[HM2Viking]

[quote=KayMichelle;2662641]

Originally Posted by mjlrn97

Wow.

Again, I thought we were discussing the merits of univeral health care.

I didn't think we were discussing the option of denying anyone medical care.

That doesn't actually exist here in the United States. You can go to any emergency care unit at the hospital and it is illegal for them to turn you away.

Then, you can just ignore the bill. You can give them a false name and never see a bill.

It could happen, however, if we had universal healthcare.

That is why many are against it. It would "universalize" the system, so that your particular problem could be scrutinized with a history. Denial could happen pretty easily.

Healthcare reform is probably a better idea. That way, we can continue with no one being denied care. You see, it is possible that no one would know that Mary had COPD because she smoked for 50 years if that info wasn't centralized by a huge bureaucracy.

I don't think you gave a good example, however, because there isn't much that can treat her breathing problem very well with so much damage. Also, if you already have gangrene, insulin isn't going to help very much.

You know, no matter how good a nurse you are, you are not God, and people do get chronic diseases. Many times, these people are overmedicated in nursing homes, no matter what you do - those with COPD live dismal lives - many on tracheostomies with ventilators.

You should try not to personalize these discussions. We as nurses, need to have a solid viewpoint on these issues that pertain to our profession, we need to discuss them. We might be the ones pushing for a policy that might actually harm our patients in the long run.

When you call people names and say how disgusted you are with them for their opinions, it doesn't exactly foster open discussion. It makes people not want to discuss anything at all. I have mixed feelings about universal health care. Yes, I feel sorry for those who are noncompliant, but I've had noncompliant patients myself, and think there should be some kind of predetermined sanctioning against it. It is frustrating for everyone.

I don't "got mine". I haven't had health insurance in many, many years. When I did have it, I paid $350 per month with a $3,000 deductible, of which I never once hit the top. I have a schmuck of a little sister who goes to the emergency room for every possible problem, which is quite often since she is a hypochondriac, and she has never paid a dime.

I know there could be terrible consequences for an open system, at a time when inflation is rampant, prices for gasoline, housing, food is going up at racing levels. I don't think we can afford that as a people.

Kay,
I took the time to pull up the following on a better way to care for chronic illness.

A wiser approach is to seek to separate cost-effective care from unproven treatments, and align the financial incentives to encourage the former and discourage the latter. The French have addressed this by creating what amounts to a tiered system for treatment reimbursement. As Jonathan Cohn explains in his new book, Sick:

In order to prevent cost sharing from penalizing people with serious medical problems -- the way Health Savings Accounts threaten to do -- the [French] government limits every individual's out-of-pocket expenses. In addition, the government has identified thirty chronic conditions, such as diabetes and hypertension, for which there is usually no cost sharing, in order to make sure people don't skimp on preventive care that might head off future complications.

The French do the same for pharmaceuticals, which are grouped into one of three classes and reimbursed at 35 percent, 65 percent, or 100 percent of cost, depending on whether data show their use to be cost effective. It's a wise straddle of a tricky problem, and one that other nations would do well to emulate.

http://prospect.org/cs/articles?arti...lth_of_nations

Also please see the following:

Indeed, the VHA's lead in care quality isn't disputed. A New England Journal of Medicine study from 2003 compared the VHA with fee-for-service Medicare on 11 measures of quality. The VHA came out "significantly better" on every single one. The Annals of Internal Medicine pitted the VHA against an array of managed-care systems to see which offered the best treatment for diabetics. The VHA triumphed in all seven of the tested metrics. The National Committee for Quality Assurance, meanwhile, ranks health plans on 17 different care metrics, from hypertension treatment to adherence to evidence-based treatments. As Phillip Longman, the author of Best Care Anywhere, a book chronicling the VHA's remarkable transformation, explains: "Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose is the highest ranking health care system? Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the veterans health care system outperforms the highest-rated non-VHA hospitals."
What makes this such an explosive story is that the VHA is a truly socialized medical system. The unquestioned leader in American health care is a government agency that employs 198,000 federal workers from five different unions, and nonetheless maintains short wait times and high consumer satisfaction. Eighty-three percent of VHA hospital patients say they are satisfied with their care, 69 percent report being seen within 20 minutes of scheduled appointments, and 93 percent see a specialist within 30 days.
Critics will say that the VHA is not significantly cheaper than other American health care, but that's misleading. In fact, the VHA is also proving far better than the private sector at controlling costs. As Longman explains, "Veterans enrolled in [the VHA] are, as a group, older, sicker, poorer, and more prone to mental illness, homelessness, and substance abuse than the population as a whole. Half of all VHA enrollees are over age 65. More than a third smoke. One in five veterans has diabetes, compared with one in 14 U.S. residents in general." Yet the VHA's spending per patient in 2004 was $540 less than the national average, and the average American is healthier and younger (the nation includes children; the VHA doesn't).

http://prospect.org/cs/articles?arti...lth_of_nations

Rgds...

