Ebola Preparedness Without a Single-Payer System

Below is testimony from Michael Lighty, Director of Public Policy for National Nurses United, to the California Assembly Health Committee regarding Ebola preparedness in a fragmented healthcare system with cost-barriers to care and declining investment in public health.

This is a proud moment for California Nurses Association/National Nurses United, whose members have taken the lead in blowing the whistle for Ebola preparedness. From a die-in on the Las Vegas Strip in September to the 50,000 strong national day of action on November 12th, the nurses of CNA/NNU have made history.

Contrary to what their hospital administrators have said about their adherence to the CDC guidelines—nurses reported quite the opposite in a survey of over 3500 nurses from every state in the US. So this new guidance in California creates a real level of security for nurses, and we thank Governor Brown and Director Baker, and the staff who worked so diligently to set this new national standard.

But what about the patients in a fragmented, under resourced “non-system” who are at the mercy of their insurance company’s high-deductible, minimal benefit, narrow network, sparse drug formulary health plan? And those on Medi-Cal who can’t find a doctor to accept them, or those undocumented workers and others who must rely solely on ER visits and a decimated public health system?

Funding for public health preparedness and response activities in the US was $1billion less in 2013, than in 2002, according to a CDC report from earlier this year.

According to CMS data collected in 2013, patients in California Emergency Departments faced waits that are 23 minutes longer than the national average. Specifically, California patients waited on average more than two-and-a-half hours in the ED.

Further, if a patient is admitted to the hospital, the average wait increased to:

• About five hours and 18 minutes from arrival to the time a patient is admitted; and
• Nearly an additional two hours before a patient is moved to a bed.

At least 5% of patients at 20 of the state’s EDs left before being treated because of the long waits, according to Center for Health Reporting/Daily News.

Let’s make a distinction between an integrated, well-resourced system that guarantees a single standard of care for all with a dedicated funding source and real public accountability – known as single-payer – verses the existing fragmented approach that seeks to regulate behavior sometimes with the force of law as in the case of this new guidance, and mostly as monetary incentives and voluntary guidance. Now, the treatment response to Ebola, for example, as other in other pandemics is largely governed by private healthcare corporations who are only accountable to their shareholders or board of directors, not the public.

Understaffing, access to treatment based on ability to pay, technology replacing hands-on care, difficulty gaining admission: it could and does happen everyday in our fragmented corporate health care system. All this happened to Ebola patient Thomas Eric Duncan in a Dallas hospital, and in his case, it was fatal and two nurses infected.
We know what works, Canada has done it: A province-based single-payer system and federal agency that has the responsibility and authority to ensure local, state and national coordination to detect, respond and treat outbreaks.

The Ebola epidemic reveals the fissures and fatal inadequacies of our healthcare “non-system.” Only greater integration, planned and directed resources, and authority to a public health system can protect people in California from the dangers of pandemics like Ebola.

This new guidance issued by Cal/OSHA stands out as a clear mandate for precaution and protection establishing a national standard. Let us a create system where that is the rule, rather than the exception.