Ezekiel Emanuel is an oncologist and the chairman of the department of bioethics at the Clinical Center of the National Institutes of Health. His book, "Health Care, Guaranteed: A Simple, Secure Solution for America," has received widespread praise. Just check out one review from the Financial Times:

"The best of recent books on this question is happily the shortest and clearest and comes out this month. I think it has the answer. The proposal laid out in Healthcare, Guaranteed by Ezekiel Emanuel ... has convinced me...If you are going to read one book on the subject, make it Mr. Emanuel's."

This weekend, on the New York Times "Health Care Watch" blog, Dr. Emanuel gave us 5 reasons why we need to "think big" when it comes to health care:

1. "Make no little plans. They have no magic to stir men's blood and probably will not themselves be realized."
2. Health care policy is fiscal policy.
3. Comprehensive health care reform is cheaper.
4. No plan is perfect, institutionalize tinkering.
5. Everything is connected.

To read the explanations behind these points, visit:
http://campaignstops.blogs.nytimes.com/2008/11/16/think-big/

In working with our partner organization Health Care for America Now, we’ve received almost 3,000 submissions on our “Keep Healthcare on the Map" interactive Google map.  It's a great way to demonstrate our reach - that we're national movement of healthcare workers and concerned citizens, and that we’re ready for the tough fight ahead.

If you’ve yet to lend your name to our healthcare map, please do so here: http://www.healthcareunited.org/map

While reading many of the submissions, we were (as always) moved by your words, opinions, and stories. We’d like to share with you a few of the entries that we’ve received from your fellow caregivers.

Michael, a registered nurse, father and husband from Tennessee, writes this:

“I see the failings in our current system every day and am scared when any of my family is admitted (into it). Nurses are understaffed, overwhelmed and under-supported and patients suffer.  I support mandatory nurse to patient ratios. I support a dramatic push to end the nursing shortage and I believe the government needs to lead the way.”

Karen, a family nurse practitioner from Colorado, congratulates President-Elect Obama and writes:

“You've definitely given us hope! Let us now come together to universally provide proper medical care to all. Understandably, we'll need to provide incentives to shift physicians, PAs and FNPs (Family Nurse Practitioners) to the primary care sector. Still, that minor hurdle can be overcome. Even before the current financial crisis, many people could not afford preventative and maintenance treatments that might otherwise have kept them out crisis. For the price of one ER visit, we could have given them months of preventative visits and all their medications.”

Elizabeth, an RN from Michigan, worries about the expenses of her own healthcare:

“As a nurse, I have seen too many times that patients have had to make a choice between purchasing their medications & eating. The last new prescriptions that I had filled at my hospital (employer) pharmacy cost me, out of pocket,  $126.00. I feel lucky that I have a job and that I am keeping my head above water for now, but I fear for the future. Good luck, and may God bless you.”

“Sarochan,” a medical student, worries that the complex insurance system might ruin any positive experience in the medical field:

“As someone who has relied on health insurance to get life-changing surgery, I know how important it is to have good insurance -- and how devastating any illness or injury can be when you know you can't pay for the medical care you need. I myself am studying to be a doctor, partially because of my positive medical experiences. But when I read about the whole health insurance situation, I doubt the sanity of wanting to enter into that whole business. Everyone deserves healthcare, not expensive insurance from companies that will try anything to not pay for the medical care.”

Cornelius, a psychotherapist in Nevada, who may have to leave the profession because of healthcare:

“I am a relatively healthy middle aged psychotherapist who because of pre-existing condition is unable to get coverage. I may have to abandon serving the most needy clients in favor of a corporate job in order not to risk catastrophe should I become ill. This needs to be a first order of business.”

And finally, Elda, an insurance agent from Texas, writes this:

“I see first hand the decisions people have to make regarding how to pay for health care and their concerns about being declined for coverage due to pre-existing conditions. All Americans should have a right to good health care at an affordable price even if the government has to change the tax codes or provide incentives to families in the form of subsidies or other financial assistance to help every American pay for health coverage.”

Last Thursday, American Public Media reporter Kai Ryssdal spent an afternoon in the emergency room of Johns Hopkins Bayview Medical Center, hoping to capture a snapshot of how the Baltimore economy affects healthcare.

