[kitkat24]

Nurses,
I am wondering if any of you have insight into universal healthcare and its' effects on nurses. Does it affect nurses wages? Is there a wage cap for RN's? etc.
Kathy

[VivaLasViejas]

I don't necessarily think government-run health care is the best idea.......if there's any way a thing can be made impossibly complex, government will find it! But we MUST get the for-profit insurance industry OUT of health care........this is, IMO, the root of all evil where medical services are concerned. Health care stopped being about "caring" when it became a business, and when you've got insurance-company CEOs who've never spent a day in medical school making millions of dollars a year deciding who should and should not receive care, something is very, very wrong.

[pickledpepperRN]

http://www.sfgate.com/cgi-bin/artic...BUGT64APEP1.DTL <http://www.sfgate.com/cgi-bin/articl...UGT64APEP1.DTL>

What premiums pay for
David Lazarus
Friday, January 16, 2004
©2004 San Francisco Chronicle

The United States squanders more money every year on health care bureaucracy than it would cost to provide medical coverage for the 43 million Americans now lacking insurance.

That's the finding of two respected Harvard Medical School researchers, David Himmelstein and Steffie Woolhandler, in a study appearing this week in the International Journal of Health Services.

They determined that of $1.6 trillion in total health care spending last year, at least $399 billion was eaten up by administrative costs such as clerical work in hospitals and processing a vast array of insurance forms.

But if a national health care plan like Canada's were implemented in this country, the researchers found, administrative overhead would be slashed by about $286 billion.

This amount, in turn, would be sufficient to not only provide health coverage for every uninsured American nationwide but also allow millions of underinsured people to improve their quality of care.

Himmelstein, who is also a physician, said in an interview that 10 percent of revenue at his Cambridge practice now goes to an outside billing firm that handles much of his insurance work.

"That amount could be used instead to care for more patients," he observed. "It could be used to hire additional people and fund a huge expansion of care."

Similarly, Himmelstein estimated that at least 15 percent of his time every day is spent dealing with paperwork.

"That's 15 percent of my time that I'd much rather spend on patients or learning more about medicine," he said.
Private health insurers, who would be decimated by taxpayer-funded universal coverage, oppose creation of a Canadian-style system in the United States. Instead, they prefer adjusting the existing system to expand the number of people covered.
But Himmelstein and Woolhandler argue that the existing system is grossly inefficient and needs to be completely overhauled. The findings of their research may be speculative, but they say it points the way toward legitimate cost reductions.
In California, they found, nearly $163 billion was spent last year on health care. Of that total, $45 billion, or about 28 percent, went to administrative costs.

With Canadian-style universal coverage, the researchers concluded, Californians would save almost $34 billion annually on administrative overhead. This would provide more than $5,000 for each of the state's nearly 7 million uninsured.

"As it stands," Himmelstein said, "you could insure all uninsured people for about $1,500 per person. The administrative savings would thus leave plenty of money to upgrade coverage for others."

The Canadian single-payer system is frequently cited as a model for how the United States might go about offering health coverage to all citizens. The Canadian system, begun nationally in 1971, guarantees all citizens access to essential medical services regardless of employment, income or health.

The system is administered regionally but overseen at the federal level. It's not perfect. A 2001 study found that patients requiring elective surgery wait an average of 16 weeks before reaching the operating table. Investment is slow in new technologies and equipment.

On the other hand, Canadian hospitals and physicians spend substantially less time on administrative chores because the single-payer system is relatively streamlined. Hospitals receive lump-sum payments each year from local authorities but have wide discretion as to how their resources are used. Paperwork is minimal.

Would Canada's system work in the United States? Probably not without some tweaking. Experts say a U.S. universal health care system probably would require strong regulatory oversight to ensure cost controls and quality (and such oversight likely would cut into at least some of the projected savings).
Government authorities might also need more say over distribution of medical resources. Just as few communities would want or need two fire stations within a block of each other, regulators would help decide where hospitals are built to avoid wasteful duplication of expensive technologies.

"Health care shares many of the same characteristics of fire departments and police departments," Himmelstein said. "Hospitals should be treated the same way."

Karen Ignagni, president of AAHP-HIAA, the leading trade group for health insurers, challenged the methodology of Himmelstein and Woolhandler's study, and said administrative costs in the report "are wildly inflated."

Many of the expenses included in the study, she said, "actually involve activities that improve the quality of health care. It's not just paper pushing."

U.S. health insurers support extending coverage to all Americans, Ignagni stressed, but are "against a one-size-fits-all approach."
For its part, the drug industry's leading trade group, Pharmaceutical Research and Manufacturers of America, also opposes creation of a single-payer health care system.
Jeff Trewhitt, a spokesman for the association, said private insurance plans offer consumers more choice and "allow pharmaceutical and biotechnology research companies to avoid innovation-stifling, government-mandated price controls."

