Waiting in health-care wastelands

As a nurse practitioner, I experience firsthand the daily impact that our current health-care system has on our most vulnerable citizens. Take Jenny, a 48-year-old disabled woman, and her family. Jenny has a rare genetic disorder resulting in developmental delays, seizures and problems with her skull. She is unable to support herself or live unattended. In the early years of her adult life, she had a job in the post office stamping mail, so she never required disability and had health insurance.

As Jenny aged, her situation changed. Her father died, and her mother developed cancer. She was forced to quit her job and move closer to her sister, out of state, resulting in the loss of her health insurance. Because her skill level declined and other significant health problems arose, Jenny was no longer able to work. Even if she was capable of some form of employment, Jenny would not receive health benefits because of her pre-existing conditions.

Medical specialists testified to Jenny's numerous disabilities and her continuing need for quality medical care. Yet applications for disability were repeatedly denied. Jenny remains without income and uninsured, but does have a case pending in the federal court system. Her sister said, "There are 750,000 cases ahead of hers on the list, so we don't hold out much hope."

What a quandary. Jenny was not considered disabled enough to qualify for disability because she worked in the past. Insurance companies would not allow her to buy coverage for less than $1,200 per month -- a price she can't afford -- because of her pre-existing conditions.

Currently, there are 45 million citizens just like Jenny without any health insurance. Consequently, President Obama is trying to take the lead on insurance reform that will allow for accessible, quality health care.

Staunch opponents of health-care reform in the United States equate the concept of universal health-care coverage with the Canadian-style, single-payer, government-run system. However, health-care systems around the world show that this is an incorrect assumption. Countries without single-payer systems such as France, Germany and Japan provide universal health coverage at a fraction of the cost of what we pay in the United States. These health-care programs are public and private hybrids with varying degrees of shared employer/employee/government responsibility for providing health care for all citizens.

No doubt, President Obama will encounter great opposition from opponents with well-rehearsed past arguments against universal health coverage for all. They will argue:

Do you want to destroy the present breadth and quality of the American health-care system, the world's finest? Do you want to create socialized medicine? Do you want someone to tell you who you can see and where you can go for care?

Let's take a closer look at the arguments.

We do have top-notch health care in this country. We conduct more research than all hospitals combined in industrialized nations. But overall, it is absolutely unconscionable to argue that we have the best medical care in the world.

The World Health Organization found that life expectancy is higher in Europe and Canada than in the United States, and American children are twice as likely to die by the age of 5 as children in Slovenia. American women have a lifetime risk of dying in childbirth that is three times higher than women in Germany or Greece. Our rate of overweight citizens is one of the highest in the world.

One reason why this is true is that too many Americans fall through the cracks and are either uninsured or underinsured, with watered-down policies and high deductibles. Opponents will lead you to believe that something is in place to take care of the uninsured, but this is a myth. Jenny and her family are the reality, and they can only hope that President Obama, together with the 111th Congress, will make the country's move toward a national health-care system a reality.

I have cared for patients such as Jenny every day as a nurse practitioner for more than 26 years. She represents only one of many faces of the uninsured. As I look into their eyes, I see their anguish, and know that we are at a crossroads. We need health-care reform now.

■ Diane Caruso, a nurse practitioner in Winston-Salem, is pursuing her doctoral degree in nursing practice at Duke University.

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