OHSU dean addresses health care reform

A voice is missing from the nation’s health care reform debate, one of uncommon compassion and insight — the collective voice of the nursing community.

It is one that desperately needs to be heard, said Michael Bleich, dean of Oregon Health & Science University’s School of Nursing.

“Why don’t we have nurses involved in the end-of-life care debate? It is not happening. We know more about this ... about human dignity (at the end of life) yet our voices are silent,’’ Bleich said.

Bleich is convinced that the wheels for major changes in the United States’ health care system are in motion.

“Health reform is happening, There is no turning back.’’

He believes what will emerge from the present debate is an outline for a new system and that details for it will be worked out later — details for a new system Bleich believes is desperately needed. He cited the words of a health care leader he knows in England to make his point.

“How can anyone sleep at night? Everyone is one step away from a financially catastrophic health problem,’’ the United Kingdom health official told Bleich.

The OHSU dean, in continuing his international focus, also spoke of Canada’s government-subsidized health care.

“In Canada everyone has access to health care. In the United States it is a privilege to get care.’’

Any comparison between the United States’ health system to those throughout the world would be incomplete without reference to insurance.

“We must understand that the fundamental difference between the United States and other nations are the huge profits insurance companies make. This is money which should be in the system,’’ Bleich said.

Another major problem with the U.S. system, Bleich said, is that it encourages physicians to become specialists rather than primary care providers, since specialists make more money.

“The system pays for them to be specialized.’’

He contended that a health care system heavily weighted with specialists is unwieldy and can not last.

“At some point the system will implode,’’ Bleich said.

He noted that there are 189 sub-specialists physician categories in the U.S. Someone with a health problem may have to see doctors from many of these specialities.

“It is not feasible. I might see more specialists than I would walking down main street in La Grande on a Friday night.’’

Bleich also spoke Thursday of the critical need to make health care services available throughout the U.S.

“Fiscal access to care does not mean physical access to care. Just because you can pay for care does not mean you have access to care,’’ Bleich said.

The fine points of this issue are often overlooked. In illustrating his point Bleich noted that he earlier worked at a hospital in Nebraska where the first lung transplant operation in the state was performed. The patient, who lived 400 miles from the hospital, was set to return home after the operation.

“I asked my staff, ‘What happens the first time he gets a cold and he’s 400 miles away (from specialists who know how to treat his condition)? They had not thought of that,’’ Bleich said.

Bleich has served as the dean of the OHSU School of Nursing since July 2008. He came to OHSU from the University of Kansas School of Nursing. Bleich, who has a Ph.D. in Human Resource Development from the University of Nebraska, earned his R.N. diploma from St. Luke’s Hospital School of Nursing in Racine, Wis., in 1976.

Bleich believes that part of the reason the voices of nurses are not being heard in the health care reform debate is that they are not given a prominent leadership role. This is not the case in places like England where it is mandated that nurses have a central role in its health care system.

It would only be fitting, Bleich said, that this also be the case in the United States for nurses on the front lines of health care.

“Nurses are with patients for their first breath and their last breath.’’