1. Section Editor(s): Carroll, V. Susan

Article Content

As Americans usher in an era of political "change," healthcare reform remains a top priority. Key Congressional and Executive Branch leaders and diverse consumer groups across the spectrum of the American electorate have identified accessible, affordable healthcare as a critical element of our lives. The inclusive agenda of President Obama provides us with a unique opportunity to rethink and rebuild a healthcare delivery system that focuses on quality, efficiency, and behaviors that promote excellence.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Only 7% of Americans are confident that they will be able to continue to afford adequate healthcare. Today, more than 45 million individuals, including nearly 9 million children, have no health insurance. Economic estimates demonstrate that, with every percentage point increase in unemployment, another 2.5 million people lose their job-related health insurance and must purchase more expensive coverage through COBRA or remain uninsured.


However, in a frightening economic climate, how might healthcare reform fare? How and who will fund reform? Will the United States move toward a "socialized" healthcare delivery system? First, our economy and our healthcare system are inextricably linked. A strong economy supports a job-based healthcare system, but that system must be efficient and affordable and include enough competition to make it possible for both large and small businesses to buy insurance for their employees and their dependents. A strong economy may provide businesses with the monetary strength needed to insure full- and part-time workers. A strong economy also provides the funding needed by the Federal and individual state governments to support Medicare, Medicaid, and other healthcare-related programs and research.


Next, we will need to shift our social perspective or view of healthcare. Healthcare is not a privilege, available to some but not others, or a simple commodity; it is an essential human right. Healthcare is one of many social responsibilities, not simply a personal one. Healthcare is a form of public good that, like police and fire protection and education, benefits all of us. Healthcare reform should help us redirect our resources to create a system that incites everyone-individuals, insurers, businesses, and government agencies-to focus on disease prevention and wellness promotion. Today, even Americans with insurance receive too little appropriate preventive care and a substantial quantity of expensive, unnecessary care.


Americans may also need to rethink our quest for ongoing, seemingly endless technological, pharmacological, and medical progress and innovation. There are few values as deeply embedded in our cultural psyche as the desire to conquer the long and ever-growing list of diseases that cause human suffering and death. However, progress and innovation bring with them high costs. To reform our heathcare system, we will have to rethink the ways we fund and pay for the steadily rising costs of care. This is a problem also faced by European countries with nationalized or socialized, but universal, healthcare. They control costs by restricting the numbers of physicians and medical students, by aggressively negotiating physician salaries, by implementing national healthcare budgets that are based on mandated benefit packages, and, perhaps most importantly as we think about change, by controlling technology expenditures. The diffusion of expensive technology is limited, and pharmaceutical prices are fixed. These measures are in stark contrast to some of our uniquely American values; to implement them will require open discussion, some soul searching, and a vision of a "new" healthcare system that includes all stakeholders in its planning and implementation.


What does healthcare reform mean to us as nurses? What roles can we and should we play in the process of changing it? We are stakeholders whose hands hold many cards. Nurses are an integral part of the business world of healthcare. Our professional lives are woven into the fabric of the healthcare delivery system. Our livelihoods depend on its economic well-being. As nurses, we provide direct care, we teach, we act as advocates, and we carry out research.


We are also consumers of healthcare. Although we may understand the system better and the ways to navigate through it successfully better than do many other consumers, we face the same affordability and accessibility issues. For example, in some urban areas with many available resources, the wait for an appointment for a nonemergency, screening mammogram may be as long as 8 months. We, too, have to preplan our path through the system to gather referrals and permissions for treatment to limit our costs. We, too, may be priced out of selected treatments and drug therapies.


Our access to research funding is also reliant on the economic pressures affecting available research dollars. As we try to demonstrate the ways in which evidence-based nursing practice improves patient outcomes and may actually reduce healthcare costs, nurses compete for limited dollars.


What to do next? Write letters. Send e-mails. Make telephone calls. Nurses can reach out to legislative leaders, both locally and nationally; to business leaders; and to those consumers of the care we provide. Make yourself visible. Brainstorm with your colleagues. We cannot, however, afford to sit back and wait. We have to be a part of the solution.


JNN Call For Reviewers

The Journal of Neuroscience Nursing (JNN) is seeking individuals to review manuscripts prior to publication. As a peer reviewer, you will provide feedback to authors based on clinical, administrative, or research expertise. Reviews are completed electronically with the use of an online tool; all reviews are blinded. Typically, you will be asked to return manuscripts with suggested revisions within a 2-week period. If you are interested, please complete the new reviewer form on the JNN page of the AANN Web site ( and submit it to [email protected] with an electronic cover letter briefly outlining your reasons for wanting to become a reviewer.