1. Kennedy, Maureen Shawn MA, RN,


At any level, it forces a rethinking of one's priorities.


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Choosing a topic for the editorial is a challenge, and it wasn't the first thing I thought about when Diana Mason resigned as editor-in-chief. The topic should be timely and relevant, and that's difficult because the journal goes to press several weeks before you read it. Diana Mason put a lot of thought into her editorials-questioning, praising, cajoling-sometimes fearlessly taking the profession to task. As codirector of and a frequent contributor to In the News, I know how hot news can quickly become cold. Likewise, issues deserving comment in an editorial at the time of its writing may be inconsequential or resolved by the time of publication.


Thank heaven, then, for the American Medical Association (AMA) and its wavering positions on health care reform: in May, just as it has with every other major attempt at health care reform, the AMA said it wasn't open to a government-sponsored, public health plan. Now it seems it might be-with conditions. Some things never change. (Truly: see this month's Viewpoint, in which Thelma Schorr, a former editor and publisher of AJN, provides a historical perspective on the politics surrounding health care reform.)


The AMA "agrees that major reforms are required to make the health insurance market work better for both physicians and their patients." (Notice who comes first.) It favors "the continuation of employment-based insurance in the private sector, while encouraging new sources of health insurance that would be available to both the uninsured and the currently insured." Tax credits or vouchers would help those who can't afford insurance to buy it.


A major overhaul of the system is needed. The way we finance health care in this country simply doesn't work-not for the government that subsidizes much of it, the facilities that depend on reimbursement, the care providers mired in stacks of forms, or individuals-even when they're insured. According to a February 2005 article in Health Affairs, "among those whose illnesses led to bankruptcy . . . 75.7 percent had insurance at the onset of illness." That was before the country's current fiscal crisis. Yet the AMA still believes in the private insurance system.

Figure. Maureen Shaw... - Click to enlarge in new windowFigure. Maureen Shawn Kennedy

On June 1 the AMA, along with industry groups such as the Advanced Medical Technology Association, America's Health Insurance Plans, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, and the Service Employees International Union jointly sent a letter to President Obama detailing their plan "to make the system more affordable and effective." The AMA aligned itself with groups that have gained the most in the current dysfunctional system and stand to lose money and power in the wake of significant reform. The lengths these groups have gone to in maintaining their stranglehold on health care delivery are, in a gruesome way, impressive; and members of Congress who accept their blood money should be ashamed. Interestingly, a June poll by NBC News and the Wall Street Journal showed that 76% of the 1,008 adults surveyed thought it important to give people a choice of a private or public health plan. I wonder: would the current system persist if those who represent the public interest had to use the same insurance plans their constituents use?


Nursing has traditionally aligned itself with the public and been at the forefront of efforts to make sure those who need care receive it. Think of Lillian Wald at the Henry Street Settlement; the Street Nurses in Vancouver, Canada (see the July issue); or the American Academy of Nursing's Edge Runners. These programs-and nurses-exemplify the "new thinking" needed to solve health care delivery problems. And the public-and some politicians-are taking note.


In a 1971 editorial in Nursing Outlook addressing the health reform proposals of the time, Edith Lewis noted that "the success of any health insurance plan will depend, to a large extent, on the willingness of the various health professions to relinquish long vested interests and zealously guarded functions and be open to new and innovative ways of doing what needs to be done." That hasn't changed, either.