I am a registered nurse. Although I have spent most of my 25-year career caring for people, I made one enormous mistake. For a brief time, I chose to work for a medical insurance company. They gave me the title, "utilization review nurse," which really meant I had control over whether people were allowed procedures, stayed in the hospital or discharged early.

Because of my discomfort with a system that left me in charge of telling a doctor by phone, some 3,000 miles away with his patient, how to practice medicine, I was far more permissive with certifications than the company liked. My phone calls were soon tapped. I was denied bonuses and raises. Harangued and threatened, I was finally booted from the insurance industry.

Meanwhile, nurses who did what they were told, who denied medical stays and who likely did harm and cost lives, were rewarded.

I know firsthand how medical insurance companies are making most of their decisions based on profit and not what doctors need for their patients. I watched my own license abused by a medical corporation whose interest was not in saving lives, but in saving money, and whose profits soared as they denied claims under a "managed healthcare system." Meanwhile, its CEOs got salaries in the millions and stock values doubled.

The film "Sicko" reflects my experience, as Michael Moore reveals case after case of those who thought they were insured, only to find they were not. Many are excluded, denied or dropped for the flimsiest of reasons. Moore depicts something I have known for years, that there are countless ways medical insurance companies deny healthcare.

As people unable to pay medical bills are dumped curbside, Moore wants to know why a Third World country like Cuba can offer its people free healthcare and the richest country in the world cannot; why every country he visited can provide better healthcare than Americans seem to receive, and without the added burden of medical debt.

That burden is shared by the caregiver's as well. Nurses are forced to comply with medical insurance companies. One in six nurses work utilization review, necessary to prove to insurance companies the patient's stay is necessary. Floor nurses spend more time away from patients to chart for the same reason. Nevertheless, patients are often discharged too early and left to play Russian roulette with their lives. This is the price our loved ones pay when healthcare is based on profit.

There is one hospital experience I will never forget. On a psychiatric unit, my patient suffered the dual diagnoses of depression and alcoholism. On the second of what is usually a three-day stay, he had plus-three tremens and was suicidal. The psychiatrist came into the station and said he would be discharging him. I told the doctor the patient's condition warranted another day because the man stated he had a gun at home and would kill himself. The doctor chuckled and wrote the orders for discharge anyway, saying flippantly, "I get $1,000 for every day I save the company money, and besides, it's the weekend."

I entered a nursing note of the patient's condition and the suicide threat. The doctor was infuriated. My supervisor supported him, until she picked up the phone the next day and heard by voicemail that the patient had died from a gunshot wound en route to a hospital.

If we do not ask the right questions, we will end up damaged by the wrong answers. The wrong questions cost 18,000 lives a year. The wrong question is: "How can we make the greatest profit from healthcare?" The wrong answers have been to cut corners, risk lives, save money and increase shares and dividends.

A right question might be: "How can we make sure all our loved ones, or every American, is healthy and leading a quality life?" Until we ask the right questions, healthcare will be based on profit.

Is it fair Americans have healthcare rated just ahead of Slovenia, and have an infant mortality rate that exceeds El Salvador? Health is the gateway to the pursuit of happiness. Shouldn't it be our constitutional right?

We all get sick. Health deteriorates eventually. As Moore states eloquently and simply, "There is no me' to this issue, there is only we.' " We, the people, are in this together. Now we need to let the governor know that, as SB840 waits for his signature. Another sound bill is Rep. Dennis Kucinich's National Health Care Act, HR676. These two bills eliminate the insurance industry's grip on healthcare.

In the meantime, I'll continue to avoid working for medical insurance companies, and "do no harm" to my patients.

— Grant Marcus, of Ventura, is director of Nurses for Social Responsibility.