How Will Universal Health Care Change Nursing?

geekgolightly, BSN, RN · Jun 20, 2009

What concerns many nurses that I work with is more of a moral dilema. We see patients have millions of $ spent on them when we know they have little or no chance of survival, yet the systems continues to try and "fix" them because the family wants to try "everything". We've had nurses who've worked in the US say these patients would have been made "no codes" months ago for insurance reasons.

I have seen the opposite here in America. Where I work (MICU) many many patients come and start full code and remain full code throughout their stay despite the very low survival rate they are given. They either have private insurance, in which case private insurance stops paying when treatment is deemed futile and the hospital is stuck with the bill, or they have pending Medicaid or Medicaid and quite frankly I don't know what they pay for terminal intensive care treatment, but we are stuck with lots of them. They linger on our floor because they are too sick to move to another facility, and they eventually die on our floor.

Most recent example, a terminal cancer patient told her family she wants "everything done." She comes to ICU and stays in ICU for five months while her cancer progresses and spreads throughout her body. She is ventilated, on daily dialysis, on two pressors and has multiple chest tubes, as well as the typical electrolyte protocols etc etc. She develops infection after infection, all of which are treated, doctors literally quit her case, but the family is unfazed, they want ALL CARE DONE TO THE END. She is unresponsive for the two months prior to her death, but they want all care done. Insurance stopped paying after 30 days, so we picked up the bill. It was either that or a lawsuit, and from what I hear, they are now pursuing a lawsuit as well.'

So no, we don't automatically get DNR's. I wish we did. Honestly, I thought that would happen if we went to a single payor system.

geekgolightly, BSN, RN · Jun 20, 2009

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We need to stop arguing amongst ourselves and agree to disagree on the end result so long as EVERYONE benefits in the end. We need to take care of our people here, our kids, we need to help each other until everyone has their basic rights met. Do you consider the treatment of Cancer/Leukemia/Diabetes a privilege to be earned?

I want to say how sorry I am to hear all that you have gone through. It isn't fair and I hate this system under which we currently live.

But to speak to this directly. The problem with this premise is that lots of people in America believe, essentially, in Objectivism. Believe in every man for himself and those who don't make it, well they should have worked harder. SO we can;t start with this premise, that we hope that everyone benefits in the end, because that would mean someone is taking up slack for someone else, and here in America, that is unthinkable. Unfortunately.

leslie :-D · Jun 20, 2009

We all just need to step out of the box for a couple of minutes. Look beyond our own paychecks, pending student loan payments (mine!), 401k that went down the drain-mine too! And come together to be sure the gov does not pull a quick one but that we take care of our friends and neighbors alike.

The problem with this premise is that lots of people in America believe, essentially, in Objectivism. Believe in every man for himself and those who don't make it, well they should have worked harder. SO we can;t start with this premise, that we hope that everyone benefits in the end, because that would mean someone is taking up slack for someone else, and here in America, that is unthinkable. Unfortunately.

1st post is the ideal.

2nd post is the dominant force, the reality.

soooo disheartening.

leslie

Junebugfairy · Jun 20, 2009

with health insurance we have 'choices'.

i buy my own insurance, i refuse to take an employer plan. i bought my coverage at 18 so i would have a lower rate overall.

i have had numerous health problems, but thanks to my ins coverage they have no bankrupt me. 80/20 plans do have more out of pocket costs than a 500 ded with 100% coverage, but that is the plan you got.

i bought a plan that covers me very well, i picked and chose which benefits i wanted.

we need to cover those who cannot afford insurance, but at the same time i want to keep my insurance because i like it.

it seems to me that everyone wants something for free, and i cannot understand that mindset.

geekgolightly, BSN, RN · Jun 20, 2009

I don't want something for free. I want for people who cannot afford insurance to be able to get insurance.

Just FYI the Obama admin health system is not going to be "free." It will be sliding scale based on income. The lower the income the lower the out-of-pocket cost. There will be a percentage who get it for free, as they have nothing.

Also, this system as the Obama admin has set forth will not shut down free enterprise. There will still be other insurance options for those who can afford it, and want it. You can get private insurance in the UK as well.

tmgsn · Jun 20, 2009

All I can say is Wow.

It'sMe, RN, BBA, MBA · Jun 20, 2009

1rrrn - what if doctors and nurses got control of the system instead of the insurance companies trying to ram people through the production line? what if drug companies had fair prices and fewer side effects? it is going to get better for patients and therefore nurses! but, i wouldn't count on 1000 bed hospitals being there forever.
what planet are you on? universal healthcare will mean the government trying to ram people trhough the production line - i know i work in the nhs. doctors and nurses have very little say in anything here- government targets must be met at all costs, and if the illness/diagnosis you have doesnt have a target - well you may as well forget quality care.
the drug companies will continue to make their money, irregardless of who is paying them, the drug companies extract billions out of our government every day.
having worked in the nhs and in the us, i can tell you where i would prefer to have my insurance and my health care and it is not the nhs!! and i can also say that my worst employer in the us was 50 times better than any of my employers in the uk.

on the lighter side, irregardless is not a word. in fact it contradicts itself. just a comment.

