Whenever-and wherever-health policy and politics intersect, you will find Mary K. Wakefield, PhD, RN, FAAN. "I have been involved in these issues for over two decades and there is not a year that I think is more pivotal than this one."

Drawing from her experience on Capitol Hill, as professor and director of the Center for Health Policy at George Mason University, and as a member of numerous public and private advisory councils and commissions, Dr. Wakefield is well versed in the socioeconomic and legislative issues affecting healthcare. Perhaps more important, she is expert at encouraging nurses to become politically active and policy savvy. "I cannot think of a more important time than right now for nurses to be engaged in public policy and politics. From my perspective, this country is at a crossroad, not just locally, but nationally and globally."

Demonstrating an early interest in policy and government, Dr. Wakefield received her Bachelor of Science in Nursing from the University of Mary at Bismarck, North Dakota, and Master of Science in Nursing and Doctor of Philosophy degrees from the University of Texas at Austin. In 1991, she became an Eastman Kodak Congressional Fellow in the Program for Senior Managers in Government at the John F. Kennedy School of Government, Harvard University.

"I served as legislative assistant and chief of staff to U.S. Senator Quentin Burdick (D-ND) from 1987 to 1992. During this time, I co-chaired the Senate Rural Health Caucus Staff Organization, becoming directly involved with a wide range of rural health policy issues, from recruitment and retention, to reimbursement, to emergency services, to telemedicine." Over the next four years, she served as chief of staff for U.S. Senator Kent Conrad (D-ND), overseeing legislative, administrative, political, public, and press relations in addition to managing several offices.

Throughout her tenure on Capitol Hill, Dr. Wakefield advised on a range of public health policy issues, drafted legislative proposals, and worked with interest groups and other Senate offices. She was a member of President Clinton's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, was appointed to the Institute of Medicine's (IOM) Committee on Quality of Health Care in America, and was chair of the National Advisory Council to the Agency for Healthcare Research and Quality. Dr. Wakefield currently chairs IOM's Committee on the Future of Rural Health Care and is a member of the Medicare Payment Advisory Commission, among others. In November, she will begin her fourth year as director and professor of the Center for Rural Health at the University of North Dakota (UND), School of Medicine and Health Sciences.

Over her 28-year nursing career, Dr. Wakefield has gained many insights into the American political landscape and issues affecting healthcare. The staff of Healthcare Traveler's Staffing Solutions (HTSS) thanks her for sharing some of these perspectives on the eve of the 2004 U.S. presidential election.

HTSS: Please elaborate on the most important healthcare issues this year.

Mary K. Wakefield (MKW): In terms of importance to this election, healthcare costs, as a general overarching theme, is a very significant issue—one that plays out in politics and in the American psyche. It can be broken down into three key themes: health insurance, state government programs, and prescription drugs.

The rising costs of health insurance put pressure on families, individuals, and employers. Recently, we have seen some premiums rising faster than increases in wages, which is a real problem.

Healthcare costs have been, and continue to be, challenges for state governments. About 18 months ago, states were under tremendous pressure to reform Medicaid. Growing numbers of people were enrolling in the government program at the same time states were attempting to balance their budgets. Responding to the pressure, states cut back on benefits to Medicaid recipients. Although our country is currently emerging from a recession, Medicaid, the largest single payor for nursing home care, will continue to be in the crosshairs of state policymakers due to the changing demographics of America's aging population and the increasing need for these types of services.

Prescription drugs—and their reimportation from foreign countries, like Canada—is another theme. I have gone on record supporting reimportation with restrictions and safety regulations, submitting a letter to the editor that was published in Roll Call, a weekly newspaper on Capitol Hill. I believe it is part of a short-term solution—not by any means a sole or long-term solution—to help lower healthcare costs and increase the portability of drugs for consumers, particularly those who rely more heavily on pharmaceuticals and have low incomes, like the elderly.