Posts Tagged ‘Health care reform’


AJN 2013 Book of the Year Awards: Winners in 19 Categories

January 8, 2014

AJN 2013 Book of the Year Awards 

BOTYSince 1969, AJN has been announcing its annual list of the best in nursing publishing. The most valuable texts of each year are chosen by AJN’s panel of judges. Only books published between August of the prior year and August of the award year are eligible. To quote AJN‘s editor-in-chief Shawn Kennedy, our Book of the Year awards, announced each year in our January issue, “are sought after by authors and publishers . . . the awards give us the opportunity to acknowledge high-quality publications.”

Below you can find the 2013 first-place winner for each of the 19 categories. To see a listing of all winners (there are 2nd and 3rd place winners for each category as well), please click this link. Read the rest of this entry ?


Michelle Obama: Health Care Reform the ‘Right Thing to Do’

September 5, 2012

The full transcript of Michelle Obama’s moving convention speech can be found here.

Here she is on making difficult decisions:

“But at the end of the day, when it comes time to make that decision, as President, all you have to guide you are your values, and your vision, and the life experiences that make you who you are.”

On health care reform:

“When it comes to the health of our families, Barack refused to listen to all those folks who told him to leave health reform for another day, another president. He didn’t care whether it was the easy thing to do politically – that’s not how he was raised – he cared that it was the right thing to do.

He did it because he believes that here in America, our grandparents should be able to afford their medicine…our kids should be able to see a doctor when they’re sick…and no one in this country should ever go broke because of an accident or illness.

And he believes that women are more than capable of making our own choices about our bodies and our health care…that’s what my husband stands for.”

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Campaign-Inspired Hot Summer Friday Thoughts

August 10, 2012

By Shawn Kennedy, AJN editor-in-chief

Commuting in and out of Manhattan gives me plenty of time to listen to the radio and of course, with Election Day a mere 90 days away, the presidential campaign offers reporters a lot of fodder for commentary. And of course, the evening papers and television stations—both national and local—augment what’s on the radio all day. Here’s a sampling of health care–related campaign news that I’ve heard and read this week.

According to the Kaiser Foundation’s Health Tracking Poll, July figures show that overall, two thirds of Americans support Medicaid expansion under the Affordable Care Act (ACA), but when it comes to whether their own states should expand programs, support drops to less than half (49%), while 43% want to keep the status quo. Importantly for candidates, “four in 10 Americans say they could still change their minds on the law.”

My take: The failure of the Democrats to adequately explain the reforms, together with the misinformation from the Republicans (death panels—need I say more?), are leaving the public confused.  The winner in November will be the candidate who can convince the voters that the ACA is either good or bad for them on a person level. (And yes, the economy is now the overriding issue, but health care will keep resurfacing as an emotional and “values” issue in the coming months.)

Senate Majority Leader Harry Reid (D–Nevada) accused candidate Mitt Romney of not paying taxes for 10 years while he was employed at Bain Capital. The Washington Post Fact Checker blog details why Reid’s claims don’t ring true—and awards him “four Pinocchios.” (Romney received three Pinocchios when he said it’s “usual” for candidates to only release two years of tax returns.)

My take: it’s going to be a very long 90 days of campaign rhetoric.

And my favorite for the week: several news stories reported that John Schnatter, the founder and CEO of Papa John’s pizza, told shareholders that, to protect their interests, he will be forced to raise pizza prices under “Obamacare.” ABC News reports that he said that “the cost of providing health insurance for all of his pizza chain’s uninsured, full-time employees comes out to about 14 cents on a large pizza,” and he will pass this cost along to customers.

My take: How is this newsworthy? Will customers really drive all the way to the restaurant (at $~4.00 a gallon for gas) and leave when they learn the price is 14 cents more? I can’t wait to hear Jon Stewart’s take on this.

I may start listening to all music, all the time.

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An NP’s Plea: Hold That Specialist

August 2, 2012

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Recently someone I know woke up in the middle of the night with severe foot pain. In the morning he headed to the ED, where he was diagnosed with a fracture of one of the sesamoid bones in his foot and sent to an orthopedist. Over the three days between the ED visit and the orthopedist appointment, the pain began to ease. At the orthopedist it was determined that the problem wasn’t that little sesamoid bone, but gout.

And then they sent him to a rheumatologist.

Why? The condition was already improving and he had no comorbidities. So, why the need for a specialist visit at a cost of $500 just to walk through the door as a first-time patient? A primary care provider should be competent to manage a straightforward case of gout—order and review bloodwork, prescribe medications, educate the patient about their diet, and follow up on their progress. Then if the patient doesn’t respond to treatment or anything unusual develops, call in the specialist.

