This is the strategy used in Canada, where drug costs have been substantially reduced. The challenges presented by this law have spilled over into the current health-care reform debate. Many people and many legislators who might have been more open to engage in productive dialogue during the current debate were no doubt made more leery of the process and of the possibility that there could be significant reform that would bring benefits to more people while bringing down the federal deficit.

The fears of opponents of the bill were correct in their fears that the bill would been even more expensive than originally budgeted. The initial estimate for the net cost was $400 billion for the period from 2004-2013. However, only a month after the bill's passage, that estimate was raised to $534 billion. It has since been raised to over $550. The cost over-runs in this bill will no doubt continue to grow, even if the health-care reform measures currently being considered are enacted.

Question Six: Single Policy Option

One policy option that may influence the health-care workforce would be a greater empowerment of nurses. Nurses are vital to the welfare of patients and provide the great majority of care. And yet they are often prevented from providing care that they are qualified to give. Allowing nurses to give care that they are now prohibited by law (and custom) from giving would fundamentally change the way that health-care is provided in the United States with a number of different stakeholders benefiting from such a change.

For example, nurses could provide a great deal of the well-baby care that is now conducted by doctors. A child with an ear infection does not in general need to be seen by a physician. A parent with child on her sixth ear infection recognizes the symptoms, which could be confirmed by a nurse on a visit to a home clinic (or via a telemedicine program). If the nurse could then prescribe the appropriate antibiotics, the child would have been treated more cheaply and probably more promptly and with greater compassion. The nurse would also benefit from the increased responsibility and rise in status.

Another area in which using nurses instead of doctors would prove to be beneficial is having nurse-midwives attend laboring women...

These nations have better outcomes for both women and infants than does the United States -- in terms of cost, the quality of care provided, maternal and infant death rates, and also in terms of job satisfaction by nurses.
The current division of labor between nurses and doctors reflects an archaic division between what was considered to be appropriate work for men and women. Confining nurses to their current duties does not serve the current health-care system -- not the doctors, not the nurses, and not the patients.

Question Seven: Information Technology

New information technologies have substantial potential to save money as well as to provide better care to patients. One such technology that is already being adopted, and will be much more widely adopted if the currently proposed health-care reform legislation is passed, is that of electronic records. Having all of a patient's records available electronically to any health-care provider should reduce waste in terms of unnecessarily repeated tests because of lack of a centralized information on what the patient has been through. Knowing what a patient has already been tested for will guide physicians and other health-care givers into picking the next best step.

Having a centralized source of information on a patient would help prevent the many (sometimes fatal) mistakes that occur when there are drug interactions. Having complete electronic records would save patients time in that they would not have to repeat their personal and family history each time they go to a doctor -- a lack of repetition that is likely to make records more accurate since patients are less likely to skip over details when they don't have to fill out the same paperwork over and over.

Having a unified electronic file would also be beneficial to patients because it would make it easier for them to have access to their own health records -- something that each patient should have the right to do. It is often very difficult in the current system for patients to get access to their entire medical history. This is fundamentally dis-empowering to individuals and makes it difficult for them to move from doctor to doctor because they may have to re-initiate care that they cannot document.

There are potential problems with such electronic systems, of course. All electronic systems are subject to failure, which means that medical information could be lost or corrupted. And all electronic systems are also subject to being hacked, with the possibility that patient medical information could be leaked.