Monday, June 22, 2009

I've been a critical care nurse for 12 years. I rarely find out about the costs my patients incur as they get care in my unit, though occasionally I hear figures. One gentleman, who had open heart surgery to fix one of his heart valves had to come back 3 months later for a re-do. His wife told me that they had just received the bills that added up to almost $200,000. That was about 8 years ago.

Not long ago I learned that the charge per day in intensive care units like mine was now $11,000. Not unrelated to that fact, just the other day, one of our patients who was a 'self pay' (read 'no insurance') was quickly and quietly packed up and transferred to the county hospital for the remainder of her critical care stay which was going to be several days.

Though I am not a health care economist I do believe that the true costs of care are incomprehensibly skewed as everyone in the system scrambles to make up for 'self pay' patients who would most likely never in a million years have the astronomical amounts needed to cover care while the private insurers and Medicare and Medicaid negotiate greatly reduced prices from that 'retail' cost. And it is further skewed by plain old greed.

The whole system is such a many-headed hydra monster! And if you try to reform it bit by bit you end up with a 10,000-paged bill that still fails the American People. Just as with the many-headed hydra who immediately regrew one and sometimes more heads when one was lopped off, when you attempt to reform and regulate an aspect of the similarly poisonous insurance/pharmaceutical complex, one or more new problems spring up. The 'hydra' can't be regulated or compromised with. It needs to be taken out in order to make the system safe for everyone. Once that is done, Problem. Solved.

Just today the Senate HELP Executive Committee discussed medical liability and ways to handle malpractice suits. Included in the discussion was an amendment from Senator Enzi (that he said he developed with Montana Max!) to have Medical Courts decide malpractice cases. These 'courts' would not be trial-by-jury but rather have some entity (who in my view would be in the insurance industry's pocket, limiting the industry's expenses) decide who was wronged and how much if anything they should be compensated. At least that crazy idea was rejected by the committee.

What would happen to medical malpractice costs under Single Payer? With no private insurance companies zealously trying to guard their bottom line? The Physicians for a National Health Program tell us this:
What will happen to malpractice costs under national health insurance?

They will fall dramatically, for several reasons. First, about half of all malpractice awards go to pay present and future medical costs (e.g. for infants born with serious disabilities). Single payer national health insurance will eliminate the need for these awards. Second, many claims arise from a lack of communication between doctor and patient (e.g. in the Emergency Department). Miscommunication/mistakes are heightened under the present system because physicians don’t have continuity with their patients (to know their prior medical history, establish therapeutic trust, etc) and patients aren’t allowed to choose and keep the doctors and other caregivers they know and trust (due to insurance arrangements). Single payer improves quality in many ways, but in particular by facilitating long-term, continuous relationships with caregivers.



This week we found out that Senator Kennedy's plan would cost $1 Trillion over ten years and yet not cover everybody.

Single Payer? Everybody is In from cradle to grave. And since we would be getting back the waste spent on private insurance company's administrative costs, estimated at $400 Billion a year, we could get $4 Trillion (over ten years) back into the system for actual care of actual patients.



The current system and currently discussed reforms are "economically and medically nonsensical," testifies Dr. David Himmelstein. Co-ops and exchanges and individual mandates and attempts to regulate the death-by-spread-sheet private health insurers have and will do little but bring us economic and medical nonsense and woe. How tragic from a system that should be duty-bound to provide us care.



President Obama believes that we have to build on the system we already have. Why?

When child labor was part of the system we had, nobody argued that we had to keep children in the coal mines, just find more palatable ways of working them.

When women were denied the vote, nobody in the end bought the argument that we had to keep them disenfranchised since that was how democracies had worked for millennia.

Speaking of millennia, nobody argued that we must keep the medical system of the Four Humours that had served western medicine for thousands of years once human anatomy and physiology were defined and the actions of bacteria and viruses were discovered. NO ONE today says, "If I was starting from scratch I'd use the biomedical model, but we have this uniquely western-civilization model that has served us since Hippocrates that we will keep and build on."

