NEWS

Why Single Payer? A Q&A with author/advocate Suzanne Gordon 

Suzanne Gordon is well known among the nation’s nurses as an author who has followed the issues of nurses and nursing closer and with more insight and candor than any writer in America today. Gordon is also a strong advocate for a single payer health care system, and the founder of Nurses for National Health Care, which is advocating for a national health care system. Gordon’s latest book is Life Support: Three Nurses on the Frontlines, which was published by Little, Brown in 1997. The following is an interview with Gordon giving her views on why nurses should support this approach. 

Massachusetts Nurse: What is the most important information for nurses to understand about single payer health care? 

Gordon: Good nurses can only give good nursing care if there are societal supports for that nursing. Nursing practice is not solely an individual attribute. It’s a collective activity that depends on the education of the nurse, on the institutions’ willingness to support the nurse, and on the society’s willingness to support the institutions the nurse is working in and with. 

If between ten to 40 cents of every health care dollar is being siphoned off for advertising, marketing, profit, and administration, then where’s the money for caring? You don’t have to be a rocket scientist to figure out that if so much of the health care dollar is being wasted, care is not going to be funded. 

The market approach also devalues care. If you value wealth over health, you are not going to value the sick, vulnerable, aging, and dying. These are people who are never going to be competitive and productive as the market defines those terms. There’s a fundamental dissonance between care giving and the market. Nurses cannot afford to ignore that dissonance. That’s why it always troubles me to hear self proclaimed nursing leaders talking about product lines and extolling the idea that a sick patient is a consumer or customer. When nurses embrace the market with eyes wide shut, it is both very dangerous and extraordinarily sad. 

Massachusetts Nurse: Why is that? 

Gordon: It’s because nurses and patients have both been turned into cost centers. As long as the needs for profit take precedence over human needs for care, you will see declining RN employment.  If you ration 43.4 million people out of the health care system, you’re going to need fewer nurses. And if they’re included in the system, you’re going to need a lot more nurses. 

Similarly, under market dominated systems, nurses working conditions will erode. Nurses need to understand, that in business lingo, efficiency doesn’t mean getting the job done effectively, it means getting the job done with the least amount of labor. And in business terms productivity doesn’t mean spending more time with each patient.It means caring for more patients in less time. 

Finally, nurses are also patients. Their family members are also patients. So a better health care system will care for them as patients as well as clinicians. 

Massachusetts Nurse: How would a single payer method of collecting and disbursing health care money impact nurses and nursing practice? 

Gordon: That depends on how the system is designed and if nurses are actively involved in designing the system. If nurses wait and watch and hope, they’re not going to be involved participants and they’re not going to get what they want. 

If they’re active participants, they can design a system that includes a focus on patients and care giving needs, not simply on doctors, diseases, managerialism or money. In fighting for universal health care nurses have to insist the system fully funds adequate hospital nursing (with adequate in-hospital educational resources for nurses), community care, home care, hospice care, and also nursing homes that actually have nurses in them. 

Massachusetts Nurse: What’s the relationship between our "multipayer" system and the "speedup", "downsizing" and "deskilling" of nursing care? 

Gordon: Multipayer systems waste too much money on advertising, marketing, administration and profit. In channeling money to care however, we must address a number of critical questions. How are caregivers going to be paid and motivated? How are they going to be educated and where? How are we going to encourage real interdisciplinary teamwork? How are we going to re-educate doctors and nurses so that they work with each other, rather than against each other? Where are we actually going to deliver care and how are we going to make sure it is delivered there? 

Funding a universal health care system is a first step in a long process of redesigning a health care system in a way that guarantees not only medically necessary care but necessary nursing care. Canadians have a single payer system, they don’t value nursing care so that’s a fight nurses will have to fight under any system. It would be a terrific mistake for nurse advocates for a single payer system to suggest that such a system is a panacea that would magically solve these really deep social attitudes toward care giving. 

Massachusetts Nurse: So what can nurses do? 

Gordon: Nurses have to wage a two-pronged struggle. One is for universal health care; the other is valuing necessary nursing care. But the two things are connected. If nurses are assertive advocates of a fair, accessible, quality health care system, then their public image will be significantly enhanced. 

Massachusetts Nurse: How could nurses nationally create a strong voice for single payer reform? 

Gordon: Thanks to MNA among others, the ANA is now on record as supporting single payer. But what is the national organization doing to educate nurses around the country about the need for universal health care? This means developing educational programs at national and state conventions and developing educational materials for dissemination to nurses and to the public. Nurses in SNAs need to pressure the ANA to do this. I would also hope nurses would join the Nurses Network for a National Health Program because this is the only national organization for nurses whose sole reason for being is to promote universal health care under a single payer system. 

Physicians for a National Health Program has 8,000 members. The Nurses Network should have four times that many because there’s four times as many nurses as doctors. Nurses have so much to gain and, if the system is properly designed and funded, very little to lose. That’s why it’s really important for nurses to join together now to fight for single payer universal health care. If we wait till the system collapses and profit-making companies have bled it dry, we won’t get the system we want. 

But if nurses mobilize they can have an enormous impact. Look what nurses in Massachusetts have accomplished around patient safety, whistleblower and BORN reform. Look what nurses in California have done to protect patients through safe staffing bills. If nurses work with physicians, patients and families, we can have a universal health care system, and sooner rather than later.