What he found, of course, won’t surprise any of you.

“Dr. Hugh Hill’s in the middle of a 12-hour shift at Bayview.  He’s on his way to seeing maybe 170 patients today.”  His patients “depend on Bayview so much that the hospital’s been filled almost to capacity.  Ninety percent of the beds are taken.”

“More than half of the patients admitted to Bayview come in first through the ER.  And Hill Says the crush has only gotten worse as the credit crisis and the economy have collided.”

Hill: “It shows up here in that people are coming in who have jobs that they are desperate not to lose. They don't want to report that the injury was on the job. It happens because they come in, they've lost their job, healthcare starts to go down, depression sets in. And it is noticeable here.”

“Overall, healthcare spending in Maryland’s going to lose $85 million this year.”

Hill: “In this particular crisis, there may be some other people hurt before us. Folks that can't make payments on mortgages and wind up out in the street. And in any kind of a recession, you worry about people who become jobless. But one of the spinoff results is that more and more people wind up in the emergency room, because it is the one place that they can go.”

“It's also, especially in states that are cutting their budgets, one of the most expensive ways there is to get healthcare.”

To read or listen to the full story, please go here: http://marketplace.publicradio.org/display/web/2008/11/06/baltimore_er/

One of the most famous healthcare-workers-turned-lawmaker, former Republican Senator Bill Frist, has written a heartfelt commentary about charting a course for the country in tough economic times. Frist, a physician, ends his comments with a plea to President-elect Obama and elected leaders of both parties:

And finally, though this may appear a bit self-serving, the doctor in me is shouting out not to forget an issue that has been driven to the background by the credit markets, job losses and threats overseas: health care.

Ever-rising health costs drive people to the ranks of uninsured. The 15 million hard-core uninsured need your immediate attention. There is nothing more intimate or more personal to any of us than the health of our loved ones. Don't let it slip to the back burner.

As the fever pitch from the historic presidential election trails off, newly elected leaders are trying to figure out how to prioritize their agendas – and the healthcare worker perspective is more important than ever. We should all follow Frist’s example; let’s use this unique moment in history to make healthcare the top priority in Washington and across the country. Click here to start by putting healthcare on the map.

Senator Ted Kennedy (D-MA) isn’t letting his own health setbacks get in the way of his lifelong mission of making our healthcare system accessible and fair for all.  Just last week, it was reported that the senator had returned to Washington, DC with the goal of presenting a “bipartisan, universal healthcare package” to a President Obama after he takes office in January.

Yesterday, the Washington Post published an opinion piece by Kennedy, celebrating the victory for mental health parity.  According to the senator, success in this decade-long fight is a “good omen for broad reform of our overall health-care system,” as “it's no longer just patients demanding change,” but “businesses, doctors and even many insurance companies” as well.

Senator Kennedy goes on to say this:

“President-elect Barack Obama has issued a clarion call for action on health care. His practical and thoughtful proposals draw from our Massachusetts experience and add important measures to improve quality and reduce costs. His plan includes crucial investments in modernizing the use of information technology in health care. He calls for a new emphasis on prevention and wellness, because the best way to treat a disease is to prevent it from striking.”

“Opponents (will) argue that the cost would be too high and that any such reform must be deferred because of the economic crisis. I reject that argument. It is painfully obvious that our health-care system costs Americans too much, costs employers too much, denies too much needed care and leaves out too many Americans. The rising cost of health care is clearly contributing to the troubled economy and needlessly strains family pocketbooks. Even worse, these costs are expected to climb higher, more than doubling in the next 10 years. We can no longer afford not to act.”

“The cost will be substantial, but the need for reform is too great to be deflected or delayed. Our recent successes in passing mental health parity for the nation and achieving broad health reform in Massachusetts suggest that most Americans will agree.”

To read the full opinion piece, click here.

You’re amazing.

In these last six months, you’ve challenged me to think in new ways about the issues we face in our jobs and how we’re going to address them - as individual caregivers and as a nation.

I’ve challenged you to push yourself; to go outside your comfort zone to make your voice heard – because your voice is so important in this debate.

The results have been remarkable:

I asked you to let your coworkers know about our movement to fix healthcare – to get them involved. As a result, our online community has nearly doubled.

