[HM2Viking]

Originally Posted by SMK1

So that still leaves a large chunk with concerns and doesn't address premed and physicians. Point?

This is the real point:

We disagree with both views. It is unthinkable to label our current system as "highest quality" given its frequent failure to provide such basic services as immunizations or prenatal, primary, and preventive care. Moreover, there is growing concern about quality problems with the care that is provided. Quality problems in the current system include denial of care, discrimination,8 disparities, geographic maldistribution,9 lack of continuity, lack of primary care,10 inadequate or lack of prenatal care,11 failure to provide beneficial prevention,12 substandard/incompetent providers,13 declining patient satisfaction and impersonal care,14,15 iatrogenesis (negligent adverse events),16 diagnostic errors,17 unnecessary procedures/surgery,18 sub-optimal medication prescribing/usage,19 and neglect of quality-of-life/psychosocial issues.20 Our "highest-quality" complacency is especially challenged by insights from two seemingly disparate sources: (1) epidemiologic research based on financial claims databases and (2) industrial quality improvement concepts pioneered in Japan. These two sources converge around the concept of "variations," illuminating widespread differences in clinical practice, further challenging the cost-access-quality trade-off assumption. Data and insights from these two new paradigms demonstrate that better care will actually cost less once improvements are made in care processes and clinical decision making.21,22
Source:
http://www.pnhp.org/publications/a_b...lternative.php

[SMK1]

Originally Posted by HM2Viking

This is the real point:

We disagree with both views. It is unthinkable to label our current system as "highest quality" given its frequent failure to provide such basic services as immunizations or prenatal, primary, and preventive care. Moreover, there is growing concern about quality problems with the care that is provided. Quality problems in the current system include denial of care, discrimination,8 disparities, geographic maldistribution,9 lack of continuity, lack of primary care,10 inadequate or lack of prenatal care,11 failure to provide beneficial prevention,12 substandard/incompetent providers,13 declining patient satisfaction and impersonal care,14,15 iatrogenesis (negligent adverse events),16 diagnostic errors,17 unnecessary procedures/surgery,18 sub-optimal medication prescribing/usage,19 and neglect of quality-of-life/psychosocial issues.20 Our "highest-quality" complacency is especially challenged by insights from two seemingly disparate sources: (1) epidemiologic research based on financial claims databases and (2) industrial quality improvement concepts pioneered in Japan. These two sources converge around the concept of "variations," illuminating widespread differences in clinical practice, further challenging the cost-access-quality trade-off assumption. Data and insights from these two new paradigms demonstrate that better care will actually cost less once improvements are made in care processes and clinical decision making.21,22
Source:
http://www.pnhp.org/publications/a_b...lternative.php

Then we are in agreement, I merely pointed out certain groups that have concerns and why. If we want to pass any sort of legislation regarding reforming healthcare it is important to understand all of the problems that people have with proposed systems and find ways to solve or alleviate their concerns. This was my point. The above information I agree with but it has little to do with what I was discussing. The whole system needs to be revamped from the ground up including malpractive insurance rates and educational expenses. These things stand to pose a big problem for the future of healthcare in this country if changes aren't made as well.

[CHATSDALE]

if we have the type of care that has been talked about
will all hospital have to be sold to the government
will health care workers be on a pay plan such as va nurses are now
will doctors be employees of government or will they be like a independent contractors can they opt out and be available to private patients only or will they be required to have certain number of free patients
it is one thing to have a show which tugs at your heartstrings but when hard decisions have to be made oprah will be having a program about something else and our dear congress and their lobby friends will be making mincemeat out of us

[pickledpepperRN]

With Single Payer the multiple providers remain the same. Private and public, profit and non-profit hospitals, nursing homes, rehab facilities, clinics, doctors, pharmacies, laboratories etc.
But instead of multiple payers we will have a single payer like an improved Medicare.

http://www.guaranteedhealthcare.org/...ayer_top10.pdf

Watch this compelling video to see the power of CNA/NNOC RNs in action and to learn the problems with compromise healthcare plans like AB 8.
http://www.youtube.com/watch?v=_dPVNl8gko8

[canoehead]

I'm from Canada, and the system does not work there, do not assume that in comparing government vrs insurance systems that by eliminating the money issue for the consumer that money issues disappear.

Each hospital is given a certain amount of money to run each year, and if it is a bad year they get by without essential staff and equipment. If we have a good year there will absolutley be a cut in funding the next year. The government does not deny services, but they do put you on a waiting list for virtually every procedure you might need, and many die waiting, or get sicker. You can lose your job and go bankrupt waiting as easily as when you have high copays. Waits are long because there is not enough money in the system to provide timely care.

An elderly person suffers an acute injury and needs nursing home care. There is an eighteen month waiting list to get into a nursing home in Nova Scotia. Each hopital deals with this by setting aside a unit to take people waiting for a nursing home. There is even a six month wait to get on the hospital unit. People die and decline because they don't get the stimulation a nursing home provides, hospital nurses give sick patients priority care (as they should).

