Among the barrage of strange events assaulting even the most durable citizen watching the transition of federal power these days, one of the most interesting is the long line of pundits and purported experts queuing up to give the Obama administration lengthy and often preachy doses of advice. I don’t remember us doing this for George Bush…hmmm. While chagrined, here I am getting in line. My intent is to balance the discourse a little.

My advice is about the undertow. The often unacknowledged subtext of much of the advice now being offered is an enormous expectation that somehow Obama will magically restore our collective capacity for ethical choice and conduct. The undertow, of course, is that we all participated in a frenzy of unethical behaviors of one kind or another to get us into the mess we are in. Many seem to me more passive than active: things fell apart and we did nothing or very little. One does not see the whistleblowers receiving Medals of Honor. Yet somehow we want Obama to single-handedly reverse this collapse of communal values and moral conduct. It seems kind of unrealistic to me. I took seriously his contention that all of us were going to have to do our share.

So here I am sending a memo to Barack Obama which I hope he will share with his probable Health and Human Services Secretary, Tom Daschle:

Memo to Barack Obama
Re: Ethics in Healthcare

As I followed your amazing campaign, certain messages caught my imagination more than others. One was that you really thought we all had to play our part in fixing all the stuff that is now broken. So I don’t really think you have to change us; I think we have to work with you to change us. I think this is the really big change we do not yet understand. And I think it is generational.

We grown ups have become accustomed to sitting in our arm chairs and commenting on what the leaders should do while doing nothing or very little ourselves. We have indeed been engaged in what is sometime called “daddy” politics. I don’t think you are advising us to change course and try “mommy” politics. I think you are asking us to try “grown up” politics. I actually think you are suggesting this “third” option, active and responsible citizenship, that most of the grown ups really do not yet embrace or understand.

So of course, you are in search of a few grown ups who do get it, grown ups who can help you create the changes we all seem to want to believe in. I am sending you this memo to tell you about one group of grown ups who could be quite helpful to you as you tackle the challenge of ethical choices in healthcare in the United States: Nurses!

I don’t know if you noticed that the overriding concern about healthcare is cost. The flip side of this coin is access and quality, the side of the coin we have not been looking at much for some time now. It is, I believe, essential in fixing healthcare that we balance these polar tensions, both of which are essential. The loss of balance is a failure in ethical choice and conduct. No one seems to want to say this out loud.

Once you announce that “Health care is a right”, everything changes. We have never been willing to say this as a nation. The primary argument against this assertion has been about cost, capitalism as sacred, solutions as socialism, and the increasingly indefensible conviction that the free market will take care of everything for us. The most weird dimension of this last assertion is that somehow the free market has a built in ethics meter or capacity that takes care of moral choice and behavior. I am kind of hoping Bernie Madoff, AGI, Hank Paulson, GM, etc. will help us refine our thinking on this bizarre assumption.

I believe that integrating ethical choice and action into the changes we are all trying to believe in requires people in the decision-making process who actually show substantive competency in this skill set. It requires people who understand the ethical implications of the mantra: Healthcare is a right! You need nurses. Just ask the citizens of the United States.

Gallup annually, in November, asks us to please tell them “how you would rate the honesty and ethical standards of people” in a list of “different fields”. As they reported in November, 2008, while we were busy voting, “Nurses have topped Gallup’s Honesty and Ethics ranking every year but one since they were added in 1999. The exception is 2001, when firefighters were included on the list on a one-time basis, shortly after the Sept. 11 terrorist attacks”.

I am going to forego the obvious question of why nurses were not added until 1999, and why firefighters only were included this one year, though I am tempted to explore that here. The point I am making in this memo, however, is that nurses top the list. Yes, that means they actually get ranked higher than medicine, the discipline folks always assume has the best possible insights into healthcare concerns.

With Gallup, for now, I am going to treat 2001 as an outlier year, and speak to the other nine years. If a group is finally included in a “contest”, and wins every year, in the highly competitive culture of the United States, one would expect this extraordinary achievement would be headlines on the front page of the New York Times. Of course, if the “contest” is about ethics and honesty, it may not seem compelling.

However, you are trying to reinsert ethics and honesty into our corrupted discourse. Hence, the best possible group of experts to assist you, according to our citizenry, is nurses. By now you may have noticed that we do “let” nurses come to the policy table. Usually this means there are several physicians and a variety of policy wonks, a few scientists, and a token nurse. I am going to assume you understand the dynamic of “token” participation in policy setting. In addition, in setting policy agendas, we spend a good deal of time trying to figure out how to keep the physicians, for profit health care agencies, and the drug and insurance companies “happy”, as if their capacity to sabotage and resist is the overriding concern. I would assert that there is not much attention to ethics and honesty in this obsession. As I recall, you have mentioned that we are all going to have change and we are all going to have to make sacrifices.

So, that’s my case. I deeply believe, along with the World Health Organization and the United Nations, that Healthcare is a Right. Human rights always involve the challenge of addressing social justice issues with ethics and honesty. If you want to reinsert ethics and honesty into the national dialog about healthcare reform, I strongly urge you to bring in lots of experts: Nurses. If you need a list of suggested participants, I will happily assist you. We are legion.

This entry was posted on Thursday, January 15th, 2009 at 11:22 am and is filed under Consumer Health Care, Politics. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.