In response to the comments on my previous post, ANA endorses Hillary Clinton, I did some investigating into why Obama may not have been chosen over Clinton.
The ANA endorsement process involves four steps. Here is a brief outline of the steps found at the ANA site (some material quoted directly to ensure accuracy):
Step 1: The ANA chooses four members from the ANA-PAC board to serve on the Presidential Endorsement Task Force. This year, it was the following:
- Sara Jarrett, RN, MS, MA, EdD of Colorado (Chair)
- Barbara Crane, RN, CRRN of New York
- Elizabeth Dietz, EdD, RN, CS-NP, of California
- Representative Erin Murphy, BSN, RN of Minnesota
Step 2: The task force works with the ANA Government Affairs to:
- Review candidates voting records,
- Work on drafting a questionnaire,
- Polling of Constituent Member Associations (CMA) and ANA membership for their preferred candidates, and
- Conducting interviews with the candidates.
Step 3: The ANA’s Board of Directors are given the recommendation from the PAC board (which includes the task force and their work with the ANA Government Affairs) and an endorsement process decision is made. The three options are:
- No endorsement or support of a candidate,
- Support one or more candidates during the primary elections, or
- Support of a candidate following the party nominating conventions
Step 4: “The ANA Board of Directors will vote to ratify the PAC Board’s endorsement recommendation.” This information is then communicated to ANA members, CMA’s, the candidates, and appropriate media parties.
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Six questions were chosen for the candidate questionnaire. Here is an example of an unanswered one. Click the names below to read the candidate’s responses in their entirety.
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My investigation:
Finding 1
Representative Erin Murphy (DFL 64A) has been an excellent advocate for nurses. Just recently, I wrote Strib: Minnesotans could save 12.3 billion in healthcare costs in which I mentioned Rep. Murphy’s continuing support. Since finding who served on the Presidential Endorsement Task Force, I did some searches on any personal endorsements prior to the ANA decision. My concern was for any bias before serving on the Task Force.
Clinton’s webpage specifically mentions Representative Erin Murphy’s joining of Clinton’s Minnesota Steering Committee in a January 25th press release along with nearly 50 other Minnesota legislators and community leaders. Curiously enough, this came on the same day as the ANA endorsement of Hillary Clinton. The timing was appropriate, but I wanted to find out more. Mike from Blog4President.US made the announcement of Rep. Murphy joining Clinton’s campaign on January 24th, 2008. Again, timing is very important as a personal endorsement should not come before the association endorsement, especially since Rep. Murphy was bound to ANA endorsement rationale:
However, as a professional organization ANA will consider candidates based solely on who will best serve the interests of the nursing profession and their patients. Political parties or personal agendas will not matter in this process. No political support will be offered by ANA without thoughtful analysis of a candidate’s past record and views on nursing.
Turns out, John Edwards had already received an endorsement from Representative Erin Murphy following the launch of a “Women for Edwards” campaign on May 15th, 2007. If any of you remember, John Edwards was in the race until January 30th, 2008, just five days after Murphy’s joining of Clinton’s Steering Committee. Blog4President.US also announced Murphy’s support for Edwards.
I am very proud of Rep. Murphy’s accomplishments, but I bring up these issues since I worry about any bias when choosing the candidate for an association that represents 2.9 million nurses. This is especially important since she threw her early support toward John Edwards and now Clinton, with no mention of any support for Obama. I hate to pick on her, but I could not find any information on the others serving on the Task Force.
Finding 2
Step 2 of the endorsement process involves conducting interviews with the candidates. The ANA sent questionnaires to all candidates, but only received answers from Democrats Clinton, Obama, Biden, Dodd, Edwards, Kucinich, Richardson and Republican Ron Paul.
The only candidates that participated in the interview were Clinton, Kucinich, and Richardson. This makes Clinton the only candidate who participated in the interview who was still in the race at the time of selection. Because Obama did not participate in the interview, he consequently lost points throughout the endorsement process. This is despite his strong answers on the questionnaire.
