[ZASHAGALKA]

Originally Posted by mjlrn97

This isn't a very good argument against universal health care. By law, we have to do a number of things we wouldn't do if we had a choice.

But ALL of those things are designed to solve the free rider problem of economics: ensuring those that would not pay voluntarily to pony up for public projects.

In the case of UHC, you would CREATE the free rider problem by socializing it.

There is a difference in making sure that all drivers pay a share for the roads and using the welfare state to ensure/enforce a substandard level of care for all. One is a public project and the other is essentially a direct transfer of wealth at the expense of a far superior system: the free market.

~faith,
Timothy.

[ZASHAGALKA]

Originally Posted by Miss Mab

Actually, I think you answered your own question here:
From you earlier:
people will generally act in their own best interests, even at great cost to the community. "

No, I pointed out how socialism is a failure because it ignores basic human motivation.

How have you enforced motivations with the claim, "IT'S FREE!"?

~faith,
Timothy.

[pickledpepperRN]

Originally Posted by ZASHAGALKA

I wouldn't suggest revolution, just a return to the Federal model of our Constitution. State and locals are more responsive because they are more local. THE MORE LOCAL you make the implementation of a program, the more responsive it must be. It is the difference between depending upon 25,000 votes to win election and 2 million.

Those 25,000 votes matter oh so much more.

This is why progressives hate the concept of anything short of Federal control. They know that Washington isn't responsive to the people. They count on it.
Progressives are very afraid of having their ideas held accountable to the people. This was directly said in the recent thread about poverty being bad for your health. Somebody directly said that it must be federal because they didn't TRUST the people to make the right decisions. Exactly.

The idea of remoteness to Washington is designed to get 'we the people' as far out of the process as possible. After all, we're all a bunch of idiots. If we weren't, we wouldn't need Washington watching over us, in the first place. Right?

~faith,
Timothy.

RNs have a long and proud history of social advocacy in the best interest of individual patients, families and communities.
WE proudly continue to work locally as well as nationally to fulfill our obligation to advocate for the public good.

The people of California and many others appreciate our advocating on behalf of our individual patients individually, on the unit, at the facility, in our towns and cities, our state, our country, and to do our part to improve health.

Registered Nurses have the professional obligation and therefore the right to act as patient’s advocate.

RNs must always act in the exclusive interest of the patient. The RN duty constitute a fiduciary duty, so that every aspect of the nursing process from patient assessment to intervention and evaluation must be for the exclusive benefit and interest of the patient, uncompromised by conflicting interests or consideration.

No person has the authority or the moral right to interfere, restrict or encumber in any way the RN’s duty and right of patient’s advocate. Not the CEO, the Governor, the President, or corporation.
WE must ensure no one has the legal right to interfere with our sacred duty and right to act in the best interest of our patients.

In California we have achieved laws and regulations codifying:

· The right as well as the responsibility to advocate in the exclusive interest of the patient.
· Freedom of speech during and after working hours.
· Right to engage in collective action.
· Safe staffing standards based on individual patient acuity with direct care RN-to-patient ratios as a minimum.
· Whistle blower protection with major fines against the employer and the individual retaliating against a caregiver, patient, or family member who reports a violation. Full reinstatement, lost wages, benefits and cost
· The adoption of a uniform excellent standard of care, including safe staffing standards based on acuity/ratios.
· The building of an independent direct care RN social advocacy organization.
· Patient, job and license protection
· Immediately invoke the duty and right to advocate in the exclusive interest of the patient.
· Direct care RN nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one direct care RN at any one time.
· The same ratios apply to all shifts.
· Patient Classification Systems shall include:
· The severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment and design, implement and evaluate the patient care plan, the ability for self-care, including motor, sensory and cognitive deficits, the need for advocacy intervention, the licensure of the personnel required for care, the patient care delivery system, the unit’s geographic layout, and generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the acute care hospital's patient population.


