Guaranteed Healthcare

Well, it's Sunday afternoon, and after working four consecutive 12+ hour day shifts in the ICU last week, taking care of the sickest, most vulnerable patients imaginable, I'll confess to being a bit tired and weary.  At home, I've begun sorting piles of laundry, and collecting the coffee cups that never seem to find their own way into the dishwasher.  MSNBC's Meet the Press is broadcasting in the background, and my boxer, Ginger, is dogging my heels and hinting that she'd really like to go for a walk to the park sometime today.   

My mind begins to wander back to some of the more poignant and intriguing memories of the past week. Yesterday afternoon three of my colleagues and I stood by with a 93 year old patient who was taking her last peaceful breaths less than 12 hours after her friends and family had prayed for her and said their last good-byes.  We watched her heart beat slow and then stop as her spirit left her body. We silenced and finally disconnected the monitor alarms that confirmed what we already knew.  She'd suffered a massive stroke just a few days after Christmas, and her family agreed that her wishes did not include aggressive and futile life support.  (Although a transfer to a medical bed or hospice care was ordered, none were available for her placement prior to her death.)

One of my colleagues who was serving as the designated Trauma response nurse was suddenly paged to the Emergency room.  A young man had been stabbed in the neck and was bleeding profusely. Major blood vessels were severed and the vascular team began preparing for immediate transport to the OR. The trauma room doc tried to control the bleeding by placing some temporary sutures and packing in the wound, when the young man began shouting that he didn't have insurance and that he couldn't afford to pay for any surgery. He said, "I don't want an operation, just let me go home."

Yes, he'd had a bit too much to drink, and was a danger to himself and not competent to make the decision to refuse.  The ER doc calmly explained to his young patient that he would die without the surgery.  Phone consent for treatment was obtained from his family. Two large IV's were started, and a bit of sedation was administered and emergency blood transfusions were initiated before the mad dash to the operating room got underway.  He would soon need that bed in the ICU.

And, on Meet the Press, David Gregory continued his interview of Senate Majority leader Harry Reid. Blah, blah, blah, Blagojevich, (the dish water is running), the war in Iraq...General Petraeus...the surge...and then, I heard Senator Reid express his opinion that George Bush is 'our worst president, ever.'

O.K. I thought, we all know how awful it's been. So, what then must we do?  I turned off the faucet; I was curious and began wondering, how's he going to justify his assertion?  What criteria, what example would have led him to that conclusion?  As the show was wrapping up, David Gregory fed Senator Reid a lead-in line, and it gave Reid the requisite opportunity to mention his recent book, The Good Fight.

GREGORY: Before you go, do you have any regrets about the way you have publicly battled with President Bush? Over the years, you’ve called him a liar, a loser, you’ve described him as quote ‘our worst President ever.’

REID: I wrote a book and I said that in the book several times. David, I am who I am. I’m going to continue to be who I am. You just have to call things the way you see ‘em. I really do believe that President Bush is the worst president we’ve ever had. I think his efforts to destroy Social Security were very bad. I think as we’ve looked now at what’s happened to the stock market, wouldn’t that have been a terrible thing to do, to privatize Social Security? Medicare, he's done it…he’s done his very best to destroy Medicare. Medicare, a wonderful program. Perfect? Of course not, but one of the best programs ever developed to take care of sick people.

 

O.K. Senator Reid. Now you've got my attention. Where you end the interview, is where we need to begin the year of healthcare reform in America.  Let's talk about a real "Good Fight".  The fight to expand and improve MediCare for all of us. Oh yes, we can! 

By the way, the American Public Health Association has given Senator Reid an 88% approval rating for his voting record on health care issues, indicating a pro-public health record. Perfect? Of course not. It's not enough for him to talk about how bad President Bush has been.  It's time for Senator Reid to lead, follow, or get out of the way of real health care reform! 

Mandate plans that masquerade as reform similar to those outlined by Senator Baucus, Senator Clinton, and Senator Daschle have failed repeatedly in the past.  They all have failed to reduce the number of uninsured or to contain costs. Their proposals don't regulate insurance premiums, they don't keep insurance companies from refusing to pay bills for medically necessary care, and they don't improve the existing defective products that are on the market now.

