[UKRNinUSA]

Originally Posted by UKRNinUSA

We have so much information available on research based clinical practice guidelines that could make a profound difference on our Public Health, and in turn our economy, if only it were implemented in a consistent fashion. We have the information and we have the technology. We just need a good plan to marry the best of the HMO and the best of the PPO, mix it with some incentives, add a dash of personal responsibility and take out the over-inflated CEO salary factor. We just might come up with something bigger and better if we took our heads out of the sand for a moment, overcame our resistance to change and worked together. Do you FEEL me?

Just had to quote myself for the skimmers (me too) in case they missed it. I know universal health care has its limitations and I know our current system also has it's limitations. But can't we learn and grow and change and become better instead of arguing ideology. Our health care system is inequitous and broken.
People are broke (financially) because of it - bankrupt due to the need for catastrophic care, broke because their premiums are too high, out of work because their employer just could no longer afford to compete in a global market and physically broken because they didn't get inexpensive preventative care that could have saved the taxpayer millions.
People are still ripping off the system -from the MediCal Mom with SUV, cellphone, cigarettes and fake nails that still comes to the ER for tylenol to healthcare CEO's making millions (Aetna CEO- $22million, United Healthcare $124million, 2005 figures.)
Pride comes before a fall. The Roman Empire fell, the British Empire fell -who's next? Could it possibly be US?????? Can't you see the writing on the wall?
And just tell me what I'm supposed to do when Medicare has finally bitten the dust (approx. 2019) and I can no longer work. If I can't get affordable healthcare and I don't want to burden my dilapidated self onto my kids (presuming they'll have me), what am I going to do? Assisted suicide has been outlawed, so that's not an option. Maybe I'll turn up on someone's doorstep, maybe Timothy's, with my contracted, incontinent, demented body, smelling like a stage 4 fungating pressure sore and shrieking " Guess who's come for a long visit -tell me how much you like your libertarianism now?"
I just think that if we have the brains and we have the resources why can't we put our heads TOGETHER and come up with something good, something better than we already have and something better than other countries have. It might be difficult but it's not impossible. Look at how far we've already come.

[Freedom42]

Why is the infant mortality rate in the Netherlands is so much lower than it is in the United States. Could it be due to access to prenatal care? Could it be the same story in the Czech Republic, Andorra, Slovenia, Cuba or any of the other 38 countries that the CIA says have lower infant mortality rates?

Universal payer is not about communism. The government would not assume ownership of health care programs. It would pay for them. That's a form of democratic socialism, and it's akin to what's practiced in Sweden, one of 47 countries where the CIA says people live longer than they do in the United States. Everyone in Sweden still has the right to choose his own health-care provider.

Universal payer is inevitable in the United States. That's why health insurance companies unveiled their own plan this week to try to stave it off and keep themselves in profits.

[ZASHAGALKA]

Originally Posted by Freedom42

Universal payer is not about communism. The government would not assume ownership of health care programs. It would pay for them. That's a form of democratic socialism. . .

Someone said I should think in terms of reality instead of ideology.

Fine. In REALITY, he who pays, decides. A single payor system where those who pay are NOT those who seek services are decided, not by those who seek such services, but by those who pay for them.

The result will be that the gov't determines your healthcare. If you think this isn't the case, take a long look at how Medicare DRGs have changed the face of what care is provided by all payor systems, including private insurance.

Some problems have been pointed out: outrageous disconnect between the pay of those at the top of 3rd party payor systems and their useful roles. I agree. I'm not a 'protect the rich' Republican. Most insurance organizations, such as car and home, are under regulation by State agencies to protect against rampant abuse. I'm not opposed to this.

There is a problem with access to preventive care: I agree. Expand THAT instead of co-opting and subverting the entire system.

Many argue that our care here provides less healthy Americans than socialized systems. I disagree. Americans are more unhealthy because we live more unhealthy lives. So, let's start with Aid to Families with Dependent Children. AFDC provides food stamps for a whole array of unhealthy food choices. Change the program to be like WIC - only coupons for healthy foods. That adds both health and incentive to the system. If you WANT coca-cola and frito-lay, go get a job and pay for it. But now, that would end the abuse by the largest abusers of AFDC: it is corporate welfare. (and you thought I was just a get the corporations rich Republican). No, cut out the corporate welfare from the system.

I'm not opposed to greater access to healthcare for all. I'm opposed to destroying the system for most of us in order to provide care for all of us. The result is that ALL of us will be less well off. That doesn't do ANY of us much good in the long run.

