by Brian King
With all the rapid changes in health care these days, trying to figure out just what's going on can be a daunting task. Besides all the incredible technological breakthroughs - like keeping babies alive that are small enough to hold in the palm of an average adult's hand, or the transplanting of vital organs like so many tomato plants for your garden - there's the unsettling news that health care in the US will henceforth be run as a business.Business? I know what you're thinking; How can health care be treated as just another business?! People who are sick and need help shouldn't be treated like so many pork bellies to be tossed about, bought and sold, subject to the laws of supply and demand. Nobody would ever dream of that. At least not until the 1990's in the US.
You might be wondering how this is supposed to work. If people continue to need a fairly constant amount of health care, are the hospitals and doctors simply going to be charging us more so they can make lots of money? That would probably create a lot of resentment among common folks in the US, who increasingly would be unable to afford very much beyond "Take two aspirin and call me in the morning."
I work in a Puget Sound area hospital. I consider it a fine place to go if you're sick and need help, with a dedicated and knowledgeable staff, all the latest equipment, and a warm and caring atmosphere. I was sitting at a desk on one of our nursing units one day last winter, finishing up a note on one of my patients and chatting with a doctor friend of mine. I remarked that it seemed to me that our pediatric patients were much sicker this winter with a particular bronchial virus that affects a large number of kids every year. My friend looked up at me and said, " Their doctors aren't putting them into the hospital any more until they're really sick."
That's the deal; pressure, big time pressure, is being applied to your doctor to cut down on the amount of health care you receive. Doctors who persist in sending their patients to the hospital are taken off preferred provider lists; fired, sort of.
Which brings us to the mysteriously declining patient census (the census is the number of patients hospitalized in a given hospital on a given day.) Over the last couple of years the average number of patients in hospitals, at any given time, has gone down across the US. This trend has been especially pronounced in the Pacific Northwest where the decrease looks to be approaching the 20-25% range. The word is out: cost-cutting, not cost-plus, is the order of the day in US health care.
So, what about nursing layoffs? If health care in our country is to be a business (dog eat dog), it makes perfect bottom-line sense to brutally lop off huge sections of the nurses. Fewer patients require fewer nurses to care for them, right? Never mind that these are trained, experienced, dedicated caregivers we're talking about. Don't worry about the huge unfilled needs for preventive medical care in our society today. Many clinicians believe that we wouldn't see nearly as many "palm of hand" babies if their mothers had had the benefit of seeing one of those laid-off nurses for regular checkups while they were carrying their babies. But prenatal care for poor folks isn't very good business. If it was, you could be certain the insurance companies would be lining up to offer it.
It looks like there's going to be continuing and substantial nursing layoffs here in Washington and throughout the US. health care system over the next 2-5 years. Unfortunately, I don't see much help coming from Hillary and Bill Clinton's health care reform proposals, which leave the US medical system completely in the hands of the private insurance companies. We shouldn't hold out much hope for the private business leopard changing it's profit-hungry spots.
Which brings us to some possible bright spots. Washington State's very own Representative Jim McDermott is sponsoring a bill in congress that, if enacted, would lead to the establishment of a federal government medical insurance system for everybody in the US. It is often called single payer because it would eliminate all the private health insurance plans, the federal government thus becoming the single payer. Californians, bless their hearts, have placed an initiative on their November ballot that would establish a single payer system for California. It was the enactment of a single payer system in Saskatchewan in the 1960's that led to its adoption by the national government in Canada.
Besides all the necessary measures to defend their members in contract talks with the hospitals, I would urge groups representing nurses in danger of being laid off to take a long and serious look at single payer. If we could win this battle against the forces of greed, maybe we could put laid off nurses to work visiting people for prenatal checks or maybe blood pressure screening, or some other thing much more useful than standing in an unemployment line.
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Contents on this page were published in the October/November, 1994 edition of the Washington Free Press.
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