Harvard researcher Woolhandler responded in an interview that the insurance and drug industries have resisted change for years. "They're extremely happy with how things are now," she said. "For them, it's a life-or- death struggle."

Yet in the face of such politically powerful opposition, most experts agree it's unlikely nationwide universal coverage will be adopted in the United States anytime soon. Then again, Canada began its system more than half a century ago on a province-by-province basis.

[fergus51]

It is important to qualify:::: Universal and government run are not necessarily the same thing. Also many countries with universal health care have private facilities as well, like in the UK or Australia.

Universal or government run systems do not cause a cap on wages. The government run systems do want to keep nurses' wages down, but so do for profit places in the US (just look at Tennet or anywhere else they close hospitals rather than negotiate with striking nurses). Negotiations determine wages in both places.

[pickledpepperRN]

http://story.news.yahoo.com/news?tm...sured_solutions <http://story.news.yahoo.com/news?tmp...ured_solutions>

U.S. Urged on Universal Health Insurance
Wed Jan 14, 4:28 PM ET
By MARK SHERMAN, Associated Press Writer

WASHINGTON - The Institute of Medicine (news - web sites) on Wednesday recommended for the first time that the government provide universal health insurance, attempting to spark an election-year debate on a decades-old problem that keeps getting worse.

The president and Congress should set 2010 as the deadline for providing coverage to all, according to the institute, part of the National Academy of Sciences (news - web sites), a private organization chartered by Congress to provide scientific advice to the government.

The report endorsed no proposal and provided no estimate of cost, except to say it would be expensive.
It said that rising costs, increasing numbers of uninsured and growing financial pressures on health care providers have created the right conditions for major reform at the federal level, a decade after Congress rejected President Clinton (news - web sites)'s proposed overhaul. The report was the last of six studies over three years that explored aspects of the lack of health insurance.

"I believe we're reaching the point where the system is unsustainable," said one of the report's authors, Dr. Arthur L. Kellermann of the Emory University School of Medicine in Atlanta.
Mary Sue Coleman, president of the University of Michigan and head of the committee that prepared the report, said the problem "is not going away. It will only get worse."

The Census Bureau (news - web sites) reported that 43.6 million people lacked health insurance at some point in 2002, compared with 39.8 million in 2000.

The study said that strong, bipartisan support is necessary for any proposal to move forward. The report got a boost former Republican Sen. Bob Dole, who praised the goal of universal coverage but said a partisan effort tied to one approach would be doomed to failure.

"If properly framed, the lack of coverage ... can be one of the big, big issues in this election," said Dole, who attended a news conference on the report.

Separately, a survey by two pollsters, a Republican and a Democrat, for the American Hospital Association found that a majority of Americans, including a majority of Republicans, are willing to pay higher taxes to "assure every American citizen receives health care coverage."

Yet reaction to the study showed the partisan divide that has marked the issue. Democrats were overwhelmingly supportive, while Republicans were skeptical.

Health and Human Services (news - web sites) Secretary Tommy Thompson said universal coverage by 2010 is "not realistic."
In a meeting with reporters this week, Thompson said, "I just don't think it's in the cards. I don't think that administratively or that legislatively it's feasible."

The Bush administration last year proposed spending up to $89 billion in health care tax credits to help those who do not have employer-based coverage. The Republican-led Congress took no action.

Thompson said the president would have more to say about the uninsured in next week's State of the Union address.
Senate Majority Leader Bill Frist of Tennessee said he was concerned that the report "may not focus enough on the reasons why health care costs continue to rise and how to pay for any reform."

Senate Democratic leader Tom Daschle of South Dakota said the lack of insurance is the leading domestic issue today. He said the report's goal could be met. "I think it's essential," he said.

The institute said the lack of health insurance was deadly, costly and a cause of insecurity even among the insured. Rejecting incremental expansions, it said only major reform at the federal level would make universal coverage a reality.

In previous reports, the institute has estimated that the lack of health insurance causes 18,000 unnecessary deaths in the United States and costs the nation $65 billion to $130 billion annually.

Layoffs and cutbacks in health benefits by employers have led even those with insurance to worry that they could lose it. Lack of adequate health insurance "creates insecurity for everyone, because losing that coverage tomorrow is so easy," the report said.