You want changes to make the system more equitable. I'm willing to discuss it. In MASS, they recently passed a mandatory health insurance law that stipulates that all citizens must obtain healthcare insurance and if they don't, the gov't will automatically provide it (while garnishing a pro-rated percentage of YOUR salary to pay for it). There's an incentive to be OFF the gov't dole if you can, and to deal with it when you must.

And successful program MUST include incentives for individuals to make wise choices. Universal healthcare simply doesn't do that. Neither, btw, does 3rd party payor systems, like we have now. Oh, they do in SOME cases: knowing I have to pay 125 dollars up front to use the ER means I don't abuse it for a papercut. But in the main, the problems with our system are inefficiencies built in by removing incentives.

BSN2009 has a good idea about a catasthropic insurance plans plus the requirement to pay out of pocket for routine care. There is an incentive based start. Add to that cafeteria plans or healthcare savings accts that allow you to CHOOSE your best care and pocket the difference, and you'd see a whole generation pondering this question when it comes to healthcare: what does it cost me? And that is the start of true economic reform. Because, economics boils down to incentives.

I'm against any program that removes personal responsibility from the concept. Because, in the end, with responsibility comes rights. And a system that deprives the incentives of individual responsibility is one that also deprives individuals of the right to seek the best care.

~faith,
Timothy.

[hope3456]

[
On the other hand I see people really taking Medicare/Medicaid for a ride. A few years ago, as a case manager, I had a 95 year old patient who was blind, demented, and dependent on both dialysis and a ventilator. I'll give you 3 guesses as to her quality of life. Try as we might we could not get her family to change her code status. Full code. But as long as the government was paying for her care the family had no incentive to change their mind. I would have given a week's paycheck to be able to tell them "sorry, the insurance has run out - how would you like to pay for her care: cash, debit or credit ?" I'm not trying to be mean, but you know how money talks, plus I have a big problem with patients being trapped in a body that no longer works with zero quality of life while their families sort out their grieving issues - the phrase "cruel and unusual punishment" comes to mind.




UKRN,

You hit the nail on the head!!!!! I just quit a job in a LTC facility and I saw way to much of this going on. As well, I am intending on writing to my elected officials about this issue. I know this is a 'hot topic', but we do have to admit that we have limited resources when it comes to healthcare. Many of these 'residents' are being kept alive by very expensive drugs that probably werent around 10 yrs ago - thereby giving them a quality of life (in a unsafe, chronically understaffed and underfunded LTC) of about....nothing. Where do you draw the line when it comes to end of life care??

[azhiker96]

Originally Posted by Freedom42

Why is the infant mortality rate in the Netherlands is so much lower than it is in the United States. Could it be due to access to prenatal care? Could it be the same story in the Czech Republic, Andorra, Slovenia, Cuba or any of the other 38 countries that the CIA says have lower infant mortality rates?

Universal payer is not about communism. The government would not assume ownership of health care programs. It would pay for them. That's a form of democratic socialism, and it's akin to what's practiced in Sweden, one of 47 countries where the CIA says people live longer than they do in the United States.

Wow, I'm surprised to see Bosnia and Herzegovina have a longer life expectancy than the United States. I guess we need to get cracking on modeling ourselves after them.

I think we need to look at the reasons for the high cost of healthcare in the US. Outlaw huge punitive judgements. Limit lawyer's fees to actual hours times hourly rate. Outlaw phamaceutical ads and ambulance chasing ads. I'm tired of folks who think they need the new whatever-color pill because they saw an ad for it on TV and everyone in the ad was smiling.

[cabkrun]

What I don't understand is the argument that a single payer health care system will lead to abuse. Just because I will have health coverage, all the sudden I'm going to go out and start eating KFC and Big Macs, not exercising, and going to the doctor when I cut my finger? I don't think so. I am anal about my health, I don't LIKE fast food, and I don't really care for going to the doctor other than when I absolutely have to, or for preventative checkups that hopefull catch something before it gets too big. I have relatives all over the world, and geez they surely don't go to the doctor when they sneeze just because they can and know it'll be paid for.

[cabkrun]

Timothy, fat cat CEO's already determine our health care. It's ALREADY RATIONED!! That is just a plain old FACT. I know from experience that it is. And forcing people to pay for health care by "capitalizing" it isn't the solution either...I'm sorry. You can accomplish the same goals of cost competition with single payer. Poor people barely able to pay their bills as it is, are not going to pay out of pocket for preventative care that can save them from serious disease, just because they are forced to go out and get a doc to compete for their business. Most of the businesses in this country are consolidating and nearly monopolizing as it is. Don't expect all kinds of competition from small health care clinics and private practice doctors just cuz we "capitalize" health care.

