The uninsured can’t afford delay

Austin American-Statesman, March 3, 2010

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Do not underestimate the power of universal coverage. How much healthier would we be and how much more efficiently would we spend health care dollars if everyone could get the care they need when they need it?

I refuse to nail the coffin shut on health care reform.

I chose neonatal intensive care as my professional home because it’s the perfect world. It’s a wonderful mix of high technology and caring, and every infant needing intensive care has access because the care is universally covered by private or public insurance. I could never work in an area that people couldn’t access because of lack of insurance.

Close to 50 million middle-class Americans are uninsured. That’s unacceptable. A year ago, we had a new president and a new national consensus to fix our broken health care system. We were united around the principles of covering all Americans and leveling or bringing down costs. Reform bills passed both houses, and each covered 30-plus million more Americans.

My euphoria was dashed in January by the Massachusetts Senate election to the seat held for 47 years by Ted Kennedy, the champion of national health insurance. In a macabre irony, the state that in 2006 enacted near-universal coverage elected Scott Brown, who campaigned on a platform to defeat health care reform. Since then, I’ve watched with horror as the national discussion of moral imperatives descended into the ugly refrain of “government takeover of health care.” Now it looks like the majority of Americans oppose reform and that political reconciliation is the only hope of passage.

A serious observer would never call the reform proposals a government takeover. It is not proposed that government provide health care. That’s called socialized medicine. And it’s not proposed that government pay for all health care. That’s called a single-payer system.

The conventional wisdom was to base reform on the system we already have — a mix of private and public insurance, and that’s precisely what the architects of both bills did.

With our health care system incapable of correcting itself, both proposals simply suggest government oversight. The uninsured would be required to enroll from insurers offering their policies in organized health-insurance exchanges, with the federal government acting as the equivalent of the employee benefit department of large employers. Low-income Americans would receive subsidies to help them pay for it. Both bills leave the employer-based health insurance system — which 80 percent of privately insured Americans have — untouched.

As for rising health care costs, we need to look at tort reform and at profiteering by pharmaceutical companies, niche hospitals, medical device companies and physician specialists.

We can limit costs and tragedy if we figure out ways to deliver care that achieves a better outcome. We can do that. I’ve seen it done.

Where I work, the saddest thing I (used to) see at work was a great big, beautiful brain-dead infant lying on an open warmer, with tubes everywhere — the result of birth trauma.

In 2003, our term infant birth injury rate was 0.3 percent, half the national average. One injured baby is too many, so the health care team set about to eliminate such tragedy. By 2009, we had reduced our preventable birth trauma injury rate effectively to zero by bundling best practices. We improved delivery room communication and implemented protocols for the use of oxytocin (a drug to start or continue labor), forceps and vacuum extraction.

Putting safety above profits, our hospital system went from billing payers $1.5 million in 2003 to currently $25,000 for birth trauma. It’s a huge savings for Texas, which foots much of the Medicaid bill. Just imagine the savings nationwide and the human tragedy avoided.

I became a nurse in 1979, 14 years after the passage of Medicare and Medicaid. Back then, health care represented 7.2 percent of our gross domestic product.The last time a serious attempt to reform health care was made in 1993 when health care accounted for 13.4 percent of the GDP. It’s now 17 percent; without reform, it’s projected to reach 38 percent by 2050.

We cannot afford to wait to fix our broken system. Do not underestimate the power of universal coverage. How much healthier would we be and how much more efficiently would we spend health care dollars if everyone could get the care they need when they need it?

Toni Inglis, MSN, RN CNS (retired), FAAN, a lifelong Austin resident and retired neonatal intensive care nurse and editor of NursingNews, writes a monthly opinion column for the Austin American-Statesman editorial page.