[Editor's note: this email was originally written as a letter to the Boston Globe.]

Date: Mon, 18 Jun 2001
From: Ann Eldridge 
To: ----
Subject: Have we reached the tipping point?

Dear Public,

For some reason this Sunday is different from other days when we all
get to read yet another article about the serious problems in our
health care system ("HMO subscribers often find provider is only a
'phantom,' " front page, Boston Globe, 6/17/01).  These stories
provide an important public service to inform and expose the human
plight and financial profiteering which are directly created in
perverse juxtaposition by the fundamental flaws in our current health
care system. The broad themes of system failure compellingly revealed
in these articles are only the tip of an iceberg. This is something I
know from personal experience as a nurse and a family member of loved
ones with serious illness.  So today I feel compelled to ask a public
question, "How bad does it have to get?" before we demand meaningful

After years of working as a nurse in a variety of settings and
teaching nursing students in even more clinical areas, and seeing,
no -- let me be honest -- feeling that I am a part of the problem in some
inescapable way by continuing to work in such a dysfunctional system,
I know that by anyone's measure things have definitely gone beyond
the tipping point and have gotten "bad enough."  Fundamental change
must occur when these facts describe our health care system: tens of
thousands killed yearly and lord knows how many seriously harmed by
preventable medical errors -- which involve nurses too; tens of
millions without health insurance and many more underinsured -- often
only painfully discovered when serious illness strikes and care is
denied; the highest health care costs in the world and ever-rising
without public accountability or standards for how and where our
hard-earned health care dollars are spent, while ranking among the
lowest worldwide in the quality and effectiveness of our system; the
most serious nursing shortage we've ever had already upon us -- in
large part another preventable symptom resulting from the financial
profiteering and other perverse incentives that pervade our current
system, and that beat down caregivers and discourage others from
entering the nursing profession.

To be sure, the for-profit health care entities such as
United Healthcare described in today's Globe article are the most
blatant profiteers, but the not-for-profits in Massachusetts such as
BC/BS, Tufts and Harvard-Pilgrim HMO's (which we taxpayers subsidize
quite generously due to their "charitable institution" status while
they spin off huge sections to for-profit subsidiaries such as
Harvard-Pilgrim's mental health section) make deliberate decisions
how to operate, including "phantom" providers to attract customers,
which are quite similar to the for-profits in the current
market-driven-spend-millions of health insurance dollars on
competitive advertising that doesn't do a darn thing to help anyone's
health (just the almighty health of the bottom line) environment
which characterizes health care delivery in the U.S. and the
Commonwealth today.

I am only one nurse out of 160,000 in our state alone, and my
memories of individual patients' and families' suffering that
absolutely could have been prevented, and health problems compounded
by a largely inhumane and massively dysfunctional system have gone
way beyond my capacity to keep track of them. How bad does it have to
get?  Many clinicians have been trying to do something constructive
with these difficult -- what should be seen as unacceptable --
conditions we are forced to work with as front-line caregivers.  For
years I have volunteered alongside hundreds of others working for the
long-overdue fundamental reforms of the system, often facing
hostility and outright opposition from legislators and "policy
experts."  The organizations MassCare, the Ad Hoc Committee to
Defend Health Care, and the Mass. Nurses Association are three groups
whose members refuse to give up on achieving fundamental
improvements. The current nurses strike at Brockton Hospital
exemplifies the drastic extent of the problems which have forced
nurses to put their entire livelihoods on the line. The Massachusetts
Health Care Trust and Safe Nurse Staffing Levels legislation filed
last December provide a path to meaningful reform but are
encountering deep-pocketed and politically-connected opposition.  So
others are needed to step forward and be a part of the solution to
this very public crisis.

Is anyone else wondering how we got so far away from what health care
should be all about, and what forces got us so far off track -- with an
exorbitantly high price tag, both in dollars and in lives -- and why
for heavens sake we seem to have such a vacuum of leadership to
meaningfully address this crisis?  Is anyone else wondering if clean
elections, or more accurately the lack thereof, might have something
to do with this mess?  How bad does it have to get before we rise up
and demand meaningful solutions?!

Ann Eldridge, RN, MSN
Clinical Instructor in Nursing, UMass Boston
and Staff Nurse, Visiting Nurses Association of Boston