Editor’s Note: Theresa Brown is a hospice nurse and author of “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives.” The views expressed here are hers. Read more opinion on CNN.
The need for a pulse-ox device becomes extreme in the hospital when a patient who had been stable suddenly gasps for breath and begins to turn blue. A pulse-ox is a small piece of equipment that clamps onto a patient’s finger and registers her oxygen level. Some cost a couple hundred dollars, but the cheapest retail for around $20. When I worked at a teaching hospital in the UPMC system in Pittsburgh, my hospital floor usually had two or three of these devices, and though we nurses begged for more, we were always told the money wasn’t “there” in the budget, despite our hospital system’s obvious wealth (operating revenues of $14 billion in the first nine months of 2018).
This is the paradox of modern health care: The clinical space where patient care occurs operates on a model of scarcity, while the back office of CEOs, pharmaceutical companies, and large hospital systems functions in a world of plenty. I have been, at times, desperate for a pulse-ox. Watching someone fight for air evokes a primal fear in anyone, and it’s important as a caregiver to know that patient’s oxygen level. Having to hurry around the floor asking where a pulse-ox device is compounds the stress and delays care when the patient struggling to breathe cannot wait.
Plus, a shortage of pulse-ox sensors wasn’t the only deficiency we faced. The disposable thermometers sometimes worked and sometimes didn’t. A nurse who helped manage patient emergencies declared that the over-the-bed blood pressure tubing we used every day was “shot.” And of course, when nurses were off on maternity leave, or for unpaid personal or family leave under FMLA (Family and Medical Leave Act), or simply because they were ill, it was rare to get a replacement, even though shortages of nursing staff are known to put patients at risk.
The mantra we started to hear was that everyone needed to “do more with less.” This puzzled me and then made me angry, since at some point less becomes only less and can’t be turned into more. When I gave talks to other nurses around the country I began asking if they had heard this same directive.
Contrast this environment of scarcity, though, with the abundance at big pharmaceutical companies, as revealed in one story from physician Mike Magee’s new book. “Code Blue: Inside America’s Medical Industrial Complex” (in full disclosure, I contributed a blurb for this book). Magee was hired by Pfizer to be their Viagra spokesman during the rollout of that potentially hugely profitable new drug. In the book, Magee acknowledges Pfizer’s awareness that Viagra “carried the risk of becoming a punch line … Unless handled perfectly.”
A week before Viagra was to receive FDA approval, ABC’s 20/20 aired a special on the drug featuring commentary by Dr. Timothy Johnson, who at that time was ABC’s medical correspondent. Pfizer’s CEO, Bill Steere, appreciated Johnson’s coverage of Viagra. To express that appreciation, the day after the 20/20 episode aired, Magee writes that Steere had him fly from New York to Boston to personally deliver a hand-written thank you note to a somewhat surprised Tim Johnson. Afterwards, Magee flew back to New York. In Magee’s telling, Pfizer found success by doing less with more, not the other way around.
In 2018, 14 pharmaceutical companies made at least $1 billion in profits and drug companies have been vilified for health care profiteering. However, labeling pharmaceutical companies as rapacious misidentifies the problem, which is that a very long line could likely be drawn from the nickel-and-diming afflicting nurses on hospital floors to the money used to promote Viagra – or any so-called “blockbuster drug” – combined with its profits. American health care is swimming in money, but the money benefits systems, companies, and big shot administrators, not patients.
Most important, the problem of only seeing scarcity in health care comes up in political arguments. The most frequent charge leveled against Medicare-for-all proposals is that such programs would be “too expensive,” but too expensive for whom? Surely not the 11% of Americans who, according to a 2015 Kaiser Family Foundation study, declared bankruptcy due at least in part to medical costs.
Surely not the roughly 30 million people – or 66% of the households in the US who are served by the Feeding America network of food banks – who have to choose between buying food or paying for medicine or medical care, as reported in “Hunger in America 2014.” And likely not the many Americans with health insurance who still can’t afford their high deductibles and medication co-pays.
When I was at the peak of my anger over not having enough pulse-ox devices, my hospital held a town hall for staff. Curious, I went and heard about the new suburban hospital being built just over one mile from a competitor’s existing hospital. I also learned that the surgeon’s lounge in my hospital had been newly redecorated, including wood-paneled lockers.
I pictured that locker room, superimposed with the tortured face of a gasping patient, as if Edvard Munch’s painting, “The Scream,” had been transposed into an interior design store and nobody noticed. We hear “patients before profits” as a slogan, and that’s not wrong, but it’s not complete. Profits are routinely prioritized over pain, over kindness, over nurses and doctors being able to do our jobs. The real scarcity in American health care is not money but compassion.
An earlier version of this article incorrectly described the number of American households who reported having to choose between paying for food or paying for medicine or medical care.