Tuesday, April 22, 2008

California Lessons

Lives at stake in health-care reform


IF you want to know why health care will continue to be a big issue in November, ask Beth Glover of Glendora.

During a Christmas party at her house last December, Glover, a registered nurse at an area hospital, describes what happened when one of her co-workers, who has a severe peanut allergy, inadvertently tasted a broccoli salad that apparently had been exposed to peanuts and experienced a serious reaction.

It was decided that someone would drive her home, but within minutes she was in grave distress, "turning black in the face, grunting as her airway closed up, and fell unconscious with no respirations.

"We called 9-1-1, pulled her out of the car onto the cold asphalt driveway, and began CPR." Soon, she was taken to a nearby emergency room, intubated and put on a ventilator.

"Within 48 hours, she was weaned off the ventilator, and discharged to home, but because of injuries suffered during the trauma, was out of work for almost two months. She also was having a hard time getting her allergies and asthma under control. One of our allergists gave her a whole lot of `sample' allergy medications because she can't afford all of her prescriptions. Her son also has allergies, so they `share medications.' The allergist told us that the medication that she should be on costs tens of thousands per year. So she is not on it.

"Blue Cross is denying her claim for hospitalization and emergency care, because she was `out of network.'

Apparently they believe she should have risen from the dead and driven to a network provider. My friend is appealing her claim, seeking legal assistance, and of course a boatload of angry, politically astute RNs are pulling for her. Blue Cross will probably regret that they harassed this particular single mom who works in a non-profit hospital caring for children with cancer."

This story illustrates what we need to remind the presidential candidates - "having" insurance can provide little protection when you actually have to use it.

Senators Hillary Clinton and Barack Obama both propose comprehensive health-care plans with an array of subsidies and some requirements on insurer. Their primary difference is on who should be required to buy private insurance.

But selling insurance is not "universal health care." Especially when insurers are permitted to continue to charge as much as they want and have no limits on the all too routine practice of denying needed medical treatment because they don't want to spend the money.

Sen. John McCain's plan is the most troublesome, offering little beyond the dismal status quo. McCain proposes tax credits to encourage the uninsured to buy insurance. But once-a-year tax credits are of little help to those already facing financial distress in an imploding economy.

His advocacy of high deductible health savings accounts as an alternative to expanded coverage will make it harder for the sicker, less wealthy among us, and retirees, to get health care. And his plan to promote the selling of insurance policies "across state lines" - code talk for more deregulation - could eradicate hard-won minimum standards we've placed on insurance carriers in California.

Ultimately, we will all have to recognize that reliance on the insurance industry will not end our health care nightmare. Insurance companies' priority is to guarantee a high rate of return to their shareholders, not making sure you get the care you need.

America's nurses know there is another approach, a single-payer system, sort of an expanded and improved Medicare for all, as in a bill still before the California Legislature, SB 840.

It guarantees everyone has quality health-care coverage and eliminates the waste and bureaucracy reflected in administrative costs of up to 30 percent for private insurers compared to just 3percent for Medicare.

Perhaps most importantly, it takes decisions about your health out of the hands of insurance companies and their built-in economic incentive to deny care.

It's a system essentially in place in every other Western country, and it works. A January 2008 study by the London School of Hygiene and Tropical Medicine, for example, found the U.S. ranked worst among 19 industrial nations in preventable deaths.

Surely that's the real reform all Americans deserve.

Geri Jenkins, RN is a member of the Council of Presidents of the California Nurses Association/National Nurses Organizing Committee.

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