Elaine Thompson/AP Photo
Registered nurse Diane Miller pulls on an N-95 mask in the COVID acute care unit at UW Medical Center–Montlake, January 26, 2021, in Seattle.
In between cheering our heroic nurses, the press has been filled with accounts of the increasing nurse shortage in the face of a pandemic whose spread is still peaking. One source is pure burnout, of nurses who are going 24/7 as hospitals are overloaded.
Nurses in ICUs, who are supposed to be taking care of one or two patients, are now forced to handle three or four. As their colleagues get sick or have to take a mental-health break, the ones who remain work double and triple shifts.
You’d expect all of this in a hundred-year pandemic. But there is a deeper reason. And it’s urgent that we connect the dots.
The reason is the plague of for-profit medicine. While other nations’ health systems are also experiencing stresses, there is nothing like the stresses that RNs face in the United States.
In our health system, dominated by for-profit health plans and for-profit hospital systems, nurse salaries are a cost center. The system’s goal is to maximize profits and minimize costs, so nursing understaffing is chronic.
A for-profit system dictates investing in fancy technology and targeting the most profitable procedures and patients. It means creating barriers to care so that people nominally covered by insurance often don’t get the actual care they require. It means massive private bureaucracies for billing, profit maximization, utilization review, and so on.
All this money could be going to pay nurses.
In other national systems, there is budgeting based on need and staffing based on need. If the Proud Boys wanted to turn their rage on America’s real fiends, they might start with for-profit medical executives.
Even though there are some not-for-profit hospitals and health insurance plans, they swim in waters polluted by the dominant for-profit part of the system. In my hometown, Boston, the great Harvard teaching hospitals, organized in a local duopoly of two large systems (Partners and Beth Israel Lahey), are nominally nonprofits. But they have to make a living, so they play the same games as the for-profits.
Though the debate has been focused on whether to have a single-payer system, Medicare is a single-payer system for the elderly, yet it (and patients) still suffer from the larger commercial environment in which Medicare must operate.
This for-profit dominance, by the way, is why Obamacare utterly failed to fix the system’s larger ills.
So as we work to get a national health insurance system, whether in a single leap or by incremental moves such as a public option, let’s remember the paramount evil: commercial medicine. We owe it to our nurses, and their patients (us!), to put these parasites out of business.
