[Mijourney]

Hi fiestynurse. I think that you present some good arguments on the pro side of universal health coverage (I agree with a previous poster that coverage and care are separate issues). I feel that with the amount of money that has been changing hands within this system, the delivery of health and medical care can be more than adequate.

You've rightly pointed out that support for access to good quality health for everyone needs to be more than fair or justified. For me, it's a matter of the heart. I'm not an anti-government vigilante nor am I a strident anti-privatization monger. I just feel that when it comes to mind, body, and spirit, health and medical coverage is necessary to give everyone who desires a fighting chance to succeed in a capitalistic society. Right now, the only ones who seem to have adequate health coverage or insurance are those who are not working, those in government, and those who can afford to pay high premiums and additional costs.

Most of us nurses, I would dare say would not be able to afford all of our health and medical needs if we did not have group insurance. It's true that copays, deductibles and the like supposedly keeps us honest. But, the fact remains that premiums still continue to rise because the cost of caring for an increasingly chronically ill society is rapidly rising. We still have the 40-50 million people with no or little health insurance coverage. Yes, we are paying for these people and those who insurance does not cover the long term complications of long illnesses.

So, what's the answer? I don't know specifically. I just don't think in matters of health care delivery we can brush it off that easily as not wanting to have anything to do with it or saying it does not or should not affect us as individuals. None of us, unless we are hermits, live as an island. What we do with our own individual health as well as with the health of others does have impact beyond the immediate. Thanks fiesty for making me think. You know I'll still be thinking and may come back with a totally different perspective.

[CaronRN58]

Sunday July 8,2001
Portland Press Herald, Portland Maine

INTERVIEW with Howard R. Buckley: As policymakers struggle with managed care, the CEO of Portland's Mercy Hospital champions universal health care for all Mainers.
Very interesting interview. To read it all point your browser to:
http://www.portland.com/news

After 7/8/01 can be found under Business Sunday archives.

CaronRN58

[fiestynurse]

CaronRN58, WOW! What a great article! A Hospital CEO speaking out about the need for a single-payer national health system. He really says it like it is.

[RNed]

Well some thought provoking ideas and opinions. First, I do not have the answers. However, we could review a few issues presented.

Natelie. Absolutely we should have a safety net. I have asked for years why this country does not have a heatlhcare progam for any child under the age of 18. Regardless of parental income. One would think we could all agree upon taking care of our young. However, we continue to fail in this regard. Why should the parents income be a factor related to medical services needed for a child. It shouldn't. Provide me with a program to accomplish this and you have my support. This program should include Bill Gate's children. Lets be fair, just because he has money doesn't mean he should have to pay for their healthcare.

To some other points. The ethical and moral dilema. We as a society have a ethical and moral obligation to provide a safety net. However, that safety net can not equal the quality of those providing the safety net. If so, we might as well assume a socialist communistic society. If we need to pay for their house, grocerys and healthcare equal to ours - do we not take the incentive away to become educated, resourceful or dare to say "rich". If I can have no more or provide no more for my family than what the "have nots" can why am I working so hard !!

Life is not fair. No disrespect intended but if we were to acheive fairness, I'm sure it would be based on the standard - is everyone equally miserable rather than - is everyone equally happy.

Once again, insurance has been interchanged as healthcare. Insurance does not level the playing field. So, we do develop a universal insurance program. Will it have a deductible? If so who pays for the working poor. And if some services are not covered? Do the rich have an option of paying for that care out of their pockets? Is that fair to those without the money? Do we tell the rich guy sorry, you can't pay for that heart transplant out of your pocket. The poor guys can't have it, so you can't have it !

My family rarely uses healthcare. We do healthy things and remain healthy. However, I pay a substantial amount of money to insure the family. Why should the alcoholic, drug addict or couch potatoe get to spend my healthcare dollars. He/she killed their liver, not me!! Unless, we can regulate human behavior healthcare will remain unfair.

Liberty is Choice ! Everyone has a choice. The choice of going to school, getting an education, making money, making decisons based upon good financial planning, not smoking, not drinking, pregnancy and on, and on, and on. Life is choices. To limit this liberty or to deny one a choice is counter to all the freedoms we currently have.

The act of being benevolent is wonderful. However, we can not mandate others to do so. It needs to be a free act otherwise it is not benevolent - it is taxation !!

When we envy what other have and revel when taxation takes their wealth for the benefit of others, we stand against liberty.

Healthcare is not a right, it is a choice, just like all the other choices life presents.

Again, I am not against better access to healthcare. However, I do not think universal insurance is the best answer, nor will it solve the problems. There will always be the "have nots" and the "haves".

