Now that the 2008 presidential race is in full swing, each of the candidates is out on the hustings promoting a variety of issues. While the wars in Afghanistan and Iraq will no doubt be the leading foreign policy issues, our work as nurse practitioners and physician assistants provides us with a unique perspective on what promises to be the most pressing domestic issue—health-care reform. Clinicians’ professional lives are driven by a political system that forces us to perform equal measures of administrative and clinical work to help patients stay healthy. It only makes sense that we use our influence to engender long-overdue changes to that system.

I will not discuss my own political views or preferences here. My goal is simply to illustrate the degree to which health-care professionals ought to play an active role early in the process. This will prevent us from being subjected to potentially unrealistic systemic changes that may not serve patients in productive ways.

What are the candidates saying about health care one year away from Election Day? The leading Democratic candidates Hillary Clinton, John Edwards, and Barack Obama are promoting universal health coverage provided by the government (to varying degrees). Republicans Mitt Romney, Rudolph Giuliani, and Fred Thompson prefer market reforms purported to allow private health plans to flourish and extend services to greater numbers of people.

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While clinicians might gravitate toward one or the other ways of addressing the problems we currently face, I urge you to take your feelings on the issue into deep consideration. The whole argument has given me a bit of déjà vu. As many of you surely remember, this was the same argument that spanned most of the 1990s and the Clinton presidency without any visible effect save for political posturing and disagreement between the parties—no change in levels of coverage (at least not positive ones) and ever-soaring costs.

It is clear to me that broadly generalized plans calling for sweeping reform without specifics are likely to fail.

Let’s face it. Change tends to occur gradually, at least in cases in which we see a beneficial outcome. We must use our position as health-care professionals to demand candidates be more specific about their plans. If a plan costs money, tell us exactly where it will come from and what programs will have to be cut to fund it (currently the tax coffers are not exactly bursting). If change is to occur, we must know how it will be implemented and over what span of time. Political shell games involving reform that will take effect a decade down the road are frequently hollow promises that seldom come to fruition. In the end, NPs and PAs are pragmatists who care for others, and we must demand pragmatic and specific plans from the candidates.

It is imperative that we make our voices heard at every level before the next election. Write, call, or e-mail the candidates’ offices as frequently as you can so that none are left in doubt regarding your wishes. Voting in primaries and elections is the final act of a long process and occurs long after a relatively large pool of candidates has been thinned. Unfortunately, many of the candidates eliminated early in the process often possess greater qualifications and superior ideas in the area of domestic policy than the front-runners. Carve out a few minutes each week and communicate with candidates, donate some money, and work to influence the outcome of the election and the future of health care—before it’s too late.

James Whyte, MSN, ND, NP, is a primary- and acute-care nurse practitioner and an assistant professor at Florida State University College of Nursing in Tallahassee.