Anyone who has had much experience with America's health care system knows that nurses are the essential players in making things work.
So as the swine flu outbreak evolves into a genuine public health emergency -- with cases being discovered in more states and the announcement by President Obama of the first death in the U.S. -- it is time to consult the nation's nurses.
And the nurses are saying that federal authorities must move more aggressively on a number of fronts. Of particular note in a call for steps to be taken to require insurance companies to suspend or waive insurance company fees -- such as co-pays and high deductibles -- that may discourage sick people from seeking care.
The California Nurses Association/National Nurses Organizing Committee, which has most of its 86,000 members in the state of California, where Governor Arnold Schwarzenegger has declared a state of emergency to tackle the outbreak, is making a smart call for national action to promote containment and prevention of a broader swine flu pandemic.
At the heart of that call is a reminder that the United States has badly neglected public health and allowed the nation's health-care infrastructure to degenerate at precisely the points where Americans are most vulnerable. "From SARS to avian flu to the current escalating outbreaks of swine influenza it has become increasingly clear that we are risking a major catastrophe unless we act to restore the safety net, and devote the resources that are needed to protect the public," says CNA/NNOC co-president Deborah Burger, who like other leaders of the union is a registered nurse.
But there is, as well, a need for action to assure that insurance company greed does not erect barriers to care.
The CNA/NNOC call comes at a time when the federal government is starting to take both the swine flu outbreak and the broader threat of a pandemic seriously -- after neglecting the issue when House Appropriations Committee chair David Obey, D-Wisconsin, urged forward-looking action during last winter's stimulus debate.
President Obama has taken an important step in the right direction with his call on Congress -- which stripped Obey's plan to provide $870 million for pandemic preparedness and related initiatives from the emergency stimulus legislation -- to allocate $1.5 billion for combating the virus. With public concerns and political pressures rising as the World Health Organization urges countries to prepare for a pandemic, it is unlikely that Maine Senator Susan Collins, the Republican who led the fight against allocating the preparedness money (cheered on by unthinking Democrats such as New York's Chuck Schumer), will object this time.
But Obama's call focuses on emergency funding to provide an adequate supply of vaccines and the equipment to handle a potential outbreak. That's just a piece of the puzzle.
CNA/NNOC officials argue that president's commitment, while significant and welcome, is not enough.
The union has developed an action plan that seeks a federal commitment to:
* Reinstate the $870 million for pandemics that was cut from the economic stimulus bill.
* Recruit and mobilize teams of scientists to create the appropriate effective vaccine for the virus.
* Cease and desist any reductions in public health programs at federal, state and local levels. Lift any freezes on public health funding currently in place.
* Implement a moratorium on any closures of emergency rooms, layoffs of direct health care personnel, and reductions of hospital beds.
*Allocate funding for recruitment and retention of school nurses, public health nurses.
* Expand the network of community clinics, especially in medically underserved areas.
*Add thousands of additional ventilators/respirators, which are critically needed in the event of epidemics.
* Assure the availability of protective equipment for all health care personnel.
* Require all insurance companies to suspend or waive all out-of-pocket expenses, including co-pays, deductibles, or co-insurance that discourage individuals from seeking preventive care for early signs of infection.
The nurses union's proposals should be taken seriously, especially by members of Congress who -- aside from Obey and a few others -- have failed to take public health issues seriously.
The CNA/NNOC is not a newcomer to this issue. Three years ago, it warned that the "firewalls for stopping the next great pandemic are getting thinner." In particular, the union focused on reductions in public health funding and serious gaps in the distribution of essential medical devices such as mechanical ventilators.
While research and technology are important, access to care is even more essential.
That's why the union's call for federal action to require insurance companies to suspend or waive all out-of-pocket expenses is so vital.
This will be controversial in Washington, where the insurance industry has plenty of friends -- including Collins, who accepted $258,700 in insurance industry funding for her 2008 reelection campaign, and more than a few of her Republican and Democratic colleagues.
But it is essential to make sure that skyrocketing co-pays, deductibles, and other charges that have been imposed by insurance companies do not discourage Americans who are ailing from seeking care.
As CNA/NNOC president Burger says: "Price gouging by the healthcare industry has already put tens of millions of families in healthcare jeopardy, especially in an economic crisis. At a time when untold numbers are already exposed to a dangerous virus, we need to be removing any barriers to medical care that would exacerbate the spread of contagion."