Senate Budget Committee Issues Testimony From National Nurses United

WASHINGTON, May 31 -- The Senate Budget Committee issued the following testimony by National Nurses United Executive Director Bonnie Castillo involving a hearing on May 12, 2022, entitled "Medicare for All: Protecting Health, Saving Lives, Saving Money":

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My name is Bonnie Castillo. I am a Registered Nurse and Executive Director of National Nurses United (NNU), the largest union and professional association of RNs in the United States. NNU proudly represents over 175,000 members who work as bedside health care professionals.

I'm particularly pleased to be joining you all today on International Nurses Day. I can think of nothing more fitting to commemorate International Nurses Day than by advocating for the quick and urgent transition to a Medicare for All system that would guarantee health care to every person in the United States.

For more than two years, nurses across this country have worked on the frontlines of the Covid-19 pandemic. We have been caring for patients despite atrocious working conditions in which the health and safety of nurses and their families have constantly been put at risk. Nurses continue to bear witness every day to the ravages of this pandemic. We have seen unfathomable levels of death, physical illness, as well as the despair and grief that comes with severe illness and death, particularly when patients are isolated from their loved ones. And we have worked through this pandemic far too often without the protections we need to do our jobs safely.

In my testimony today, I will use the experiences of registered nurses from across the country to illustrate how the current healthcare system is fundamentally unable to provide the therapeutic quality care that our patients need and deserve. By erecting financial barriers to care, it provides starkly disparate care to different people and communities and, for many, provides no care at all. It is also financially inefficient and wasteful for the country as a whole. The only way we can guarantee every person living in this country receives the healthcare they need with a single standard of excellent care is by adopting a single-payer, Medicare for All system.

If it was ever in doubt before, this pandemic has shown that our current profit-driven and fragmented health insurance system does not work. It does not provide quality therapeutic care to millions of Americans, and it does not value and protect its own health care workers. Critically, the current fragmented system of health insurance is unable to provide the comprehensive pandemic response that we have needed for more than two years.

Why didn't nurses and health care workers get the protections we needed in the pandemic? Because our employers value money over our lives. More than 5,104 nurses and other health care workers have died as a result.

Why didn't we have the emergency stocks of critical medical supplies that we would need in a pandemic? Because the hospital and healthcare industry has long-employed a "just-in-time" supply and personnel model, where they plan their supply chains and staffing based on maximizing profit, not improving and safeguarding patient care.

We have seen high death rates from Covid-19 across the country. The United States population makes up less than five percent of the world's total population, but U.S. Covid-19 fatalities comprise 16 percent of total global Covid-19 fatalities. Our hospitals have been consistently overrun with critically ill patients. There are 30 million people in this country who are uninsured and tens of millions more who are underinsured, who therefore do not get the medical care they need. Without consistent access to high-quality care, including preventive and primary care, our patients are at higher risk of underlying medical conditions, which in turn, puts them at higher risk for severe Covid-19 illness, hospitalization, and death.

We do not have the health care infrastructure we need to effectively respond to this pandemic or prepare for future surges. This is because profit-driven hospital systems have decided where to open and close hospitals based on how much money they can make from the patients in those communities. As a result, rural, low-income, and Black, Indigenous, and people of color (BIPOC) communities lack access to medical care. If our health care infrastructure had been built to provide equitable health care to all communities, our response to the Covid-19 pandemic would have looked very different.

The problems with our health care system far predate this pandemic. For years, nurses have witnessed the preventable tragedies that result from this profit-driven system. Nurses watch as too many patients forgo needed medications, procedures, or care because they cannot afford the costs. They watch as insurance corporations refuse to cover critical care that is required for the health and well-being of patients. Insurers override the professional judgment of licensed health care professionals, and nurses can do little about it when our patients do not get the care that they need. Nurses watch as patients finally come to the hospital emergency room with advanced stages of illness or disease that could have been prevented if they had access to treatment earlier.

The system we have now is beholden to the corporate interests that determine who gets treatment, and what treatment they get. It is deeply inefficient and unsustainable because it prioritizes short-term financial returns rather than long-term investments in our health. This leads to a system that is unaffordable for our country and for our patients. Many patients cannot afford the costs of their care individually, and the country cannot afford the financial burdens of a system with built-in inefficiencies, administrative waste, and needless profiteering. The Covid-19 pandemic, with nearly one million recorded fatalities in the U.S., has shown clearly that our society cannot afford the consequences this has on public health. Any delay in fundamentally transforming our health care system costs money, but more importantly, we pay with our health and with our lives.

The United States leads the world in health care spending. We spend more money per person on health care than any other nation in the world even though millions of people do not get the health care they need. Instead of providing health care for all people in the U.S., we waste hundreds of billions of dollars each year on unnecessary administrative costs, huge profit margins for corporations, and inefficiencies. Despite paying top dollar for our health care, we get poor results. Our country ranks near the bottom among industrialized nations on many international health indicators, including on critical barometers such as average life expectancy, infant mortality, maternal mortality, and death from preventable diseases. High costs and poor health outcomes persist because access to an insurance plan is not the same as guaranteed health care for all.

