Universal Health Coverage? - page 2

This topic came up last night in our seminar. Again, we struggle and struggle with this concept. I often times look at Medicare and how they handle things such as coverage, reimbursment, etc. As... Read More

  1. by   Q.
    Here's another example.

    My professor was speaking with a teacher's union that offered probably the most comprehensive health care insurance for their teachers. The union was puzzled by the 4.5million dollars annual that was spent for the teachers in health services. Why so much? Because of the 450+ ER visits that were NOT necessary and could have been treated by a NP or an MD office visit.

    Again, people will ultimately, do what they want regardless of what is available. They don't care about cost. They want what they want NOW.
  2. by   fiestynurse
    This is where education is key. People do not know the proper way to utilize our dysfunctional system. The show-up at the ER when they should have gone to the urgent care clinic - they show-up at the doctor's office when they should have gone to the ER. They are simply confused!
  3. by   fiestynurse
    The Congressional Budget office projects that single payer would reduce overall costs by $225 billion by 2004 despite the expansion of comprehensive care for all Americans. No other plan projects this kind of savings. There are states studying this system right now and determining how they can make it work.
    The program would be federally financed and administered by a single public insurer at the state or regional level. Premiums, copayments, and deductibles would be eliminated. Employers would pay a 7.0% payroll tax and employees would pay 2.0%, essentially converting premium payments to health care payroll tax. 90-95% of people would pay less overall for health care. Financing includes a $2 per pack cigarette tax. The General Accounting Office projects an administrative savings of 10% through the elimination of private insurance bills and administrative waste, or $100 billion in 1994. This savings would pay for providing medical care to those currently underserved.
    All Americans would receive comprehensive medical benefits under a single payer. Hospital billing would be eliminated. Instead, hospitals would receive an annual lump-sum payment from the government to cover operating expenses-a "global budget" A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc.
    Doctors would have three options for payment: fee-for-service, salaried postions in hospitals, and salaried positions within group practices or HMOs. Fees would be negotiated between a representative of the fee-for-service practitioners(such as the state medical society) and a state payment board. In most cases, government would serve as administrator, not employer.(this is not "socialized" medicine) Doctors would really have more freedom and say-so then they do now!
    Single payer would be the simplest and most efficiant health care plan that Congress could implement. So, what is keeping our elected officials from going forward with this? First of all, we need campaign finance reform, which we now have. Secondly, we need a President who will put this at the top of his list of priorities. Thirdly, we need a grassroots effort from every healthcare worker and concerned citizen. There are already many organizations and people endorsing this effort and fighting for this very type of healthcare reform. It is the only thing that makes sense!! I hope to see it become a reality in my life-time.
    Last edit by fiestynurse on Apr 27, '02
  4. by   fergus51
    So why don't we work on booting wasters out of the ER? If they aren't there for an emergency, the nurses or doctors should get the right to boot them out. Why don't we reform a good system instead of just giving up and saying we can't care for people? You're always going to have abusers (like the well insured who go to their docs for a hangnail), why not work at eliminating it?
    Last edit by fergus51 on Apr 27, '02
  5. by   Q.
    Tracy,

    Do you really think Americans would go for being told that their problem isn't urgent enough to be seen in the ER at 10pm? Trust me, I am all for that myself, but even while sitting in the ER with an earache, and seeing a rule out MI stoll in, they STILL complain about why they weren't seen first.

    They think the ER and health coverage is like a ******* restaurant or all you can eat buffet.
  6. by   James Huffman
    Answers and questions for Fergus,


    Why don't we ever look at real cost saving measures, like eliminating the fee for service system and putting doctors on salary?

    Putting docs on salary? Why? Having probably 99% of nurses on salary has not done a lot to improve nursing.

    Why don't we have any independant nurse practitioners, or use them more in primary care, and the hospitals (Ontarios NP board did a study that found 80% of people in ERs could be treated by an NP alone)?

    a. I don't know. Why aren't more nurses in independent practice when it is perfectly legal already? Somebody tell me. I've been at it for 22 years. The nurse (in this case myself), and the public both benefit.

    b. However, it is time for nurses to face the reality that SOME patients (certainly not all) do not want to be treated by a nurse. There is probably a certain portion of the population who will never want to see anyone other than a physician. For the rest, we as nurses have done a poor job of educating about what we can do.

    Why isn't there a single midwife in my town of 80 000 people (studies have shown midwifery to be the best model of care for the vast majority of women but the nearest one is a three hour drive away)?

    Again, I don't know. What are nurses waiting for? Let's not think that some big bwana is going to change our lives: let's do something now to make our profession change and be more responsive to the public.

    Why are drug companies given such ridiculous patent rights here so each pill costs the health care system about 3$ when it's new?

    Maybe it's so they'll have an incentive to create new drugs. Far be it from me to defend drug companies, but no one in their right mind is going to spend the time (years) and money (at least millions) to create new drugs when there's no chance of a sizeable return on investment. Simple economics, folks.

    Why hasn't there been some effort to decrease the use of expensive technology on hopeless cases (You know, the 23 weeker they keep alive for a month in the NICU, or the brain dead 90 year old they keep on a respirator for days)?

    Probably because many of what used to be (say, 1960) called "hopeless cases" now leave the hospital and go live healthy lives. Why do thousands of people come from around the world to be treated in the US? Because we push the parameters, and try the impossible, healthwise. Do we always succeed? Of course not. Do we sometimes make mistakes? Sure. But I'd rather see somebody make a mistake than rest on the old status quo.

