An open letter to The Secretary of Health (whomever that turns out to be!!)

H -- Hurry, people are suffering needlessly!
E -- Everyone – not just a few people deserve core services
A -- Accountability – no more shrugging shoulders on the part of payers/providers
L -- Leadership – on behalf of the greater good, not individual money niches
T -- Together – stop deciding FOR people, begin working WITH them for health
H -- Healthcare Vs. Illness care – let’s not wait ’til it breaks & try to cure

R -- Reality – what real people face; not the wishes of the wealthy & well heeled
E -- Evaluated – follow the data, focus on achieving the best outcomes
F -- Fit – one size doesn’t fit all. Address special needs of high risk people
O -- Orchestrated – but not MANAGED – work together to serve patient Vs. payer
R -- Reach – out to find community leaders who can engage the people
M --Money – too much waste, too many hands in the till, too few resources aimed at making a significant difference in the lives of patients and families who get lost in the money shuffle



Dear Secretary of HHS–

Above you can see my thoughts on health reform. As a nurse, I come with a professional bias on how healthcare should be designed and delivered. Some of the things I believe in and will describe for you here would upset my own nursing colleagues because they have begun to prosper on the status quo. For instance, where have all the nurses gone – they’re working for insurance companies! Rather than taking care of patients, they are taking care of the assets of the payers who would rather not spend money on the “covered lives” they’ve accepted the responsibility to serve. I offer that perspective so that you don’t think I paint my own kind with a softer brush than I do others in this broken system. We’ve all got room to examine and change our practices.

When are we going to see dollars spent on wellness in America? Those of us with adequate insurance and at least some disposable income take part in such things as fitness clubs, diet plans, annual physicals, having our teeth cleaned, using community walking paths, nutritious eating, wellness counseling, and holistic alternative care options.

We’re clear on the problem. Here are a few facts I gleaned while watching public television:
5% of the people use 55% of the healthcare resources.
75-80% of hospitalizations are for chronic disease episodes – why? It is too little, too late.
Source: http://www.mnchannel.org/video_archive.php?video_id=22

But what does the typical American do?
He or she ends up in the hospital because no one teaches or supports him or her with the tools to manage life and health, to recognize early warnings, to take initiatives on his or her own behalf. Sometimes technology is all that is needed so that early intervention (short of coming to the Emergency Room) can be provided to prevent the crisis from occurring.

The average American can’t name his of her healthcare provider. (You’ll note, I didn’t say physician because I think if we limit our thinking to physicians, we lose sight of the wide range of care services people need – including the services of nurses at all levels). Sometimes that is because that American doesn’t have a primary care provider. Sometimes it is because there is no provider accessible. Frequently it is because the inattentive American doesn’t “get it” that healthcare is a daily activity we each engage in, not something we finally attend to when the pain or the problem is too hard to bear.

The reluctant Americans wait to access healthcare until the problems are beyond control. And, they know that there is no money, in their government plan, their minimally funded insurance plan or in their own pockets to address the difficulty before it becomes catastrophic. Why aren’t all our payer sources (from CMS to the VA to nationally recognized health plans) putting their money into prevention, rather than protecting themselves from “big costs” when it all begins to unravel? It is as though we have the motto: “Pay now; get sick later; I told you so!” It is a “gotcha” mentality rather than one that serves the need of people.

What needs to happen?
Dismantle health insurance as we know it – just look at the salaries we pay to people at the top of these enterprises and you can see why an honest person would hardly find him or herself in such a job (remember Bill McGuire, former CEO of United Health?). Obama is on to something when he wants to get rid of the Medicare “Advantage” programs – my husband is 78 and manages his statements from Medicare just fine. Let’s help people learn to manage rather than convince them to let us manage their money and healthcare decisions for them!

Build on best practices -- Take the best of what we’ve learned from Medicare, Medicaid and the VA system, mix in whatever Massachusetts is up to and help citizens see how to live healthier lives (yes, even with chronic illness! Look what happened in AIDS care in middle-America, where we treat it as a chronic disease, not a death sentence!).

Challenge the heart of Americans – I know that in the 1980s we declared that “Greed is Good!” but every time I hear statistics about poverty, prematurity, hunger or seniors aging alone, I am touched that the GREATER GOOD is what matters, not my “need” for Tuesday tennis shoes to match my grey work-out sweats. We all have to sacrifice a little to get the American healthcare system we want and can be proud of.

Stop paying for poor productivity – and yes, I mean everyone with their fingers in the healthcare till! What are we doing subsidizing vacations and cruises for prescribers, golf trips for healthcare executives, ginormous salaries for physicians who don’t see patients and nurses who don’t practice nursing care? (and don’t get me started on lobbyists!) Let’s pay for outcomes that improve patient’s lives, programs that change the health of whole communities, ideas that squeeze the nickel ’til the buffalo brays in an effort to get the most out of every dollar we spend on healthcare!

You, Ms. or Mr. Secretary, may be our last, best hope. Obama may build the only federal administration in my lifetime that could actually be responsive and accountable to the people rather than to special interests. Now is the time. Healthcare is the issue. Do not let this moment pass without enacting change.

Sincerely,


Paula S. Forté, PhD, RN

What does this inauguration mean to you?

I’m one of those middle-aged, American women who was hoping that in my lifetime, I would be able to celebrate the election of a woman with enough chutzpa to really do the job of president, not just declare candidacy. We got one hell of a contest but, in the end, something even more amazing unfolded, the election of our first Afro-American president who has the diversity of Kansas and Kenya all wrapped up in a Hawaiian mindset. Who could have ever imagined that?

This inauguration, this history-making, stereotype-busting, oh-m’God-can you-believe what-just-happened inauguration means to me a fresh appreciation for what liberty is all about. I am white, female, middle-class, middle-income, well-educated and boringly “ordinary” in the statistics of this amazing country of ours. I have enjoyed every freedom known to man in the latter half of the 20th century. But what this inauguration brings is the fresh, new opportunity to say out loud, in the hearing of politicians and policy-makers alike, the America I know and love, “has no clothes on!”

We, common, ordinary Americans now have a champion about to be sworn into office who doesn’t need to paint himself or his America as perfect. He admits he’ll make mistakes, even before he’s seated and given the chance. He’s seen America’s warts from the shenanigans of Washington to the mean streets of Chicago to the littered beaches of Honolulu. He knows what America is, where America’s been and (thank heaven) where he wants America to go. The liberty to speak the truth is an astounding thing. We finally will have an administration that isn’t all about saving face, but about naming the problems America is facing and getting them solved.

My career spans over 30 years in healthcare. I am full of opinions and ideas about what might make that one sector of America’s troubles better. To date, I have never been moved to speak any of these ideas to anyone in any political party. This reluctance is not born of fear, but of the confidence that no one in office really cared what I thought. Now, I do see myself writing to the former senator, Tom Daschle about what I think, what I know from inside the belly of the beast, and what I think we can do to make Americans safer, healthier and more engaged in protecting their own health. I do see myself standing up in community forums and speaking what is on my mind. I do see myself encouraging others, especially physicians and nurses, to say what we’ve seen and stop pretending we don’t know what’s wrong with the most expensive healthcare system in the world. We do. And now, in this administration, we can say it with confidence that something may be done about it.

After all, what is liberty if it is not the freedom of speech? But liberty with hope is a powerful thing and more Americans than ever before in my lifetime are eager to speak what they know, to speak truth to power and influence the re-emergence of the great American country by the people, for the people; the one we all grew up believing could prevail.