[BlueRidgeHomeRN]

[quote=ingelein;2662533][quote=KayMichelle;2662530]

How absurd, of course I don't think these people "don't deserve healthcare". I just don't think that the government should use their police powers to force Peter to pay for Paul's bad choices.

You are jumping from conclusion to conclusion. No one has ever advocated that we "DENY" anyone healthcare. Just that we don't become enablers by financing the fix to bad choices.





Your post just proved my point.

You are a nursing student, perhaps you should familiarize yourself with the Core Nursing Values

quote]

Funny, the Nursing Core Values you chose to overlook...

• Autonomy
• Stewardship
• Justice
• Truth
• Freedom
• Integrity

Do you think we can stick to UHC and not "denial" of care. There is a big difference. Professional Nurses who do not see value in handouts, enabling, and "curing the world" are every bit as professional as those who want to save everyone--a futile pursuit.

PS-slamming students is also un-cool......

[BlueRidgeHomeRN]

Originally Posted by carolinapooh

I am sorry - but I agree with this. I am a card-carrying, flag-waving, proud-to-be-an-American, and I wouldn't want to live anywhere else - but I agree completely with the Germans on this one.

Oh, I see the flames coming...bring them on....

Sorry to disappoint, but this is a kudo, not a ...

My original post was trying to point out just your thoughts--I think its a great idea, too, but if you saw my post about the Florida helmet law, you know that many of our fellow Americans want to have their cake and eat it too--the FREEDOM to make choices without the RESPONSIBILITY for the consequences (sorta the way the average 13 year old thinks!!).

So--the level 1 trauma center I worked at in Orlando had beds full of neurotrauma, unhelmeted cyclists...no assests, no insurance, and ready to spend the rest of their life in a SNF on the hospital's dime. And we wonder WHY Tylenol are $10 @? Gotta make up the money somewhere....or go bankrupt and serve NOBODY!!

[suanna]

I don't know that it will have much of an impact on out compensation package at all. The health care providers still have to pay a nurse to do the job and the market is the driving force behind our compensation. The job itself may change a bit with everyone having the availability of health insurance we may find younger patients from a lower economic class becoming more often. Despite appearances, there are still some people that worry about how they are going to pay for a hospital stay. These folks may have the oppertunity to get the health care they need. We all may have to brush up on patient care other that geriatrics.

[jjjoy]

Originally Posted by KayMichelle

Honestly, I can't think of anything a government does right so I hate to put our healthcare industry into their hands.

Not one darn thing?! The fact that we do have many freedoms in a relatively stable society means that despite all of the problems (and I won't deny there are *many* problems) with government that it's not all gone to hell. I'm not for the federal government micro-managing the entire country, but to say it does *nothing* right seems rather over the top.

On a separate note, I'm not sure who used the term "police state" but do be aware that to the general public this terminology is embued with a lot more emotionalism than the way you describe it is used academically. You clarified that you were using it only as indication of a state that can incarcerate those who don't follow it's laws (such as paying taxes). I'm not sure what other kind of state there is out there that is effective. What is more relevant is who makes the laws to be enforced and if those laws are more or less fair and consistent.

[ingelein]

[quote=BlueRidgeHomeRN;2663031][quote=ingelein;2662533]

Originally Posted by KayMichelle

How absurd, of course I don't think these people "don't deserve healthcare". I just don't think that the government should use their police powers to force Peter to pay for Paul's bad choices.

You are jumping from conclusion to conclusion. No one has ever advocated that we "DENY" anyone healthcare. Just that we don't become enablers by financing the fix to bad choices.






Your post just proved my point.

You are a nursing student, perhaps you should familiarize yourself with the Core Nursing Values

quote]

Funny, the Nursing Core Values you chose to overlook...

• Autonomy
• Stewardship
• Justice
• Truth
• Freedom
• Integrity

Do you think we can stick to UHC and not "denial" of care. There is a big difference. Professional Nurses who do not see value in handouts, enabling, and "curing the world" are every bit as professional as those who want to save everyone--a futile pursuit.

PS-slamming students is also un-cool......

