Medicine: Have we gone too far? And, is our system ethical as a whole? - page 2

Sometimes I disagree with some of the things that I do in my job. I'm sure we've all felt this, such as a 95 year old full code on a vent, or other such scenarios. Personally, I feel like... Read More

  1. by   Mission
    Quote from SCRN1
    - When working Labor & Delivery and Mother/Baby, I realized there were more patients there on Medicare than private insurance. The ones with Medicare got the same treatment, including all the freebies as anyone else. Who pays for all this? Taxpayers. These were people who fully able to work but refused so they could get free housing, free medical care, free groceries, etc and not have to leave home to work for it.
    Do you mean medicaid? I can't see someone who qualifies for medicare being able to have a baby and it not being investigated. I know many young women who qualify for medicaid who also work, therefore they are taxpayers and entitled for benefits, I couldn't pay my rent on what they make a month, that's why they qualify.
  2. by   SCRN1
    Quote from Mission
    Do you mean medicaid? I can't see someone who qualifies for medicare being able to have a baby and it not being investigated. I know many young women who qualify for medicaid who also work, therefore they are taxpayers and entitled for benefits, I couldn't pay my rent on what they make a month, that's why they qualify.
    You're right. I always get the two confused. Sorry 'bout that.
  3. by   nurse4theplanet
    Quote from SCRN1
    There are lots of things I don't agree with but happen anyway.

    - We had a patient who was homeless and admitted. They did surgery and later found the name he gave didn't match his SS#. For some reason, they couldn't release him because of that and because of him not having any place to go. He remained in the hospital for a year getting dialysis.

    - Another hospital, another homeless person. He got a private room while there were some who work and have insurance having to share semi-private rooms. Private rooms cost more. But he got the private one because he has a tendency to hit someone if they touch him while asleep.

    - When working Labor & Delivery and Mother/Baby, I realized there were more patients there on Medicare than private insurance. The ones with Medicare got the same treatment, including all the freebies as anyone else. Who pays for all this? Taxpayers. These were people who fully able to work but refused so they could get free housing, free medical care, free groceries, etc and not have to leave home to work for it.

    - It doesn't stop with the young "women" either with people living off the system. There are so many people who can work but don't who wind up in the hospital at one point or another and get all the same treatment as those who work and have insurance. What really burns me up is there are so many who know how to play the system and get what they want while there are those who really can't work and can't get help or either it takes them years to get it.
    Are you implying that someone should not receive healthcare or should receive inferior healthcare if they don't have private insurance.

    I agree that there are problems within our system and that there are patients who will manipulate the system if they have the opportunity, but insinuating that a 'medicare' pt or a homeless pt that has a medical need should get inferior or bias care based on their insurance or lack there of is simply unethical. There are laws that are designed to protect patients from that very point of view. Now I see why they are so necessary.
  4. by   GardenDove
    Yes, we supposedly have laws to allow all people access to our hospitals regardless of ability to pay. But, what about access to non-acute aspects of healthcare, such as clinics, preventative care, etc? Wouldn't it be cheaper and more ethically sound if the uninsured were able to establish a relationship with a doctor through a clinic, rather than waiting until they are in a full blown crisis and end up in an ER?
  5. by   Cattitude
    Quote from asoldierswife05
    are you implying that someone should not receive healthcare or should receive inferior healthcare if they don't have private insurance.

    i agree that there are problems within our system and that there are patients who will manipulate the system if they have the opportunity, but insinuating that a 'medicare' pt or a homeless pt that has a medical need should get inferior or bias care based on their insurance or lack there of is simply unethical. there are laws that are designed to protect patients from that very point of view. now i see why they are so necessary.
    i don't think the op was implying those women get inferior or no medical care. i think she was just venting as we all do sometimes. and maybe that the ones that could work get jobs!!!

    after years of dealing with some "entitlement" minded patients, it can be frustrating. that is not to say they don't deserve treatment. it just tests your patience at times. for example, it may bug me a bit when i see one of my medicaid pt's coming home from the salon with a new hairdo and freshly done nails. not only is the taxpayer's money funding her rent, medical care, food, pet care,cigarettes, but apparently all beauty stuff too! this while someone else is being denied care. not so fair right? and that's just a tiny example.

