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Old 12-06-2009, 08:50 PM
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Default Senators: Listen to the Patients

Dear senators: Listen to the patients

Nurses hear health-care horror stories day in and day out.
America can do better than this, says R.N. THERESA BROWN

Sunday, December 06, 2009

Welcome to the American health-insurance system."
It was almost the first thing out of my patient's mouth when I started my nursing shift one Friday morning. He was in his 30s, had metastatic cancer and his mother was hiding in his bathroom, yelling into her cellphone, trying to get answers from his insurance company.

That day was his last possible day either to re-enroll with his present insurance company or pick a new one. He had good coverage, but had been living out of state, then moved in-state to be with his parents. Good as it was, would the coverage he had be able to cross state lines?

That same day, I had another patient with a health-insurance story to tell. She'd paid out-of-pocket for intravenous antibiotics she'd needed at home. The drugs cost $300 -- a health insurer would pay maybe half, but patients without insurance pay full price -- and she didn't have it. Still, she explained, "They tell you you'll die without this medicine, so you find a way to pay for it."

Now she had two blood clots in her arm. The doctors wanted to send her home with injections of a blood thinner, but a full dose would cost $1,300. I was in her room when the discharge nurse went over the costs with her. My patient didn't hesitate. "No," she said in her matter-of-fact way, "I can't afford that." But it wasn't safe to send her home on pills alone for anti-coagulation.

A visiting friend asked if there wasn't a way for my patient to be discharged with the shots in hand. "Not officially," I said, and then I thought about it, "Not to say that it couldn't be done." It got me to wondering if there was a way to finagle those injections for her. I wouldn't be her nurse when she was discharged a couple of days later. The timing spared me from having to decide how much I was willing to risk to get this incredibly kind woman the drugs she needed to stay alive.

I have my own story, too, as a patient's mother. My 10-year-old daughter hurt her wrist last Sunday. I didn't think it was broken, but after an hour of ice and rest it wasn't better, so I did what parents do, called the pediatrician to ask if I should take her to the emergency department. Before I could even describe my daughter's problem the doctor's answering service asked me not just if I had health insurance, but if I had "Company X" insurance. Their on-call triage center also had to confirm that my insurance was with "Company X."
Our family does have "Company X" health insurance, but what if we didn't?

I'm a nurse; at work I navigate the maze of modern health care on behalf of my patients, but that day, calling from home, I felt my anger rising. Since when was I required to verify my specific insurance coverage before I could leave a message for a doctor?

Thinking over these three stories, I wonder if this is really the world we want to live in. Where registering for insurance means three hours of combative conversation that your very ill son cannot help but overhear? Where nurses, and maybe doctors, too, have to contemplate breaking the rules to get patients the care they need? Where you can't ask for help without first showing your company card?

The debate over health insurance reform has now come to the Senate. In the days ahead I ask opponents of reform to put their arguments aside and listen to the stories patients have to tell. Find a friend on private insurance who has been critically ill, an elderly family member with government-sponsored coverage through Medicare, a neighbor who's a veteran and gets health care from the VA. Listen, and decide if, compared with government insurance, our piece-meal system of private insurance is really working as it should for everyone.

Realize also what you are deciding -- whether in our country, the richest in the world, the sick should depend on the uncertain mercy of the health-insurance market, or should be guaranteed, via government regulation or government insurance, the minimum in care they need.

I am one nurse telling three stories. There are 2 million more nurses out there, most with many similar stories to tell. A great nation has the courage to embrace decency, to do what is right. Our current health-care system is broken. Maybe if we listen to patients we will find a way to fix it.

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Old 12-06-2009, 11:21 PM
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This is what I've been saying all along, the health care system in this country sucks lemons and needs a major overhaul. Yes, I have medicaid to suppplement my Medicare, but with a spend-down amount I cannot pay unless someone else comes up with the money out of the goodness of his or her heart. I'm still waiting to hear if the partials I need will be approved by medicaid. I've almost choked on my food several times in the past week alone. If it weren't for my cats, I'd have said "screw it" and thrown in the towel long ago, and there are people who are far worse off than I am.
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