I asked you to reach out to your fellow caregivers and talk with them about this important election. In response, you contacted over one million healthcare workers through our campaign. 

Then, I asked you to get out and vote like the future of healthcare depended on it. Yesterday, thousands of you from all across the country showed up and cast your ballots. You broke records and shattered expectations.

I’m humbled by what we’ve accomplished. Thanks to you, we’ve elected a president, vice president, and a new congress that have signed a pledge to support our core principles and work with us to make tomorrow’s healthcare better than today’s.

But, more importantly, I'm inspired by what we'll be capable of in the coming months. More than ever, we need you to help keep healthcare on the map - literally.

I've added my name to a growing map of caregivers and everyday Americans urging President-Elect Obama to keep healthcare a priority, because I can't wait to begin to make these changes.  I hope you'll lend your name, as well: http://www.healthcareunited.org/map

 

From coast to coast, Healthcare United's ground team is gearing up for tomorrow's big day.  Below is a report from Julia Greene, who's on the ground in the swing state of Virginia, talking to nurses, doctors and other caregivers throughout the state about this election:

Our Virginia Healthcare United team visited several facilities in the northern area of the state last week. Our goal: to encourage our fellow caregivers to vote early. First stop, INOVA Fairfax Hospital, where we gathered at shift change to pass out information on how to vote early and a comparison piece we produced on the two Presidential candidates.

Our next stop was the INOVA Fair Oaks Hospital, where we met with Andrea Sall, RN. Andrea is a nurse and manages a terminally ill clinic in the area. She's been passionately involved in Healthcare United in Virginia, and is a great asset to the campaign (pictured right). We met in the parking lot and spoke of getting her fellow caregivers to vote early, flagging down other healthcare workers as they left late for the day. Andrea took a big stack of fliers and stickers with her to bring back to work tomorrow and the next day. (Way to go, Andrea!) She's also ready for the work that begins after Nov. 4th - holding our elected leaders accountable to the promise of fixing health care.

After a stop to get more batteries for our camera we stopped at Reston Hospital Center for the 5pm mid-shift change. By the close of the day, we had conversations with dozens of caregivers about the importance of this election, and passed along information on how they can vote early and avoid complications on Election Day. All in all, it was a great day on the Healthcare United campaign trail!

And on the Pacific coast, Mara Kieval, RN has been pounding the pavement in Oregon's 5th Congressional District with her fellow RNs. One of our own nurse activists, Teri Cummings, RN, is running for City Council in West Linn, and we're all cheering her on for a big win. Here are a couple of shots from an earlier meeting of caregivers and last week's canvass with Teri:  

 

To get involved with GOTV efforts in your state, check out your state page and contact a local organizer. (And if we don't have a field operation in your state, you can make calls to other caregivers in key battleground states by using our phonebanking tool.)

Thousands of healthcare workers have already cast their ballots across the country - and thousands more will be going to the polls in the next 36 hours. If you're one of them, tell your colleagues by posting a comment to this blog entry. You don't have to say who you voted for, just let us know you made your voice heard in this election. And feel free to share any stories or thoughts on this election, too.

Posting comments requires a quick sign up process. You'll only have to do it once; after that, you'll just need to enter a login and password that you create yourself.

Assessment. We do it every day for every patient we see. How do their eyes look, what's their blood pressure, what do their tests show? Each small test can give us the very valuable information we need to build an opinion and devise a treatment plan. Assessment is part of our natural state, like breathing, or walking.

As we enter the last days of this election, how to assess the facts on where the candidates stand is a skill we need to share with our coworkers, family, friends and neighbors.

Especially when it comes to healthcare. Things can get complicated however, when there's false information flying about on the campaign trail.

This is what Senator McCain has been saying in his stump speech:

"[I] won't fine small businesses and families with children, as Sen. Obama proposes, to force them into a new huge government-run health-care program, while I keep the cost of the fine a secret until I hit you with it."

That's simply not true. Here's what is true about Senator Obama's healthcare plan:

Fact #1: It doesn't force anyone into any plan. If you have health insurance through your employer and you're happy with it, you keep it under the Obama healthcare plan.

