One Is the Loneliest Number

By Shawn Kennedy, AJN editor-in-chief

The great Bartholdi statue, liberty enlightening the world: the gift of France to the American people.  Speculative depiction published the year before the statue was erected. In this depiction the statue faces south; it actually faces east/Wikimedia Commons

The Bartholdi statue, liberty enlightening the world: the gift of France to the American people. Speculative depiction published the year before the statue was erected. In this depiction the statue faces south; it actually faces east/Wikimedia Commons

I’ve been struck recently by how the United States sometimes seems to stand apart from other nations. This is sometimes called “American exceptionalism.”

The most obvious example of this is the recent push—temporarily put on hold due to the emergence of negotiations about the possible handover of Syrian chemical weapons to Russia—to garner support among other nations for a military strike against the Syrian government in response to its use of chemical weapons against its own people.

By now, most of us have seen the graphic videos on media outlets and they are indeed disturbing. There are signs of neurotoxicity in some of the victims: rigid posturing, seizures, and foaming at the mouth. According to news reports, U.S. Secretary of State John Kerry says the evidence is “undeniable” and it deserves a harsh response. While several other countries and alliances have issued statements condemning the use of chemical weapons, thus far, other than France, none have come forward to agree to military action; there seems to be little likelihood of action by the United Nations (UN).

It may well be a case of apples and oranges, but another example of how the United States stands alone in comparison to other developed countries is in our approach to health care. The passage of the Affordable Care Act (ACA), and then the Supreme Court’s upholding of its individual mandate provision, made me think this country would at last join most of the other developed nations of the world in providing for the health of its people.

But how naive I was! The resistance by opponents of the law has now moved to the states, many of which have refused to expand Medicaid or institute the insurance exchanges that are essential to providing health coverage for those currently without it and who must obtain it to meet the individual mandate. According to Kaiser Health News, a number of states are offering insurance exchanges or marketplaces where consumers not covered by employer-provided insurance can “shop” for low-cost plans and plans that fit individual health care needs and budgets (according to one report, a Minnesota resident can purchase a plan for under $100 a month). In those states which declined to set up exchanges, a federal plan will be available. Enrollment in the exchanges is set to begin October 1.

Most developed nations provide health care for their citizens. I know from conversations with many non-Americans that they don’t understand how we do not. The ACA was hammered out against strong resistance from many stakeholders, and too many concessions may have been made to industry and to those who opposed the very idea of health care reform; as a result, the law needs work. If everyone worked together to make it better, it could be improved. But at this point, it appears we may be trading one very complex and dysfunctional system for another, with people in those states that will not expand Medicaid still left without coverage (in many cases, these are states with already high levels of chronic illness and poverty).

The idea of health care for all is fading beneath the layers of complicated regulations and partisan gamesmanship, with the consumer as befuddled as ever. As nurses, we need to help our patients understand what they need to do to be in compliance with the new law. I urge you to find out about what’s happening in your state and learn where one can access information so you can direct your patients. In addition to federal government sites (a general information page plus a site which specifically provides information about the exchanges,, states have their own Web sites. Kaiser also has a continually updated page about state health exchanges.

As for what happens with the crisis in Syria, we can only hope that any response  by the United States and other nations will not further escalate the suffering of the Syrian people or cause additional hostilities elsewhere. The UN Refugee Agency puts the number of those who’ve fled Syria at over two million, and says that by the end of the year “it is estimated that half of the population of Syria will be in need of aid.” Hopefully, there will be some intervention that will point to a path to peace.

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Editor-in-chief, AJN


  1. Peggy McDaniel September 13, 2013 at 4:07 pm

    As a nurse living as an expat in Australia I can vouch for the fact that the Aussies I meet and speak to can’t believe America does not provide some type of universal coverage for it’s citizens. All I can do is shake my head and agree… Their national coverage isn’t perfect but it’s very good, and citizens can purchase private cover if they desire. This basically provides them more choice and speedier treatment for elective surgeries. This private cover is MUCH less expensive than basic health insurance in the USA!

  2. Kathy Leuckel September 13, 2013 at 11:10 am

    Unfortunately, a large percentage of nurses at my hospital have very little knowledge about the Affordable Care Act so they are unable to speak to the issues. In my view, nurses see the word “politics” and their immediate knee jerk reaction is I don’t want to “be involved” in politics. Helping them to see that politics is part of their day and everything they do can be a first step. Giving them examples is basic healthcare issues that they care about will perhaps enlighten them. Until nurses have knowledge of the parts of the ACA that directly effect their patients and their own healthcare they will be ill equiped to discuss, educate or guide their patients.

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