Unfortunately, according to a letter sent back to nurses who were upset about the ANA endorsement, the following are the actual results of the member-base votes*:
Clinton - 42%
Obama - 21%
McCain - 8%
Edwards - 9%, Huckabee - 8%, Romney - 5%, Guliani - 3%, Thompson - 3%, Kucinich - 1%, Paul - 1%, Biden - 0.5%, Richardson - 0.12%, Dodd - 0%, Gravel - 0%, Hunter - 0%
*Despite my frequent activity working for nursing and political issues, I was not aware of this voting and consequently, my vote was not represented in the final tally. I am curious to know what the actual numbers are.
Finding 3
The California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) are vocal supporters of national single-payer coverage, which Clinton’s plan lacks. In advertisements that came out prior to the endorsement, the NNOC came out in full force challenging Clinton’s healthcare plan. Check out this YouTube video of one challenge:
It is only fair to say that Obama has been challenged as well because his plan does not include single-payer coverage either.
However, Obama has been consistent with the ideal that he supports a single-payer system. From Obama’s fact check:
Obama said, “Here’s the bottom line. If I were designing a system from scratch I would probably set up a single-payer system…But we’re not designing a system from scratch…And when we had a healthcare forum before I set up my healthcare plan here in Iowa there was a lot of resistance to a single-payer system. So what I believe is we should set up a series of choices….Over time it may be that we end up transitioning to such a system. For now, I just want to make sure every American is covered…I don’t want to wait for that perfect system…The one thing you should ask about the candidates though is who’s gonna have the capacity to actually deliver on the change?…I believe I’ve got a better capacity to break the gridlock and attract both Independents and Republicans to work together.”
Finding 4
The movie SiCKO pointed out the fact that many members of Congress receive contributions from the healthcare industry. Clinton is one who has, and still receives money from many of these insiders. The CNA/NNOC concluded an analysis on contributions and released a press release last summer. This was outlined on Fierce Healthcare:
The CNA/NNOC analysis concludes that healthcare industry players contributed $3.7 million to current candidates during the first quarter of 2007. It also notes that the industry–which it defines as including drug and insurance companies, doctors, hospitals, dentists and nursing homes–spent more than $2.2 billion on federal lobbying over the past decade. By CNA/NNOC calculations, Sen. Hillary Clinton (D) and Sen. John McCain (R) got the lion’s share of healthcare contributions of all presidential candidates, collecting 40 percent of the overall total.
Using data from the Center for Responsive Politics, Barack Obama receives 99% of his donations from individual contributors with a mere $25 received from PAC’s. Clinton receives 87% from individuals with over $1 million from PAC’s. She also recently donated $5 million from her own wallet to catch up with Obama’s advertising.
In an article entitled, “Deborah Burger and Maureen Caristi: Guaranteed healthcare, not just insurance,” the author’s look at the bigger problem of healthcare reform. Pieces quoted from the article:
“…simply adding more Americans into a flawed insurance system will not solve our national health care crisis. Especially when you let insurers continue to charge as much as they want, and do nothing to stop their callous, all too routine practice of denying medical treatment or blocking access to specialists or diagnostic tests because they don’t want to spend the money.
Mandating people to buy insurance is at the center of the debate on health care between Sens. Hillary Clinton and Barack Obama — she’s for it, he’s against it…”
“Obama has a point that the cost of insurance makes it a bad bargain for many Americans. Insurance policies now average over $12,000 per family just for the premiums, not including skyrocketing deductibles, co-pays and other costs that have made medical bills the leading cause of personal bankruptcy.”
“The individual mandate cheerleaders claim that if you don’t put everyone in the insurance pool, only the sick will buy health care and insurance companies will raise costs. Have any of them noticed that insurance premiums have gone up 87 percent nationally the past decade without a national individual mandate?
But individual mandates are popular with the insurance industry and those close to it. Insurers reap millions of new customers with minimal requirement to change their behavior. It further entrenches a broken system, expanding the reach of an industry that treats every dollar spent on care as a “medical loss ratio.”
It distorts the role of government, which should be to protect people, not act as an insurance agent.”
Finding 5
Many people across the internet are looking for the quote that Clinton apparently said about nurses being “overpaid and undereducated.” There are also rumors about her calling nurses “glorified waitresses” at one point. I scoured the net, including searching my graduate school databases with no evidence of these quotes. However, the website, Snopes, thinks they found the source for the “overpaid and undereducated” quote.
