosocial needs.


* Portability, flexibility, and utility are essential.


* Care should be integrated and coordinated.


* Issues related to quality and costs need to be transparent.


* Outcome and efficacy research should increase in tandem with bench and clinical research.



As we prepare to make a political choice, we will have to make judgments about the quality of each option's attributes. We have to evaluate the merits, strengths, limitations, and practicality of the proposed changes. Whether we are liberal thinkers, conservative thinkers, neo-conservative thinkers, left-of-center, right-of-center, or squarely in the center, choice is paired with responsibility. We choose from a personal viewpoint, but we have professional responsibilities as well. Our personal choices as nurses have consequences for other people, and the responsibilities associated with our choices extend into the wider social realm.


Choice can be hard. We may make choices we later regret. However, having the option to make a choice is a good thing. How you choose is ultimately personal, but the real value is in the choosing.