Single-Payer Healthcare: a Reality for California?
Voices From the Nursing School
By Julie Illi Laird
Synapse, UCSF Student Paper
As a nurse, I have seen countless examples of the devastating outcomes that result when people do not have access to care due to lack of insurance. Just last week, I visited a 35-year-old cancer patient to help her manage oxygen treatments at home. She had beaten breast cancer at age 25. However, she was a restaurant worker and did not have health insurance; consequently, once she started working again, she no longer qualified for MediCal and could no longer see a doctor to be screened for recurrence. Sadly, when the cancer did come back it was not detected until she went to the ER one night when she could no longer breathe. Cancer metastases cover most of both her lungs. As she can no longer work, she is once again eligible for MediCal. Unfortunately, this coverage has come too late to save her life. I wish this story was an isolated event, but the fact is 18,000 people die in the U.S. every year solely because they do not have health insurance. A single-payer system would not only give access to care to the millions of currently uninsured, it would also create a better environment for all healthcare workers to practice in.
The reality of a single-payer system for California may not be as far away as you think. Senate bill 840 — a proposal for single-payer healthcare in California — was passed on the floor of both the Senate and the Assembly last year (only to be later vetoed by the governor). It will be re-introduced in the upcoming months. State Senator Sheila Kuehl, author of SB840, explains the rationale behind the bill: “SB 840 would replace insurance companies with a statewide trust fund that collects premiums paid by employers and individuals. The creation of a single state fund reduces the administrative portion of California’s healthcare costs from nearly 30 percent to under 10 percent. With everyone in one pool, which spreads the risk as widely as possible, no one would be denied coverage for a preexisting condition. Individuals would be free to change jobs, start a business, go to school or start a family without losing coverage or doctors they trust.”
SB 840 is good for the practice of healthcare, as well. Under this new system, decision-making would be returned to physicians and advanced practice nurses as treatment options would no longer be determined by what is covered by each individual’s insurance plan. SB 840 would end uncompensated medical care by ensuring that everyone has a payer. Paperwork would be infinitely streamlined and medical offices would no longer need teams of administrators to argue for authorization and bill dozens of different insurance companies every month. Practices will be able to refocus their staffing on nurses and other providers, which will increase the quality of care and decrease medical errors. Continuity of care will improve as patients are no longer forced to change medical groups when they switch jobs or their employers switch plans. This will lead to more meaningful, long-term relationships between providers and patients — improving quality of care and patient safety.
In the face of a rapidly deteriorating healthcare system, the term “universal healthcare” has taken on a new popularity in 2008. Many of current proposals, however, are simply mandates for universal coverage rather than universal care. Mandating insurance provides neither a guarantee of affordable insurability, nor actual medical services, nor does it resolve the problems of the tremendously expensive administrative overhead and system inefficiencies of the private insurance-based system. While insurance mandates make perfect political sense, they are complete economic non-sense. The only truly comprehensive, economically feasible method for providing universal care is the establishment of a single-payer system.
The advantages of a single-payer healthcare system for California are clear. Increasing numbers of UCSF students not only agree, but also are doing something about it! In a tradition that started in January 2006, almost 400 health professional students from across the state converged in Sacramento on January 28 to call on state legislators to support SB 840. Participants conducted legislative visits with 38 (out of 40) Senators and 65 (out of 80) Assebly members securing at least four new co-authorships, two new yes votes, and numerous pledges for continued support of SB 840. Preceding the legislative visits, a raucous rally was held on the Capitol steps. In a sea of white coats and rally signs, keynote speaker Sheila Kuehl announced, “That our newest generation of [healthcare providers] is exhibiting such a strong commitment to universal health care means it is only a matter of time until it becomes a reality. They are acting to protect not only their future patients, but also their own ability to practice good medicine. [Legislators] must listen.” And, so should you. To learn more about the issue and how you can get involved, visit the UCSF student run website “Nursing Students for Universal Healthcare” at http://ns4universalhealthcare.blogspot.com/
Julie Illi Laird is a MEPN student, UCSF School of Nursing.