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On November 19, ANA submitted written testimony for a Senate Finance Committee hearing "Health Care Reform: An Economic Perspective," that focused on Finance Committee Chairman Baucus' "Call to Action" document outlining his vision for health care reform. ANA's testimony emphasizes that reform must provide, not just access to coverage, but access to care through the assurance available, qualified practitioners. Read the full testimony: Written Statement of the American Nurses Association To the United States Senate Committee on Finance Health Care Reform: An Economic Perspective November 19, 2008 215 Dirksen Senate Office Building The American Nurses Association (ANA) congratulates Chairman Baucus on putting forward a vision for health care reform that emphasizes the urgency for action in 2009. ANA is the only full-service professional organization representing the interests of the nation's 2.9 million registered nurses, and advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, and sharing a constructive and realistic view of nursing's contribution to the health of our nation. We agree that reform of the current broken health care system is desperately needed in order to meet the needs of all people living in the United States. ANA believes that any national health strategy, such as that articulated by Chairman Baucus, must begin with the premise that health care is a basic human right. Our country's current fragmented, inequitable health system bears witness to the lack of a clear national vision and strategy for optimizing the health and productivity of its people. The U.S. health care system must be restructured to guarantee high-quality, affordable health care for all. Chairman Baucus' proposal emphasizes many of the key elements that ANA believes are essential to a reformed health system. Among these are prevention and screening, health education, cultural competency, chronic disease management, coordination of care and the provision of community-based primary care. These are precisely the professional services and skills that registered nurses bring to patient care. As the largest single group of clinical health care professionals within the health system, registered nurses are educated and practice within a holistic framework that views the individual, family and community as an interconnected system that can keep us well and help us heal. Registered nurses are fundamental to the critical shift needed in health services delivery, with the goal of transforming the current “sick care” system into a true "health care" system. RNs are the backbone of hospitals, community clinics, school health programs, home health and long-term care programs, among many other roles and settings. The support, development and deployment of this keystone profession is essential for any quality health reform plan to succeed. It is with some concern, then, that ANA notes the negligible acknowledgement of registered nursing's essential role in providing those exact services to which Chairman Baucus would give heightened attention in the delivery of care. We believe this is based on a fundamental, and common, misunderstanding of the problem at hand. Simply put, access to coverage is not access to care. These two concepts are not synonymous. Concentrating one's focus on a guarantee of coverage only promises to place more people into a broken system. Failure to address issues related to the delivery of care will strain the health infrastructure even more than it already is today. While Chairman Baucus' proposal describes in some detail renewed consideration for physician education and training toward primary care, certainly a component of workforce reform, it completely fails to appreciate the significance of the growing nursing shortage and the neglected systems that exist within our communities -- such as public health and preventive services, community clinics, hospitals, mental health services, long term care, primary health care, schools, work places, and other venues where health services are delivered -- that will have to serve the greater number of individuals that would be covered under his proposal. Simply tweaking Medicare GME - while certainly in need of reform will not result in creating a health workforce that will be able to meet the care needs of the United States. A high-level, on-going system for national health workforce planning is needed to develop solutions, not only to the current flaws in education, distribution, and utilization that have resulted in our existing inequitable, fragmented system, but to explore innovative delivery solutions to meet future needs. Substantial investment is needed in the people and places where health care is provided - this will be the foundation to successful reform. This investment must move toward the creation of patient-centric delivery models that expand choice and access to innovative primary care models, featuring interdisciplinary care teams and enhanced coordination of care services, such as those delivered by advanced practice registered nurses. This reflects a similar approach describe in the Chairman's proposal to invest in community health teams. Chairman Baucus' vision builds on the existing employer-based health insurance system, while also creating a public Health Insurance Exchange. As a matter of policy, ANA believes that a single-payer system is the most desirable structure for financing a reformed system. However, we also acknowledge merit in reform plans that would create a public-private coverage partnership, based on a principle of shared responsibility. In any public-private approach, significant health insurance market reforms will be necessary so that all plans would be held to the same high quality standards and meaningful benefit designs regardless of whether they are offered through the improved public system or through the private employer-based system. For an individual mandate to be equitable, it must be paired with such market reforms as are described in Chairman Baucus' proposal. ANA applauds Senator Baucus' initial thinking around significant issues that would move the current health care system in a new direction, such as: --Creation of a Comparative Effectiveness Research Institute --Establishment of a national system for performance measurement and reporting. --Continuing the movement toward standardized quality measures. --Addressing social determinants that affect health status. --Attacking health disparities and seeking respect for cultural and language differences Each of these elements supports a framework to create a system that not only covers the health needs of people but also cares for people. Senator Baucus describes his vision for reform as a trigger for this crucial conversation with consumers and patients, providers and other key stakeholders within the health care industry. ANA hopes to work with Chairman Baucus, the Senate Finance Committee, and other progressive voices seeking comprehensive health reform, in order to assure that the promise of coverage is backed up by high-quality, accessible, affordable health care for all. | ||