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Healthcare is among the top issues in the upcoming presidential race. While most Americans are concerned about healthcare costs, those working in the industry hold particular interest in the decisions of a future president.
Local nurses paid close attention when candidates spoke at a recent debate at Philadelphia's Drexel University. Though healthcare and related issues were discussed, nursing was directly mentioned by one candidate only, John Edwards.
Encouraging political discourse, Drexel played host to the Democratic presidential debate Oct. 30. Candidates, Sens. Chris Dodd (CT), Joe Biden (DE), Hillary Clinton (NY) and Barack Obama (IL), former Sen. John Edwards (NC), Gov. Bill Richardson (NM) and Rep. Dennis Kucinich (OH), gathered to discuss topics including Iran, illegal immigration, the economy and healthcare.
Brian Williams, anchor of the NBC Nightly News and Tim Russert, host of Meet the Press, moderated the debate, sanctioned by the Democratic National Committee.
Many watched the discussion at Drexel's Main Building auditorium and at home, but did candidates speak to the issues voters are concerned about? What about nurses? Did they feel spoken to, were their issues addressed? Some Drexel School of Nursing staff talked to ADVANCE about their views.
Healthcare's Importance
Unfortunately, healthcare seemed to take a back seat in this debate, mainly addressed in the lightning round, allowing candidates 30 second responses. Williams asked the only pointed question about healthcare - on skyrocketing physician malpractice costs. "With so many young people choosing not to go into medicine, so many veteran physicians choosing to get out - how do you expect this nation to continue to attract quality people to medicine?"
Dodd was first to respond: "... first, obviously providing some benefits to people who choose to go into [healthcare] so we can attract them to work in [needed] areas - a larger healthcare plan ought to be a part of that as we consider universality - to make sure - the cost of insurance [is] not going to be so excessive that you'd be discouraged from going in that direction."
Biden: "They graduate and have these gigantic bills, 40,000 bucks a year. You [have] to give them the ability to write that off if they engage in public service, move into areas where they need doctors. [then] you [have] to get the insurance company out of looking over their shoulders; They know the decisions to make."
Edwards: "What we need is a universal healthcare system that gets doctors out of the business of deal[ing] with insurance companies on a daily basis." Edwards then added, "But I want to talk about another piece of this-we have a nursing crisis in America, a serious nursing crisis. So, what we need to do is expand our nursing schools, give scholarships to young people who commit to come out and go to the places that are underserved. We need to get rid of things like mandatory overtime. We need to have safer staff-to-patient ratios so we can deal with this crisis, for the men and women who actually provide a huge amount of the healthcare in this country."
Clinton: "In my proposal for the American Health Choices plan, we basically give the insurance companies an ultimatum. They have to get into the business of actually providing insurance, instead of trying to avoid covering people. That is one of the biggest problems that doctors face. They face this constant barrage of harassment and bureaucratization from the private insurance world."
Obama: "We need to deal with the insurance companies. On Medicare and Medicaid, the reimbursement system is not working. Instituting a universal healthcare system that emphasizes prevention will free up dollars that can go to reimbursing doctors. But we've got to deal with the cost of medical education. With college costs generally, and that's why I put forward proposals to get banks and middlemen out of the process and expand national service to encourage young people to go into these helping professions."
Kucinich: "I'm the co-author of the bill, HR 676 that establishes Medicare for all. As long as you have the private insurance companies involved in providing health services, people aren't going to get care. Doctors know the insurance companies want to substitute their judgment for their practice. Everyone knows the insurance companies make money not providing healthcare. We should join every other industrialized nation in the world by caring for our people by having a not-for-profit healthcare system."
Richardson: "I have a specific proposal. In exchange for 2 years of tuition paid by the government or loans, you give 1 year of national service to the country. Get rid of the student loan and bank agencies that are ripping off the system. Re-establish, on a general basis, the doctor-patient relationship. Deal with Medicare reimbursement. Deal with ways that we also not forget health professionals, and that's nurses..."
At the Base
Mary Ellen Smith Glasgow, PhD, RN, CS, associate dean for undergraduate programs in health professions and nursing, MSN programs and CNE, who watched the debate on television, felt the event was beneficial to students, who are introduced to advocacy in nursing courses offered at Drexel. "We have a course - community public health nursing which talks about care of vulnerable populations and writing to your senator or congressman about issues important to students and the populations they serve," she added.
Regarding the candidates' comments about healthcare in the debate, she added, "Clearly education is expensive and we need to look at certain fields where there are shortage areas and how we can assist in attracting more nurses, advanced practice nurses and physicians in rural areas," said Glasgow, "so I do think some of the initiatives that we need to continue are scholarships and loan forgiveness programs for the nursing, medicine and health professions where we do have shortages." However, the nursing faculty shortage was not mentioned. "That's something the candidates did not address, so saying we need more nurses - we also need the faculty to teach them." She suggested promoting a nursing academic career to young people, increasing nurse faculty salaries and generally looking at ways to make the nursing faculty role more attractive.
Detail-Oriented
Marcia Gardner, PhD, RN, CPNP, CPN, assistant dean for MSN, RN-BSN co-op and dual degree programs at Drexel, with a specialty in neonatal care and pediatrics, was disappointed with the discussions. The candidates used "buzz words" like universal access to care, diminishing the power of insurance companies, "but where do you go from there?" she asked.
"As providers we are interested in hearing what the candidates would propose to address these issues rather than just identify that they are issues. What's the next grat idea? We didn't see that anywhere."
Glasgow agreed, "I would have liked to hear not just what they are going to do, but how are they going to do it."
Talking Points
Gardner also pointed out, "What was in my opinion missing in the responses of the candidates was an appreciation of the non-physician providers. Clearly nurse practitioners are part of the solution to this issue of access to healthcare and this issue of cost-effective, comprehensive and positive outcome healthcare and that's the model that advance practice nurses are trained in.
"I think when people think of healthcare they don't flash on nursing the same way they do with [physicians] and that's unfortunate because nursing is a great part of the solution to access, cost and effective care," Gardner stressed.
Kate Hartner is associate editor at ADVANCE.
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