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J A N U A R Y | F E B R U A R Y 2 0 1 6 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 9 Q. Getting rid of private insurance is a pret- ty big proposition. Instead, many current proposals suggest expanding coverage for kids, requiring people to buy insurance but giving subsidies, and forcing employers to provide insurance or pay into a state pool. What's wrong with those ideas? Rather than dissect all the different games played, if you look what the common denominator is, it's that they insist patients go through private insurance with the 30 percent waste factor. The other thing is they don't mandate anything for the insurance company at the end of the day. It's all to preserve the private delivery of insurance. Over the years there have been scores of incremental remedies. Very typically they'll be to allow coverage for children who live in poverty. Or proposals to take care of certain diseases. Everything I've mentioned sounds good, right? Yes, but that's always a substitute for a comprehensive program. And if we know anything about public health or regular medical care, it's that comprehensiveness is important. What's the sense of checking a woman's uterus and getting a smear for cancer if you ignore the fact that she's cough- ing up blood or that she lost 30 pounds or that she's shaking from hyperthyroidism? In a word, it's bad medicine, and the only reason these incremental things go forward in my book is to keep those insurance companies making big bucks. Partial solutions are fool's good. They make the problem worse. And it's worth mentioning that they can be given when the state's finances are pretty good, the next year they can be taken away. Q. What will it take to convince Americans to reject this model of private insurance? There's two reasons I think it's going to happen. The first is the one I wish were the only reason: namely, it's morally obvious that we have to take care of our sick. There's just no morality in saying, "You're poor and therefore you die of your measles," or "You're poor and your broken hip won't be treated." I think probably the politically much more significant reason is our economy. Our health system for some time now has been destabilizing our economy, and by that I mean wrecking American businesses and global competition. And you can see the auto industry shrinking and big steel going elsewhere, and not an insignificant part of that is the residual obligation to offer healthcare to employees. And it's just now starting, long overdue, for business to get the message and throw its enormous strength and influence in public affairs in the direction of a national health system. Q. You had an interesting way of explaining how we'd all save money with single-payer. Can you elaborate? There are more than a few studies to support the idea that were you to get the pres- ent input into the health system financially and organize it along a single-payer line, 95 percent of Americans would be paying less than they are today, both in taxes and out-of- pocket and co-pays, deductibles, and all the other ways we do it. It's worth a minute to go through the math. Presently 60 percent of all health expenditures are directly or indirectly through the tax system. I say indirectly because present laws allow businesses to deduct health insurance as a cost of doing business. So that's the part that isn't apparent. All the rest is quite apparent. The taxes we pay for Medicare, the money that goes for Medicaid, the large amounts of money going to military medicine, public health, the Insti- tutes of Health. Turns out, when you look at the whole packet, we are now spending 60 percent of the total cost of healthcare through public means. The other 40 percent comes from where? Out of pocket. So we are paying for a public system, but we have another 40 percent surcharge that only Americans have to pay for a very incomplete system. So with the elimination of the huge amount of admin- istrative waste and high cost of handling of private insurance, you have more than enough money to take care of everybody and probably begin to deal with the problems that are being neglected. I refer to coverage for vision, dental, long-term care, drug coverage. Q. How do you answer people who support national health insurance but don't support providing healthcare to undocumented immigrants, or only to citizens? It's just silly, or stupid, to exclude a significant portion of the population, and in some areas it's a majority, from access to healthcare. It's just the nature of illness. Many, many important illnesses are conta- gious. If you don't treat the undocumented person with active TB, you may find a lot of documented people, citizens, who get it. You treat populations. So from a public health perspective, that's the end of the discussion. Q. What is the role of nurses in our health- care system, and what role can they play in advocating for national health insurance? A. I'll start by saying that the care in healthcare is the nurse's province. We doctors do deliver some care and so do hospitals and so do other elements in the system. But it's the nurses, it's always the nurses that are crucial. They have a vital role in not only contemporary practice, but also in the vision we have of the future system, which is heavily oriented toward prevention, early detection, rehabilitation, and relief of suffering. Nurses are uniquely qualified for those functions, and they fulfill them now and they'll fulfill them much more when we get a rational system. A tribute to Dr. Quentin Young Dr. Quentin Young, who for decades as a past president and national coordinator of Physicians for a National Health Program was one of the nation's most prominent advocates of a single-payer, national healthcare system, died March 27, 2016 of natu- ral causes at the age of 92. To pay tribute to Young's memory and life's work, we are reprinting an interview we had the honor to conduct with him in 2007 about why single-payer healthcare is the only health policy solution that makes sense for the United States. Young worked for decades to achieve single-payer, traveling and speaking around the country, and was a longtime activist, working to desegregate hospitals during the civil rights movement and serving as personal physician to a number of historic figures, including Dr. Martin Luther King, Jr., author Studs Terkel, and former Illinois governor Pat Quinn. "The world is a sadder place today," said RoseAnn DeMoro, executive director of National Nurses United, noting that Young was a consistent ally and friend of nurses and the organization. "Quentin Young was a beautiful human being."