[JennieBSN]

Originally posted by RNed
Liberty is Choice ! Everyone has a choice. The choice of going to school, getting an education, making money, making decisons based upon good financial planning, not smoking, not drinking, pregnancy and on, and on, and on. Life is choices. To limit this liberty or to deny one a choice is counter to all the freedoms we currently have.

The act of being benevolent is wonderful. However, we can not mandate others to do so. It needs to be a free act otherwise it is not benevolent - it is taxation !!

When we envy what other have and revel when taxation takes their wealth for the benefit of others, we stand against liberty.

Healthcare is not a right, it is a choice, just like all the other choices life presents.

Beautifully stated, RNed!! The crux of my argument exactly.

July 6th was 'cost of government day.' This means that July 6th is "the day of the calendar year that the average American worker has finally managed to earn enough money to pay his or her share of the total cost of government – federal, state and local"(Neal Boortz). Universal healthcare would simply push that date back further. The social programs to help the indigent of our society are growing bigger every year, and the cost of those programs is passed down directly to those of us who exercised good decision making and responsibility for our actions. In essence, we are being penalized for good decision-making.

I too think benevolence is a wonderful thing. However, I do not like being FORCED to be benevolent. No one ASKS me if I want to pay for the medicaid, AFDC, and SSI programs in my state and country, I am FORCED to do so through taxes. No one ASKS me if I want to pay for the free healthcare that the welfare brood mares receive in this country...I am FORCED to through taxation.

Children are truly vicitms of circumstance. They are relegated to live the lives their parents have made for them. I agree with RNed that they should, therefore, have free healthcare...even the 'RICH' kids. This is not forced benevolence, it is taking care of those in our society who genuinely do not have a choice. Adults, however, DO have choices. If their choices lead them to poverty and poor health, so be it. TOO BAD, SO SAD. I shouldn't have to pay for someone else's indiscretions and poor decision making simply because I was more responsible and have the means to do so. That is communism/socialism. Last time I checked, America was a Republic.

[Mijourney]

Hi. I agree with some of the points that have been made by the posters who feel that health care should be a choice. For me, the issue is not whether health and medical care are funded solely by government, private industry or a combination of the two or something else. I just don't see having access to good quality health and medical care as limiting someone's freedom. In fact, I think having acess to good health and medical coverage is liberating. It has the potential of making the people in the world smarter, stronger, and thereby freer. I assume that most of us would like an opportunity or chance to have a choice. Choices are limited when you can't get access.

[Cdn_Psych]

Oh, where do I even begin to reply?

I'm a Canadian RN & I'm astonished to learn that I live in a "communist" country because my healthcare costs are (largely) paid through taxes. One of the things that seems to be overlooked here is that whether you pay for your health care by taxes or by "choosing" to pay a corporation (to deny you care), you still pay.

The beauty of the Canadian system is that it is a single-payer system (though that is slowly changing due to corporate pressure from the multinationals). As a result, our administration costs are much lower than the "free market" model in the USA, and the system covers everyone. We spend far less for health care than the USA does and everyone is covered. A universal, single payer system is much more *EFFICIENT* than the free market model of the USA.

The other thing you may wish to consider is the fact that bacterial and viral pathogens do not respect socioeconomic status. It's easy to say that those poor people with TB got what they deserve (what a callous thought), but the fact is that if TB is allowed to flourish among those who are poor, the presence of this communicable disease is a threat to *YOU* because it is a communicable disease that can be passed on to *YOU*.

Whether you pay the government through taxes, or pay an HMO for managed neglect, you still pay. The "communist/socialist" system we have in Canada is cheaper and universal.

I think it's the sensible way to go.

Originally posted by kday



Beautifully stated, RNed!! The crux of my argument exactly.

July 6th was 'cost of government day.' This means that July 6th is "the day of the calendar year that the average American worker has finally managed to earn enough money to pay his or her share of the total cost of government – federal, state and local"(Neal Boortz). Universal healthcare would simply push that date back further. The social programs to help the indigent of our society are growing bigger every year, and the cost of those programs is passed down directly to those of us who exercised good decision making and responsibility for our actions. In essence, we are being penalized for good decision-making.

I too think benevolence is a wonderful thing. However, I do not like being FORCED to be benevolent. No one ASKS me if I want to pay for the medicaid, AFDC, and SSI programs in my state and country, I am FORCED to do so through taxes. No one ASKS me if I want to pay for the free healthcare that the welfare brood mares receive in this country...I am FORCED to through taxation.

Children are truly vicitms of circumstance. They are relegated to live the lives their parents have made for them. I agree with RNed that they should, therefore, have free healthcare...even the 'RICH' kids. This is not forced benevolence, it is taking care of those in our society who genuinely do not have a choice. Adults, however, DO have choices. If their choices lead them to poverty and poor health, so be it. TOO BAD, SO SAD. I shouldn't have to pay for someone else's indiscretions and poor decision making simply because I was more responsible and have the means to do so. That is communism/socialism. Last time I checked, America was a Republic.

