How Will Universal Health Care Change Nursing?

It'sMe, RN, BBA, MBA · Jun 21, 2009

It is so good to see that at least two people feel so strongly about their position. But both of you have avoided answering the biggest question: How will this be paid for? There is no free ride and the plan you suggest comes with at least a 2,000,000,000,000.00 price tag. How and who is going to pay for it? We are currently the world's richest nation. We are quickly becoming a debtor nation under the current administration. How do you pay for this UHC plan without borrowing the money at a time when tax revenue is falling like a brick dropped from the top of the empire state building?

It'sMe, RN, BBA, MBA · Jun 21, 2009

By the way ghillbert, here is an article from the Medical Journal of Austrialia that discusses health care rationing in Austrialia. Took about 30 seconds to find it. Totally invalidates your argument that there is not rationing in the Austrialian UHC.

Here is a quote direct from the journal: It is no longer possible or ethically acceptable to deny that rationing occurs in medical practice. ○ We ration already by using contraindications to treatment. ○ There are no rationing criteria that are universally ethically acceptable. ○ We need ways to establish community preferences if we are to develop responsible methods of rationing healthcare services.

Titre du document / Document title

Healthcare rationing : constraints and equity Auteur(s) / Author(s)

LITTLE J. Miles (1) ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, CANADA

Résumé / Abstract

○ It is no longer possible or ethically acceptable to deny that rationing occurs in medical practice. ○ We ration already by using contraindications to treatment. ○ There are no rationing criteria that are universally ethically acceptable. ○ We need ways to establish community preferences if we are to develop responsible methods of rationing healthcare services. Revue / Journal Title

Medical journal of Australia ISSN 0025-729X CODEN MJAUAJ Source / Source

2001, vol. 174, no12, pp. 641-642 (15 ref.) Langue / Language

Anglais

Editeur / Publisher

Australasian Medical Publishing Company, Sydney, AUSTRALIE (1914) (Revue)

Mots-clés anglais / English Keywords

Ethics ; Rationing ; Medicine ; Health economy ; Australia ; Human ; Oceania ; Mots-clés français / French Keywords

Ethique ; Rationnement ; Médecine ; Economie santé ; Australie ; Homme ; Océanie ; Mots-clés espagnols / Spanish Keywords

Etica ; Medicina ; Economía salud ; Australia ; Hombre ; Oceania ; Localisation / Location

INIST-CNRS, Cote INIST : 3557, 35400009898470.0080

Nº notice refdoc (ud4) : 1054808Titre du document / Document title

Healthcare rationing : constraints and equity

Auteur(s) / Author(s)

LITTLE J. Miles (1) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, CANADA

Résumé / Abstract

○ It is no longer possible or ethically acceptable to deny that rationing occurs in medical practice. ○ We ration already by using contraindications to treatment. ○ There are no rationing criteria that are universally ethically acceptable. ○ We need ways to establish community preferences if we are to develop responsible methods of rationing healthcare services.

Here is the link in case you want to retreive the article and read it for yourself. Of course it may be easier to shout that someone is lecturing you instead of engaging in an intelligent discussion. Of course you may be upset when you find someone that uses facts, unlike your claim of no rationing, instead of just making up data. Enjoy. Time to go play golf!

Revue / Journal Title

Medical journal of Australia ISSN 0025-729X CODEN MJAUAJ

Source / Source

2001, vol. 174, no12, pp. 641-642 (15 ref.)

Langue / Language

Anglais

Editeur / Publisher

Australasian Medical Publishing Company, Sydney, AUSTRALIE (1914) (Revue)

Mots-clés anglais / English Keywords

Ethics ; Rationing ; Medicine ; Health economy ; Australia ; Human ; Oceania ;

Mots-clés français / French Keywords

Ethique ; Rationnement ; Médecine ; Economie santé ; Australie ; Homme ; Océanie ;

Mots-clés espagnols / Spanish Keywords

Etica ; Medicina ; Economía salud ; Australia ; Hombre ; Oceania ;

