How Will Universal Health Care Change Nursing?

Fiona59 · Jun 24, 2009

http://videolog.uol.com.br/video.php?id=415355
This is a normal government funded hospital in Recife, Brazil. UHC... Thinking out of the box... Please... Private pay hospitals in Brazil are very good and in many ways comparable to American hospitals. Take care.

I work in what Americans would call "an inner city" hospital. Even on our worst nights, we've never had scenes like that. My first though was natural disaster or huge MVA?

Saúde · Jun 24, 2009

Why is it inconceivable for a average salary earning individual to pay for their own medical expenses? I hear a lot of people talking about solutions to our current healthcare mess. But I rarely hear people talking specifics on how the healthcare mess started in the first place. Does anyone have expertise on how and when this mess first started?

IMO - HMO's and managed care systems are the culprits of the escalating costs of medical care. Both these systems take the responsibility of paying out of the hands of the person receiving the care. This is very important to understand because it removes the market incentive and results in incremental and artificial rises in healthcare costs. I think there is an obvious correlation between the government and corporations paying for medical bills and the rise we've seen in medical costs.

IMO - The current proposals to remedy our healthcare mess are not much different than the remedies that caused the mess in the first place. The only difference is that the current proposed rememdies are on steroids and are gift wrapped in beautiful colors.

I was curious what folks thought of the idea of changing our tax codes to allow individuals to deduct ALL healthcare costs from their taxes, just as employers can? Take care.

kinesjl · Jun 24, 2009

Your "these terrible things will happen" theories are just that, theories - not based on fact. You do not show any basis for your theories.
Perhaps under this plan, something like an MRI won't be able to charged at several thousand dollars, when it costs nothing like that to provide. The amounts charged and reimbursed are ridiculously inflated - who's getting all the bonus?
My home country has both UHC and private insurance. Why would anyone take private insurance? Because you get to skip lines, and choose your surgeon, and go to fancier facilities. Why else? Because you get a tax break - you pay a lower medicare levy. Plus, tax rates are NOwhere like 54%.
I think it's interesting that the people who are most against UHC are the people with no actual experience of it.

On the contrary, the state models, such as Massachusetts, which are often cited as a blueprint for health care reform, provide ample evidence of the pitfalls of governement health care.

Although the state has reduced the number of residents without health insurance, 200,000 people remain uninsured. Moreover, the increase in the number of insured is primarily due to the state's generous subsidies, not the celebrated individual mandate.

Health care costs continue to rise much faster than the national average. Since 2006, total state health care spending has increased by 28 percent. Insurance premiums have increased by 8–10 percent per year, nearly double the national average.

Program costs have skyrocketed. Despite tax increases, the program faces huge deficits. The state is considering caps on insurance premiums, cuts in reimbursements to providers, and even the possibility of a "global budget" on health care spending—with its attendant rationing. A shortage of providers, combined with increased demand, is increasing waiting times to see a physician.

Giving the government greater control over our health care system will have grave consequences for taxpayers, providers, and health care consumers. That is the lesson of the Massachusetts model.

darrell · Jun 24, 2009

I was curious what folks thought of the idea of changing our tax codes to allow individuals to deduct ALL healthcare costs from their taxes, just as employers can? Take care.

Beautiful. I can afford, say, $100 per month for healthcare. Handle it through a risk pool or whatever. I can not afford $1200 per month for two people's meds (our current real-life estimate) plus a few thousand more for office visits, labs and whatnot. Even if it is deductible.

Obviously I can get rid of the cars, drop the cable and Internet, tighten up the meal belts and stop visiting relatives - all of this will save money which can then go into healthcare expenses. Not much good for the economy, I suppose, and certainly not an improvement to my quality of life, but prioritization and all that...:).

D

Saúde · Jun 24, 2009

Currently, it is illegal for individuals to cross State lines to purchase health insurance.

A market study by eHealth Insurance found that prices vary drastically from State to State. For example, in their study they found the 10 top cities for affordable health insurance all had policies with premiums under $60/month. In contrast, for the exact same policy in New York City the premium was $334/month. The study found that there is a direct correlation between the amount of regulation the State Governments place on the insurance companies and the costs of the premiums. For example, in New York City their State Government forces Insurance Companies to sell policies at the same price to everyone, regardless of age or health for the sake of universal access. This results in increased premiums for everyone. Younger people tend to drop or not get the policies because it's unfair to them.

A market study by the AMA surveyed 294 Metropolitan Cities and found that in 95% of the cities 1 insurance company provided coverage for 30% of the population. In 50% of the cities 1 insurance company provided coverage for 50% of the population.