Lillian Wald RN and Lavinia Dock RN protest unsafe conditions at the Shirtwaist factory

California direct care RNs and community supporters advocate for safe staffing law

[ZippyGBR]

Originally Posted by ZASHAGALKA

Is that 2% before or after the trillion dollar cost overruns?

Is it before or after Americans, used to services on demand, - DEMAND an end to rationed care? You can't end rationed care. It must be rationed, by dollars or waits. Unlimited demand = unlimited supply (an impossibility) or, rationed supply.

'care on demand' is there in UHC system , just perhaps not what the USA is used to ...

EMTALA came about to prevent WABC practices (wallet, airway breathing circulation) as well as religious hospitals refusing people who didn't meet their standards of behaviour ...

if there is unviersal access to primary care people won't need to use the ED for primary care , and if they present they can far more safely be 'turfed' to primary care

other aspects of 'care on demand' will remain if peopel are willing to pay over and above ....

however the picture painted by many posting on the board is of a system which doesn't provide 'care on demand' with p[rolonged waits for primary care consultations and prolonged ED ' holds' being the norm ...

there is also the aspect of the amount of specialist time and effort spent on "the worried well' becasue there is no 'gatekeeping' of referrals to secondary care and no incentive for primary care to develop their services

In fact, if you use Medicare as an example, you aren't even close. In 1965, proponents of Medicare predicted that it would NEVER cost more than 1% of income tax and would cost 9 Billion by 1990. In 1990, we spent 67 Billion on Medicare, a cost overrun of 700 PERCENT.

~faith,
Timothy.

what does 9 billion 1967 dollars equate to in 1990 dollars?

[HM2Viking]

Originally Posted by ZASHAGALKA

In fact, if you use Medicare as an example, you aren't even close. In 1965, proponents of Medicare predicted that it would NEVER cost more than 1% of income tax and would cost 9 Billion by 1990. In 1990, we spent 67 Billion on Medicare, a cost overrun of 700 PERCENT.

~faith,
Timothy.

We already ration health care. I don't think your medicare comment holds water. If in 1965 the prediction was that medicare would not exceed 1% of ????tax. It really is on track for staying within that ballpark. The medicare tax is on the order of 1.45% now. Any growth in the cost numbers can certainly be attributed to the combination of longer lives, additional technology (MRI anyone???), and increased reliance on prescription drugs.

I think that this debate can be divided along a care vs cure continuum. Care (UHC advocates) believe that money is better spent on prevention through a basic plan of consistent benefits. Cure (private sector/current system) would almost rather let people get sick...and if you can afford to pay for the cure out of pocket so be it. Somewhat of an exaggeration but I think it reflects a reality of belief.

The market theory has failed and is failing.

<H3>Won’t this result in rationing like in Canada?

The U.S. Supreme Court recently established that rationing is fundamental to the way managed care conducts business. Rationing in U.S. health care is based on income: if you can afford care you get it, if you can’t, you don’t. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don’t have health insurance. That’s rationing. No other industrialized nation rations health care to the degree that the U.S. does.
...
If there is this much rationing why don’t we hear about it? And if other countries do not ration the way we do, why do we hear about them? The answer is that their systems are publicly accountable and ours is not. Problems with their health care systems are aired in public, ours are not. In U.S. health care no one is ultimately accountable for how it works. No one takes full responsibility.

http://www.pnhp.org/facts/singlepaye...#canada_ration</H3>

[ZASHAGALKA]

Originally Posted by ZippyGBR

'care on demand' is there in UHC system , just perhaps not what the USA is used to ...

EMTALA came about to prevent WABC practices (wallet, airway breathing circulation) as well as religious hospitals refusing people who didn't meet their standards of behaviour ...

if there is unviersal access to primary care people won't need to use the ED for primary care , and if they present they can far more safely be 'turfed' to primary care

other aspects of 'care on demand' will remain if peopel are willing to pay over and above ....

however the picture painted by many posting on the board is of a system which doesn't provide 'care on demand' with p[rolonged waits for primary care consultations and prolonged ED ' holds' being the norm ...

there is also the aspect of the amount of specialist time and effort spent on "the worried well' becasue there is no 'gatekeeping' of referrals to secondary care and no incentive for primary care to develop their services



what does 9 billion 1967 dollars equate to in 1990 dollars?