This happens all the time. When I was first diagnosed with hypothyroid I was sent off to an endocrinologist (under protest). There was nothing unusual in my presentation and I had no comorbidities or history that would indicate the need for a specialist. Again, a primary care provider is capable of reviewing thyroid panels, assessing the patient’s signs and symptoms, prescribing medication, and following up. But treatment was delayed for three weeks while I waited—feeling fatigued, achy, and depressed—for my visit with the specialist, at a cost of over $400.

Same thing recently when a friend of mine wanted to start on topical estrogen for atrophic vaginitis—her women’s health NP, who had seen her for years, insisted she go to a gynecologist. She had no comorbidities, no risk factors that would contraindicate the use of topical estrogen, which is a safe and straightforward treatment for most women. So, now she goes off to a physician who doesn’t know her for a repeat pelvic exam, a painful procedure in someone with vaginal atrophy, at the cost of $350 to walk through the door.

It’s not just a problem of delayed care and less continuity of care—multiply the above scenarios by the thousands of similar scenarios across the country and it’s obvious that the economic costs are tremendous. These costs are reflected in higher health care insurance premiums and costs of public programs like Medicare and Medicaid.

I practiced for years as an NP in a network of health centers serving a large rural population in the Adirondacks. I loved it—I saw everything and had the autonomy to manage patients through all kinds of urgent and primary problems, plus the physician support to back me up when I needed it. I managed countless people with gout and hypothyroid, and guided women through menopause and its myriad symptoms and associated problems. All of the primary care providers in the network did.

When a patient had complicating factors or greater risks of adverse outcomes, or didn’t respond as expected to treatment, then we sent them to a specialist. Even then, we often began with a phone consultation before referring them for a visit. This is how the family doctor or “GP” practiced for many years before us.

What changed? Worries about liability? The trend toward overspecialization of nursing and medicine? The expectations of health care “consumers”?  The increase in physicians entering specialty practices versus family practice? The health care reimbursement system?

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About Those Death Panels

July 18, 2012

By Shawn Kennedy, AJN editor-in-chief

Diana Mason, former editor-in-chief of AJN, wrote a post on July 9 on the JAMA Forum blog that’s well worth reading. In it, she talks about the resurgence of “death panels” rhetoric to stir opposition to the Affordable Care Act (ACA), specifically in relation to the Independent Payment Advisory Boards, which are to issue binding recommendations for controlling costs if Medicare grows too rapidly.

In a nutshell, these boards will determine where to reduce costs. If Congress opposes the plan, it will have to come up with same-size cost cuts if it doesn’t want to institute what the board recommends. The message that opponents of the ACA want the public to hear is that their fates will be determined not by them but by an arbitrary committee.

But IPABs are about reducing costs of programs, not passing judgment on individuals.  (As Mason notes, the death panel rhetoric was “declared the “2009 Lie of the Year” by PolitiFact, a project of the Tampa Bay Times and partner news organizations.”)

People should have conversations about how they wish to be treated in their last moments, but these should occur with loved ones and direct care providers and be supported by the legal system. People shouldn’t have to worry that they will be rushed along to death if they’re not ready—in fact, this seems to be the opposite of what usually happens.

According to a report from NPR, on Monday, July 9, the Republicans, for the 31st time, introduced a bill to repeal the ACA (this bill is called “The Repeal of Obamacare Act”). It’s political posturing—it will pass the House but will fail in the Senate, as all the prior bills have. One Connecticut representative, Rep. Rosa DeLauro, commented like this: “Mr. Speaker, instead of working to create jobs, reduce the deficit, and do the business of the American people, this majority has been consumed for months now with trying to repeal health care reform.” 

But the Republicans will continue to do this to send a political message. And the rhetoric will likely continue and only get worse as we approach the November election. Mason’s post points back to a message in my post from last week: nurses, take the time to learn the facts, for your own and for your patients’ sake. Politicians have not been known to be especially truthful, but outright lies to instill fear in the very people they are supposed to care so much about—shame on them.

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Forward or Back? Some Personal Notes on Why the Affordable Care Act Matters

June 28, 2012

By Jacob Molyneux, senior editor/blog editor

So today the U.S. Supreme Court did something a little surprising in upholding the individual mandate provision in the Affordable Care Act (here’s the text of the full decision). It was the right thing to do, given judicial precedent, but it still comes as a surprise that Chief Justice Roberts was the swing vote rather than Kennedy, or that they actually did this. Justice Roberts must have looked to his conscience and seen how history would judge him. Or it’s nice to think so.

This is good for many reasons: those under 26 on their parents’ plans can now stay there. A bunch of money earmarked for nurse education will not suddenly disappear. Health care exchanges holding insurance companies to minimum standards will be implemented. Accountable care organizations can continue to experiment in an effort to replace the disastrously expensive fee-for-service model with one tied more closely to outcomes. And a great deal more.