IMO - We have a monopolized managed care system with little or no competition, entwined with hyperregulation by State Governments, entwined with our Federal Government making laws cripling competition by not allowing interstate commerce of insurance policies....... and we wonder why the average salary earning individual can't afford health insurance anymore??? Take care.

buransic · Jun 24, 2009

Re: Top 10 Most Expensive Cities in the World.

I'm thinking it might be more coincidence. Switzerland has a federal program for basic coverage and people have to buy supplemental insurance for coverage for chronic or catastrophic conditions. In 2006 they spent 11.5% of GDP on health care. The US was number one at 15.3%. Japan? Twenty-first at 8.1%. Canada was 8th at 10.0%. Hmmm...the country with the highest, by 35% over the 2nd highest, spend as a percentage of GDP is us (US). That's also an interesting coincidence. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5813a5.htm

Saúde · Jun 24, 2009

HMO's have considerable government regulation and oversight. Here's a real life example.

I am a 39 year old mother, that is disabled and in a wheelchair for life. My doctor has told me that I need a medically necessary surgery, and that I will die an early death without it. The catch is, my HMO will not pay for this surgery. I have been through three appeals already, and I went through a State Board of Appeals last Monday. I lost again. The reason I lost is: the state claims they cannot make the HMO pay for my surgery because there is no law saying that the insurance must pay for a medically necessary surgery.

The logic behind HMO's is the control of health care costs. There is an obvious historical correlation between government involvement in trying to control health care costs, which started in the 1970's, and the increases we see in health care costs today. The high costs of health care we see today is not a result of a free market, but a result of a free market morphing into a controlled market. Take care.

MedSurgeMess · Jun 24, 2009

We've gotten way off of the subject: How will UHC change nursing?

Let's hear from the nurses from various countries with UHC-how is you pay as it relates to the cost of living in your area

rnnowalways · Jun 24, 2009

Thank you, Spidey's mom. You had done a lot of research on this subject. Being a person who lived in a country with a Universal Healthcare, I am totally horrified by a prospect of having the same sysyem here. And so is everybody else I talk to who came fromthe same background. We have a first - hand knowledge about it. IT DOES NOT WORK!! It decreases a quality of care, and the main reason it cuts costs - that sick people do not get the care that they need. There is a long waiting list for necessary procedures, including very necessary ones. THAT IS HOW THE MONEY IS SAVED!! think about all your family and friends with health problems, all your elderly mothers, fathers and other relatives, and decide - are you ready to let them die because of the lack of a necessary care which will not be provided to them under government-run plan. I know first-hand how it works, I lived with it - believe me, IT IS BAD. if a person is older than certain age, government decides if they are worth giving a care they need to survive, after all - they will die sooner than a a younger person, who might need it more. it will be rationed. Will senators who try to push this nightmare helath care through use the same system? i know now they do not have to pay for anything and the healthcare plan they use covers everything with them making their own choices regarding which procedures they need to have. Nothing is limited or rationed out to them. It is a lie that we will have the same or even close to that sysyem - BECAUSE IT IS VERY EXPENSIVE! But they want to ration it out for us! I feel it is extremely unfair.

It will be a nightmare. And yes, nurses and doctors will get paid less, and there will be less innovation, because all the monetary incentives for it will be gone - did you see anything which is run efficiently by government? look what they did with our tax dollars so far? bonuses for those who ruined this country and all the bailouts? for us? not...