[natalie]

If you believe you are spending a good portion of your paycheck on the indigent, you're wrong. It had become popular political folklore to rail against the taking of our hard-earned cash to pay for these "low-lifes." And somehow, the hardworking poor that cannot afford healthcare got tagged as lowlifes. Medicaid accounts for less than 6% of the federal budget.

Guess where the huge percentage of the budget is at? Senior citizens. They're the ones that vote more than any other group, and they're the ones that have received the beneficients of the elected leaders that want to become re-elected. Social security and medicare are prime examples of SOCIALISM alive and well in the US. They are NOT means-tested programs and are the ONLY non-means tested programs in this country. Don't get me wrong. I want my tax money to go to social security, but I want it to go to those seniors that need it. It's evolved so far from the original intent of FDR. He wanted to provide a safety net for the POOR elderly. At that time, the mortality average was somewhere around age 65.

Social security and medicare account for 35% of the federal budget. 35%-that's huge. Do any of you know of well-to-do seniors? I know plenty. And they're all getting free retirement and free healthcare.

Before anyone replies that they paid into the system and deserve it back, please know that the time paid in is equal to less than 5 years of benefits received. So they retire at age 63 and have used up their benefits before age 68. My in-laws did this and they are 75 years of age. They're not well-to-do, but are taking trips to Hawaii, traveling around the US, and buying a new car every 2 years. They're doing it off their SS monies.

Feistynurse, appreciate all your expertise. Surely if we can afford these luxuries to financially-stable seniors, we can take a look at providing healthcare to the lowlife, hardworking slug that makes $8/hour. And surely we could provide decent end-of-life care for the seniors in nursing homes.

This is a great org. that has been around a while.
http://www.concordcoalition.org/

[fiestynurse]

Here is something else to think about. What about all the extra coverage that we pay for that could be eliminated by a single-payer system. You pay insurance premiums for your health care coverage and then you pay for car insurance to cover the medical expenses of injured drivers, then we have medicare and medicaide that you help finance through taxes and then there's workers compensation insurance that pays for medical expenses of an injured worker.... WE PAY FOR ALL OF THIS.
A social insurance system that pays for all of this would be so much more efficient, with more money left over for actual care.

In addition, did you know that medical care debt is quickly becoming one of the top reasons why people file for bankrupcy in this country. WE PAY FOR THIS TOO.

[natalie]

http://dailynews.yahoo.com/h/nm/20010704/hl/care_1.html

US: Children of the Working Poor Lack Health Care
By Alan Mozes

NEW YORK (Reuters Health) - Children of American working families living at or just slightly above the poverty line--the ''working poor''--are the most likely to fall through the cracks in the health care system, according to a recent study.

``Children in working poor families were far more likely to lack health insurance coverage and to experience disruptions in insurance coverage compared to children of non-working poor parents and compared to children in moderate to affluent families,'' said study lead author Dr. Sylvia Guendelman.

Guendelman and Dr. Michelle Pearl at the University of California at Berkeley analyzed data on close to 14,000 children of working poor, poor, and moderate to affluent families that had been collected in a 1997 US Census Bureau (news - web sites) ``National Health Interview Survey.''

They found that 16% of the working poor children who were in less than excellent health had not visited a doctor within the past year, compared to 12% of the poor and 9% of the moderate to affluent group. They also found that overall access to all types of health care was much more difficult for children of the working poor, who were less likely to have a regular source of care.

In addition, the researchers noted that children of the working poor were uninsured at four times the rate of the moderate to affluent children.

In 1996, the poverty line was defined as an income of $31,822 for a family of four. The study authors defined the working poor as earning less than 200% of the poverty level.

Guendelman and Pearl reported their results in the June issue of Archives of Pediatrics and Adolescent Medicine.

Despite the implementation of the federal Children's Health Insurance Program (CHIPS) in 1997--designed to provide insurance at the state level to about 5 million uninsured children of the working poor--barriers to enrollment still exist. Guendelman and Pearl stated that the program has suffered from insufficient outreach and too much red tape, forcing a large portion of eligible children to delay or completely miss receiving the care they need.

Guendelman told Reuters Health that about 25 million American children live in working families that earn less than 200% of the poverty line. And she suggested that federal welfare-to-work policies implemented over the past few years should take responsibility to ensure that these children get and are able to maintain health care coverage.

``The working poor have received far less attention than welfare folks, and studies such as mine begin to portray the realities of this often neglected population,'' Guendelman said. ''Our findings were not unexpected given that until recently poor working families were given few incentives and have not been eligible for means-tested programs such as Medicaid.''

SOURCE: Archives of Pediatric Adolescent Medicine 2001;155.651-658.