[ZASHAGALKA]

Originally Posted by cabkrun

What I don't understand is the argument that a single payer health care system will lead to abuse. Just because I will have health coverage, all the sudden I'm going to go out and start eating KFC and Big Macs, not exercising, and going to the doctor when I cut my finger? I don't think so. I am anal about my health, I don't LIKE fast food, and I don't really care for going to the doctor other than when I absolutely have to, or for preventative checkups that hopefull catch something before it gets too big. I have relatives all over the world, and geez they surely don't go to the doctor when they sneeze just because they can and know it'll be paid for.

Because, if there is no incentive to protect a resource, then there is no disincentive to keep from overusing it.

Ask any ER nurse about medicaid, EMTALA, and abuse of the system. No, not everybody abuses it. But enough do to clog up our EDs across the nation.

Human motivations are all incentive based. You might not like fast food, but if all the food at grocery stores and fast food were free, how many people would live on a 100% mickey d's diet? It doesn't take everybody misuing a commodity or even most for serve damage to result.

Or, look at it another way: if all speed limit laws were repealed, MOST drivers would still be safe. But you can bet that the increase in danger on our roadways would far surpass the percentage of just those that abuse the new rules. They would create a danger for everybody.

~faith,
Timothy.

[Shamira Aizza]

Originally Posted by cabkrun

I would like to see studies that back these speculative thoughts up.
If Universal Health Care in Europe and Asia is failing, why are we so far down on the list of health of citizens?
Canadians (or Europeans) running over the US for health care is BS and a myth. Show me some info on this supposed fact.

It's not speculative that the waits are longer, or the population is smaller and lives within 2 hours driving distance of a border where privatized care is available to them, or that more Canadians have knee surgery in the US than in Canada, or that socialized systems ration health care.

The reason we are so far down the list is because in general, we don't take care of ourselves. We eat a lot of bad food. We don't exercise as much as we should. We engage in behaviors that impact the health of our newborns.

Someone wanted to see facts. I'll start out with a link to a site with numbers from 1994...and the Canadian system hasn't improved since then. NCPA Brief Analysis 104: Price Controls and Global Budgets: Lessons from Canada. Here's a summary; about 5% of Canadians are on a waiting list for BASIC services...this doesn't include specialists services or things like a CT. 177,000 are waiting for surgery. Remember, the population of this country roughly matches California. Imagine if 177,000 people in California were waiting for surgery. And for proof a failure to improve this system has resulted in the development of the "Wait Times Reduction Fund" by the Canadian government.

33% of Canadian physicians have referred a patient for services out-of-the-country, usually to the US. The premiere of Quebec came to the US for treatment of skin cancer, and paid for it himself.

This is how Canada is able to report lower cost-per-person than the US in health care expenditures; they simply deny or delay the care.

I'd also like to point out that the statistics used to show lower mortality rates among certain countries are not obtained by any consistent standard. The only agency that compiles these Stat's is the WHO, and they do not have researchers on staff. They do not conduct research. They simply ask countries to give them their numbers on infant mortality (etc), and they publish them. What this means is that the country contributing these numbers gets to decide how they are obtained and calculated. For example; the US may attempt resuscitation of any preemie at 24 weeks, and calculate this as an infant death if the child dies, say...3 days later. However, a Scandinavian country may not even attempt resuscitation on anything less than 27 weeks, and might not count any infants who died who were born below 30 weeks. Sort of makes them look like neonatal experts. If they are supposedly engaging some sort of medical expertise that makes them superior at providing neonatal care, then I'd ask how many of you would be willing to go to Cuba, or the Balkans (still rebuilding from years of occupation and civil war), and have your babies, because these places are reporting lower infant mortality rates. It has nothing to do with the health care system and everything to do with the way they punch in the numbers.

Here's more for people looking for evidence; it's a link to a company called "Timely Medical Alternatives." It's a company based in Canada, and run by Canadians all educated in Canada. Timely Medical Alternatives Inc. for Hip replacements. This link is to their "Services" page, and those services include linking patients to private providers in the US and Canada because of wait times. The site includes a link that is actually called "Waitlists," and if you review it you will see that in Ontario alone there are 50,000 people on waitlists for orthopedic and general surgery alone! You will also find that this is with a decrease in wait times, because Canada has begun to ease up on their restrictions on privatized health care.