I was not slamming her as being a student, one of our BEST debaters when he was a student was HM2Viking. I was trying to convey the idea that perhaps with experience her way of approaching a patient would change a bit, DEMANDING a patient to do anything will get one nowhere.Again, nurses do better when we TEACH, not PREACH.

No one has said in this debate that enabling is a correct way with dealing with a non compliant patient, I wonder why it continues to be used as an argument point? This seems to be an attempt to TWIST what the REAL purpose of the original comment was. If you can find where I posted it was acceptable to ENABLE, please refresh my memory.

I used the NLN website for the core values.Those were the only ones listed, I didnt CHOOSE to overlook the ones you listed, they were not on the NLN site. Again, trying to TWIST my meaning.

http://www.nln.org/aboutnln/corevalues.htm

When quoting things, its helpful to list the source.

[Jolie]

[quote=ingelein;2663539
No one has said in this debate that enabling is a correct way with dealing with a non compliant patient, I wonder why it continues to be used as an argument point? [/QUOTE]

Perhaps not in so many words, but if continuing to pay for futile health care services to rescue clients who decline to follow treatment regimens that would stabilize their conditions is not "enabling," then what is it?

[ingelein]

Originally Posted by Jolie

Perhaps not in so many words, but if continuing to pay for futile health care services to rescue clients who decline to follow treatment regimens that would stabilize their conditions is not "enabling," then what is it?

Could you post some examples of these futile health care services?

[Jolie]

1. Inpatient, residential treatment at weight-loss facilities for morbidly obese clients who are documented to have family members bring in food or who order food from late-night delivery services. (As documented on TLC and Discovery Health programs.)

2. Continuing treatment for complications of uncontrolled diabetes (neuropathy, circulatory problems, amputations, vision problems, kidney failure, dialysis) for patients who refuse to check their blood sugars, or attempt weight loss or exercise. (This would include my aunt who refuses to participate in daily care of her diabetes, but calls 911 and rushes to the ER for treatment of unpleasant complications. BTW, she has both a primary physician and an endocrinologist, whose suggestions she ignores.)

3. Repeated emergent treatment for complications of heart disease (multiple angioplasties and/or by-pass operations) for patients who refuse to alter their lifestyles to include exercise, attempted weight loss, reduced fat diet, efforts to stop smoking, etc. (This would include a dearly beloved neighbor who recently passed away from complications of his 4th bypass surgery.)


I could go on, but you get the idea.

[ingelein]

Originally Posted by Jolie

1. Inpatient, residential treatment at weight-loss facilities for morbidly obese clients who are documented to have family members bring in food or who order food from late-night delivery services. (As documented on TLC and Discovery Health programs.)Absolutely right! I agree.

2. Continuing treatment for complications of uncontrolled diabetes (neuropathy, circulatory problems, amputations, vision problems, kidney failure, dialysis) for patients who refuse to check their blood sugars, or attempt weight loss or exercise. (This would include my aunt who refuses to participate in daily care of her diabetes, but calls 911 and rushes to the ER for treatment of unpleasant complications. BTW, she has both a primary physician and an endocrinologist, whose suggestions she ignores.)I don't think this would ever happen, to deny them continuing care despite non compliance would bring a slew of law suits when they actually do go blind, or lose a leg, or die from complications of gangrene , the families would say treatment was withheld. Bariatric surgery should be allowed, private health insurance has considered it "cosmetic"surgery and routinely denied it.UHC hopefully will see the value in it.

3. Repeated emergent treatment for complications of heart disease (multiple angioplasties and/or by-pass operations) for patients who refuse to alter their lifestyles to include exercise, attempted weight loss, reduced fat diet, efforts to stop smoking, etc. (This would include a dearly beloved neighbor who recently passed away from complications of his 4th bypass surgery.)Limits on bypass surgery sounds fair.


I could go on, but you get the idea.

I understand and actually agree that it is cost prohibitive to continue some treatments and surgerys. I think that the French have a good model for the care of the chronic conditions, maybe HMViking has this info in his probably massive file.

Another question, what do you think about Medicaid paying for babies of women who choose not to do selective reduction in a multiple baby pregancy causing the babies to be born very prematurly . Babies under the weight of 2.6 pounds are eligible for Medicaid and SSI, even if they are generally healthy, with only the typical preemie problems.During the time of hospitalization there is no limit on the parents income to be eligible for this entitlement.Any idea of how much a preemies hospital costs are? Multiply that by the number of the babies.

http://www3.fertilethoughts.com/foru...d.php?t=290929