Who’s Flying the Plane?

We've Gotten Off Track photo: JParadisi 2009

       Perhaps a change of nomenclature is needed in health care.  Physicians should be called Pilots, and nurses renamed First Officers, like in the airline industry, which the health care industry often compares itself to. The term doctor’s orders would change to instructions. Instead of a nurse requesting orders from a doctor, the First Officer would ask for further instructions from The Pilot. The name changes promote the team approach that more accurately describes patient care. 

     Gallup Poll: Power Elite Believes Nurses Should Have More Say in Policy, Management  posted by Shawn Kennedy on the American Journal of Nursing blog, Off The Charts  quotes that “69% of ‘people who run things in this country’ see nurses as having little influence on health reform.”  The poll ranks nurses at the very bottom of the list of groups influencing health reform, under patients, who lag behind physicians. Listed as the most influential  are  government, insurance and pharmaceutical executives. In other words, the people flying the plane do not control the plane. Decisions about health care policy are made by people who are not on the plane. Sometimes the decision makers aren’t even at the airport. 

         That’s not to say that physicians and nurses should dictate health care policy without thought or consideration of cost for treatment or alternative options. In the short story Voyagers, I write about recognizing the need for administrators, whose jobs keep hospitals solvent and regulated. However, demoting nurses, doctors, and the patients themselves to the bottom of the list of influential voices in health care policy, while allowing corporate administrators to have the most influence, seems a crippling case of the tail wagging the dog.

Oh, Did You Want Anti-Nausea Medications with Your Chemotherapy? You’ll Have to Pay Out of Pocket for That

   Note: If you are uninsured and diagnosed with cancer, you will probably find an oncologist and a hospital that will treat you. However, although your chemotherapy cost of tens of thousands of dollars is absorbed, no one will pay for the antiemetics (anti-nausea drugs) that your doctor will prescribe for you to take at home to manage the side effects of chemotherapy. (If you know something different, please post it in the comments.) So, if you don’t have any money, your oncologist will prescribe compazine (prochlorperazine), which is cheap, and used over 20 years ago, when people banged their heads against the toilet vomiting from chemo.  There are newer, more effective drugs, like Zofran (ondansetron) and Kytril (granisetron), that control nausea and vomiting. They are expensive. Uninsured patients usually can’t afford either. They don’t complain though, because they are getting their chemotherapy for free and they know they should be grateful. So they suffer. It’s the politics of health care.

A Metaphor: Health Care Reform on Life Support

oil on wood (2008) artist: JParadisi

     The idea that the Health Care Reform bill is on life support is disappointing, but not surprising. It was admitted in a weakened state of health. It appears suspiciously a victim of domestic violence by special interest groups. The bruises on its body resemble the outline of handprints of the insurance companies it was created to protect our citizens from. Already, my patients are complaining of rising health insurance deductibles this year. It is estimated that 14 million people will still be uninsured if the Health Care Reform bill rallies and passes. It is a complex piece of legislation that confuses even those of us who strongly advocate for health care reform. I think that’s where the undecided get lost and fall to the wayside; afraid to support what they do not understand.

     In my grief over Health Care reform, I console myself  by remembering that at least it’s a step in the right direction. At least an estimated 34 million currently uninsured citizens will be insured, and people who are currently insured won’t lose their insurance if they change jobs or become ill. These are progressive and necessary improvements to the present situation. I tell myself that if we lose this moment in history, it won’t come again anytime soon. Something is better than nothing. Fight for the life of the Health Care Reform bill, don’t let it slip away.

     But I know, even if successfully resuscitated, it will not be the strong, idealistic super hero it once was. It is anemic. The bill has been bled by special interests groups and insurance companies. It’s vital organs have been damaged by poor perfusion (lack of blood supply). It is now being threatened with further leeching in order to get even a shadow of its former self passed into legislation.

     Health Care is a human rights issue. Human rights issues are intimately linked to economics. Historically, in most countries, including the United States, it is this link that causes resistance. It is the cause of resistance to Health Care Reform now. Until Health Care is recognized as a fundamental human right, and not a for- profit industry, our citizens will continue to suffer.