The titles alone ("Wait Times Reduction Fund," "Timely Medical Alternatives"), are revealing themselves. Here's a quote from the Canadian Medical Association on a policy paper they wrote because the Canadian government was holding back some of the money from this fund, "All too many Canadians simply seek care elsewhere when life or limb is at stake and return to Canada and launch lawsuits at provincial governments and others. This trend can be expected to increase" (in the wake of a recent Canadian court ruling). This was written 8 months ago.

I'd like to point out that advocates of a more socialized system tend to also be advocates of embryonic stem cell research. Here's what Canada is spending on SCR: $31 million. That's nothing. Private donors alone have given that much in the US. California alone will spend $3 Billion for SCR. GWB approved $250 million for SCR, $39 million for Embryonic SCR. Stem Cell advocates are mad now...what services will they cut to fund embryonic stem cell research to any functional degree?

The CMA has turned against socialized care, socialized care does not support SCR, so why would we want to turn to a program that will ration care and leave us with no alternatives when the government says "no care for you. You are too old or too sick." Admittedly, costs will decrease if we are all put on waiting lists until we die.

[hollyvk]

My, my, my, my, my! (Having just read through all the previous postings at one sitting).

Let me provide some clarifications and then raise a couple of new points.

Canadian vs UK healthcare systems: Canada has a one-size fits all system, if you don't like what they have (or how they're doing it) your only choice is to travel out of the country for care. The UK has national health services that are available to all, but if you have your own private health insurance coverage (or you're Lord Big Bucks and can pay out of pocket) you can access private healthcare providers and services. I've had family in both systems, I prefer the UK system. (Although if you have UK elderly relatives, there is systemic rationing of heroic care for older patients, but truly is that a bad thing given the cost versus benefit?)

What is the No. 1 reason individuals in this country file for personal bankruptcy? Medical expenses incurred by uninsured or underinsured people.

I have a diabetic friend who wound up without coverage and had to go in for foot amputation at an HCA facility last year. Two months later the facility filed suit, obtained a judgment, and placed a lien on his house. Being too stubborn to file for bankruptcy (still not able to work, and no private disability insurance either), he lost the house to foreclosure, so the debt load continues to snowball . . .

Heathcare in this country is built on the premise of "cost-shifting." The uninsured patient costs are absorbed by the private healthcare insurers and passed on to consumers (and their employers who provide group coverage), in other words--to all of us. And the bankruptcy, foreclosure, and downward trending economics of the affected patients are also passed on to us all in the form of higher mortgage, credit, and tax costs.

So who's getting rich off this setup? Well, it's not the nurses, and it pretty much isn't the physicians (not unless they start their own insurance companies), nor is it the facility administrators. Who does that leave? What stocks and mutual funds continue to perform well in tough times? Can you say:

"For profit healthcare companies?" (think HCA, Tenant)

"Drug companies?" (think GlaxoSmithKline, Merck, Pfizer)

"Medical supply or device companies?" (think Abbott, Baxter, GE Healthcare)

"For profit heathcare insurers?" (thinks UnitedHealthcare, Cigna, Aetna)

And if you think the nation's largest employers have been able to sucessfully leverage their health insurance costs against these financial giants, you are sadly mistaken. Wal-mart (I think you're lucky to get any coverage with them), McDonalds (ditto), UPS, General Motors; even these groups aren't big enough.
We're all just small potatoes compared to the clout of the actual players. Which is why things get much more interesting when 2 of the big players want to go toe-to-toe over costs, say for example HCA versus UnitedHealthcare. . . .

Would having some sort of bare-bones universal health coverage be a good thing? I think so because it would help control the costs the big players are sucking out of us on an ever-increasing basis. And I particularly resent having to foot the research and development (R & D) costs for the drug companies when most other countries are able to negotiate much better drug rates than we see in the US.

Would that make it a communist or socialist scheme? No, because it doesn't have to be the ONLY option, and goodness knows we are all about having a lot of options in this country. But the size of the group for the indigent and the uninsured in the US is really large, and that's why those big players are working so hard to keep us disinterested in having such a system--it will cut way into their profits.

But in the meanwhile, you can reap some of the benefits accrued by the big players (and offset your ever-increasing insurance and out-of-pocket costs). All you have to do is buy their stock or invest in mutual funds that emphasize those big healthcare companies. If you can't beat them, join them!

HollyVK, RN, BSN, JD and investor