Dear Mr. President

Dear Mr. President;

I apologize as this is the first time that I have had a chance to write to congratulate you on holding the highest office in the land. It must be a real honor to be chosen as leader of the free world. You are a good man and you seem to have a very nice family. I am sure you deserve the honor.

Because I have been so busy, it has been rare that I have been watching the news. Frankly, I find it very depressing because in general, I am just not smart enough to have an opinion. I imagine that you have very well qualified economists with advanced degrees advising you. I have nothing to compare with that kind of experience. You see, I am just a nurse who sees red flags go up when I read about ‘healthcare’ reform.

There are a lot of arguments that seem to warrant extreme action in the realm of health care but the one that I hear most from Washington is that health care costs too much and therefore we must pay less. I don’t understand how that works. Before pestering you with all my questions, I decided to try it for myself. I went to the grocery store, approached the cashier with 120.00 worth of groceries and told him that I would only be paying 110.00 because I thought the price of groceries was too high.

Well, that went over like a lead balloon, let me tell you. The cashier went and got the store manager who explained that if I wanted to pay less, I would have to buy fewer goods or goods of a lesser quality. I took that to heart. It made sense to me. I think it warrants stating again:

If you want to pay less, you have to buy fewer goods or goods of a lesser quality,

You see, Mr. President, it costs a whole lot of money to provide health care. Like all businesses health care providers sell widgets. And our widgets cost a lot of money which is passed onto the consumer.

Now, I am a just a nurse but my job is that of consultant. I work with all kinds of smaller health care providers.

My clients do not spend a lot of money. They are located in modest zip codes in B grade office space. Office parties are generally potluck and Christmas bonuses, while appreciated, do not constitute a significant percentage of anyone’s annual compensation. But they make a decent living providing a much needed service and all of us involved are proud of that.

Do you know what my client’s greatest expense is? Nurses! Yes, I may be just a nurse but if you could clone me 215,000 times, you might have enough of us to staff the hospitals and nursing homes needing us. Of course, I know all about the controversy you created with the whole stem cell thing and I just have to wonder if it was good karma to piss the pope off so early in your presidency. But I digress. You made it clear there would be no cloning.

Nurses cost money. We are expensive to train. You can imagine what a potential disaster it would be to have millions of little nursing students running around unsupervised in a hospital. But at the end of the day, we can get a job anywhere. In fact, we are the only profession I know that regularly sports resumes with 20 or more jobs in five years and are still in hot demand. You see, we seldom get fired. Rather, we always leave for more money offered by desperate competitors. Of course, once we jump ship, the new employer has to invest an enormous amount of time and money training us and if they are lucky we will stay for a few months before moving on.

Now, this doesn’t sound like very professional behavior but I guarantee you that teachers would do the same thing if they were offered an additional ten thousand a year or better benefits or better hours by other schools. So would engineers, computer programmers, etc. In fact, if there was a shortage of people willing and qualified to work at Taco Bell, you would see people making a lot of money selling tacos. And I imagine the price of Taco Bell products would go up or the quality of the food would go down.

Nurses provide the bulk of services offered in hospitals, home health, hospice, etc. Admissions to the hospital are very rare unless a serious need for nursing care exists. Other procedures and care rendered by physicians is done outside of the hospital whenever the need for nursing care isn’t evident.

But we have learned to live with the nursing shortage. I have been a nurse for over twenty years and we have never NOT been in the midst of a nursing shortage. Complaining about it is rather like complaining about the weather. We make a lot of noise about hurricanes here in South Louisiana but it does nothing but waste time and energy to complain about our oppressively hot summers on a regular basis.

So, you want to pay less for nursing care – our widgets – but the supply is too low and the demand is too high. You can’t let just anyone get a hold of sharp instruments and lots of medications.

But, I noticed that nurses were grossly underrepresented in Washington when you discussed health care. I’m sure my invitation was lost in the mail. Chances are we were far too busy to attend anyway,

Cutting the Medicare budget makes sense in a lot of ways. The people receiving the benefits are usually not in a position to vote anyway. It is people like my Mama and Daddy who get Medicare. And while I am truly fond of my parents, they are nothing special. Like most elderly Americans, they have outlived their usefulness to the political engine that runs this country.

Both of my parents get on my nerves by the way they assume responsibility for their health. They exercise every day. They go to church and volunteer at hospitals and food banks keeping them spiritually fit and mentally active. Eating at their house is an adventure. You would be surprised what you can do with ground turkey. Even now with full benefits, they refuse to turn over responsibility for their health to the government. If you want my opinion, if more septuagenarians were like them, it might be harder for nurses to find a job but that’s a subject for another letter.

My next question is, why do you think it is appropriate to reduce my parents’ Medicare benefits to ‘fix a broken system’? I honestly want to know. I am just a nurse. I don’t see how these things work. Medicare now covers 95% of our elderly. Before it was implemented, only 50 percent of seniors had health care coverage. I don’t see that as broken. Perfect? Of course not. But ‘broken’ is a pretty strong word to use when you consider all the people who have benefited from Medicare.

One thing I really support is the advancement of electronic services in health care. I have seen any number of studies that correlate the success and efficiency of health care providers to the sophistication of their software. Every day, more options are becoming available to health care providers. I have had the privilege of working with software companies and have experienced this first hand.

Now my question relating to the billions of dollars (19 billion) you plan to spend to support electronic health records, is, ‘why’? Without being impertinent, Mr. President, I am asking you to please explain to me the government’s role in electronic health data. The last time the feds got involved in computer health care stuff, I made a lot of money teaching the HIPAA Privacy Rule to a whole lot of clients. They spent a lot of time and money paying for me to teach healthcare ethics 101 – the same respect for patient confidentiality already built into nurse and therapist practice acts and health care facility policies. It was kind of redundant if you must know. But it was required by law and so I made money but I didn’t feel really good about it. I spent a lot time with nurses taking a lot of time away from patients to do something that never once benefitted the first patient.

So, if your 19 billion dollars includes more federal regulations, thank you but I respectfully decline. I think if you ask most of my colleagues you will get the same information. We are doing fine. If you really want to help, supply actual hardware to clients and grants to software vendors but stay out of the mechanics of collecting and disseminating health care data. We do not tell you how to be a lawyer. Please do not tell us how to be health care professionals.

I really must get back to work now. By way of copy to my state representatives, I am sharing my opinions with them as well. In addition, I am sharing with a few hundred friends on the internet. I hope they will read this as it was intended and find encouragement to share their own ideas.

Meanwhile, Mr. President, I do have a lot of questions. I hope that you will take time to answer them so that when it comes time to support your healthcare reform, I will know exactly what I am supporting or speaking out against.

One final thought, Mr. President: I may be just a nurse, but I am also a proud American.

With warm personal regards,

Julianne Haydel RN

Haydel Consulting Services LLC