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Universal health care: Where a nurse can be a nurse

John Gurule, RN

John Gurule, RN

John Gurule went into shock when he took his first rounds as a professional nurse, and it wasn’t the kind of shock he’d later treat in emergency rooms. Instead, Gurule could hardly believe that he had no time be the kind of nurse he was trained to be.
“They build up a nurse’s ethic in you to always put your patients first. I learned in school that nursing is a full complement of skills—it’s emotional, it’s physical, it’s spiritual. Taking care of a patient isn’t just giving meds and keeping someone clean. Nurses, in their training, learn that it’s good to take time to listen to your patients because sometimes they know more about what they need than you do.”

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Yet as Licensed Practical Nurse in private nursing homes and then at for-profit hospitals as a Registered Nurse, Gurule found that many facilities understaff nurses to cut costs.
“I was shocked because you couldn’t really be a nurse. You couldn’t take care of patients. You were given lots and lots of patients, and you had to triage them in your day, and God help you if you were given a lot of really sick patients.”
Faced with so many pressing tasks, Gurule found he could barely stop for a kind word or joke that builds the human connection.
“I had thousands of patients who I couldn’t get a rapport with. But when I was able to let patients talk to me, and I talked to them and still got everything done, I felt really fulfilled.”
Gurule wanted to understand how the U.S. health system had strayed so far from putting patients first. He launched a 10-year investigation into the history of nursing and health care in the U.S. and across the globe. Then, on June 21, 2000, the World Health Organization released its first-ever rating of the most effective health systems across the world. The U.S. ranked 37th of 191 countries, despite spending more of its gross domestic product on health care than any other nation.
“(Every health system that) worked had some form of universal health care,” Gurule said. “If (the health system) works right, that’s where a nurse will be able to finally be everything a nurse should be.”
Gurule said universal health care is effective and affordable because it puts patients and prevention first.
“That’s why I founded Colorado Nurses 4 Health Care 4 All, because I want nurses to be in on the transformation to universal health care and prevention. Whatever affects nurses, I want them to have a role in, because it’s going to affect the patient.’ I say to them, “The state of Colorado is your patient and you need to do everything you can to get it healthy.

Even with employer-based health insurance, health costs skyrocket

Kyla Pfief, Emma Pfief, and Mr. Pfief

Kyla Pfief, Emma Pfief, and Mr. Pfief

Kyla Pfief and her husband never really thought about health care until she became pregnant with their daughter, Emma, in 2011. But they weren’t worried, either.

“We thought we had a really great insurance plan (through my husband’s employer) with a $1,000 deductible and $3,000 maximum out-of-pocket,” Pfief said. “We thought we were golden.”

When Pfief had to have an emergency C-section, newborn Emma needed a three-week stay in the Neonatal Intensive Care Unit.

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The Pfiefs soon realized how expensive health care can be even for those with good coverage. The family paid $6,000 that year—10 percent of their annual earnings—toward Emma’s care. Still, they felt blessed to have Emma blank doing well and access to good insurance.

Then, when Emma was almost 2, Pfief found her in her crib unresponsive.

“It was three times that we went into her room that we could not wake her up. She didn’t wake up in the car ride either, or at the doctor’s office, so they took her by ambulance to the hospital.”

Each hospital visit came with $350 co-pay, and it took three stays, several specialists, and many months to determine a diagnosis: a genetic metabolic disorder that means Emma can’t make her own carnitine, a cellular compound essential to the breakdown of food into energy.

Some weeks, the family traveled to Denver two or three times for appointments at Children’s Hospital or National Jewish Health. Each appointment meant a $50 co-pay in addition to co-insurance payments for all diagnostic testing.

During the fiscal year Emma was 2, the family spent nearly $10,000 on medical expenses, and their medical bills continue to mount. That’s because the out-of-pocket maximum doesn’t include co-pays and co-insurance charges.

Still, Pfief counts her blessings that Emma thrives at almost 3.

“She’s healthy as can be.”

And, flawed as it is, she knows she’s better with insurance than without it.

“In my job, I work with a lot of people who were uninsured before (the Affordable Care Act). Most are on Medicaid now. They’d come in with these $7,000, $8,000 or $10,000 bills for an overnight hospital stay. How are people who are living on $700 a month supposed to pay a $15,000 hospital bill?”

And Pfief still worries about the rising costs of health care.

“There are just so many different medical bills and fees that we have to pay in addition to our monthly premium. None of those costs are deducted from our annual-out-of-pocket responsibility. Our daughter’s health care bills will eat up a tremendous amount of our annual income this year and I don’t know how we will afford higher premiums again next year,” said Pfeif.

Colorado family strugles financially despite hard work, insurance

Trish Bond

Trish Bond

Dental hygienist Trish Bond has been told she’s a great listener.
She’s also learned to share enough to put her patients (who can’t say much while having their teeth cleaned) at ease.
When people are late for their appointments, as sometimes happens, Bond has learned to gently ask what happened.
“Invariably, they are so relieved I’ve asked, you know, and something has come up in their day unexpectedly. You just never know what people are going through.”

Take Bond, for example. Earlier this year, it looked like she and her husband Jason and their two children were going to lose their home. Raging medical debt has released a storm on the family nearly as terrifying as her husband’s rare cancer, diagnosed nearly three years ago.

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Trish Bond has always worked and carried medical insurance for her family. Over the years, only one dentist offered employee medical benefits: So she’s paid out of pocket to self-insure her family.
It’s getting harder and harder for her to do.
“I make less money now then when I got of college 25 years ago,” she said. She says she’s watched over the years as her dental employers have had a more and more difficult time making a living. She’s not sure of all the factors, but she knows one is increasing challenges they gave dealing with insurance billing.
Routinely dental insurance denies claims, she said.
“They’ll say ‘This night guard is not dentally related,” and it’s like “What dental school did you go to? (Insurers) are trying to treat the patient.
“I’ve had them refuse crowns. The doctor will have to send another narrative about why something is needed, or send more pictures,” she said.
“I think it’s a delay tactic. Some of them don’t even cover X-rays anymore.”
This insurance “drill” now threatens her family’s financial health even as her husband Jason Bond battles for his life against malignant mesothelioma.
Caused by exposure to asbestos, mesothelioma is among the rarest of cancers and one of the most difficult to diagnose. He underwent months of bill-escalating testing before anyone had a clue what was going on.
She watched as her 6’ 3” husband lost so much weight so quickly that an Internet research led her to this conclusion: It had to be one of three things: heart disease, sclerosis of the liver, or cancer. And the doctors had already ruled out heart disease and sclerosis.
Treatments such as surgery and chemotherapy can help improve patients’ prognosis and increase life expectancy, but mesothelioma has no known cure.
Jason will soon undergo his second surgery to remove the tumors. His last surgery took 13 hours.
Jason Bond worked up until last year, when he finally had to go on disability.
With all the medical expenses—$28,000 out of pocket last year alone— Trish Bond still makes too much to qualify for Medicaid. “We could qualify if I didn’t work, but that’s not who I am. I believe in working, in being independent. What I don’t understand is how our health care system just lets us working Americans drown.”
Every day Bond and her family do their best to keep hope alive. They were recently able to refinance to keep their home, at least for now.
“We believe in miracles. We are high faith,” she said. And that’s what it takes, she said, because “Financially and emotionally, these last years have been so hard.”

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