NURS 6050: Policy and Advocacy for Improving Population Health “Health Policy and Politics” Program Transcript [MUSIC]
NARRATOR: Crafting policy to address health care issues.
MARY WAKEFIELD: Now let's think about that public policy maker who is trying
to fashion a solution to one of those challenges of cost access or quality. What is
it that determines what the solution is that gets put on the table and how that
solution moves through the policy-making process?
NARRATOR: The important role nurses play in health care policy.
KATHLEEN M. WHITE: Every nurse should care about being involved in the
policy process because we are the experts in health care.
NARRATOR: And a perspective that is critical.
DEBORAH TRAUTMAN: I was told when I was on the Hill that all politics is local
and all health care is personal. And I think that, as nurses, we understand that.
NARRATOR: Getting started in the policy process.
CARMELA COYLE: Policy begins with a good idea. The problem is to try to
move from an idea and a concept and good research to a piece of legislation that
can actually pass can be a long and winding road.
NARRATOR: This week, are experts share insights into the policy process, the
politics of health care policy, and the invaluable role of the professional nurse.
MARY WAKEFIELD: When I first moved to Washington, D.C. and worked in the
public policy arena, I was a bit of a policy purest, if you will. It was my belief that
public health policies crafted to address access cost or quality were designed
based on, for example, good research, on doing the right thing, if you will. And it
didn't take me very long to figure out that in fact it's not just about good research
or what I might view as an obvious solution to a particular problem associated
with quality of health care.
In fact, there are a number of factors that influence what solution gets put on the
agenda, how that solution moves through the policy-making process, and
whether, in fact, it even survives through to the end of that policy-making
process. © 2012 Laureate Education, Inc. 1 There are a number of factors that influence health policy. Health policy can be
influenced by crises. Media can influence what gets put on the policy-making
agenda or how it's treated once it gets there. Political ideology. Personal
experiences of members of Congress can influence how they respond to a
particular health care challenge.
Research findings also can be influential. Special interest groups can exert a lot
of influence on what gets put on the health policy agenda. Constituents like each
of you who might draw the attention of your policymakers. It might be that you'll
draw the attention of your congressional delegation to a particular problem the
you're saying. So constituents can be a factor that influences health policy.
Market forces can also be a driver of health policy. In addition, fiscal pressures.
So you have a number of different factors then that can influence both what gets
put on the policy-making table and how it's treated once it gets there.
In terms of personal experience, there was a congresswoman, now elected, from
the state of Florida who had a close personal friend with a particular disease.
And she was pretty public about introducing legislation that would be designed to
cover pharmaceuticals that were important to addressing that disease. So here is
a member of Congress who has a personal experience that's influencing what, in
this case, she did to address that particular problem of access to
pharmaceuticals to treat a particular health care problem.
So personal experiences matter on the part of members of Congress, believe it
or not. It's not all just about research findings. In addition, constituents' voices
matter. If individuals express their views about a particular health care problem to
their elected officials, it behooves elected officials to pay attention.
A lot of times nurses and others think that the only influence that's exerted or
factor that exerts influence in Washington or in a state capital is a special interest
influence. I'd suggest to you that's not really true. There are all the factors that
I've mentioned. And constituents, that is your own voice, is an extremely
important one.
So don't dismiss out of hand the impact that you can have as a factor, if you will,
in influencing what gets put on the policy-making table and how it's treated once
it's there. Because at the end of the day, guess what? Policymakers or elected
officials are either voted into office or they're voted out. They are ill-prepared to
be unresponsive to what is that their constituents are telling them.
So do all the other factors matter? You bet they do. But your voice matters too.
KATHLEEN M. WHITE: In designing health care policies, nurses have
traditionally wanted to be involved. It's been a great experience for me over 30
some years being a nurse. I think I got actively involved in health care policy and © 2012 Laureate Education, Inc. 2 politics very early in my career. And it's just always been something that has
fascinated me and something I've wanted to be interested in.
And yet, we're constantly amazed in trying to get a policy either changed or on
the public agenda that is new for nursing, is good for health care, or at least as
nurses we think it's good for health care, and something that we think the public
would benefit from. And I can tell you that over the years in trying to get
legislation either, first on the public agenda, and then being considered, often it
takes two, three, four, go arounds before a piece of legislation actually even
makes it out of a committee.
And it's surprising that you think, wow, this is a great idea. This will improve
things. And yet when it's new to a group of legislators who are teachers or
bankers or real estate agents or lawyers that really have no expertise in health
care whatsoever, they don't always see the importance of a policy. And so just
the fact that you have to introduce what seems to be a really good piece of
legislation that will improve things two, three, even sometimes four times, before
it even gets to that public agenda, I think is something that continues to surprise
me over the years.
A second thing that surprises me continually is that legislation often gets
introduced when one person has a problem. And they go to their legislator and
they say, this needs to get corrected. And the legislator meets the need of a
constituent. And so when you think about elected officials, they can be in one of
two camps. They can either what they call pleasing their constituents or pleasing
their conscience.
And so when you have one person's interests being represented, you really have
to think about whether or not that policy is a good one for all, for all of society.
And so certainly that evaluation of the good of society comes in looking at that.