The only way to solve the health care crisis in this country, is to enact a single-payer, Medicare for All system.

By moving to a single-payer system, we would transform the profit-driven health insurance system into a health care system that prioritizes patient care. Under the Medicare for All Act of 2022, the existing Medicare program would be improved and then expanded to cover every person living in the United States. Medicare for All would immediately reduce inefficiencies in the current fragmented insurance system by cutting unnecessary administrative expenses associated with billing countless insurance providers, negotiating in-network and out-of-network payments, and fighting against high copays, prior authorization barriers, and unexpected expenses. Medicare for All would also remove the huge amounts of money that are funneled into insurance industry executive pay and corporate profits instead of being spent on our health.

Study after study has shown that a single-payer system is the only way that our country can provide guaranteed health care to all, with comprehensive benefits, while also reducing the amount of money we spend on health care overall. In other words, with Medicare for All, we would get more, cover everyone, pay less, and experience better health care outcomes. Economic analyses have shown that our country would save between two and five trillion dollars over ten years if we implemented a single-payer Medicare for All program.

Medicare for All would save us hundreds of billions of dollars each year by eliminating the administrative complexity and profiteering in our current system and by leveraging our collective buying power under a single-payer to negotiate fairer prices for everyone. Through bulk negotiations, Medicare for All would end high prescription drugs prices. Instead of payments going towards inflated prices, administrative complexity, and health industry profiteering, our health care dollars would be redirected to providing quality patient care.

As a registered nurse, I can envision exactly what Medicare for All would mean for patients in this country. Whenever someone needs medical care, they would see the health care provider of their choice without any worry about financial and insurance barriers to care -- about insurance networks, copayments, deductibles, coinsurance, preauthorization requirements, limits on health care spending, or surprise billing. Every patient would receive the care they need free at the point of service.

We would no longer see patients who could not get lifesaving care because their insurance provider denied them coverage, or because they did not have insurance to begin with. We would no longer see huge numbers of patients who present with severe illness or disease because they could not afford the care they needed months or years earlier. Patients would no longer have to ration their medication.

And for those of us who are health care workers, we would be able to provide medical and nursing care based on our professional judgment, without the interference of insurance companies who are not licensed health care providers and whose interests are in reducing claims to increase returns.

The Medicare for All Act would allow for tangible and practical improvements to health care delivery for registered nurses and other health care workers at hospitals across the country. Importantly, the bill would change the way that hospitals are paid for their services. This payment model would fundamentally shift the profit-motives of hospital corporations and ensure that they focus on patient care while simultaneously investing in their caregiver workforce and protecting worker health and safety.

The Medicare for All Act would pay all institutional providers through a global budget that would allow them to provide quality patient care for their communities. Aligning hospital payments with costs, these global budgets would be tailored to meet and reflect the care and access needs of the patients served by each hospital. Through the global budgeting model, payments would more closely reflect the actual costs of providing health care to patients, and those payments would ensure equity across health care institutions.

Through global budgeting, the Medicare for All program would also use targeted funding to ensure that hospitals are providing for the health and safety of their patients and their health care workforce. For example, the bill explicitly requires that hospitals have the funding necessary for safe nurse-to-patient staffing ratios, for pandemic preparedness costs, for safe patient handling, and for other occupational health and safety programs.

Providers would be accountable for their spending and would no longer be able to overcharge the Medicare program. Importantly, the global budgeting model requires transparency and allows the public to track where our health care dollars are going. We can ensure that rural hospitals and hospitals in underserved areas always get the funding they need to stay open. Providers must also report all relevant data associated with operational costs and justify their spending. With periodic audits and review, providers would be held accountable for their projected spending and the program could monitor whether the provider is meeting program goals and standards.

Importantly, the Medicare for All budget and payment system would greatly improve health equity and would decrease the health disparities we see for rural and low-income communities and for communities of color.

If Medicare for All was in place before the pandemic, we would have been better prepared to respond to Covid-19 with sufficient nurses, doctors, respiratory therapists, and other staff as well as beds, equipment, and medical supplies. The Medicare for All national health budget would also include "a reserve fund to respond to the costs of treating an epidemic, pandemic, natural disaster, or other such health emergency".

If we had a Medicare for All system, health care workers would not needlessly become infected, hospitalized, or die because of the health care industry's reliance on the "just-in-time" supply model. This model, which prioritizes profits over worker health and safety, failed to get health care workers the necessary PPE and other critical medical supplies that would have kept them and their patients safe. Instead, the global budget payments for hospitals and skilled nursing facilities would include funding for infectious disease response preparedness. These facilities would be required to maintain a one-year stockpile of personal protective equipment, and to provide occupational testing and surveillance, medical services for on-the-job infectious disease exposure, and contact tracing.

Medicare for All would not only save money and improve the health of patients, but it would also improve the lives and practice of our healthcare professionals -- our doctors, nurses, and other clinicians.

As registered nurses, our primary responsibility is to protect the health and wellbeing of our patients. Our existing health care system does not allow us to do that. We cannot expect a system that is designed to profit off illness, pain, and suffering, to work in the interests of our patients. Medicare for All is the solution we need to ensure that every patient gets the health care they need.

Thank you.