My uncle needed a cardiac bypass, and after seeing the cardiologist was on the waiting list for 4 months. The cardiologist was too busy to see him again until the surgery. He died the weekend before surgery was scheduled.

My mother needed physiotherapy but the closest office was 90 minutes away, and the waiting list to get in was 6 weeks. She had to move in with relatives so she would be close enough to tolerate the drive, and wait in pain for the 6 weeks.

A September 2007 newspaper article talked about a 29yo female who suffered a brain injury four years ago, and is still waiting to get into rehab. (The article requires payment the link, sorry)


In the Canadian system money still rules, and long wait lists weed out lots of patients. It is illegal to set up private care that would give the rich an advantage. If borrowing or selling would save a loved one's life I'd do it, but I wish we had that option.

[SMK1]

The long waits are a huge issue, but it isn't like there aren't waits in the American system. I just got health insurance over the summer because I was experiencing some problems. It took a month to get in to see anyone, meanwhile I was having palpitations, a resting HR of 120-130's (nowhere near my norm), BP 180/120 (again I don't have HTN ), dizziness and the list continues. After a summer full of testing I found out that I have Graves disease and a suspicious nodule on my thyroid that needs to be investigated due to the possibility of cancer. I found this out almost 1 month ago and must wait until late October to get in to see an endo and it was the ONLY endo with an appointment available in a 3 city metro area. So I am waiting 2 months to have a biopsy. Now the waits could be far longer in Canada but it isn't like there aren't waits here as well, not to mention the insurance hold up while they decide how they are going to get out of paying a claim. There are many people who die waiting here because they are fighting with insurance companies to get them to do what they are supposed to do. Or the people who have no relief in sight because they have no insurance and are required to pay upfront 200-300 dollars to see a doctor who may not be able to tell them anything useful without further testing for which they don't have the money. No system is perfect, but what we have is no longer just broken, it is shattered.

[sanctuary]

For all who feel that a "Government Run Health Care System" will be more expensive, or hugely invasive , remember that our dear elected officials, from the Prez on down to the newest house member all have it, for free, no co-pay, no problem, and they are not complaining.

[sharona97]

The Washington D.C. boys club generally don't complain about their federal benefits. The successful players IMO work hard to change whatever in their own state. Or work to pass bills in D.C..

[jmgrn65]

People don't die waiting on Heart Surgery in the US, if they need it they can get it immediately.
The reason there is a long wait to get into see a specialist is simple, not enough specialists.
We at least have health care available. 3rd world countries don't have insurance they don't even know what that word means. if they don't have money then they don't get any care. Unless they are lucky enough to get to a clinic. Yes I have been to 3rd world country.
There is no easy answer. I beleive that every child is entitled to health care. I don't know how I feel about all adults, because there is too much abuse of the system. IMO

[HM2Viking]

From Don McCanne at PNHP:

Kaiser Daily Health Policy Report
September 25, 2007
Employers, Health Insurers Increasingly Use Care Managers To Review
Physicians' Treatment Plans, Ensure They Conform to Evidence-Based
Practices

A growing number of employers and health insurers are using care
managers, or integrated health managers, who "essentially audit an
employee's health care and look for ways to both improve outcomes and
save money," the Wall Street Journal reports. According to the
consulting firm Deloitte & Touche, there are more than 200 care
managers in the U.S. who provide "programs designed to save employers
and health plans money by reviewing employees' health care claims and
targeting high-cost cases for special management," the Journal reports.

Care managers often review physicians' treatment plans to ensure they
are following established evidence-based practices and help
coordinate care for people with serious illnesses. Based on the
reviews, "the companies then may nix certain drugs or procedures,"
the Journal reports.

Critics say that some of the programs "intrude into the private
relationship between patients and their doctors and that they add yet
another layer of bureaucracy, while saving money mostly by denying or
switching specific drugs and procedures," according to the Journal.
Other critics say that care managers can be inflexible and ignore
differences between individual patients and the judgment of
physicians and nurses.

Cecil Wilson, immediate past chair of the American Medical
Association, said, "The patient's physician should ultimately be the
one in charge," adding that cost-saving should not be the main goal
of care managers (McQueen, Wall Street Journal, 9/25).

http://www.kaisernetwork.org/Daily_reports/print_report.cfm?
DR_ID=47740&dr_cat=3


Comment: Big Brother is watching you. Only he is not from the
government. He is an agent of the Invisible Hand.

Intrusive micromanagement of health care today is not coming from an
oppressive government, but rather it is an innovation of the free
marketplace.

Rather than micromanaging health care, the stewards of a government-
administered single payer system would macromanage the funds to pay
for health care. Health care micromanagement decisions would be left
to patients in consultation with their health care practitioners.

Of course, oversight of the spending of public funds would be
essential to be certain that they are not inappropriately diverted
through fraud and abuse. But that would be at arms length and not
through disruptive intrusions.

Again, the private industry is foisting off on us yet more of its
primary product: wasteful administrative excesses.