But now we should ask ourselves: Do we go forward or back? This is the real question when it comes to the American health care system. Going back isn’t an option, though many are sure to go on pretending it is (the Republicans will make repealing the Affordable Care Act a centerpiece of their campaign promises, no doubt, a rallying cry against the Democrats). Ignoring reality is something humans are very good at, though it doesn’t always end well, if history is a guide.

And in truth it will take an increasingly powerful act of will to ignore the medical bankruptcies, medical tourism for affordable care to Mexico and further afield, the emergency rooms crowded with the uninsured seeking care for minor and major ailments, the yearly statistics that tell us our health care system is the most expensive per capita and yet has outcomes worse than those of many far poorer countries.

Still, some will surely rise to the occasion as they intone mantras about the free market’s ability to solve all problems for the good of all. Meanwhile the one percent who own an increasingly large percentage of the nation’s wealth will simply avert their eyes, able to afford the best surgeons, concierge care, home visits, brand name drugs.

This matters to me for personal (among other) reasons. At age 27 I left my job working with abused and neglected children and their caregivers and went to graduate school in North Carolina. Living on a tight budget, I opted out of the university’s health care coverage. That is, I chose not to purchase health care . . . it wasn’t mandated, and I didn’t need it.

That fall, as I immersed myself in following my creative dream, I found myself losing touch with reality. My clothes hung off me, I had a thirst that drove me nearly insane (at one point I sat in a bathtub all afternoon sucking on ice cubes just to stop myself from buying and guzzling random selections of liquids at the store—Yoo-hoo, of all things, and orange juice, and Guinness, seltzer, Coke, milk, chocolate milk, etc., etc.). I felt disoriented. One day I saw double as I drove my used pickup truck along the lush parkway. When I went out for a run I found myself barely able to complete a mile, let alone my usual five or six.

As must be clear by now, my immune system had decided to attack my own body, wiping out the insulin-producing cells in my body. It was nothing I did, nothing I could have averted. I was strong, young, healthy, fit. And now, after some blood tests, I learned I had type 1 diabetes and would need to be my own nurse for the rest of my life, checking my blood glucose level many times a day, injecting myself before meals and when the blood glucose level was too high. From then on in I’d need to be attentive to every permutation of exercise, diet, medication as I tried to achieve the “tight” glucose control that would keep me from losing limbs, sight, nerve endings, organs, and eventually my life.

But at the time, in the midst of the initial confusion and struggles, I had a very simple problem on top of all the others: how do I afford this meter to test my blood glucose level, the strips that cost almost a dollar each, the syringes, the two types of insulin, an endocrinologist to monitor the condition? I borrowed some money from an older relative and scraped by. I was lucky enough to have that option. I applied for free medications from a state program. Until I got on my feet a bit more, I spent a lot of time being anxious, broke, and a little scared, skimping on test strips when it was dangerous to do so, regretful that I had decided to go back to graduate school for something unlikely to make me wealthy.

Later still, working as an adjunct university lecturer and a freelance editor, I found what it’s like to be denied access to affordable coverage on the open market. That was upsetting, and it’s one of the things the ACA intends to remedy. Now I’m lucky to get insurance through my job, but the medications are still expensive. I now have two other autoimmune conditions that require medications and specialists. I’m fine, overall, high functioning, but much of my “extra” money is used for medications, tests, physician visits. Without being part of a group plan at work, I’d never be able to afford insurance and all of the medications I need. A full-time job at a large company is a requirement.

So I know why health care reform matters, even if the ACA doesn’t go nearly far enough to control costs, even if it still cedes too much power to the marketplace, to drug companies and insurance companies. Read the rest of this entry ?


The Affordable Care Act on Trial

March 16, 2012

By Maureen Shawn Kennedy, MA, RN, editor-in-chief

Courtesy of Kaiser Health News

According to the National Conference of State Legislatures, 47 states have enacted some legislation to block or limit various requirements of the Affordable Care Act (ACA). And a week from Monday, on March 26, the Supreme Court will begin hearings on the constitutionality of the law, as 26 states bring suit against the federal government. The primary issue for the Court: can the federal government mandate that individuals must purchase health insurance?

Other closely related issues the court has also set aside time to consider are whether other provisions of the law can still be implemented or must be voided if the individual mandate is struck down, the legality of the proposed Medicaid expansion, and whether the court must in fact wait until the individual mandate is actually implemented in 2015 before even considering its legality.

So how do many Americans feel? The Kaiser Family Foundation has been tracking opinions on the law and offers an excellent interactive chart that shows opinions according to different variables, including age, income, political party affiliation, gender, and current insurance status. Their findings may surprise you.

For more information about the Affordable Care Act and it implications for nursing, here are some links to AJN’s coverage since it was signed into law in 2010:

“Nurses and the Affordable Care Act,” Mary Wakefield
“What Future for the Affordable Care Act,” Diana Mason
“Health Care Reform and a System in Flux,” Jacob Molyneux

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