A Single Payer System Now, Please!

Nurses speak out for Single Payer:
A Single Payer System Now, Please!

 --Rachel Prusak, Family Nurse Practitioner and Vice President of Nurses for Single Payer
I was about to sit down and write my monthly story about the need for a single payer system when a Facebook memory from 2011 popped up in my news feed, entitled “Single Payer Now Please.” Yes, that’s right, exactly six years ago. So Instead of rewriting a piece, I decided to share what I wrote in 2011. It clearly shows I was frustrated after an especially difficult week, and I decided to write an open letter to Insurance companies on social media:

Dear Insurance companies,
Here are three real examples of live patients I tried to treat this week, but you made it extremely difficult to nearly impossible.

First case: A 36-year-old female, two weeks postpartum, had a stroke. There is only one neuro-surgeon in the rural area who will perform revascularization surgery, but he does not take her insurance because the pay is low and surgery risky. Her only chance is to have the insurance company fly her to a big city hospital, where a surgeon has agreed to perform surgery. If not, she could die.

Second case: A 54-year-old female presented with an abscess that needed wound care and antibiotics. I prescribed strong antibiotics that I knew would work to prevent her from needing an expensive hospital visit for IV antibiotics, but insurance would not cover them. She had to come up with $150 on her own, which was very hard, so she left the pharmacy without her medication.

Third case: An 80-year-old female with diabetes could not get a a glucometer covered by her insurance company, but her meds were covered. It can be dangerous to take diabetic meds without knowing your sugar, hence needing a glucometer.

After presenting these three cases, I ask you, if my job is to help patients of a community stay healthy and out of the hospital to keep costs down, how am I supposed to do that if the system is run by your dictating what I do? 

I have a few tips for you:
1. Cover the costs that keep people healthy and out of the hospital.
2. If you are going to cover pregnancy, you must cover complications of pregnancy and family planning
3. Don't make your payments to surgeons so low that it is more of a risk for them to perform. Rural areas are losing all their surgeons because of this, and people are dying of treatable illnesses.
4. If you don't cover antibiotics, you will be paying for expensive procedures and IV antibiotics.
5. If you don't cover glucometers you will be covering very expensive dialysis and leg amputations.

In conclusion, Insurance companies need to listen to nurses and doctors who want to keep communities healthy in a cost-effective way. Prevention is always less expensive (and more humane) than emergency care. Managing chronic conditions is more cost effective than treating the complications. My job is beyond stressful since I can't treat the patient but must answer to insurance companies that don't care about the patient in the room with me. We need a Single payer system Now, PLEASE! Everyone will be treated equally and health care providers and the patient can make the decisions, not someone sitting in an office with no concept of health care or understanding of my patient.

Ready to throw in the bloody towel,
Rachel Prusak, APRN, FNP-C