    there's no simple answer to this problem. i don't agree to prolonged agonizing treatment for pt's that are obviously not going to make it. i think it's selfish on the family's part. in icu, we as nurses make these pt's look all clean and neat for visiting hours. these families rarely see what's under the sheets. the mottled, skin, stage 3 decub, fecal bag, etc. they still think uncle harry's going to magically wake up. i really wonder if families were given the prognosis( a poor one) and told that they had to pay out of pocket, would they still be as aggressive? just a thought...
  6. by   SCRN1
    NOOOOOOOOOOO! I was not implying that someone on Medicaid or someone who's homeless shouldn't be allowed healthcare by any means. I thought I'd said so, but I see I left it out. I was just pointing out there are other ways that healthcare costs the taxpayers a bundle, in addition to what the OP was saying about people with no hope receiving treatment or for alcoholics to get new livers. My main point in that is that a lot of these people I was talking about are capable of getting jobs but refuse because they can get it all for free while someone pays for it for them.
  7. by   nurse4theplanet
    Quote from SCRN1
    NOOOOOOOOOOO! I was not implying that someone on Medicaid or someone who's homeless shouldn't be allowed healthcare by any means. I thought I'd said so, but I see I left it out. I was just pointing out there are other ways that healthcare costs the taxpayers a bundle, in addition to what the OP was saying about people with no hope receiving treatment or for alcoholics to get new livers. My main point in that is that a lot of these people I was talking about are capable of getting jobs but refuse because they can get it all for free while someone pays for it for them.
    Thanks for clarifying. I agree that people manipulate the system and it is indeed frustrating, as well as compounding the problems/issues referenced by the OP. But we must be careful not to lump everyone into a stereotyped category. Your 'medicaid' mom may be milking the system, but (for her baby's sake at the least) she should be given equal care. And there are lots of medicare moms that don't abuse the system...my sister is one of them. I would hate to think any nurse would be bias in their care towards her and my nephew because of the other pitiful souls that perpetuate this stereotype.

    I agree with another poster who said that more needs to be done to get these underserved populations into the ambulatory care setting, instead of our hospitals taking in patients in critical conditions because they haven't received basic healthcare. Our first line of defense is preventative medicine and health promotion. That's the only way to keep costs down and keep healthcare affordable.
  8. by   Jolie
    Quote from asoldierswife05
    Are you implying that someone should not receive healthcare or should receive inferior healthcare if they don't have private insurance?
    I am not trying to speak for the OP, but I would like to voice my opinion on this issue: I don't believe that those without private insurance should receive inferior quality healthcare, but nor do I believe that those who receive healthcare courtesy of the taxpayers should get benefits SUPERIOR to those of us who work to pay for ours and theirs.

    I lived in PA a number of years ago, at a time when recipients of taxpayer funded healthcare received comprehensive medical, dental, prescription, and vision benefits. Both my husband and I were gainfully employed, paid substantial premiums thru payroll deduction, and neither of us had dental or vision insurance. We also had to meet deductibles before our coverage "kicked in", and were limited in our choice of providers, while those covered (at no personal expense) by publicly funded plans had benefits far superior to ours with no financial obligations.

    That is not right, either.
  9. by   Halinja
    Quote from Jolie
    nor do I believe that those who receive healthcare courtesy of the taxpayers should get benefits SUPERIOR to those of us who work to pay for ours and theirs.

    That is not right, either.
    I agree.

    I also agree with a previous poster...we need to concentrate MUCH more of our attention on prevention and early care, to prevent the huge run-up costs of catastrophic care later.
  10. by   nurse4theplanet
    Quote from Jolie
    I am not trying to speak for the OP, but I would like to voice my opinion on this issue: I don't believe that those without private insurance should receive inferior quality healthcare, but nor do I believe that those who receive healthcare courtesy of the taxpayers should get benefits SUPERIOR to those of us who work to pay for ours and theirs.

    I lived in PA a number of years ago, at a time when recipients of taxpayer funded healthcare received comprehensive medical, dental, prescription, and vision benefits. Both my husband and I were gainfully employed, paid substantial premiums thru payroll deduction, and neither of us had dental or vision insurance. We also had to meet deductibles before our coverage "kicked in", and were limited in our choice of providers, while those covered (at no personal expense) by publicly funded plans had benefits far superior to ours with no financial obligations.

