In Praise of Public Health Care

Public health care is more than going to the hospital for free.  It is a reflection of how we treat each other.  What we value.  An acceptance of the commonality of us all, and the inherent worth of each person, regardless of social standing.  

I became a Registered Nurse because of Canada’s public health care system.  I wanted to take care of people, all people who needed it.  The idea that anyone could get care aligned with my core values.  After I completed my nursing education over 30 years ago, I chose not to go to the USA like a lot of my classmates did. Even though the money was better, and the jobs were there, I was uncomfortable with the idea of people paying for health care. Both my parents were Americans.  I had heard the horror stories of people being turned away from emergency rooms because they couldn’t pay. So, I stayed here and I worked within a system in which I was proud to be a part.

I used to work nights when my kids were little, like a lot of Registered Nurses do, trading sleep for “ease” of child care.  One night, the paramedics rushed into the Emergency department where I worked with a patient who was unconscious. He was not breathing, and had no heart rate.  Within seconds he was stripped off the gurney, IV access was initiated from multiple sites, medications were administered, and an airway was secured.  

A team sprang into action to save his life–without knowing who he was. There was no ID or MCP available, we didn’t need it.  We collected blood and registered him under John Doe so it could be analyzed.  We knew nothing about him, except that he needed help.  He got the care of a king. It was only after the lifesaving necessities were completed that someone finally looked through his stuff, found a wallet, and his name.

I felt good about what happened that night.  I felt good about being on a team like this:  where people who need care are sure to get it,  where a premier and a pauper get the same service.  

So I plugged away working in a health care system I believed in.  I believed in its value and its necessity.  I  continued my nursing education: I went back to MUN and got a Master’s Degree as a Nurse Practitioner.

It Takes a Village…of Nurse Practitioners 

The pay increase between a Nurse Practitioner and a Registered nurse is minimal at best, and often nonexistent.  In my first years working as an NP, I actually made less than I did as an RN.  The salary doesn’t account for the expense of the education.  If I work every day until I retire, I still will not have it paid off. Because nurses and nurse practitioners do unpaid work placements, I had to leave a paying job  to do unpaid clinical work which only increased the cost of the degree. In addition, the compensation for a NP doesn’t reflect their responsibilities. NPs do the same work as colleagues who make between 2 and 5 times their salary.  

People are usually shocked to hear what I make when I tell them. I often joke, “Clearly, I didn’t do the math.” But the truth is, I didn’t even think about the math.  I cared about helping people.  All people who needed it.  Nobody goes into nursing exclusively for the money.  It would be like living in Newfoundland for the weather.  There are other rewards, both personal and meaningful, that make the vocation worthwhile.

I continue to work as a Nurse Practitioner and I care for anyone who needs it–if they can get to me.  If they can wait long enough.  If they can access the care.  More and more people are without a primary care provider. 

The Limits of Physician-Centered Care

People are flooding our emergency departments to get basic care because there is nowhere else to go.  I see people’s desperation, their worry, and their suffering.  I see people not getting the care they should be getting.  I want to help, but my other NP colleagues and I are stymied by an outdated physician-centered health policy.  

Physician-centered health care doesn’t work.  Ask the doctors leaving our system.  Ask the people looking for care. Physician-centered care is as it sounds: health care centered around a doctor’s family practice. It presumes that quality health care can only be delivered by doctors alone.     

Nurse Practitioners are an obvious, homegrown part of the solution to the problem of access to healthcare. However, NPs are continually blocked from being fully integrated into the public health care system because of physician-centered care.  

As a result, NPs are having to set up shop privately to meet the huge need out there. In the meantime, there seems to be more political will to bring in and train physician assistants, and more interest in recruiting doctors from Ireland, than availing of Nurse Practitioners. NPs are a resource available right here, right now, and they are willing and able to work. 

Public Health Care for Patients AND Providers 

I am now working in a province and a country that is questioning the necessity of public health care. Our system is slowly being eroded, and good people are leaving it every day because they are so exhausted and burnt out.  So what are we going to do?  

We have to stand up for the public health care system by taking care of the people working in it, so they can take care of our communities. We do have the resources for this, if we just allocate them accordingly. 

At the moment, private companies are offering RNs and NPs twice the pay and more shift flexibility than the public system.  Who wouldn’t want that? If it seems too good to be true it’s because it is. 

Privatization might seem like a quick and easy fix, but over time, it takes more than it gives. Covid exposed the horrors of private health care in long-term care for seniors.  Making money and caring for people are conflicting goals.  When push comes to shove, profit gets the right-of-way, at the expense of peoples’ care.  We know this, and we cannot let ourselves forget it. 

Health Care Crisis is a Community Crisis

We can’t separate someone’s medical needs or their health from the lives they are living.  A symptom belongs to a person, and person belongs to a context, and a community.  This community in turn, is part of the public, and in this domain we cannot separate the people who need and receive health care from those who provide it. We are all connected and what affects one, affects us all–now more than ever. .  

The lines separating the middle class from the working poor from the marginalized are fading.  Any one of us is one crisis away from not managing anymore. Mental health and addictions are overwhelming our communities. Prisons are becoming the new asylums. People who need medical care are caught in a revolving legal system that not only can’t help them, but often makes them worse-off. People can’t afford to heat their homes, if they have homes.  

I am seeing more and more people with unstable or nonexistent housing.  People can’t afford to eat good food and are grocery shopping at the dollar store.  What is the point of prescribing a medication that someone can’t afford? Why tell someone to increase their fruits and veggies if they are depending on foodbanks or soup kitchens to eat? 

Our Health Care Practices Must Match Our Values

We have to go upstream, and help people build lives they don’t have to escape from.  This is impossible without safe and affordable housing, access to education and leisure activities, and meaningful jobs with adequate pay and benefits. It is also impossible without public health care. 

If we truly value the lives of human beings, our public systems need to reflect this in their policies and where they are allocating their resources. Diverting them to private contractors is not the answer. 

I began my career so I could work in public health care; and now more than ever we have to stand up for it by taking care of each other and building the type of community we want to actually live in. It starts there. We need to renew our values in our hearts and our minds, and the Newfoundland and Labrador we want to build will follow.