Localisation / Location

INIST-CNRS, Cote INIST : 3557, 35400009898470.0080

Nº notice refdoc (ud4) : 1054808

It'sMe, RN, BBA, MBA · Jun 21, 2009

so candian uhc is the role model we should follow? check out this citation:

october 18, 2005

health care rationing in canada

the fraser institute has released its annual analysis of waiting times in the canadian health care system. [link.]

total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, fell from 17.9 weeks in 2004 back to the 17.7 weeks last seen in 2003.

do you really want to wait 17.7 weeks to see a cardiologist? surgeon? orthopedist? cancer specialist?

not me. i needed to see an orthopedist and i waited 4 hours. not days. not weeks. 4 hours. and my insurance paid for it. i paid my $50 copay and walked to the back. then got sent to the pt next door. started therapy the same day. no waiting. great service. with friendly happy staff.

which one do you want, walk in and get seen are wait 17 weeks.

it is hard to argue with the facts, isn't it?

allnurses Guide · Jun 21, 2009

By the way ghillbert, here is an article from the Medical Journal of Austrialia that discusses health care rationing in Austrialia. Took about 30 seconds to find it. Totally invalidates your argument that there is not rationing in the Austrialian UHC.
Here is a quote direct from the journal: It is no longer possible or ethically acceptable to deny that rationing occurs in medical practice. ○ We ration already by using contraindications to treatment. ○ There are no rationing criteria that are universally ethically acceptable. ○ We need ways to establish community preferences if we are to develop responsible methods of rationing healthcare services.
Here is the link in case you want to retreive the article and read it for yourself. Of course it may be easier to shout that someone is lecturing you instead of engaging in an intelligent discussion. Of course you may be upset when you find someone that uses facts, unlike your claim of no rationing, instead of just making up data. Enjoy. Time to go play golf!

Perhaps in your eagerness to get to golf, you neglected to actually read the article? Or could it have been a deliberate attempt to obfuscate the facts? The article is about medical ethics, and how you choose who is treated. Going on your terms, every physician in every health system in the world employs healthcare "rationing". You and I both know that this article has nothing to do with "rationing" care in the Australian UHC system due to inability to afford to treat everyone. It is about the ethical consideration of who to treat in terms of risks and benefits.

Ooh, here's one about America!They must ration healthcare too!!

Osborne, M. & Patterson, J. (1996) Ethical allocation of ICU resources: A view from the USA. Intensive Care Med. Oct; 22(10): 1010-4.

By the way ghillbert, here is an article from the Medical Journal of Austrialia that discusses health care rationing in Austrialia. Took about 30 seconds to find it. Totally invalidates your argument that there is not rationing in the Austrialian UHC.

By the way, it's Australian. A little less Austria (that's in Europe).

lamazeteacher · Jun 21, 2009

rnbbamba: antagonism restricts communication. please post facts

"overall, business people want to see immediate reactions to their actions as opposed to long term forecasting in other words "tell me what will give me the most for the dollar, now!" quote from rnbbamba's post # where does the quote originate? whose viewpoint is that?

laws become bad, because their sponsors play tit for tat. ridiculous addendums are added so that those idiots elected by us get what they want for their constituents. but is it really for their voters or for their political contributors?" quote from rnbbamab's post#64

did the mba school you attended teach that? if not, where and why does it seem true to you? do you hold any hope for our electoral process and business practises in the usa?

"first, i am not in an hmo, and in fact i have traditional health insurance."

what was it about hmos that you learned while being at the helm of one, that made you decide against having that covereage?

"second, always quote your source of information, to validate it."

agreed!

"third, present the facts in their entirety. many of the deaths related to mortality in the us, (as opposed to accidents?) would still have occured because those people (which people are they?) would not have sought health care anyway. those were life style issues." please cite the authority/source for this conclusion.

"and there are many studies by unbiased groups that not only dispute these numbers, but also dispute the number of uninsured people in america" please cite what groups you consider to be unbiased, and how you know that they are authorities to be relied upon (authority for that).

"total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, fell from 17.9 weeks in 2004 back to the 17.7 weeks last seen in 2003."

quote from rnbbamba's post #74

the link in your post wasn't available so i couldn't check, but i imagine that

the stats above are squewed because of geographic location. canadians realize, as others may not, that northern and remote areas of provinces have difficulties with access to medical care, as travel in winter is limited, and patients cannot always leave their homes. cities and towns that have larger populations, have much less waiting time from referral to treatment. canadians can have specialists' care without referral, which obliterates waiting time.