    That is not right, either.
    I agree with you. In fact, I agree with most people's voiced frustrations throughout this thread.

    I guess my point is that we need to be very careful to focus our frustrations and complaints on the system and not the individual...not stereotyping those who receive government assisted healthcare into one category.

    Sometimes its easy to place our frustrations with the healthcare system on a specific group of people, or label those people according to the bad apples that we come across in our practice...but there are many people out there that NEED that assistance.

    I also think that the population that suffers the most under our system (besides the elderly who are living off what's left of our pitiful social securtiy system...but that's a whole diff thread lol), are the middle class.
    Like myself and my parents, we make too much money to qualify for government programs, in fact we are their main source of revenue, yet we don't make enough to pay out the high insurance premiums that result from them.
  11. by   GardenDove
    And part of the reason for high premiums is to pay for the last ditch, and often futile efforts, to save the life of a person who hasn't come to terms with his/her situation. Since I've worked in the ICU the past year, it's really driven this fact home to me how much we, as a healthcare community, spends on these heroic attempts to reverse the irreversable.
  12. by   nursemike
    Quote from GardenDove
    As far as someone's right to drain the healthcare system because they are in denial about death, isn't there some sort of communal responsiblity here? Do we have a right to a million dollars in futile care just because we're scared to die? What about the basics for everyone? That's where I think our system is out of whack. We don't have infinate resources, as much as we would like to pretend.
    I think I can see your point, but I strongly suspect it's a bit off the mark. As expensive as heroic measures can be, I don't think these million-- and multi-million dollar cases as common enough to be a major drain on the system. I think it's more often the thousand and tens-of-thousand dollar cases that could have been avoided with hundreds of dollars of prevention.

    A few years ago, there was a patient at my facility whom, in one of my more morbid moments, I called "the human Medicare check." This was before I was a nurse (if that's any excuse). This poor fellow was very old--late 80's, I think, and old for his age. He was diabetic, with both lower extremities amputated, but every couple of months he'd be back to whittle off a little more or treat a stage IV decub or whatever, then back to LTC. I don't think I ever saw him in double digits on the GCS. Not much of what any of us would call quality of life.
    I don't think there was any intent to defraud Medicare. Each intervention did ward off a life-threatening crisis, but none was going to cure him. I believe he was a no-code by the time he passed, but I don't know for how long. I don't think of removing a gangrenous extremity as a particularly heroic measure, nor does letting him go septic and die seem especially humane. Yet, clearly, it would have been very much in his best interests and those of society if he could have been adequately treated before he reached that state.
    My father, who is diabetic, gets pretty decent care through our facility, funded primarily by his Medicare. I don't feel he is being let down by the system, although he is burdened by an unfortunate amount of debt for co-payments and deductibles. Reluctance to add to that debt is a bit of a hindrance to compliance with care: he doesn't want to "run up doctor bills when nothing's wrong" with him. Makes me wonder whether the patient I spoke of might have felt the same way, with no family to tell him to screw the co-payment, they're happy to get the Medicare.
    Hilary was right, a decade ago. We do desperately need health care reform for millions of uninsured and underinsured Americans. (I share the concern of many that when such reform comes, it will be an even bigger mess than it is. Part of the problem, as I see it, is that Congress is usually so worried that some may get benefits such as welfare or medical care who don't need them that they make it needlessly difficult for those who do need them, and meanwhile, there are still plenty of less deserving recipients who figure out how to work the system. College students get food stamps while people who are hungry can't adequately document that they haven't eaten in three days.)
    Anyway, I think that's a bigger, and costlier, problem than liver transplants and ventilators. JMHO.
  13. by   medsurgnurse
    Quote from Mission
    :yeahthat:
    I think a course and maybe even a clinical rotation in palliative care needs to be to be mandatory for nursing and medical school.
    That's not a bad idea. We have to rotate through other specialties why not palliative care. When I start doing hospice nursing I had to reprogram my "nurse thinking." But I have never been asked to end a life and would not participate if asked. I do believe in adequate pain control.

close