In remarks by Hillary Clinton for the United Nations Fourth World Conference on Women (Sept. 5th, 1995 in Beijing, China), Clinton said the following,
As long as discrimination and inequities remain so commonplace around the world - - as long as girls and women are valued less, fed less, fed last, overworked, underpaid, not schooled and subjected to violence in and out of their homes - - the potential of the human family to create a peaceful, prosperous world will not be realized.
Full text and video can be found here. There were multiple statements made about nurses which could have caused this to be misinterpreted. However, many people still swear that they heard Clinton make the rumored comments.
Finding 6
Here are excerpts from the letter sent by ANA president, Rebecca Patton, in response to those against the ANA endorsement of Clinton,
In making this endorsement, the ANA Board recognized Senator Clinton’s longstanding commitment to nursing and health care. During her time in the Senate, Clinton has been an advocate for nursing issues. Clinton was in support of the Title VIII Nurse Reinvestment Act programs which provide much needed funding for nurse education. She recognizes the need for more nurse practitioners and supports increased authority for and utilization of nurse practitioners as a means of improving access to health care. She has a long history of advocacy for health care reform, and her current plan emphasizes the need to reduce costs, improve quality and ensure affordable health care for all Americans. She was a co-sponsor of the Mental Health Parity Act of 2007 which would improve mental health services.
From its inception in 1896 to the present day, ANA has recognized that individuals can shape health care policy consistent with the goals of registered nurses and in the best interest of their patients.
Obama’s Views:
- Regarding the Title VIII Nurse Reinvestment Act, Obama not only supports it, but he calls for greater funding in this statement:
I support reauthorization of Title VIII training programs with greater financial incentives for students and nurse faculty, including scholarships and loan repayment. Given the dire shortage of nurses, no less than $200 million should be allocated for Title VIII programs and the Nurse Reinvestment Act.
- Regarding APRN’s, Obama endorses this idea heavily in his statement,
I will support inclusion and expanded reimbursement for APRN services through federal health programs, my new public plan, and private plans offered through my plan’s National Health Insurance Exchange.
- S.558 - Obama is also a co-sponsor of the Mental Health Parity Act of 2007.
- From Advance for Nurses, Kate Hartner sums up Obama’s responses,
Obama proposes: supporting minimum staffing ratios, limiting overtime, reauthorizing Title VIII training programs with scholarships and loan reimbursement, health system reform, paperless systems, supporting nursing unions and expanding APRN practice.
I think it is only fair that a rationale letter would address how Obama and Clinton differ in their views, rather than explain most of the same things the candidates agree on.
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Summary
Needless to say from my week of exhausting investigation, I am disappointed in the American Nurses Association. I feel they prematurely endorsed a candidate that has a history of supporting nurses, but lacks the necessary ideas for a new direction for healthcare in this country. Obama’s healthcare plan, though not single-payer, works better in this country that seems entirely focused on their wallets. Clinton has gone as far as to say she’s willing to garnish wages as an enforcement mechanism. How can we force people to purchase coverage from insurance companies, feeding into our already broken healthcare system more, then go on to say we will punish our own citizens by taking away their hard-earned money if they don’t buy? And that dubious statistic that Clinton throws out that Obama’s plan will leave out 15 million people? That was already proven false at FactCheck.org. Blueollie has another excellent analysis on this topic.
I will say that I am slightly disappointed in both candidates as they do not provide true single-payer universal healthcare. However, Obama’s plan will best address the cost control issue currently plaguing our system. Mandating insurance will frustrate consumers while limiting options for those with low incomes. The question here is… is it better to have stripped down insurance (to satisfy a mandate to have coverage), or to buy into affordable, full coverage, which includes subsidies if you do not qualify for SCHIP or Medicaid?
As a registered nurse, I wait for the day when I don’t have to tell my patient that the life-saving drug they are prescribed costs $4 a day, since I worry they will have to choose between taking the drug, or eating a meal. As a registered nurse, I wait for the day that I can treat my patients out in the community, before they end up in the hospital bed, since preventing a disease will cost much less for everyone. As a registered nurse, I wait for the day that a patient of mine can see any doctor or APRN of their choosing, without having to get prior-approval from their insurance company. As a registered nurse, I can’t wait for the day that Barack Obama becomes our next president.