"ethical consideration of who to treat in terms of risks and benefits." quote

from gillbert's post #75

i have seen more unethical treatment provided in the usa than in any other

developed country, in modern history (after 1950). for example, in 1965, at los angeles county hospital hispanic and african american women had tubal ligations done without their knowledge during c/sections, at doctors' discretion, upon reasoning that they had "enough children".

an unmarried woman went in there with a history of abruptio placenta

sustained during a fall onto her abdomen from a fire escape, and her baby's hr "gradually diminished and then disappeared on the 3rd day of her confinement", her doctor told me. he said her unmarried status indicated "that she hadn't wanted the baby anyway!" so no c/section was done to save fetal life. i reported him to the head of ob there.

lamazeteacher · Jun 21, 2009

It is so good to see that at least two people feel so strongly about their position. But both of you have avoided answering the biggest question: How will this be paid for? There is no free ride and the plan you suggest comes with at least a 2,000,000,000,000.00 price tag. How and who is going to pay for it? We are currently the world's richest nation. We are quickly becoming a debtor nation under the current administration. How do you pay for this UHC plan without borrowing the money at a time when tax revenue is falling like a brick dropped from the top of the empire state building?

We have been a debtor nation longer than the past 5 administrations, due to grandiose scheming in the business sector; and engagement in wars that we had no business getting into. The figure you site above, is supposition based on an unnamed period of time and criteria. The way health care will be paid, is by discontinuing the enormous salaries and bonuses heretofore given healthcare insurance companies' executives, extra taxes without loopholes for the wealthy (5% of their income above $250,000/year), and rationing (oh be still, my heart) - not healthcare, but the places where machinery/technology used.

Competing hospitals purchase state of the art technological machinery that is underused. By regionalizing its use and providing transportation of patients to centers with the needed equipment for diagnosis and treatment, many bucks will be spared. There are far too many admissions to hospitals here that could be avoided by using home health care, thereby avoiding many nosocomial infections. Doctors depart their offices at 4 or 4:30 p.m. most weekdays, without making hospital rounds (they have hospitalists who are family practitioners do that). Their incomes will be appropriately diminished, and their working hours staggered to allow patients to come to night and weekend clinics, and not miss their work. :nurse:

allnurses Guide · Jun 21, 2009

so candian uhc is the role model we should follow? check out this citation:
october 18, 2005
health care rationing in canada
the fraser institute has released its annual analysis of waiting times in the canadian health care system. [link.]
total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, fell from 17.9 weeks in 2004 back to the 17.7 weeks last seen in 2003.
do you really want to wait 17.7 weeks to see a cardiologist? surgeon? orthopedist? cancer specialist?
not me. i needed to see an orthopedist and i waited 4 hours. not days. not weeks. 4 hours. and my insurance paid for it. i paid my $50 copay and walked to the back. then got sent to the pt next door. started therapy the same day. no waiting. great service. with friendly happy staff.
which one do you want, walk in and get seen are wait 17 weeks.
it is hard to argue with the facts, isn't it?

i had pacificare private health insurance.

in an accident my shoulder was injured.

i went to my primary physician who recommended an orthopedic doctor and filled out the authorization forma.

two weeks later i was allowed to see the orthopedist. by this time i couldn't move my arm. just extending my elbow was very painful.

the orthopedist did an x-ray, prescribed pain medication and ordered an mri. also put me on state disability so taxpayers supprted me at about 25% of my usual pay.

authorization for the mri took another two weeks of pain. i could hardly dress or wipe myself. brushing my hair was impossible.

i had the mri but was told i had to get an authorization from my primary physician to go back to the orthopedist....two more weeks. and one for an appointment.

then he prescribed physical therapy....two more weeks.

four sessions were authorized but i learned a lot from my hero therapist. did the exercises twice a day and saw her once a week, improving steadily.

finally i was well enough to go back to work, still doing the new exercises.

i sure wish my wait had been only four hours or even four weeks. as it happened it took nine weeks from the injury to the start of physical therapy.

tmgsn · Jun 21, 2009

Strange, so if health care is so good in Canada why do so many cross the border to get treatment? And why is the news so loud now about the Canadians wanting change in their health care? Odd, the rosy picture you paint is not what the facts describe.
Oh, don't worry about me gloating as I work as a staff nurse, I know it is only temporay until I rebuild my real estate investing business. And the really neat thing is that after only 4 months I have already been offered a VP position. So don't worry about me, I have a very bright future in front of me. Diversification and education with real degrees takes care of that situation. Have a great life.

