President Biden's State of the Union, and why the U.S. health system needs redesign

In his 2024 State of the Union address on Thursday night, President Biden addressed health care issues and policies dominating headlines, including reproductive care, prescription drug prices, and cancer treatment innovation. But we need to do more to redesign the American health system, says Vincent Guilamo-Ramos, executive director for the Institute for Policy Solutions at the Johns Hopkins School of Nursing. The institute works with health care leaders to redesign the U.S. health system, with nurse-led solutions.

Image caption: Vincent Guilamo-Ramos

"We must shift policy and practice away from sick care and to preventive, value-based, whole person care," Guilamo Ramos said. He spoke with the Hub after Biden's State of the Union address.

Why do we need to redesign the U.S. health system?

Our national health and public health systems should primarily focus on prevention—that is health promotion and care that keeps us healthy and restores health when we become ill. Right now it doesn't—it primarily focuses on treating illness after we are seriously ill, which is more harmful for the individual and more costly for the system.

So where do we start? First consider who gets care and who doesn't—that's equity. And then where people receive health care, which is access. This includes preventative care and restorative care for all people—no one can be left to the wayside just because they aren't fully covered or because of where they live.

And then think about who delivers that care: nurses. The majority of health services across the U.S. are delivered by nurses, who make up the largest segment of the health care workforce. What's more, nurse-driven models of care are distinct. They focus on the whole person and are designed to support not only individual patients but their families and broader communities.

Nurses are highly skilled health providers that fully understand the importance of building trust with the people they serve. We must be part of this redesign and policy solutions to get us there.

How does inequity factor into health?

We have to eliminate inequity. Eighty percent of a person's health is predicted by social determinants of health; medical care accounts for only 20%. While President Biden only spoke about health specifically when discussing research, reproductive health, and prescription prices, he focused heavily on economics and debt burden. Individuals, families, and communities with worse health outcomes often lack access to favorable social conditions such as quality education; jobs with fair pay; safe, affordable housing; and access to safety net programs. This is why it's so important that policymakers, researchers, and health practitioners have a clear roadmap on how to influence these factors, and how they lead back to health.

What's more, the social determinants of health are foundational to the nursing model of care. That's why nurses are leading health redesign efforts to integrate consideration for harmful social determinants of health with high-quality clinical care. This is the Nurse Led Model of Care, but it's not just for the nursing workforce. The model's principles are useful to all health and public health providers and represent a scalable, innovative solution to our nation's health inequity challenges.

How do we keep moving forward, not backward?

It starts with rebuilding trust in our health system. And that's a job for nurses.

At a time of diminishing trust in health science, the public maintains a great deal of trust in nurses. They have been ranked the "most trusted profession" by a Gallup poll for 22 years in a row. What's more, nurses make up the largest health care workforce. That means there are already women's health nurses in position for research and reproductive care, oncology nurses transforming cancer care, and all with the expertise to scale effective health care system solutions.

It is time for us to fully recognize nurse leadership. We must pick up the pace and keep moving forward, with nurse-driven policy solutions as a critical factor in our national response.