Cut Insurance Profits, Not Nurses : Health: They provide more than TLC. Doctors, patients and the level of care would lose.

As I lay in a hospital bed recuperating from major surgery, thousands of nurses were marching to the White House to protest the “restructuring” schemes that would replace many skilled nurses with inexperienced aides.

“We are the last patient advocates in America,” said the organizers. How right they are.

I am among the privileged in our society. The University of California pays for my medical insurance and I received excellent care from the doctors, nurses and aides at Alta Bates Hospital, a prestigious medical complex in Berkeley.

Yet six hours after I returned home, the MacNeil/Lehrer NewsHour featured a story about the “showcase” hospital I had just left. Alta Bates, along with thousands of other hospitals around the country, is planning to lay off many of its staff nurses and replace them with “multiskilled technicians” who often have no more than three weeks of training in patient care.

Are nurses really replaceable? Of course not. Aides can and should perform many unskilled tasks that free nurses to provide clinical care to patients. But judging from my brief hospital stay, that is how the system already works. There are, moreover, good clinical reasons for skilled nurses to take vital signs, to change dressings, to check intravenous drips, to administer medication. By attending patients, nurses use their clinical experience to observe existing or potential problems, watch for post-operative complications, gauge the patient’s comfort and need for a physician’s attention. Nurses are the eyes and ears of our doctors.

When hospitalized, nearly everyone feels vulnerable, anxious and overwhelmed by existential dread. Nurses’ aides can perform many tasks, but they cannot offer the confident answers that a skilled nurse can provide. One aide, for example, entered my room confused about what kind of medicine or food I was to receive. The nurse entered, checked the chart and, familiar with my surgeon’s orders, knew exactly what was needed.

Then why can we no longer afford nurses? And who profits from laying off skilled nurses? As Deep Throat taught us, follow the money.

What we have in the absence of universal health insurance is a chaotic system of managed care. I would estimate that the hours I and my physicians have spent wrangling with numerous medical bureaucrats would have paid for all the nurses who took care of my post-operative needs.

Upon returning home, for example, I received a letter from my insurance company saying that they had authorized only one night’s stay at the hospital. I guess they think I spent the second night--still dazed from three hours of surgery and general anesthesia--engaged in an orgy of luxury.

Medical cost containment is necessary. But cutting nurses will no more control medical costs than eliminating school lunches will reduce the national debt. The real cause of escalating costs is that greedy insurance companies and hospitals are fiercely competing for the one-eighth of the American economy devoted to health care.

The insurance industry and hospital administrators defend their “downsizing” by arguing that the nursing profession is merely interested in protecting jobs. Of course they are. But we also need the nurses.

Every society must ultimately be judged by how it treats its most vulnerable citizens. Let hospital CEOs eager to lay off nurses languish in a hospital bed for a few days. Let them encounter the hesitant aide who knows how to wash a floor but not how to check a medication chart.

After being hospitalized, I am even more convinced that the only way to control medical costs is to create a single-payer system and eliminate a medical insurance industry that cares more about profits than about patients.

Meanwhile, let’s support the nurses. Eventually, most of us will discover how much they support us.