The Employer-Based system has failed us. Health insurance is not at all affordable for most self-insured Americans and becoming less and less available to employees of large companies let alone employees of small businesses. It is estimated that 119 million Americans are ready to jump ship out of their employer-provided health insurance and into a public plan. Our system is as inappropriate for the delivery of health care as the Four Humors Theory of medicine would be in today's world. I do not see the reforms that Congress is currently talking about fixing any of this. In fact, their 'reforms' may make things worse.

As Rose Ann DeMoro, Executive Director of the California Nurses Association/NNOC says at HuffPo today, we need to fight for the passage of a bill that actually works:
Every other industrialized nation in the world enjoys better healthcare at a lower cost than us, because their care is privately-delivered, but publicly-financed. It's called the single-payer system, and it's not an experiment. Our system is, however, a unique American experiment giving unprecedented powers to private insurance corporations, and this experiment has failed.


As a nurse, I know how to revive a stopped heart, but the heart must be capable of responding. Private insurers are not capable of responding to America's health care needs. We have copious evidence of this. On the other hand, a Single Payer system is. The reforms that our Congress is trying to come up with have no evidentiary basis proving that they will work. Single Payer has a track record of success in other countries like Canada as well as here in America with Medicare. If you want evidence-based policy, you have to turn to Single Payer.

I'm not returning to the old days. I'm not settling for tinkering with a system that was inferior and inappropriate to begin with. I am not settling for a poisonous, hydra-like system that will fail us. I'm moving forward fighting for what is right for my patients, my family and my country: Single Payer Health Care for All.

The Battle is still on. Keep your swords and shields (and cauterizers) up.

3 Comments:

Blogger Ginny in CO said...

Excellent ad. How much is it or will it be aired?

I've been working for 32 years, 16 in critical care, 12 in home care. Plus acute care and case management. This January my COBRA payments jumped from $425/month to $650. I could only make one.

I've been on the receiving end of the self pay patients from ICUs in corporate hospitals. It is a relief that there are hospitals and physicians who continue to treat despite the reality that the entire bill will have to be written off. It still makes the patient's recovery a guilt ridden nightmare.

My daughter was in a step down surgical unit in 1998 for a ruptured appy for a week. The bill was $18 K. In 2007 she was in a surgical unit for a week after an L-5/S-1 fusion. $85 K. BCBS tried to deny payment over a glitch in coverage for one month. (The previous insurance company had stopped the insurance a month earlier than directed.) As it turned out, we were allowed 63 days of non-coverage due to having been on the previous plan for 7 years. They agreed to pay the bill and then immediately put it under review AGAIN. The hospital and doctors had to wait almost 8 months for payment.

The private health insurance companies have failed us too many time to be allowed another chance. There is no way they can deal with cutting their costs enough to make the system cost effective, let alone the additional advantages that Himmelstein lays out.

My only concern is that the system will include worker's comp and auto insurance care as well.

10:24 PM  
Blogger Sue Cannon, PhD, RN said...

The ad was run during the new nurse show Hawthorne, RN. You can check out more about it by going to the CNA website: www.calnurses.org.

Obama is asking for stories like yours at this site: http://my.barackobama.com/page/content/health-care-action-center/?source=feature#story

I'm sorry the private insurance companies let you down. Truth is they have let the bulk of Americans down and need to be taken out of our system. We so desparately need Single Payer health care reform--that is publicly funded and privately delivered. 72% of America wants a plan like Medicare to be open to all. Call your Congress people too and let them know you are fed up with the private insurance companies and you want them out of our health care system. Representative Udall needs some encouragement as do your Senators to do the right thing and give us a Medicare-like public option.

Thanks.

12:20 PM  
Blogger Sue Cannon, PhD, RN said...

Ginny, I forgot to say that under Single Payer all those other places we pay medical premiums go away like in car insurance and worker's comp because everybody already would get medical care for whatever problem they have. Huge cost savings here for sure!

6:16 AM  

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