The Census Bureau said a decline in workplace-based coverage was the main reason for the increase in uninsured between 2001 and 2002.
___
On the Net:
Institute of Medicine: <http://www.iom.edu>

[nekhismom]

Originally posted by mjlrn97:
I don't necessarily think government-run health care is the best idea.......if there's any way a thing can be made impossibly complex, government will find it! But we MUST get the for-profit insurance industry OUT of health care........this is, IMO, the root of all evil where medical services are concerned. Health care stopped being about "caring" when it became a business, and when you've got insurance-company CEOs who've never spent a day in medical school making millions of dollars a year deciding who should and should not receive care, something is very, very wrong.

I agree that we must get the private for-profit insurance companies out!!! I think we need a UNIVERSAL health care system. How many times have we seen nurses on this BB say that they are uninsured or can't afford their employer's insurance? How many uninsured pts. do you see everyday? How many kids and low-income people are without coverage, and how many more are set to lose coverage with the impending budget crises throughout the country??? something has to be done, and private insurance IS NOT the answer.

One of the articles posted talked about canada's approx. 16 wk. wait for elective surgeries. Well, they are ELECTIVE, aren't they? Sometimes we have waits that long here, depending on the surgery. Of course medically necessary surgeries should receive priority.

I've also heard about an "access to care" problem that can be created by universal health care. To that I say, we already have an access to care problem under the current system. We have too many people who are uninsured or underinsured or scared to go to the hospital/dr's office because of the costs. Wasn't there an article on here recently about people being arrested for not paying their medical bills?? Americans already have an access to care problem. Many of us can't afford proper care, or drugs. Healthcare is just too expensive, even with insurance. Many of the insurance policies I have seen lately cost more than they are worth, and God forbid you get sick, because you will definately incur a HUGE out of pocket expense before the insurance kicks in.

This is a subject very near and dear to my heart. I for one will ALWAYS support a universal health care system.

[kitkat24]

Thanks for the articles and opinions and input! It is great.

What is the difference between "government-run" healthcare and "universal healthcare" ? I assumed these were the same thing. If the government did not run "universal healthcare" then who would?

What about the notion mentioned in the first article about ingenuity and invention? What about the idea that we are motivated by money? We sure are movitated by money, as RN's, come contract time, aren't we? If in a universal healthcare Doctors and nurses make what a bus driver makes, then where is the incentive? Where is the incentive for pharmaceutical companies to invent new drugs to treat cancer and autoimmune disease and HIV and come up with new antibiotics or anti-virals or new vaccines. Has Canada been inventive? Have government run universal healthcare systems displayed ingenuity? When one in 8 of us females develop breast cancer, do we want there to be a newly developed treatment, so that we can survive to raise our children?

I am looking for answers for these types of questions. It seems that they are not out there. Even the Harvard study does not show the cons of universal healthcare. The only thing they discuss is a 16 weeks wait for elective surgery. Well, if you need a simply lap chole for gallstones, that is elective surgery. You could be fine and just need the lap chole, right? If you are required to wait 4 months or 16 weeks for an elective lap chole, and a gall stone becomes logded in your common bile duct, and you then develop pancreatitis and need TPN and lipids and IV pain medication before you can even have your surgery, that ends up being far more costly, doesn't it? I am sure a mastectomy is an elective surgery. Do you want to wait 4 months to have the cancer cut out of your breast? Most surgeries are elective, even we patients know and feel that they are not elective. The only surgery that is not elective is emergency or trauma patients. Where are the people to question that aspect?

And, paperwork that physicians and nurses do is not soley for administration, is it? Why do nurses chart for hours on five patients? Is it to prevent law suits and cover your butt, or is it simply wasted administration? How would universal care prevent the need for doctors and nurses to thoroughly chart on each and every patient?

And, what about law suits? Who would be sued in malpratice and who would pay in universal healthcare? Would the taxpayers pay for malpractice suits? Could a patient sue the government (TAX PAYERS) as well?

Where is patient choice in universal care? What are your options and choices versus government run universal care? We think we are limited now by HMO's, I have a feeling we aint seen nothin' yet, until we have the government telling us what hosptials to use etc.

What are patient to nurse ratios in a universal care system, and what EXACTLY are the wages for say an RN who has worked full time for 5 years in our current system, versus an RN who has worked full time for the same lenghth of time under universal care. These are also things that we need to consider that NOBODY seems to mention or discuss in any of the articles. I want to see figures: EXAMPLE UNiversal care RN makes $26.50 per hour and a RN in US current system makes $28.00 per hour. I want wage hours for comparsion. Do UNiversal care RN's get overtime pay? Do universal care RN's get paid hourly or on salary with no overtime pay?

I sometimes feel that nurses are so brain-washed by the democratic party of the US. They walk along like mindless sheep following the pro abortion, pro DFL agenda and just incessantly chant the mantra that the DFL'ers tell them to believe: Universal care, government run healthcare, and they do not submit any of the above questions.

