The United States has a significant problem with long-term high rates of per capita health spending growth. This growth is largely driven by increases in unit costs of health care services. Therefore it would seem logical to look for opportunities to reduce those unit costs as a method of bringing down the rate of growth in health spending. Physicians are the most expensive care-givers. Other health professionals can often provide as good a quality of care at a lower price. Therefore, policymakers should encourage the use of these less-expensive providers. A section of the recent Institute of Medicine report on nursing shows that this logic doesn’t fit the real world. (IOM Report)
The report has a great deal of useful information on nursing and the role nurses play today and can play in a future with an aging population in more need of health care. The report also gives some detail on the practice restrictions even nurses with advanced training and degrees face in providing all the care they are trained to and capable of providing to patients. Many cannot really treat a patient without direct physician oversight and in most states cannot prescribe or order other treatments. Given the level of training and skill of most nurses, there is simply no logical reason for these practice restrictions. The days of a nurse as a subservient assistant to a physician should be over.
One of the things a democracy may be burdened with is a willingness to allow the policymaking process to be unduly influenced by money. In the United States, the notions that organizations as well as individuals have free speech rights and that money spending is free speech have combined to create a corrosive effect on doing what is best for the population as a whole. No where is that more true than in health care. Relatively wealthy groups, i.e. physicians, are able to use donations and lobbying to encourage the enactment of turf-protecting rules and laws which keep their incomes, and health care costs, high. We will get a better health system when we get a better policymaking system.