It'sMe, RN, BBA, MBA · Jun 20, 2009

I don't want something for free. I want for people who cannot afford insurance to be able to get insurance.
Just FYI the Obama admin health system is not going to be "free." It will be sliding scale based on income. The lower the income the lower the out-of-pocket cost. There will be a percentage who get it for free, as they have nothing.
Also, this system as the Obama admin has set forth will not shut down free enterprise. There will still be other insurance options for those who can afford it, and want it. You can get private insurance in the UK as well.

The system of sliding scale payment for health care already exists in the US. It is the system found in the Community Health Centers. Based on your level of income you pay a certain amount. A clinic visit can cost you $5 if you are a family of 4 and below the poverty line and as much as 100% if you are a family of 4 with good income. The clinic is staffed with young physicians and NPs. Lot of Residents moonlighting. You can actually get pretty good care there.

However, this is where "poor" people go. Middle class and up go to their private physician. Insurance pays. Their copays are anywhere from $15 to $50. The waiting room is nice and usually has a flat screen TV.

Just like the "dumbing down of America" within the public school system perputated by the federal government and the educators unions you will see a "leveling" of the health care provision field. Eventually, under UHC, we will all go to the big building in town, sit in an overcrowded waiting room for hours, be seen by a "physician extender" and treated for our ailement. This is the promise of health care reform.

allnurses Guide · Jun 20, 2009

What rubbish. I have lived most of my life in a country with UHC (and also private insurance, if you want) and we don't even have "physician extenders". We certainly are not loaded into trucks going to some drab government health building haha. You can even choose your doctor and make appointments so you don't have to wait!!

It'sMe, RN, BBA, MBA · Jun 20, 2009

I wonder if the US government is driving private medicine out of business so that they can take over everything. Look at the reductions in what they will pay for medicaid and medicare. If they aren't doing it on purpose, then their doing it on accident. They are obviously bankrupting the private health care system for some reason. Anyone know?

Yes, it is quite obvious why they are doing it. We, in our fear of electing a female to the highest office in the land that represented a far left leaning small population of citizens accidentally elected an extreme left wing socialist into the white house. The socialist are doing exactly what they have always wanted to do, obtain power and control over the productive resources of this nation so they can control everything. Control equals power. Health care represents between 16% to 22% of our GNP. Huge slice of the pie. They want it, they are in power and they are going to do it quickly before the sheeple figure it out. We are going to wake up in 24 months and find that our economy is worse than Spains, Germany's and France's. And the socialist are pushing us even harder to become more European. Very few people can tell you what is going on with the bill but lots of folks can tell you the top three winners of American Idol. It is easy to take over a country when no one is paying attention.

It'sMe, RN, BBA, MBA · Jun 20, 2009

The up side of UHC for nurses? We will be able to finally get a national union that represents all of us and our issues. Since the government now owns GM it is not much of a leap of intelligence to consider that we all join the UAW and the Federal Employees Union, AFGE. If the government becomes successful in taking over the telecommunications industry we could combine the UAW, AFEG and CWA and then we would have some considerable weight in pay, benefits and staffing ratios. Could be a good thing!

It'sMe, RN, BBA, MBA · Jun 20, 2009

What rubbish. I have lived most of my life in a country with UHC (and also private insurance, if you want) and we don't even have "physician extenders". We certainly are not loaded into trucks going to some drab government health building haha. You can even choose your doctor and make appointments so you don't have to wait!!

LOL! And you certainly didn't get your health care in a country as big as the USA. Our leadership (Obama) cut its teeth in the community organizing arena and community health care clinics. This is the model they will follow because it is all they know. The current bill, in it's design, will provide an option to join the public program but it will tax the private insurance provided by employers. Being a smart business man, I will put my employees in the public program. Hence the end of private insurance. No need for it. Few will pay for it. With private doctors dropping out of Medicare/Medicaid in droves do you really think they will stay in it under the government plan? No way. It will be better to join a clinic and work your hours, take your government paycheck and go play golf or spend time with your family. Private insurance in the USA will die because no one will pay for it when it is cheaper to be in the government plan.

Oh, and don't forget, our wonderful 28% combined income tax rate is now going to soar to 54% or more, just like in European countries. So who is going to have money to pay for private health care or private health care insurance anyway?

The socialist this week are in full fear of having the bill costed out by the CBO. $2,000,000,000,000.00? And there is no money to pay this bill. This on top of an unfunded stimulus package and financial and industrial bailouts? Unemployment at double digits?

Rubbish? Garbage, I say... LOL! :yeah: