Although the presidential election is still a month away, our minds are on politics. Reform of the U.S. health care system remains a central issue, and regardless of which candidate wins next month, there will be changes that affect nurses and how care is delivered. We asked AJN contributing editor Joyce Pulcini to summarize the Democratic and Republican platforms regarding health care reform—at least as they stood when we went to press in September (see Policy and Politics). Her article also offers commentary from nursing leaders, including the current presidents of the American Nurses Association and the American Academy of Nursing, as well as the vice chair of the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing at the Institute of Medicine (IOM).
To highlight the topic, we commissioned what may be the first political cartoon ever to appear on our cover. (We checked our archives, and while we found illustrations with patriotic or political themes, none were political cartoons or caricatures.) In commissioning the cartoon, we asked the artist to convey a nurse's dilemma in deciding which candidate to support. We're pleased with the result. Indeed, our nurse is assessing the two “patients” with an expression of apprehensive concentration; and the look exchanged between the candidates reflects mutual suspicion and mistrust—fitting, given the nature of the campaign.
When I've talked about presidential politics with people outside of health care, I've been surprised to learn that many assume most nurses support President Obama over former Massachusetts governor Mitt Romney. They seem to think that because so many nurses belong to unions, the majority of nurses must be Democrats (unions historically have supported Democratic candidates), and that most support the Patient Protection and Affordable Care Act. Yet when I've spoken with nurses from around the country, it's obvious that we're as divided as the rest of the American public. For example, I've heard from nurses who support President Obama's stances on immigration and health care reform, yet intend to vote for Romney because they agree with conservative Republicans' opposition to same-sex marriage. I've spoken with other nurses who think Romney might be better equipped to fix our ailing economy, but intend to vote for Obama because they're wary of the far-right views and influence of the Tea Party.
It seems to me that various policymaking bodies are finally realizing that nurses have been grossly underutilized in the health care system. There's a sense of general agreement that, if nurses are allowed to practice as we've been educated to practice, we will be key players in the revamping of the health care delivery system. The IOM's 2010 report, The Future of Nursing: Leading Change, Advancing Health, provided the initial impetus for the expansion of the role of nursing, and the RWJF's Future of Nursing: Campaign for Action has furthered this effort through state coalitions aimed at implementing the report's recommendations. Now others seem to be warming to such expansion. Most recently, a group of health policy experts convened by the Center for American Progress met to identify ways to control increasing health care costs; their recommendations appeared online August 1 in the New England Journal of Medicine. Among their proposals is a call to “make better use of nonphysician providers.” They explicitly recommend that “the federal government provide bonus payments to states that meet scope-of-practice standards delineated by the Institute of Medicine. Medicare and Medicaid payments to nonphysician providers should allow them to practice to the full extent permitted under state law.” And while we'll likely see this change first in primary care and community settings, there's no reason it can't happen in hospital settings as well.
Like you, we've been bombarded for months with political ads, campaign phone calls, and the spin from an endless parade of political analysts on television talk shows and Twitter, in print and online—wherever “news” is found. We have much to gain in reforming health care, but we each need to do our homework, look beyond the rhetoric, and get the facts for ourselves. You can find the candidates' platforms at www.barackobama.com and www.mittromney.com. Read them, decide who offers the better way forward, and vote.