Let Healers Heal with Medicare for All

Now that the Trump administration is acting to undermine the success of the Affordable Care Act, potentially rolling back key provisions, it is more important than ever for all of us who want universal access to comprehensive healthcare to set our sights on development of a single-payer health system. The “Medicare for All” bill put forth by Sen. Bernie Sanders (I-VT), and co-sponsored by 16 senators, provides a way forward to this goal. We need to support it, and support the legislators who get on board with it. While the likelihood of passage of this bill right now is slim, pressing it forward can broaden the base of support for single-payer health care, which is already supported by more than half of Americans.

While the Affordable Care Act has provided health coverage to more than 20 million people who previously lacked it, but wider reforms are needed to bring both universal access to comprehensive healthcare and a reversal of our market-based system. As Harvard’s Marcia Angell said recently in the Boston Globe, markets are good for many things but “terrible for healthcare.”

Market forces can increase bureaucratic costs, some of which could be eliminated by a shift to single-payer. A recent analysis showed how single-payer could save $504 billion in bureaucratic costs. These funds could then be put towards increased access, helping prevent the results of lack of access; medical bankruptcy, worsening illness, and sometimes death.

In addition, at a time when the ACA has brought many more people into the system, and with that a need for increased numbers of healthcare professionals, all too much of those professionals’ time is spent on the bureaucracy which supports the current market driven system. This can contribute to burnout and potential losses to the professional workforce, which we can ill afford.

I see the impact of this every day in my work at both a community behavioral health center and a university. I see the frustration of the clinic nurse who spent 10 hours last week trying to secure payment from insurance companies for medications prescribed by primary care and psychiatric providers but denied payment. He tries to stay focused on how these efforts will help his patients gain access to a prescribed asthma inhaler, antipsychotic medication, or insulin pen. But it is not the best part of nursing; it is not what most nurses are in it for. It is exhausting and often demoralizing work, and the link to professional burnout has been known for some time.

This dynamic is repeated throughout the week; a nurse practitioner tries to find a cardiologist who accepts her patient’s insurance, a psychiatrist tries to find a resource for neuropsychiatric testing to clarify a patient’s diagnosis. Introducing this role function to the student nurses, I try to couch it as an opportunity to model and teach self-advocacy skills. When they express dismay at how the system seems to work against their patients, I try to instill hope.

And there is cause for hope, with the upsurge in support for single-payer and “Medicare for All”. Of course, the health insurance industry will fight against any bill that legislates its demise. But political support is growing, and may well overcome this powerful lobby. In addition, the upsurge of activism since the presidential election has given voice to many who have never spoken out before. Groups of constituents crowded legislators’ town hall meetings early this year and during the August’s recess, objecting to the attempts to remove popular features of the ACA. These legislators or the ones who replace them will continue to be called to account for supporting policies that restrict access to care.

Single payer health care would free clinicians from having to arm themselves daily to do battle with other sectors of the health system on behalf of patients. It would free us all from having to use our health care dollars to support shareholders in publicly traded companies. And it would free us to change the unacceptable reality of being the only highly industrialized nation in the world without universal access to healthcare.

Dr. Alice Geis is a psychiatric nurse practitioner who is Assistant Professor at Rush University College of Nursing, Director of Integrated Health and Interim Medical Director at Trilogy Behavioral Healthcare, and a Public Voices Fellow of the Op-Ed Project.