1. Medicaid patients ARE allowed to use preventive care with primary docs. But, because it's FREE, using the ED is more convenient.

2. Medicare was projected to cost 9 billion IN 1900: a forecast that included inflationary adjustment. In any case, there was not a 700 percent inflationary decline in dollars amounts during that time frame.

If you would just agree to the free market for health care, EVERY person could be provided with all the care they need for five dollars a month. THAT is hands down a better deal than the government.

~faith,
Timothy.

[ZASHAGALKA]

Perhaps you believe I'm being disingenuous about the 5 dollar a month comment in my last post. Either that, or totally unrealistic.

Maybe so, but NOT more so than suggesting that a token increase in taxation would pay for gov't restricted care.

The tax liability would be unlimited. Progressives don't care about that.

The American people will.

Two programs, Medicaid and Social Security, will cost 1 trillion dollars, or, a third of the budget next year. In less than ten years, on top of that, the 'trust' fund markers will be called in, requiring spending on top of those yearly averages. We will have to increase taxation by billions to fund what is already promised.

And yet, we are to believe that tripling these programs will amount to a negligible cost? Let's be realistic or at least, honest.

~faith,
Timothy.

[HM2Viking]

The reason for a federal funding stream with state control are to assure that resources are able to get where they need to be. Texas and Florida providers benefit under Medicare because of the ability to transfer funds to where the patients are.

Think of snowbirds. A snowbird is a retiree who lives in the upper Midwest during spring, summer, fall and then lives down South during the Winter. How could a state rationally manage that type of funding and expenditure.

Not all federal regulations are bad.

Medicare funding is fixable with some creativity. We can cut substantial amounts from medicare costs simply by discontinuing the Medicare Advantage subsidy. That subsidy to private insurers adds around 15% in additional cost for covering a Medicare Advantage beneficiary vs a traditional Medicare beneficiary.

Medicare for All would also help reduce administrative costs for medical coverage. This could be used to help reduce deficits. Adopting strict evidence based practice guidelines are another way to reduce costs. Reimbursing part D drugs on an evidence based effectiveness protocol would help reduce costs. Allowing Medicare part D patients to use their benefits to buy drugs from Canada would reduce costs. Authorizing bulk purchase discounts for medicare beneficiaries would reduce costs. The simple reality is that the US must contain medical inflation to the levels achieved by OECD countries or our economy will implode.

[ZASHAGALKA]

Originally Posted by HM2Viking

The market theory has failed and is failing.

That presupposes that the CURRENT system is market driven. It is government driven already. The failure is with the government intervention that has destabilized the entire system. So of course, the solution to government intervention is more government intervention.

Before you can claim that market theory has failed, we would have to first TRY market theory.

Everywhere it's currently employed in health care, orthodontics, dentistry, lasik eye surgery, cosmetic surgery, over the counter meds: it's a stunning success.

~faith,
Timothy.

[ZASHAGALKA]

Originally Posted by HM2Viking

The reason for a federal funding stream with state control are to assure that resources are able to get where they need to be. Texas and Florida providers benefit under Medicare because of the ability to transfer funds to where the patients are.

Think of snowbirds. A snowbird is a retiree who lives in the upper Midwest during spring, summer, fall and then lives down South during the Winter. How could a state rationally manage that type of funding and expenditure.

Not all federal regulations are bad.

Most are.

I see your point: the States have no idea how to raise taxes. Since they are SO BAD at it, the Feds MUST step up and do this favor for them.

It's just a shame my State isn't capable of taxing as well as the Feds. Right?

It's about control. The Feds are infamous about using funding as their mechanism of control.

~faith,
Timothy.