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J U LY | A U G U S T 2 0 1 4 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 7 We continue our explorations of the life and career of Kay McVay, a longtime intensive care unit RN at Kaiser Permanente and pres- ident emeritus of the California Nurses Asso- ciation. In this installment, McVay discusses how societal attitudes toward healthcare and paying for healthcare that are held by both providers and patients have changed over the decades. From McVay's experience, the corpo- rate healthcare industry has managed to convince the public that something that should be thought of as a human need and right is instead a product that we choose to buy – like a new television or a pair of shoes. You often describe how you grew up poor in Watts in South Los Angeles. This was the late 1930s, early 1940s. Do you remember the times you or your family had to access health- care or how they were able to afford it? When I was about five or six years old, it seemed like I was always in Children's Hospital on Sunset Boulevard for one thing or another. I had measles. I had pneumonia. I had small pox. I had "Hollywood polio." They say you can't get measles again, but I got it three times. I was so inspired by the nurses at that facility; they are why I wanted to become a nurse. They always seemed to want to make me laugh and play games. They were people who really cared. It didn't matter who you are, what you are. People just went to the county or community hospital for care and they got it. Nobody talked about money. I remember going to the doctor for fixing my feet and my father pushing a quarter across the counter, and that paid for my care because that's what he could afford. And what was it like when you started actually nursing in the late 1950s? What was the mentality of the medical staff? Let's just say that if somebody was brought into the ER, nobody ever talked to the patient about their insurance, and what it covered, and we need to know this and that before we can start treatment. You'd simply be cared for. Right then and there. No questions. All the docs had the same idea, and the nurses had the same idea. It's hard to imagine that the hospitals didn't care about costs back then. Well, it varied from hospital to hospital. I remember at one hospital, every patient had a pink form and on every shift, the nurse had to mark how many supplies were used on that patient and sign it. So, for example, every time I put a new paper sheet protector under the patient, that was a dime. But I didn't see why anyone should have to pay a dime just for a clean bed. I mean, come on, that's just part of being a patient in the hospital. It's bad enough that you're sick, why should be penalized for using more sheet protectors? When I started working at Kaiser in 1965, I didn't have to do that. At Kaiser, you didn't make any charges out. It was an entirely different kind of healthcare and different organization. If you had Kaiser, everything was just covered. We were all considered Communists because we worked for Kaiser, but we all kind of enjoyed it at the same time because we knew that we were doing that job that needed to be done for the people. I'm sure they all cared on some level about costs, but the point is that it was not for the purpose of making a huge profit off the patients. So when did you become aware that the idea of providing healthcare as a social good was starting to deform into the idea of running healthcare as a way to make money? I think it was the late 1970s and the 1980s when things really went downhill. Everything has become, "How much can we charge?" or "Will this be reimbursed at the rate we need to make however much money?" The first time I realized the stock market played with shares of these compa- nies and the hospital industry is when I knew the idea of real care had disappeared. Providing care to people was no longer the prime interest of healthcare. Tell us why you hate it when the healthcare industry or hospitals call patients "customers" or "consumers." Well, if I'm really a customer, not a patient, then I should be able to just get up and walk out. But patients can't do that. Patients need care. It's not a choice like shopping for a new blouse or new shoes. Talking about patients as customers and healthcare as a commodity just helps to rationalize why some people have such poor healthcare at outrageous prices and others have none. It's not okay. Healthcare should be a right, not a privilege. It's like having a real public school system. The idea here in the United States is that if you can't pay for it, then you don't deserve to have it. That's not my philosophy. It never has been, and never will. Nurses understand that, and we can help change it. "Conversations with Kay" appears in each issue of National Nurse. Through McVay's stories, we docu- ment the origins of the modern staff RN movement as well as the changing practice and culture of nurs- ing and healthcare. The first installment appeared in the January-February 2014 issue. Conversations with Kay