Talking to patients about the health care debate

[bluesnurse]

Today I took a triage call from a patient, an active lady in her late 60's. She's been taking a beta-blocker for years to regulate her heart rhythm. This month, her insurance company took it upon themselves to switch her to a generic "equivalent." She had a reaction to it, passed out in her yard, and ended up in the ER in afib. She called to get a 30-day supply of the brand rx, which she's paying for out of pocket. I filed an appeal with her insurance to get the brand covered but they will drag their feet for a week or two, I'm sure.

As we were wrapping up the conversation, she said, "It's scary how insurance is getting." I agreed with her and said, in an empathetic tone, "I hope something will be done to improve it soon."

Well, she freaked out. "Honey," she said, her voice rising, "I'm telling you I'm SCARED. I'm almost 70 years old and in five years, health care will be rationed and people over 70 will be at the bottom of the list. They're going to let all the older people die so they can pay for more illegals to sneak over here and have babies. If Obama gets his way, everyone my age is going to be left to die and the [slur] are going to to take over!"

I was dumbfounded. I stammered, "Umm, ... I don't really think that's going to happen."

"Oh yes it will, honey. Just wait." she replied icily. I paused ... getting into a debate on the phone with a livid arrhythmia patient did not seem like a good idea.

"OK, then, I'll call your medication in to (pharmacy); make sure you save the receipt and call me if you have any problems," I blurted, and as soon as she agreed I said goodbye.

What bothers me even more is that this is not the first time I've heard a patient express that fear. And the big age cut-off they all cite is 70. Who the heck is putting this nonsense into peoples' heads?

As the whole health care debate kicks up, it's going to be front and center in the news and people are going to be paying attention to it and talking about it. The patients we take care of know we're in the trenches, they know it's personal for us, and it's inevitable that some will be curious about our thoughts. I'm always open to discussing any reasonable point of view.

But the experienced nurse in me also knows that things are going climactically downhill. I don't want to be confrontational, but I do feel some professional responsibility to discredit damaging myths when I hear one. Has anyone else encountered this? Any thoughts?

[elkpark]

When I run into that kind of situation (professionally, when I'm not entirely free to just blurt out whatever I want to :)), I usually respond with something bland but questioning, like, "Gee, where did you hear that, because I haven't heard anything like that ..." If they continue, I just keep repeating pleasantly, "Well, that's not what I've been hearing ..." I just can't bring myself to let statements like that pass without any comment, but also don't want to get into a pointless argument.

[Multicollinearity, BSN, RN]

Yes, it would be tempting but unwise to issue this retort: "So why do the Canadians live several years longer than we do...?"

I like Elkpark's response, as usual.

[elkpark]

(Thank you! :))

[keithjones]

canada is an entirely different set of circumstances than usa. most canadian elderly are well off, heck most of them live in florida 9 months of the year! lol! to provide cradle to grave full health coverage for the entire population of the us would require 80% tax rates, that is where rationing comes in. it already happens btw, when resources are limited statistics dictate who gets health care and who doesnt. i.e. organ transplants! the problem with universal healthcare lies with people like those 9 people who visited a single emergency room 2600 times in a 6 year time span! when politics comes up if i get a clear reading that the person agrees with my POV then ill talk about it, if not ill quickly change the subject, no need to get a jab in.

[jRN2be]

That is socialized medicine. That is what Obama is shooting for.. Nurses will be sitting in hard back metal chairs, no tile floors, and no computers. That 70 year old that needs a heart cath, the one that is not long for this world anyways, will be put to the back of the line... its a shame.

[Junebugfairy]

i do not support a 'single payer' system, but i do support a coverage option for citizens who cannot afford coverage.

i genuinely care about the needy, i want to help them, but we honestly cannot make a perfect system which is 100% great for everyone. what we can have is a fair system, a system that does it's very best to improve quality of life.

i buy my own insurance, and i like my coverage. i handpicked every benefit that i wanted, so i know what i am getting, and what is covered.

i want to keep my own insurance, yet allow others to have access to a plan which they can afford.

nothing is free, and we should not expect free health care. we should expect fair health care.

[bluesnurse]

What some people don't seem to understand is that health care is *already* being rationed.

Maybe I'm more acutely aware of it because I work in an OP clinic, and the insurance red tape is getting worse literally every month. My ability to provide nursing care is being rationed away from me when I'm spending hours daily making calls and filling out forms because everything my cardiologist orders gets challenged, second-guessed, and postponed by a bean counter on the other side of the country.

Not only is health care being rationed, physicians are already being told how to practice medicine. The patient is ultimately the one that loses. Something's got to be done, and all this paranoia is only making it more difficult to have a reasonable discussion.

[cherrybreeze, ADN, RN]

i do not support a 'single payer' system, but i do support a coverage option for citizens who cannot afford coverage.

i genuinely care about the needy, i want to help them, but we honestly cannot make a perfect system which is 100% great for everyone. what we can have is a fair system, a system that does it's very best to improve quality of life.

i buy my own insurance, and i like my coverage. i handpicked every benefit that i wanted, so i know what i am getting, and what is covered.

i want to keep my own insurance, yet allow others to have access to a plan which they can afford.

nothing is free, and we should not expect free health care. we should expect fair health care.

i agree with this!

i pay a good amount for my health insurance, and i work my orifice off to have/keep it....i don't want to see it taken away, kwim? i have a couple of chronic health conditions, so i make good use of my coverage, sadly. i do want to see something available for those that don't have it, but i don't think the people that do have private coverage should have it jeopardized, either.

[lindarn]

Without a doubt in my mind, the insurance companies are running scared. They know that the majority of Americans favor a single payer system. The general public is tired of insurance companies, "practicing medicine without a license", and denying needed health care to line their pockets.

They deny care, and then build bigger and fancier buildings that only serve to deny care to the individuals who are supplying the $$$$$ from their premiums. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[Virgo_RN, BSN, RN]

I try to avoid discussing anything political or religious with my patients. The reason they are in the hospital is because they are experiencing an acute health crisis, and my job is to help them get through that and move them on to the next phase, be it rehab, home, SNF, LTC, or hospice. I know little to nothing about how they will be billed or what will be covered by their insurance/Medicare, and so when they have those questions, I simply order an MSW consult for them.

[DeLana_RN, BSN, RN]

Perhaps some health care does need to be rationed; how about my friend's FIL, an 89-year-old advanced Alzheimer's pt (bedridden, nonresponsive) who is slowly dying under the substandard care of his daughter who rarely turns him but refuses to have him in hospice care. She does not pay for any of his care, including frequent hospitalizations for aspiration pneumonia, but continues to collect his social security and pension checks (could this be the reason why she refuses to let him die with dignity?)

Anyway, it's pretty obvious to me that the kind of health care we currently "enjoy" (those of us who are well insured, anyway) is unsustainable under the crushing burden of the huge baby boomer generation combined with huge deficits incurred by the government this decade with no end in sight. There will have to be some kind of rationing. It needs to be done carefully, thoughtfully, and of course without anything such as involuntary euthanasia. In my friend's FIL's case, hospice care should be provided but expensive ICU care perhaps not.

European countries have had some rationing for years (e.g., no 90-year-old would be started on dialysis there) and the population is generally healthier than in the U.S. Considering the coming demographic changes, there is simply no other way.

I am worried about the future for nursing and health care workers. However, the impending nursing shortage will hardly be relieved with wage cuts...

DeLana