Fact #2:  It doesn’t fine small businesses. The fact is that small businesses will be offered a Small Business Health Tax Credit for up to 50% of premiums to help them provide quality health care to their employees. (http://www.barackobama.com/pdf/SmallBusinessFINAL.pdf)  And only large employers would be required to either provide health insurance to their employeesor – if they choose not to offer any health benefits – contribute toward the cost of insuring those without coverage. That's a cost that we currently all bear in the rising costs of healthcare premiums – so Obama's plan just makes sure that large employers can’t get away with contributing zero toward health care. For more on the Associated Press Fact Check, visit: http://ap.google.com/article/ALeqM5huxFz9UzzIQM5OrgZXnhWONwMp6wD94322H80

These are the facts for your assessment. More importantly, these are the facts to share over coffee with a friend, around the lunch table, or while raking the yard next to your neighbor. Sometimes talking about "politics" can make us uncomfortable. But this isn't politics; it's just sharing the facts.

I was just flipping through our Flickr photo album trying to find a picture from a recent event and I was amazed by what I saw. I know we've still got a long way to go in our fight to fix healthcare; and I know that the hardest work is yet to come (especially the next 6 days). But I want to ask you to take just a minute to stop and breathe right now. Take a minute to look back at how far we've come and what we've accomplished together:

 

We've met with elected officials and candidates at every level of government and talked with them about the healthcare crisis. From state legislators to U.S. senators, Healthcare United caregivers across the country have been meeting with candidates to share firsthand accounts of the state of America's healthcare system. And we've gone a step further - having them sign the Healthcare for America Now! pledge to let them know we'll still be paying attention after November 4th.

We sent over 4,000 Prescriptions for Change to the national conventions for both political parties. You wrote some of the most thoughtful, informed proposals for fixing healthcare that I've ever seen. And, believe me, I've read through a lot of proposals in the last few months. Dr. Toni Lewis went to Denver with your prescriptions in hand and delivered them to key congressional leaders to show them that caregivers know better than anyone what it will take to get our system working for patients and not insurance companies.

We've stood side-by-side with celebrities, community leaders, and healthcare allies to get our message heard. When it comes to finding solutions to the problems with the healthcare system, nobody beats caregivers. But, when it comes to getting the public to sit up and take notice, it doesn't hurt to have a television celebrity on hand. Recently, ER's Laura Innes and Gloria Reuben joined healthcare workers to knock doors and talk with voters about the importance of healthcare in this election. 

  We've brought thousands of caregivers together through phone calls, emails, and face-to-face meetings. Of everything we've done together, I'm most proud of the community we've built among healthcare professionals. You've shared with us your stories of coming together with your colleagues and talking about the issues you face on the job and what it's going to take to make it better. You've shared a lot of laughs together - and a few tears. But, mostly, you've given each other the inspiration to keep the fight going in your town and at your hospital or care center; because you know that it's part of something much bigger, happening all across the country. Those are the moments that I talk about when people ask me what I do. Those are the moments that make me proud to be a part of this movement and hopeful for the future of healthcare.

There's a lot of work left to do. It's a lot to ask of caregivers, I know. When you come home after a 12 hour shift and you see a new email from Dr. Toni asking for just a few more phone calls, or just one more email to a decision maker - it can be daunting. But, those little extra steps that you take are what have brought us so far in just a few months. We're closer than we've ever been before.

Keep fighting. Keep challenging each other to think differently about the way things are and the way things could be. Together, we will make healthcare happen.

When one mentions improving our healthcare system, one of the first obstacles on the minds of caregivers is chronic disease.

We know the toll that preventable and treatable chronic disease takes on our system: it’s the number one cause of death and disability, and accounts for nearly 75% of our nation’s healthcare costs.  And with our system designed to provide acute triage-based care rather than preventive care, it’ll take increased recognition of the problem in order to fix it.

The Partnership to Fight Chronic Disease, an organization committed to raising awareness of this problem, has released a new video message that urges women to get answers from the candidates about healthcare and chronic disease.  The video features celebs  Mary-Louise Parker, Lauren Bacall, Katey Sagal and Phylicia Rashad alongside everyday women.

Here’s the video:

 

To learn more about chronic disease, please visit the Partnership to Fight Chronic Disease’s website at http://www.fightchronicdisease.org.

