Dying for Health Insurance: Nurses and Doctors on Health Care Reform
Out of all major industrialized nations in the world, only the USA does not have universal health care.
"Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance," comments Dr Steffie Woolhandler, co-author of a Harvard study that shows uninsured Americans to have a higher risk of death than their privately insured counterparts. "Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives."
Just a few days ago, in an article for the Huffington Post, Dr Quentin Young wrote, "Our present arrangements, dominated as they are by the for-profit insurers, result in about $400 billion annually being wasted on useless paperwork and bureaucracy." Those excess administrative costs, he says, are a burden on the medical profession, the public and the economy.
The solution? Dr Young suggests that replacing private insurers with a “streamlined, nonprofit single-payer financing mechanism” would result in enough savings to cover every uninsured person and eliminate co-pays, deductibles and caps. Patients would be able to choose their doctor and hospital.
"We could also reap savings from bulk purchasing, negotiated fees and rational capital improvement planning,” Dr Young continues. “From the standpoint of health economics, it’s a no brainer."
No brainer for some, perhaps, but the debate rages on. According to Dr Young, Republicans are committed to “enhancing the profit margins of the insurance and drug monopolies.” But he says Democrats are not offering a fully acceptable solution to the problem, either. President Obama’s 10-year, $1 trillion health care bill proposal does not provide a universal plan, comprehensive coverage or affordable care for every American.
Worse Than Seeing Sausage Made
Wendie A. Howland, RN, MN, CRRN, CCM, CNLCP, recently worked as a Coordinator for Revenue Integrity. "My job was to get money from insurance carriers whose minions were charged with not giving it to us," she says. "I spent forty hours per week writing appeals after collecting evidence to document that the care we gave this patient or that had, in fact, met their published criteria for reimbursement….and more often than not, despite our meeting every single criterion, the claim would be denied."
A typical final letter from an insurance carrier, Howland says, would state tersely, "This ends the appeals process. There are no further appeals allowed on this claim."
This process frustrates Howland, a dedicated nurse who has worked in various health insurance settings for over 15 years. "They are prosecutor, jury, and judge, and not a damn thing anyone can do about it," she says. "I have had them tell blatant lies to my face (and refuse to put them in writing), accuse my medical director of lying, and you wouldn’t believe what all else. It’s worse than seeing sausage made."
Let’s Get This Done
According to Kent Klein, Voice of America‘s Washington correspondent, Democrats may be on the verge of forging ahead with health care reform legislation, with or without Republican agreement.
The 30 million people who would receive health insurance coverage through the Democratic plan cannot wait, President Obama is quoted as saying. "It is time for us to come together. It is time for us to act. It is time for those of us in Washington to live up to our responsibilities to the American people and to future generations," the President stated at the health care summit. "So let’s get this done."
The Biggest Nursing Issue
While Democrats and Republicans debate, ordinary people continue to struggle with existing health care system problems.
"If our health care system is so screwed by our health insurance system, we all suffer," says nurse Howland. "People don’t get the care they need, not because the care itself is so expensive, but because paying for it via that massive insurance gestalt makes it so."
The Harvard study mentioned at the beginning of this article, "Health Insurance and Mortality in U.S. Adults," analyzed data from national CDC surveys and showed that there are more deaths associated with lack of health insurance than with common killers such as kidney disease. The rise in deaths is probably related to increasing numbers of uninsured Americans, a failing medical safety net for the disadvantaged, and a decreased quality of care for the uninsured. The data also indicates that one American dies every 12 minutes because of lack of health insurance.
Lead study author Dr. Andrew Wilper, who teaches at the University of Washington Medical School, said, "We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease–but only if patients can get into our offices and afford their medications."
Until a drastic transformation occurs, doctors and nurses will continue to witness the dire effects of an inadequate health care system. "We let the insurance industry pull the wool over all those eyes saying that if it weren’t for them, care would go to hell," says nurse Howland."That is a huge lie. I see people suffer for it all the time. And that, to me, is the biggest nursing issue there is."
