Nurses Know the Human Costs of Care. That’s Why Many Want ‘Medicare for All.’

Critics say universal health care will penalize providers the most. These nurses are undeterred.

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Messages left at the headquarters of a pharmaceutical industry trade group during a Washington rally last month.CreditCreditAl Drago for The New York Times

The experiences that have turned the members of National Nurses United, the nation’s largest union for nurses, into vocal advocates for a universal, government-run health care system are numerous and horrific.

Renelsa Caudill, a Washington, D.C.-area cardiac nurse, remembers being forced to pull a cardiac patient out of the CT scanner before the procedure was complete. The woman had suffered a heart attack earlier that year and was having chest pains. The doctor wanted the scan to help him decide if she needed a potentially risky catheterization, but the woman’s insurance, inexplicably, had refused to cover the test.

Melissa Johnson-Camacho, an oncology nurse in Northern California, remembers a mother who had to ration the special bags that were helping to keep her daughter’s lungs clear. The bags were supposed to be changed every day, so that the daughter did not drown in her own fluids, but they cost $550 each.

And Karla Diederich, also from California, remembers saying a final goodbye to her friend and fellow intensive care nurse Nelly Yap in their hospital’s parking lot. Ms. Yap was dying of metastatic cancer. She was scheduled for another round of chemotherapy, but the hospital had changed owners while she was on sick leave and she’d lost her job — and insurance — as a result. “Nelly spent most of her life taking care of other people,” Ms. Diederich says. “And when she needed that care herself, it was not there.”

The women say that their professional experiences have led them to an inescapable conclusion: The motives of gargantuan for-profit health care industries — hospitals, pharmaceuticals, insurance — are incompatible with those of health care itself. They argue that a single-payer system, run by the federal government and available to all United States residents regardless of income or employment status, is the only way to fully eliminate the obstacles that routinely prevent doctors and nurses from doing their jobs.

Several proposals now working their way through Congress would aim to create just such a system. The nurses’ support for such proposals — the union has endorsed a bill put forth by Representative Pramila Jayapal of Washington — is somewhat surprising, because the zero-sum nature of American health policy tends to place them on the losing end of any major system overhaul. The money it will take to provide many more services to many more patients will have to come from somewhere, the thinking goes. And the paychecks of doctors and nurses are a likely source.

That calculus has not deterred the nurses.

Perhaps that’s because they see so much time and money wasted by the bureaucracy of the current system. By most estimates, the administrative costs of American health care surpass those of any other developed nation. Or maybe it’s because of the innumerable avoidable medical crises they constantly find themselves confronting. Patients go into heart failure because they can’t afford blood pressure medication, or gamble with their diabetes for want of insulin, then turn up in the hospital needing care that’s far more expensive than any preventive measure would have been.

Or maybe they just know that a steady job with decent health benefits does not exempt anyone from the arbitrary agonies of our current system. Ms. Johnson-Camacho recalls having to discharge a patient without essential chemotherapy — not because the patient was uninsured but because his insurer refused to cover the drug that had been prescribed. “I had just finished explaining to him how important it was to take this medication faithfully,” she says. “I told him, ‘Every day you skip it is a day that the cancer has to potentially spread.’ And then we had to send him home without it.”

Ms. Johnson-Camacho says another patient — a young man with a treatable form of cancer — was so overwhelmed by the cost of his care, and so terrified of burdening his family with that cost, that he told her he was planning to kill himself.

Anyone who has been to a hospital or seen a family member grapple with illness has at least one story like this. Nurses, who encounter the system daily for years or decades, have hundreds, and they know better than most how brutally such stories can end. “It’s barbaric,” Ms. Diederich says. “Crucial medical decisions are being made by businessmen whose primary goal is to make a profit. Not by medical professionals who are trying to treat their patients.”

The next remaking of American health care is still a long way off. Recent congressional hearings and a report from the Congressional Budget Office have helped to clarify the long roster of questions that lawmakers will have to address if they are serious about any of the many bills now circulating. But concrete answers to those questions have yet to materialize, and in the meantime, American patients are ambivalent. Polling suggests that a majority now support the idea of universal health care, but many are still wary of the trade-offs such an overhaul would require.

Proponents who want to persuade those skeptics would do well to have nurses make the case. “People say they are scared to have the government take control of their health care,” Ms. Diederich says. “But they should be scared of the people who are in control now.”

Jeneen Interlandi has been a member of the Times editorial board since 2018, and a contributor to The New York Times Magazine since 2006. She writes about health, science and education. @JInterlandi

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