Creativity in policy

At the October 2014 annual meeting of the Academy, Stephanie Ferguson went to the microphone and challenged the fellows in attendance to be more visibly involved in someof themost important issues of ourday, including the expansion ofMedicaid and continuation of the Children’s Health Insurance Program (CHIP). Her call is timely, given the continuing need for reforming health care and the changing political landscape. I’m writing this in January, just after the 114th Congress got underway. The majority party in both houses of Congress is now Republican, and 31 of the states now have a Republican governor. It’s anticipated that even Republican senators and representatives may struggle to reach consensus on some issues, and, when they are able to do so, President Obama is expected to use his veto power if the legislation doesn’t align with the administration’s positions. Developing policy recommendations requires clear identification of the problem, creativity in developing potential policy solutions, and trust in a consensusbuilding process for evaluating which of these solutions to embrace. But real policy making is rarely so clear cut. When I think about what is likely to unfold, I am reminded of the contributions nurses make to debates about health-related policies. And, yes, this should include the Medicaid expansion and renewing CHIP or finding another solution to ensure that every child in the United States has access to health care. Taking positions on issues is not difficult if a group is monolithic, but we are not a monolithic group. Nurses do tend to support policies that promote the well-being and health of individuals, families, and communities regardless of political party affiliation. In the past year, I have learned that some of the Academy’s fellows are not quite comfortable sharing their viewpoints that may bemore conservative, particularly on fiscal issues. The Academy is on record as being committed to diversity and inclusivity within our organization but that must include diversity of political views. In fact, I would argue that we could be a stronger organization if we ensure that our policies reflect consensus among politically diverse nurses. I’m convinced that the Academy can and should be a place where a respectful process of seeking diverse perspectives could enable us to develop policy recommendations that can be embraced by reasonable policy makers of myriad political affiliations. Doing so might even result in creative solutions that have yet to be considered. I hope that those fellows who have diverse viewpoints will offer their views and challenge the groups within the Academy to listen carefully and think through new ways of solving the old problems that persist in the face of a body politic that seems stuck on positions rather than building consensus on solutions. Last year, the Academy urged the continued funding for CHIP to ensure that states could operate their programs without interruption. We are supportive of the Affordable Care Act as a way to reduce the number of uninsured in the nation, improve access to care, and reduce health care costs. The board does develop positions on some issues, but it relies on our expert panels to identify priority issues, develop position statements, and make policy recommendations that can guide the Academy in its work. I hope that the expert panels will actively seek diverse viewpoints, and I will hold myself to the same standard and will encourage the board to do the same. We have a wealth of knowledge and experience within the Academy that can greatly inform good public policy going forward. In the process, wemay just discover a way to model the way respectful and informed deliberation can lead to workable, creative answers to seemingly intractable problems.