Last week, ER stars Laura Innes ("Dr. Kerry Weaver") and Gloria Reuben (physician assistant "Jeanie Boulet") went door-to-door with fellow caregivers in an effort to drive other doctors, nurses and caregivers to the polls on Election Day. Now, they're counting on us to join them in that most critical of missions.
In the video, Gloria says:

"I think it's a good thing to get involved and to be out there and to take whatever action that one feels comfortable in taking or what one may want to take...some people may choose to do phonebanks from home, that's great. Anything anyone wants to do, we'll take it!"

Since we launched Healthcare United in April, we've played a vital role in making healthcare a central issue this election season.

Now it's time to take the next step. As caregivers, we need to make sure that each and every one of us heads to the polls next Tuesday. (For those of you in "early voting" states, this might mean reminding our friends and colleauges to vote early, as well!)

The good news is that it's never been easier to make sure this happens. We've made it easy for you to call your colleagues and remind them that Election Day is just around the corner. It's a simple message that allows you to ask them if they'll be joining us in voting.

And get this: for making 10 calls, you'll receive a Healthcare United bumper sticker. Make 25 calls, and you'll receive a Healthcare United "Patients First" t-shirt.

Join Gloria, Laura, and thousands of other caregivers in making this possible. It's time to get doctors, nurses and caregivers out to vote! Let's make the call! 

Click here to get started: http://www.healthcareunited.org/ercalls

A Healthcare Forum in South Milwaukee for Wisconsin Assembly District 21 candidates drew a large crowd on Wednesday Oct 22, 2008. The Forum was sponsored by Healthcare United and Wisconsin Citizen Action. Candidate Glen Brower and State Senator Jeff Plale fielded questions from participants on both national and state solutions to the healthcare crisis.
Healthcare United activists were out in full force. Cindy Kroll, RN who works as a hospice nurse, asked the candidates what they would do about the “profiteering” she witnesses everyday in the healthcare industry. She cited the large profit margins by health insurers, and the profits and building and technology arms race of the hospital industry while they scale back on nursing care for patients. One speaker talked about her experience with the individual insurance market and how she and her family have gone into near bankruptcy and do not have access to healthcare for their illnesses due to being rejected for pre-existing conditions. She noted that it was this same individual market for health insurance that the McCain plan hopes to expand.
Mardell Kaluzny, RN, a retired Nurse Educator and a Republican stated that she spent a lot of time educating legislators on healthcare both Democrats and Republicans. Mardell, a Republican, feels that healthcare is a complicated policy area and its up to healthcare professionals like her to explain how the system works.

In addition to all the candidate races in Wisconsin, there is a healthcare referendum on the November 4 ballot. The referendum asks for affordable and accessible health care to all Wisconsin residents at the same quality that state legislators get.

The Virginia team held its "Candidate Forum" for the 11th Congressional District on Saturday. It was held at The Virginian, a retirement community in Fairfax. There were 32 attendees, twenty of whom were healthcare professionals. Gerry Connolly, the Democratic candidate for Congress, was the guest of honor.

It was a great afternoon. Nurses, physicians, nurse practitioners, and nursing assistants asked hard (and often emotional) questions of our candidate and came away impressed with his knowledge and commitment to improving patient care. Their questions and comments often included personal stories that revealed the fractured state of our healthcare system. There was even a spirited debate on the merits of electronic record-keeping. Mr. Connolly emphasized that healthcare is a right, not a privilege. He said that healthcare professionals must have a voice in proposed solutions, instead of allowing wonks, policy makers, and powerful lobbyists to set the tone for change.

Everyone was so engaged in the discussion that we ran over the scheduled time of the event. Many of the participants, including the candidate, stayed behind to talk about the issues and make new friends. Our Healthcare United Virginia activists are fast becoming a family, and are excited to push for healthcare reform in 2009.

Do you live in Virginia? If so, we'd love to meet you! To get involved, contact me via email at matt@healthcareunited.org or via phone at (202) 251-4288.

According its description on Flickr, this photo was taken in the Hyde Park neighborhood of Chicago, Illinois. The photographer captioned her shot with, "When Walgreens becomes your doctor's office." What do you think? Is this the future of healthcare?

For anybody waiting for a big red flashing sign that healthcare is in serious trouble... I think this might be it.