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A Guide to Single Payer: Chapter 1

“For seventeen years, I have practiced the art of healing and compassion. I have saved lives, eased pain and suffering, given hope, comforted, brought joy and peace, and provided dignified deaths. And, because of this, I have reaped the rewards of love, joy, spirituality, peace, respect, and fulfillment. Now, as I have been for some time, I am filled with guilt, worry, anger, frustration, anxiety, and shame. I am no longer the instrument of healing, but the doer of harm. I am no longer able to give compassion, because there is not time for such nonessentials. I am no longer able to fight for my patients’ right to good, safe care and well-being. I feel ashamed of myself because I allow the money powers to degrade my profession by forcing me to flirt with disaster and act inhuman.”

Does this voice sound like your own? We are part of a health system which has replaced humanitarian values with the heartless tenets of the market. Why do all attempts to “reform” the system seem only to make the problem worse?

For a health system to meet the needs of us and those entrusted to our care, three essentials must be addressed simultaneously and consistently: Access, Quality, Affordability.

“Incremental” reforms to improve access and cut costs have failed to meet our goal of universally available, quality, cost-effective health care. On the contrary, they have greatly increased the layers of management and bureaucracy, thus squandering resources.

Of this we can be sure: there is enough money in the system to cover everyone, give those in need more and better quality care. The problem is how that money is being spent.

Measures aimed at expanding access alone, take resources needed for care and spends it on clerical and management staff determining eligibility and other overhead. Measures meant to improve quality alone, lead to excellent care for some, no care for others, and higher cost burden on all. Measures focused on reducing costs alone, lead to diminished quality.

We need a holistic remedy for the health care system. MNA and ANA have concluded that only a “Single Payer” system, fairly funded and universally applied, will make health care a fundamental right of everyone. Nurses are uniquely qualified to lead the way to the legislative remedy for what is essentially a public health emergency. To be effective educators and advocates, we need familiarity with some basic principles of health economics and health policy. This sort of material is not generally included in the curricula for our professional preparation. So we need to catch up, to stop the “money people from degrading our profession.”

What would “single payer” health care really mean to us, to our families, to our patients, to our institutions and communities? If it improved cost control and access to care, would quality suffer? What’s the truth behind the horror stories we hear of in Canada, a nation very similar to our own but with universal, single payer health care since the ‘70’s? Can a uniquely American single-payer be fashioned?

The answers to these and other questions are absent from mainstream media and the public debate. To counter that, during the next several months MNA will be devoting this page to presenting accurate information on single payer health care and how it would affect each of us as practitioners, as patients, as staff and managers.

Definition of single payer terms “Universal”: All residents of a geographic/political entity; includes everyone, regardless of medical condition; a vast pool that guarantees affordable costs; “Everyone in, nobody out.” (In some single-payer plans, there are waiting periods for newcomers but then they are included.)

Your questions and feedback will be most valuable. Please send your questions and comments on this page and on single payer reform to David Schildmeier, Editor, Massachusetts Nurse, 340 Turnpike St., Canton, MA 02021, e-mail, dschildmeier@mnarn.org.

To view the full American Nurses Association Action Report: “Nursing’s Preference for Single-Payer Mode of Health Finance and Organization”, Summary of Proceedings, ANA House of Delegates, 1999, on ANA’s website: www.nursingworld.org

For general information on single payer reform, visit the web site for the Nurses Network for a National Health Program: www.nnnhp.org