1. Coffey, Jeanne MS, RN


Five good reasons why nurses should champion it.


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When Aetna bought his company in 1996, Leonard Abramson, the founder and CEO of U.S. Healthcare, got almost a billion dollars in stock options, a $10-million, five-year consultancy contract, and the company jet. The deal shows just how imbalanced and unfair our competitive health care system can be, with its 44 million uninsured and millions who are denied necessary service. FIGURE

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More than a decade of profit-driven health care has demonstrated that America's experiment with managed care is failing. Not only is the system expensive to administer, it has achieved its transient cost savings by refusing coverage to sicker patients and denying services to those who are insured. As drug company profits soar, for example, millions of Americans who thought they had adequate coverage are shouldering increasing copayments. What many nurses don't realize is that the erosion of health coverage is directly related to the influence of market-oriented, profit-driven health care.1


Nursing has been hit especially hard: deteriorating work conditions discourage people from either entering or remaining in our profession. Nurses, therefore, must take an active role in ensuring that resources are directed toward preserving safe, high-quality care.


Many providers and nurses' associations have joined citizens' groups in calling for publicly funded, universal health care. Here's why:


Insuring everyone under one national health program would spread the insurance risk over the entire population. In our current system, job changes and employer health plan conversions can result in loss of coverage, especially if illness identifies someone as an "insurance risk." Employers also lose in this system because insurance pricing cycles increase premiums every few years-which explains why some companies are dropping employee and retirement health plans. Putting everyone in the same "insurance pot" would help to ensure them access when they need it.


The cost of prescription drugs would decrease. Drug costs are higher in the United States, where the uninsured and the elderly, who lack coverage for prescription drugs, pay the highest rates. In Europe and Canada, by contrast, national health systems negotiate price discounts with drug companies (much as large HMOs do).


Billions of dollars in administrative costs would be saved. A lot of money is being squandered on organizational strategies such as restructuring or mergers that have done little to cut health costs or improve quality.2


"Competition" could focus on quality, safety, and patient satisfaction, rather than on the current "quality" benchmarks that emphasize lean service, lower staffing costs, and hotel industry standards to measure patient satisfaction. The current lean system has decimated nursing management teams and inservice education programs, and it rarely allows for the assessment of patient progress or family support after discharge.


Resources would be redirected toward patients and their unique needs and responses to illness. Our current system showcases (and compensates) costly, high-tech, invasive interventions that should serve as a last resort rather than a mainstay of care.


The United States has much to learn from Canada, Germany, Holland, and Scandinavia about how to provide universal health coverage that results in more and better care and better outcomes and patient satisfaction.3 Isn't it time for nurses to agree that universal coverage is the only way to place patients ahead of profits?




1. Sullivan K. On the "efficiency" of managed care plans. Health Aff (Millwood) 2000;19(4):139-48. [Context Link]


2. Wiener CL. The elusive quest: accountability in hospitals. New York: Aldine de Gruyter; 2000. [Context Link]


3. Anderson GF, Poullier JP. Health spending, access, and outcomes: trends in industrialized countries. Health Aff (Millwood) 1999;18(3):178-92. [Context Link]