I submit: Look at Medicaid and Medicare and then ask yourself if you want the government overseeing all of your medical care and determining what is best for you!

Please, keep the information and opinions coming. It needs to be discussed.
Kathy MN RN

[kitkat24]

Study: Taxes Pay for Most Obesity Costs

By MARK NIESSE
The Associated Press
Wednesday, January 21, 2004; 1:05 PM


ATLANTA - Taxpayers foot the doctor's bill for more than half of obesity-related medical costs, which reached a total of $75 billion in 2003, according to a new study.



The public pays about $39 billion a year - or about $175 per person - for obesity through Medicare and Medicaid programs, which cover sicknesses caused by obesity including type 2 diabetes, cardiovascular disease, several types of cancer and gallbladder disease.

The study, to be published Friday in the journal Obesity Research, evaluates state-by-state expenditures related to weight problems. The research was done by the nonprofit group RTI International and the Centers for Disease Control and Prevention.

"Obesity has become a crucial health problem for our nation, and these findings show that the medical costs alone reflect the significance of the challenge," said Tommy Thompson, secretary for the Department of Health and Human Services. "Of course, the ultimate cost to Americans is measured in chronic disease and early death."

States spend about one-twentieth of their medical costs on obesity - from a low of 4 percent in Arizona to a high of 6.7 percent in Alaska.

California spends the most on health care for the obese, $7.7 billion, and Wyoming spends the least, $87 million.

"We have a lot of taxpayers financing the costs of overweight and obesity for those in public sector health plans," said Eric Finkelstein, a health economist with RTI International who conducted the study. "That provides justification for governments to find cost-effective strategies to reduce the burdens of obesity."

About 64 percent of adults in the United States are either overweight or obese, according to the CDC's 1999-2000 National Health and Nutrition Examination Survey.

Physicians are seeing more and more people having health problems because they're overweight or obese, said Dr. Denise Bruner, chair of the board of the American Society of Bariatric Physicians.

"This is one of the major health epidemics we're looking at in America," she said. "I truly see this as a very grave problem for which we in the public need to certainly be pro-active in terms of taking charge of our health."

Obesity should be treated and prevented more aggressively through public health programs to encourage healthy diets and exercise, said Michael Jacobson, executive director of the Center for Science in the Public Interest, a nonprofit health advocacy group.

"It would certainly make for happier lives, and also save medical expenses," he said. "A healthy population would save taxpayers a huge amount of money."


Question:

What ethical responsibility do taxpayers have to healthcare problems related to lifestyle choice??

Universal healthcare will cause all taxpayers to pay for all of the lifestyle choices of other people, even if you exercise eat right, do not smoke, and take care of yourself......

[NurseHardee]

mjlrn, I think that it's much more than a problem of insurance companies alone feeding at the trough. But agree with you that this is an important chunk of the problem.

As for about a government run health care system? The government runs the military already, and this has hardly helped control costs. Nor has it helped make the military available only for wise use.

Never the less, a government mandated single payer system is a must to move us forward against the tide of deteriorating and totally corrupted US system of delivery of medical care. Neither the Democrats nor the Republicans have what it takes to reform this mess, so we are certainly doomed short term to yet worse to come, IMO. I would like to see a Movement to picket the hospitals.

NurseHardee

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
mjlrn...
I don't necessarily think government-run health care is the best idea.......if there's any way a thing can be made impossibly complex, government will find it! But we MUST get the for-profit insurance industry OUT of health care........this is, IMO, the root of all evil where medical services are concerned. Health care stopped being about "caring" when it became a business, and when you've got insurance-company CEOs who've never spent a day in medical school making millions of dollars a year deciding who should and should not receive care, something is very, very wrong.

[VivaLasViejas]

If I were in charge, I would have my universal health care system administered by an independent entity made up of doctors, nurses, and other providers, as well as financial managers and ordinary citizens. This organization would be funded by, and accountable to, the federal government, and yes, there would HAVE to be some rationing of services........but the bureaucrats wouldn't be the ones deciding that. This way, EVERYONE would have access to basic and intermediate-level health care services; these would include birth control, heart and kidney transplants, chiropractic care, and bariatric surgery. However, I would NOT expect universal coverage to pay for cosmetic surgeries, so-called alternative therapies, or those which are considered experimental.........those who want these services and can afford to pay for them should do so.

Of course, there are a billion things that could go wrong with such a system, and I'm sure there are those who will gladly point them out. But we have to start somewhere, and getting the insurance industry out of health care would be a helluva start. For them, there's always auto, life, fire, flood, and disaster insurance to keep them going.....leave health care to the people who KNOW health care!!