MaritesaRN · Jun 24, 2009

I went to a Single Payer event in Rochester, NY, last month where Rep. John Conyers (he & Dennis Kucinich co-wrote HR676, which I would advise everyone on this forum to READ before spouting off about "government-run" health care) was a guest along with Rep. Eric Massa, newly representing Rochester and a very vocal advocate of Single Payer. I was asked to speak about my experience as a case manager/discharge planner at a public hospital where all the uninsured patients are dumped by private hospitals. To be fair, the public hospital where I work is also a Level I trauma center, so the "higher level of care" transfers are often appropriate. Before I got to speak, Rep Conyers was asked about reimbursement by a physician in the audience and Conyers said that Medicare rates would be increased and that he believed all nurses should also get a raise!!
Health Care will NOT be "government run" under HR676. There is a lot of confusion in the debate because of many of the terms which are used. "Universal health care" really is universal coverage for a privately delivered, publicly financed system. "The Government" won't tell you what doctors you can see & what you can & cannot have the way FOR PROFIT insurance companies currently do if they still decide to cover you after you've gotten sick. And the FOR PROFIT insurance companies have worked their way into the Medicaid & Medicare programs by offering "managed care" options which are supposed to be less costly, but are actually devised to allow the FOR PROFIT insurance companies to exploit these publicly financed programs by deciding what to ration.
So a lot of this anti "universal" health care and anti Single Payer propaganda is coming from the Insurance Industry. They don't want to lose the cash cow of the health care industry -- those poor CEOs can't live without their multimillion dollar salaries and corporate jets.
As for the first post on this thread, please don't be so naive as to believe that there isn't an agenda behind what all these economist authorities are spouting -- look deeper into the backgrounds of these people and follow the money. Betcha none of them has ever had to decide whether to buy food or medicine or pay the rent or get your pills. Not a single one. They are telling you not to look behind the curtain and are distracting you with lots of shiny baubles.
Statistics can be manipulated to prove any point desired and the LAST study on anything health related I would ever trust would be anything by Blue Cross/Blue Shield or any drug company. As far as I am concerned those statistic manipulating reptiles have their heads up their anal sphincters and have absolutely NO connection with what working and poor people have to deal with in every day life. And I'll betcha there's some connection somewhere to either Insurance industry or Big Pharma.
And lastly, "The Government" is "We the people". Unfortunately, "we the people" have been dumbed down and lied to for a generation or more and we don't hold our elected representatives to task. Too many of them are bought & sold by insurance industry & Big Pharma and the decimation of Medicare/Medicaid and favorable legislation for these huge corporations is proof of it. So "the government" has become separate from "we the people" and corruption runs deep and wide.
We as nurses really need to become more politically active in changing our crumbling system and follow the lead of the California Nurses Association in advocating for a Single Payer system. Profit does not belong in health care -- there is NO ethical justification in what the for-profit insurance industry has done to the people of this country. PERIOD. Single Payer is the ONLY solution and I will fight for it until the day I die.

:yeah:Well said , well done. I myself do not understand as to why some people just can not see the "light". thank you so much for putting it in an accurate and correct perspective of the universal health or others call it socialized medicine.

nursecassia · Jun 24, 2009

I am a Canadian Nurse, So I work in a publically funded hospital..I can tell you that there are shortfalls with this system, as well as great strides...In British Columbia where I am there are significant wait times for procedures, however people do not have to pay for these procedures...there are also wait times in hospitals, where I am depending on the day it can be anywhere from 2-12 hours...that being said there are always people that come in that should just be going to see a GP but because we have a shortage end up in our ER....we also dont have enough long term care beds so our beds fill up with people waiting for placement in a LTC facility..As an RN i make a good wage, I have great benefits...the support staff also make a good wage although they are considering hiring a private company to do things like housekeeping, dietary to cut costs...We do pay taxes, not as high as in the States by any means..the patient ratios where I am are less than desired and sometimes we have patients in hallways but as stressful as it gets sometimes the people you work with really band together to get the job done...we are sometimes 8-1 on night shifts, and for a team of 8 have an RN and LPN...The biggest thing is that people here dont stress about what will happen if they end up needing a doctor visit or hospital stay, we may pay in taxes but no one here ever has to lose their house, or take out huge loans for medical expenses...Whenever we travel to the states for even one day we always always get insurance..I think alot of you are brainwashed into thinking this private pay thing is a good system, sure if you can pay for it....We may have to wait longer for things but we dont have to end up wishing we were dead after accumulating so much debt.. I strongly believe public is the only fair and equitable way to go...health care shouldnt go to those that can afford it, enough said..I would never ever ever want to work in a system that promotes this. If you end up going public you will see the challenges, but you will also see so many of the benefits as well...People here are grateful of the care they recieve not stressed or resentful, they dont have high expectations because they arent paying house and home for it... SOrry if I sound like a US hater, I am not...I just really dislike this crap system you have now that does nothing but make major corporations richer and kick those that are down.

nursecassia · Jun 24, 2009

also, I am reading more and more of your posts and I am sick to my stomach...not for the horrific stories because those are to be expected from a private pay system but for those of you that really truly believe that a private system is the way to go I am saddened....Do you all realize how incredibly selfish this system is? Who are you, or any insurance company to value one persons life over anothers...If two people enter a hospital bleeding out, who is going to get care first? the insured or the uninsured...it is as simple as that...THIS IS MORALLY wrong!!! Those of you that think this system works are also those of you that either 1.) have a ton of money 2.) are a person that gets richer off of others....remember, everyone is only one step away from being in a slum ... things change in peoples lives fast..you may have health care today because you make the big bucks, but wait till you get in that unexpected car accident, cant work to pay the bills and end up at the bottom of the barrel...I stand firm on the fact that private pay is nothing but heirarchy making the rich richer and the poor poorer...publically funded is EQUAL and FAIR!! you may not like it cause you have to wait in line for someone ahead of you but I guess you would just have to suck up your ego and realize that indeed we are all humans and should be treated equally....NO system is perfect, they are all flawed but why would you want to choose the morally repugnant one?