Senator Reid should begin to demonstrate leadership and translate his opinion of Medicare into action! He should persuade his colleagues to abandon their unworkable plans that put corporate profits ahead of the needs of their constituents. President-elect Obama is on record as saying he would sign single-payer legislation if Congress puts it on his desk.  Reminiscent of the challenge issued to reformers by President Franklin D. Roosevelt, he seems to be saying, "I agree with you, I want to do it, now make me do it."  I guess that means, until we lead the way, we can't expect our leaders to follow. Nurses, physicians, and the public agrees, we should improve and expand Medicare to cover everyone.

Americans are afraid that they can't afford to get sick. Their fears are not unfounded.  Three quarters of those bankrupted by illness were insured when they first got sick.  With the recent economic downturn, the ranks of those without insurance are growing.  Allowing insurance companies to exist for profit at the expense of the sick and injured is wrong.  For those of you who think you have insurance, think again. We don't need mandates that require us to purchase defective insurance products.  We need health care! 

Everyday nurses see the devastating consequences of our broken and fragmented healthcare system.  This brings me back to a description of some of the patients I've helped to care for this past week.  The examples are composites of patients in the unit, without specific identifying information, to protect privacy.  Among them, a 54 year old disabled business woman, a 46 year old day care provider, and a 34 year old manager of a group home for dependent adults. As of this writing, one of them has died of the complications of a preventable disease.  Although suffering from different illnesses, the odds are overwhelming against the survival of the other two.  Treatable chronic conditions progressed to a critical, life-threatening illness because of a lack of access to affordable primary care.

Every day nurses and doctors care for patients who never imagined that they were one illness, injury, or paycheck away from losing their insurance coverage.  Every day we take care of patients like these whose jobs don't provide them with coverage, and they have to choose between paying for medicine and paying for food and housing.  Every day we care for patients whose length of stay will exceed the maximum number of days their insurer will cover. We see patients who will be forced out of their community acute care hospitals and transferred to rest homes and long term care facilities by "case managers" from their HMOs, or the hospital's own "utilization review" team.  They have their eye on the industry bottom line, instead of the care our patients deserve to restore them to their optimal level of health.  

Some people naively refer to such facilities as "nursing" homes, but they are often staffed with more housekeepers, maintenance workers, and unlicensed care techs than with enough RNs to provide patients with  ongoing assessments, intervention, and effective therapy.  RNs have substantial scientific knowledge, technical skill, and sophisticated education and experience that often prevents complications from the patient's disease or the medications used to treat the disease. 

Decreased reimbursements have led acute care hospitals to cut services like hospice and rehab. They are downsizing and creating more private rooms.  They have private hot-lines for physicians to schedule admission for wealthy patients and those who have "good" insurance, giving them priority over emergency room patients who often sit in crowded waiting rooms or languish on guerneys for 24 hours or more.  Many leave if they can; they give up and get sicker and may die. In the process, perhaps, they end up spreading contagious diseases to the public at large.  It's rationing based on ability to pay, rather than medical need, any way you look at it.  Patient's choices are restricted and provider's recommendations are often overruled by company bean counters. 

Patients are not customers who can pick up and go shopping for a better deal. Health care is not a commodity, but an essential public service.  Every other industrialized country has some form of universal health care, and according to a recent Commonwealth Fund study, they have better health outcomes.  We do have a single-payer system in America that works.  It's Medicare.  But it's currently limited to insuring people over 65 and the disabled.  And while we may agree with Senator Reid that it's not perfect, Americans with Medicare are far more satisfied with it than those with private insurance.  By eliminating the waste and fragmentation of the private insurers, according to studies by the Congressional Budget Office and the General Accountability Office, we could save enough to cover all of the uninsured and upgrade coverage for everyone!

A single-payer, Medicare for All system is embodied in H.R. 676, sponsored by Rep. John Conyers and 92 other members of Congress.  It would have automatic enrollment for everyone and provide comprehensive services covering all medically necessary care and drugs.  It would help job growth and the entire U.S. economy by removing the burden of health costs from business.

The greed of a few has jeopardized the social, economic, and health care security of us all.  The gap between the rich and the poor in our nation is at its widest ever.  Universal access to health care or lack thereof, says something about our society's moral character.  At some point, rich and poor, young and old alike will need health care.  It's time to restore equality and assert that we are indeed, one people.  One nation, one plan.  Health care is a human right and in a democracy, it is incumbent upon all of us to affirm and defend that right.

Single-payer Medicare for All is the RIGHT answer.  It is right on choice.  It is right on efficiency. It is right on accountability.  It will be a public, nonprofit system that will respond to what patients need, not what corporate executives and stockholders want.

Join me in sending that message to Senator Reid and the Obama transition team!