All the money in the world will not take good care of you in a LTC. Why did you become an RN? Has life been so bad to you as to make you this bitter? I simply stopped chatting when I felt I could not reach people here-- but this last post of yours has brought vomit to my lips. Tell me, does a staff nurse actually do pt care? It does not sound like you care enough about any one else to do that part of the job. I am not trying to attack you, but did you read your blog before you posted it? So cold. I am sorry for you, I will pray for you to find the love you must have had in your heart at one time to become an RN. Life is not, is not, all about money and position!

MAISY, RN-ER, BSN, RN · Jun 21, 2009

Although some of us have alphabet soup behind our names, the meal isn't always good. Some of your statements are so thoughtless and skewed that I wonder how the institutions of higher learning you obviously attended would feel if they saw your disdain of the working poor or disadvantaged.

You are right it will cost us alot, however I believe we will "reap what we sow" and overall it will break even and then reduce our costs when are citizens are actually given care. The haves always have in every country, and I am sure many doctors will pull themselves out of the pool by not accepting Medicare and UHC; unfortunately Medicare floats many a practice and hospital-their snobbiness won't last too long.

UHC or a mixed plan should be initiated slowly and must be evaluated and re-evaluated for it's effectiveness. Both sides will have to play nice on Capitol Hill, something that doesn't happen often. Laws are routinely re-evaluated and modified and is also the reason all laws do not resemble their original proposals.

Right now a good place to begin would be basic coverage to all American citizens for primary care. Require physicians at all levels to take the state healthcare based on their practice, so 10% of total patient count must be the US healthcare policy. Right there an improvement in care will be seen for those who can only be seen by appointment (months) in clinics.

Any health plan initiated will be difficult to initiate, but initiate it we must! No one should be homeless due to mental illness, lose limbs because they can't afford their testing supplies/medicines/and physician, or die because no one would help them.

All I know is that I don't want American children to be on a folder asking for donations to fix a cleft lip, donate because they can't eat, or for a dollar a day...... If something doesn't happen soon, it will be some of them. We just can't let that happen.

geekgolightly, BSN, RN · Jun 21, 2009

First, I am not in an HMO, in fact I have traditional health insurance. Second, always quote your source of information to validate it. Third, present the facts in their entirety. Many of the deaths related to mortality in the US would still occured because those people would not have sought health care anyway. Those were life style issues. And there are many studies by unbiased groups that not only dispute these numbers but also the number of uninsured people in America.

I wasn't questioning what health insurance you held? You said that you had been PRESIDENT of an HMO in an earlier post. That is what I was referring to. I suppose I should have quoted your own words back at you. I can do that if you like.

It is immoral for HMO's to target health insurance carriers who have become ill and comb through their files for any clinical error, which is what HMO's do, as I am sure you are aware, what with having been president of one. That is not an accusation, it is not relative to circumstance, it is immoral by anyone's account.

geekgolightly, BSN, RN · Jun 21, 2009

I was the President of an HMO.

For your perusal.

geekgolightly, BSN, RN · Jun 21, 2009

here is the link for the quote
http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2006/Sep/U-S--Health-System-Performance--A-National-Scorecard.aspx

Requoted just for you, It's Me.

Are you really saying that the Commonwealth Fund is a biased organization? Although, I find that laughable, and would be mighty interested in what you see as non-biased (much like how FOX news is always whining about bias, but is certainly the #1 perpetrator of bias in media.)

How about the World Health Organization? Or is that biased as well?

"The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18 th ."

http://www.who.int/whr/2000/media_centre/press_release/en/index.html