Everyone knows that healthcare is in crisis. In Oregon, deductibles have increased over 50% in the last 10 years, premiums have increased over 20%, and 14% of Oregonians without a high school degree still lack any healthcare coverage. In 2017, the RAND corporation’s in-depth study predicted that a single payer healthcare in Oregon could provide universal, high quality health coverage, cut administrative costs by 25%, nearly eliminate out of pocket healthcare charges, and significantly reduce the total cost of healthcare to Oregonians making under $100,000 per year. These economic arguments are compelling, but other strategies of healthcare reform might result in similar projections. For a nurse like me, short term economic arguments only scratch the surface of why we need single payer healthcare.
Fragmentation is the greatest threat to healthcare in this country. The profit-driven patchwork of insurance companies that dictate the care nurses like me provide cannot meet the needs of whole people, or whole families who we nurses see as inextricably interconnected.
As a seasoned nurse, I knew from the minute that she opened the door that Masha had dementia. Bent over with back pain, she led me to the bedroom where I found her husband, Ivan sitting on the edge of his bed in a pool of his own urine. Ivan had returned home the previous evening after receiving what he called a “million-dollar hip” following a fall last month. Medicare paid for Ivan’s surgery, and for a nurse, me, to come to his home twice per week to tend his operative wound. Medicare did not pay for the months of rehabilitation Ivan would need to learn to walk again, or assistance in the home to meet the basic needs of a man who could no longer walk to the toilet, or care for Masha in her time of need.
After I helped Ivan to get clean, his daughter Laura arrived from her night shift job. Like many adult daughter caregivers, Laura’s health had suffered from the burden of her parents’ unmet healthcare needs. She had developed high blood pressure and depression but had no time to seek care for herself and could not miss work for fear of losing her income and health insurance, on which her own young family depended. Numerous studies have shown that insurance type directly predicts the outcomes of surgeries like Ivan’s. Numerous studies have identified profound inequities in the negative health impact of caring for a disabled family member, and uncovered the intergenerational transmission of poverty and illness that results from unpaid and unsupported caregiving in the US. But to the company I worked for Ivan was not a person, not a husband, or a father, but a hip. So I dressed Ivan’s wound, I offered my sympathy, I left and was late to my next appointment.
When Ivan’s next visit disappeared from my schedule, I knew that he was back in the hospital. To his million-dollar hip, how much more in painful surgery, expensive drugs, and ICU stays were added, all for the lack of the most basic care? What of the cost of Masha’s current and future needs, or Laura’s developing cardiovascular disease and depression, or the human cost of lost dignity and suffering? As a nurse, I could have begun to address all of these things. I could have helped the family to plan, examined the interconnectedness of all of their illnesses and come up with cost-effective, evidence-based solutions to benefit the whole family, but this is not the kind of work that a patchwork of for profit insurance companies pay for. Only under single payer would the same entity be responsible for the health or Ivan, Masha, Laura, and her family, an entity with vested interest in the health or all of its members and of generations to come. Only under single payer will I and my fellow nurses be able to practice the holistic, family-centered care that we were trained to provide. It’s time for nurses to demand that this country let us do our job, it’s time for nurses to demand single payer healthcare. SB 770A is the chance we have to make this dream a sustainable reality.
Robin R. Tarter RN BSN MS
OHSU School of Nursing