As I write this, it’s hard to believe that we have said goodbye to 2019 and we are embarking on the new decade of the 2020s. While the last decade was a great one for the IHP, I know we can look forward to more great accomplishments in the coming years that will distinguish the IHP as the stellar academic institution it is. We have so much to be proud of and so much to look forward to!
As one of the final acts of the decade, 89 IHP students in the School of Nursing and the School of Health and Rehabilitation Sciences were approved by the Board of Trustees for completing their studies. We wish these new graduates well in their new careers and hope they stay connected to the IHP.
To start the new year, this week we are welcoming 86 new students in our Accelerated Baccalaureate in Science Nursing program. They have arrived from all over the country to begin a journey that will bring them into the heart of health care. They come to us with degrees in Biology, Psychology, Art, Business, Exercise/Health Science, Music Education, Pharmacy, Veterinary Science, Languages, and Engineering. They will leave behind their lives as Mental Health Specialists, Population Health Coordinators, EMTs, Paramedics, Medical Scribes, Pharmacy Techs, and Veterinary Assistants and immerse themselves in a whole new culture, committing to a future as a nurse. They will study harder than they have ever studied before and they will have experiences that will be transformational.
I also want to begin January by welcoming back all of our existing students and wishing everyone in the IHP community a peaceful, joyous, and successful new year.
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I recently was part of a panel, sponsored by the news organization Axios, that discussed access and affordability of health care. One of the panelists asked a simple question that made me sit back and think for moment: “What is the minimum level of health care benefit a U.S. citizen should have access to?” He said that right now, the minimum level of benefit we all have is the Emergency Department, a totally ineffective and inappropriate setting for most people.
I have thought about this question a lot in the context of evaluating so many of the policies and plans from national politicians like Democratic Senators Bernie Sanders and Elizabeth Warren and former Vice President Joe Biden, all of whom have proposed versions to fix the country’s broken health care system.
So, full disclosure – I am not sure I am totally in favor of Medicare for All. Yet.
Right now, my experiences as a home care nurse who mainly dealt with a Medicare population inhibits my ability to fully support that proposal. I would love to see a health care plan that meets the needs of the population it serves in the most effective and cost-efficient way. However, Medicare is nether cost-efficient nor does it meet the needs of the population it serves. As an acute care benefit, Medicare does not pay for the kind of long-term care, chronic illness, or community-based care that most seniors need. Instead, it focuses on hospital care and very short-term care skilled care following discharge.
Nurse practitioners can’t certify a patient for home care or recertify their plan of care. This has to be done by a physician (added cost) who knows little about what is happening in the home (reduced quality). These kinds of restrictive and illogical regulations are incredibly short sighted and give me pause as I think about extending that kind of incoherent bureaucracy to the country’s entire population.
As I think about the future, I envision a health care delivery system for all with strong community-based resources that provide high-quality preventive and primary care services and ongoing care for people with chronic medical and behavioral illnesses. I think about a system that uses the right provider for the right patient at the right time, each working as members of an interprofessional team committed to patient/family wellness. I see public health care providers in our communities addressing the social determinants of health.
Can we get this kind of health care under one of the Medicare for All plans that are being proposed? Will inane regulations get in the way of providing the right kind of care to children and adolescent and people with behavioral health problems? I don’t know the answer to that which is why I can’t say yes to that concept yet. I think there is much more that needs to be explored as we migrate to a national health insurance model. A good place to start would be the health care legislation proposed last October by Massachusetts Governor Charlie Baker, which has many interesting elements. I’ll have some thoughts on that in my February Yardarm column.
There is so much hope in beginning a new year. I am optimistic that we can do better for those who don’t have access to the kind of care we would want for them. Maybe 2020 is that year.