Health care is always one of the top issues on the national agenda, and as the United States prepares to elect its first new president in eight years, all eyes are on the presumptive Democratic and Republican nominees, Sen Barack Obama (D, Illinois) and Sen John McCain (R, Arizona).
Yet, “presidential elections seem a little remote, I think, in terms of actual impact on one’s life,” says Nicole Gara, Vice President of Government and Professional Affairs for the American Academy of Physician Assistants (AAPA). “I think it’s hard for local members of Congress to get attention, and it’s even harder for people running for state office. But those are probably the places that you should start.”
That’s why leaders from both AAPA and the American Academy of Nurse Practitioners (AANP) are encouraging all members of their respective professions to do their duty as American citizens and health care professionals. The message is simple: VOTE!
Focus on Financing
Neither the AANP nor the AAPA endorses presidential candidates. However, leaders from both organizations are keeping an eye on the campaigns. So how much attention are the presumptive nominees paying to nonphysician clinicians?
AAPA President Cynthia B. Lord, MHS, PA-C, may speak for most Americans (or at least the cynical ones) when she says, with a laugh, “If you really look at McCain and Obama—the two big candidates—at their health care policy, first of all, they change every day depending on who they’re speaking to, I think.” Getting serious, she adds, “But they’re basically focused on financing; everything is about financing.”
Her assessment is echoed by Jan Towers, PhD, NP-C, CRNP, FAANP, Director of Health Policy for the AANP. “One of the things I find is that they talk a lot about how to pay the insurance and [give] a lot of attention to doctors and hospitals,” she says. “But there doesn’t seem—yet—to be a good awareness on the part of either candidate of the role that other health care professionals play in the health care system.”
“Are we on the radar? I don’t see any evidence of that,” adds Gara. “They’re really concerned with the financing aspects. They’re not drilling down to workforce issues very much.” (See sidebar.)
Getting those issues adequately addressed may be more difficult than usual in light of the current state of the nation. Polls have indicated that health care has dropped from the No. 2 to the No. 3 spot, behind the war and the economy, in terms of issues considered most important by voters. “It gets harder when the economy gets tough,” Towers says. “People have to be able to eat, work, hang onto their houses.”
“The war and the price of gas and everything else could easily consume everybody’s attention,” adds Gara. “But the [health care] system is probably failing badly, and really, procrastination isn’t going to help.”
The “Other” 468
Every four years, an increasingly large chunk of the national attention is focused on the US presidential elections. “I think you can’t help it, it’s like a four-year primary,” Gara says with a laugh. “The election season gets longer and longer, and for pretty much everybody who turns on the TV, that’s what they’re going to see in the news.”
But this election year, one-third of the seats in the US Senate and the entire House of Representatives are up for grabs—that’s a combined total of 468 legislators. Clinicians “need to be looking not just at what the president is going to be thinking but also what the representatives from their state or district are thinking,” Towers observes.
Health care providers received a reminder of the importance of supporting and working with members of Congress during the recent Medicare reimbursement bill brouhaha. To forestall a 10.6% payment reduction for physicians (scheduled to take effect on July 1), Congress instead voted to reduce reimbursement to private insurance companies that serve Medicare recipients. When President Bush exercised his right to veto the bill, members of both the House of Representatives and the Senate voted by an overwhelming majority (383 to 41 in the House and 70 to 26 in the Senate) to override his veto. (The measure is considered a stopgap, and Congress will have to revisit the issue in 18 months; Towers says, “It depends a lot on how the elections go, as to just what direction that might take.”)
Cindy Lord knows firsthand what effect that reimbursement cut could have had. She works in a primary care practice in eastern Connecticut (“we are in the underserved part of Connecticut—as much as it can be underserved”). “If that 10.6% reduction had gone through, our practice—it’s a family practice, but after many years, it gets very elderly; almost all of my patients are 80- and 90-year-old farmers who are still doing well, but elderly—wouldn’t be able to accept any new Medicare patients,” she says. “We would have had to close our practice to those people. It was stressing the two docs I work with.”
The elderly are just one of a growing number of patient groups whose needs are not being adequately met. “When you look at the elderly and Medicare, the disparities among ethnic minorities, as well as just access—47 million people without insurance, or even worse, the underinsured—and then you look at the chronic disease we can’t care for …,” Lord trails off. “I don’t know. The list goes on and on.”
And that is the primary reason why AANP and AAPA are encouraging all members of the professions they represent to take action.
A Right and a Privilege
The right to vote is, of course, a privilege granted to all American adults, but for a health care provider it can hold additional import. Besides being a private citizen with his or her own belief system and priorities, each PA or NP is a professional whose right to practice is legislated and regulated to an extent greater than that for many other careers. And the laws that affect them have an impact, by extension, on the patients they serve.
“As health care providers, when you look at our vision and our mission and the reason that our whole profession was established—to take care of patients—unfortunately, it’s not just about the ‘do good’ and the medicine,” Lord points out. “If we don’t exercise our right to vote, then we truly will have—we’re seeing it now—trouble practicing medicine and caring for our patients. And our patients always come first.”
That dedication to patient care makes NPs and PAs great clinicians—but often, reluctant politicos. “It’s not a natural activity for most people who go into health care,” Gara notes. “They want to take care of patients and make them better. They don’t want to deal with politics and politicians. I think it’s only when they realize how important this is to everyday life that the little light goes on and people start to say, ‘Oh, I can do this and I should do this.’”
“This” begins with exercising the right to vote—although Towers, Gara, and Lord emphasize the importance of being an informed voter. With that in mind, AAPA—which Lord describes as “much more proactive over the last several years”—has launched “PAs for a Healthy America: Vote 2008.” A section of the organization’s Web site, available to both members and nonmembers, provides links to the presumptive Democratic and Republication nominees’ health care platforms (and, hopefully soon, responses to a five-item questionnaire AAPA sent to both candidates), as well as information on who is running for election to Congress.
AAPA “is trying to provide easy resources,” Lord explains. “As an individual, you’ve got to make a decision. And those who say, ‘I don’t have time for this,’ that’s a choice they make. We’re trying to show them this is a choice you need to make, and it’s an easy thing to do.”
Towers encourages NPs to review the information on the candidates’ Web sites, which “tells you a lot about what a candidate does and doesn’t know. Once you look at those things, you get a better grasp of whether or not they’re really tuned in to the issues that affect NPs and their patients.”
Even better, for those who can manage it, is attending town hall meetings or fundraisers that provide an opportunity to ask questions of the candidate directly. Clinicians “need to be asking about what candidates perceive to be the health problems in their state and their district and what they think the resolution should be,” Towers says. From there, you can inquire as to the candidate’s knowledge of NPs or PAs and how he or she would address specific issues that PAs or NPs have.
Leaders from AANP and AAPA want you to vote, and they want to make it easy for you to make a decision. But they don’t want to make that decision for you. “I don’t think anybody should be ruled out,” Gara says. “Everybody can be persuaded of the facts, and everybody can be approached. I’m definitely not a one-issue kind of person, so I really hate to see people make decisions based on a single position that somebody has taken.
“[Health care] is really not a partisan issue, you know,” she concludes. “It’s really for everybody.”