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**JANUARY 27, 2021**

Kuttner on TAP

Nurse Burnout-Connecting the Dots

****

In between cheering our heroic nurses, the press has been filled with
accounts of the increasing nurse shortage in the face of a pandemic
whose spread is still peaking. One source is pure burnout, of nurses who
are going 24/7 as hospitals are overloaded.

Nurses in ICUs, who are supposed to be taking care of one or two
patients, are now forced to handle three or four. As their colleagues
get sick or have to take a mental-health break, the ones who remain work
double and triple shifts.

You'd expect all of this in a hundred-year pandemic. But there is a
deeper reason. And it's urgent that we connect the dots.

The reason is the plague of for-profit medicine. While other nations'
health systems are also experiencing stresses, there is nothing like the
stresses that RNs face in the United States.

In our health system, dominated by for-profit health plans and
for-profit hospital systems,

**nurse salaries are a cost center**. The system's goal is to maximize
profits and minimize costs, so nursing understaffing is chronic.

A for-profit system dictates investing in fancy technology and targeting
the most profitable procedures and patients. It means creating barriers
to care so that people nominally covered by insurance often don't get
the actual care they require. It means massive private bureaucracies for
billing, profit maximization, utilization review, and so on.

All this money could be going to pay nurses.

In other national systems, there is budgeting based on need and staffing
based on need.

****If the Proud Boys wanted to turn their rage on America's real
fiends, they might start with for-profit medical executives.

Even though there are some not-for-profit hospitals and health insurance
plans, they swim in waters polluted by the dominant for-profit part of
the system. In my hometown, Boston, the great Harvard teaching
hospitals, organized in a local duopoly of two large systems (Partners
and Beth Israel Lahey), are nominally nonprofits. But they have to make
a living, so they play the same games as the for-profits.

Though the debate has been focused on whether to have a single-payer
system, Medicare is a single-payer system for the elderly, yet it (and
patients) still suffer from the larger commercial environment in which
Medicare must operate.

This for-profit dominance, by the way, is why Obamacare utterly failed
to fix the system's larger ills.

So as we work to get a national health insurance system, whether in a
single leap or by incremental moves such as a public option, let's
remember the paramount evil: commercial medicine. We owe it to our
nurses, and their patients (us!), to put these parasites out of
business.

~ ROBERT KUTTNER

Follow Robert Kuttner on Twitter

Robert Kuttner's latest book is
The Stakes: 2020 and the Survival of American Democracy
.

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