Confronting the barriers to health care reform.

Reforming health care is made more difficult when attention is successfully directed away from the root causes of increasing health care disparity and inflation. This article challenges nurses to accept an active role in health care reform as a part of professional responsibility. It is my intent, through this article, to challenge nurses to think about our contribution to the problems we face in health care. I will encourage us to consider our role in reform. In addition, I will discuss how big business dominates and interferes with the goal of reform. I will implore nurses to be more deliberate about retaining their role as a trusted voice for reform. I will discuss the challenges of keeping the focus for reform on the root causes of health care disparity and inflation. I will ask nurses to expose efforts by big business to support reforms that play with the edges of the problem while working overtime to protect their status quo. And finally, I will describe two areas in which nurses can participate in reform. The first is in our own profession and workplace. The second is in the political world where law and regulation can protect the general public and restore sanity to our health care system. It is impossible for me to talk about health care outside of the environment in which the health care industry functions in the United States. It is clear that health care in this country is big business. Profit interests dominate the reform environment. They overpower the efforts of those who are trying to protect the consumer. Nurses, as employees of the system, are not profiteers, but we do have an economic self-interest that can cloud our ability to support change, especially if that change is one that threatens our position. Nevertheless, we do have an inside view of the system. In general, nurses continue to be seen as supporting people even at the expense of their own personal gain. From this position of trust, we hold a solemn responsibility to speak up. This trust is fragile. To be true advocates for the patients, we have to support that which is in the best interest of the health care system over our own self-interests. Only if nursing shares in the sacrifice involved in change will we retain our authority to confront other parts of the system. Besides honestly confronting our own self-interests, it is our job to fight those organizations that block needed reform because it would reduce their profitability. Examples include companies that produce pharmaceuticals, medical devices, and testing materials; insurance companies; investor-owned private health care systems; and some specialty medical practices. They provide products and services needed in health care, but profit is their priority. These companies are sophisticated and well-financed and use their money to protect their business interests. More money spent on health care is a positive from their perspective. Unfortunately, their gain can be a loss for other important priorities when individual and family income is declining. We can value the products and the economy created by these stakeholders. We can defend their right to make a profit as long as it is not at the expense of our patient's ability to afford care or our government's ability to fund health care for those in need. These business interests have enormous resources to block unwanted reforms. They use resources to divert the attention of policy makers and the public away from the root causes of health care disparity and inflation. They only support changes on the edges of reform. The consequence of this diversion is comparable to our misdiagnosing the root cause of a disease: We spend time and money solving a related issue while our patient bleeds to death. An example of this diversion is the use of the value of "personal responsibility." This is a core value of our country and therefore can be used manipulatively to suggest that consumers are the problem in health care, not big business interests. …