DEBORAH TRAUTMAN: When we think about, what does it mean to influence
policy, I think of it quite simply as-- influencing health policy I think of three
factors. And one is first in my mind is that evidence matters. That in order to
effectively influence policy, it should be evidence-based. Additionally, I think that
communications matter and relationships matter. And that as a profession when
we think about being involved in advancing better policy that if we start with
evidence-- our evidence coupled with stories-- and we share those with
whomever it is that we're trying to educate about and/or work with shaping new
policy, that's where we first start.
But that communication is very important in that we need to be clear and
articulate in what it is that we're trying to address. In addition, when we were
talking about influencing policy, the policy, the politics, and the process are what
folks will frequently talk about as the three P's. I would suggest that in addition © 2012 Laureate Education, Inc. 3 there's the press, the public, and personalities, and that when we're trying to
move policy forward, we need to think about each of those.
In our organizations we currently participate in many of the key committees
and/or task force that are leading the direction for our institutions. And I think that
we also should be thinking about this not just on the federal level because a lot of
policy is also very state. I was told when I was on the Hill that all politics is local
and all health care is personal. And I think that, as nurses, we understand that.
We get what it means to advocate for better health and health care.
So there is opportunity for us to think about, then what does that mean in driving
some of these next steps to getting us to be a healthier America? And that not
every nurse needs to go visit their member of Congress. But every nurse should
know who their member of Congress is. Not every nurse needs to, in my mind,
be the extrovert who is speaking on a large platform, but we have opportunities
to talk to on an individual basis to the patients and to their families.
And what we should be helping do is continue to think about what services and
resources are necessary to help us move, again, to being healthier.
CARMELA COYLE: As I think of major influences affecting health care policy, I
tend to think of it as a three-legged stool. You've got the legislative process that's
affecting health care policies. The laws that we shape, the laws that we enact.
There's a second leg of the stole which is the regulatory process. It's the
thousands of pages of detail that have to be written to clarify what it is our
lawmakers had in mind.
And there's a third leg of the stool. And that is the special interest groups. The
special interest groups play a very, very important role by informing legislators
and regulators, from the front line perspective of health care delivery, of what the
implications of a new law or a new regulation might be.
I think if there are forces affecting those, there are several. One is, I think, our
elected officials. Our legislators are certainly being held more accountable by the
voters for making certain that we've got the kind of health care system that
people want to see in the United States.
I think that we're also seeing consumer expectations on the rise. And more
pressure, I think, today than we certainly saw at 10 or 20 years ago from a
broader array of special interests to make certain that the policy we've got in
place is really serving every one, not just what we've traditionally viewed as the
key stakeholders in the health care system.
But I think we've seen greater accountability. I think we see greater engagement
and involvement. From my perspective a strength of our system, but it makes the
creation of health care policy that much more challenging, © 2012 Laureate Education, Inc. 4 And I think one of the new entrants is we really are more focused on measuring
how we've done at the end of the day. There's been policy that's been put into
place, and we don't really know if it works or if it doesn't. I see much more
emphasis in new laws and new regulations on evaluating three years out, five
years out. Is it working? And if not, come back and report it and we'll have to
revisit the legislation.
So I think all of that is a set of new forces really helping to shape policy and
refine it in ways we haven't seen before.
DEBORAH TRAUTMAN: Nurses sometimes say they don't like politics. I don't
disagree with them. Politics is probably the least desired part of the process. But
you can't divorce policy from politics. But I believe-- especially now because we
have some pretty partisan times in our federal government, at least, and maybe
even at the state and local levels-- that if you could have the voice of health care
professionals ringing through that partisan divide that we may be able to make
more progress that we can't otherwise because of ideologies.
I have never known the nursing profession to make clinical decisions and care
and judgment based on someone's political ideology. But politics is a part and we
have to recognize that. But what I would suggest to us as professionals is that we
need to just increase our effectiveness in managing some of the politics, or at
least acknowledging and addressing them.
So who are the stakeholders that we should bring along with us? Who's going to
be in favor and helpful to us in advancing policies? And who are those that are
opposed? And we need to educate ourselves on what their positions may be. So
that's a part of it and a part of, what I would say, the evidence.
The communication, again. In thinking through our message and being able to be
clear and succinct and brief. Because the effectiveness of getting our point
across is based upon not just what we want to do but how well we communicate
that. And then relationships are incredibly important. Not only building
relationships within the profession of nursing, but outside. And with our elected
members of Congress as well as with others.
And in particular I would say for state and federal policy it's important to know
who are the committees of jurisdiction that are working on policy? Who are the
staffs? Some folks have said that they thought if they try to set up a meeting with
their elected member and are referred instead to a staff person, that that's not as
good. And I would say that that's incorrect, that many times it is the staff who are
the source of information and the filter of information that goes to our elected
members. And so it's as important to have relationships with those individuals as
it is with members themselves. © 2012 Laureate Education, Inc. 5 The advantage that we all have is that very few of our elected members will turn
down their own constituent. It may be harder to get in to see someone from
another office or state. And not all of our states have representatives on some of
the key health committees. But most all of the staff that I met when I was in the
Speaker's office and the committee staff that work both on the minority and
majority side, were very open to listening to perspectives that were being brought
forward by health care professionals. Because many times what others know
about health care is from their own personal experience or what someone tells
them.
Health care professionals, nurses in particular, have firsthand experience and
know not only what might work best, but have stories to tell that help make it real
beyond just a theory or a proposed solution or alternative.
[MUSIC] © 2012 Laureate Education, Inc. 6

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