    Why isn't there at least SOME effort to eliminate the useless CYA orders?

    The answer is simple, and it's called "lawsuits." One possible solution: go to the English system, where the plaintiff pays the defendant's legal fees if the defendants wins the case. Until there is a reform of the US legal system, CYA orders will be there.

    Why aren't people educated about when to see a doctor and when not to (I think a triage nurse should have the right to boot non-emergency folks out of the ER and tell them to call their GP)?

    a. Some people will never be educated, no matter how hard you try.

    b. ERs are seen as free health care. (And I'm told that a huge number of the names and addresses given in minor cases are false). What if -- let's say -- people had to pay cash out of pocket for minor stuff in the ER? Do you suspect they might go to their doc? Giving a triage nurse such authority is a waste of time: many of those cases could be treated by the time the nurse had finished diagnosing the problem. Just make people pay.


    I do consider healthcare to be a basic right like a high school education, and that may be because I spent my formative years in Canada and had some problems with our insurers when we lived in the US.

    What do you mean by "basic right"? What level of healthcare? Which type of caregivers? I'm sorry to burst everyone's bubble, but Canada's system is great, if we compare it to the US in 1948, say. Canada's healthcare is old, antiquated, and unresponsive to the public. It's no accident that so many Canadians come to Buffalo, Vancouver, and Detroit for things like CT scans and MRIs.

    Jim Huffman, RN

    www.networkfornurses.com
  7. by   Q.
    That is a good question. What part of medical care IS a basic right? Where does it stop and start? As medicine becomes more advanced, more and more things are seen as "basic." CT scans, MRI's, etc.

    The way it is now, most "basic" health care IS free, except no one seems to want to use it as it is seen as substandard: that being the Public Health Department. You get your immunizations, education, health screenings, etc ALL FREE OR NOMINAL COST. And you practically have to BEG people to attend the local health fair where these free services are offered.

    The public don't want those things. They see their neighbor who makes, say $120,000/year (considered affluent now here in the US) who goes to his doc and gets all this care like tests, pills, treatments, etc and compares that to HIS opportunities of health care, being the preventative basic services that the PHS offers, and they see it as simply NOT FAIR.
  8. by   fergus51
    Originally posted by Susy K
    Tracy,

    Do you really think Americans would go for being told that their problem isn't urgent enough to be seen in the ER at 10pm? Trust me, I am all for that myself, but even while sitting in the ER with an earache, and seeing a rule out MI stoll in, they STILL complain about why they weren't seen first.

    They think the ER and health coverage is like a ******* restaurant or all you can eat buffet.
    That's exactly my point. I don't really care what people would go for. If someone comes to the ER without an emergency security should escort them out. Don't like it, tough. Health care is not Burger King. It is called the EMERGENCY ROOM for a reason.

    I have heard the same arguments for not bringing in more NPs or nurse midwives. People want to see a doctor, not just a nurse. Again I say tough. If you want burger king type medicine and pay for it out of pocket, fine. If we want to provide basic care I say NPs, CNMs, and kick people out of ER when they don't belong there.
  9. by   Q.
    Tracy,

    I like that. The only thing I see wrong with that system is when it starts to get out of control.

    HMO's started out, initially, as a third party who made physicians accountable for the tests they ordered, the billing they did to ensure safety and consistency. Thus, HMO's would question this test or that test, in the interest of the patient. Only now things are out of control. NOW you have an insurance company that denies paying for vioxx, though the person is on coumadin, and vioxx is the only NSAID-type that is safe to use with coumadin.

    As Registered Nurses are replaced and more and more UNlicensed people are put into place, I see THOSE people sending potential life-threatening situations OUT of the ER.

    How do we ensure that this doesn't happen?
  10. by   fergus51
    Originally posted by James Huffman
    Answers and questions for Fergus,


    Why don't we ever look at real cost saving measures, like eliminating the fee for service system and putting doctors on salary?

    Putting docs on salary? Why? Having probably 99% of nurses on salary has not done a lot to improve nursing.

    Why don't we have any independant nurse practitioners, or use them more in primary care, and the hospitals (Ontarios NP board did a study that found 80% of people in ERs could be treated by an NP alone)?

    a. I don't know. Why aren't more nurses in independent practice when it is perfectly legal already? Somebody tell me. I've been at it for 22 years. The nurse (in this case myself), and the public both benefit.

    b. However, it is time for nurses to face the reality that SOME patients (certainly not all) do not want to be treated by a nurse. There is probably a certain portion of the population who will never want to see anyone other than a physician. For the rest, we as nurses have done a poor job of educating about what we can do.

    Why isn't there a single midwife in my town of 80 000 people (studies have shown midwifery to be the best model of care for the vast majority of women but the nearest one is a three hour drive away)?

    Again, I don't know. What are nurses waiting for? Let's not think that some big bwana is going to change our lives: let's do something now to make our profession change and be more responsive to the public.

    Why are drug companies given such ridiculous patent rights here so each pill costs the health care system about 3$ when it's new?

    Maybe it's so they'll have an incentive to create new drugs. Far be it from me to defend drug companies, but no one in their right mind is going to spend the time (years) and money (at least millions) to create new drugs when there's no chance of a sizeable return on investment. Simple economics, folks.

    Why hasn't there been some effort to decrease the use of expensive technology on hopeless cases (You know, the 23 weeker they keep alive for a month in the NICU, or the brain dead 90 year old they keep on a respirator for days)?

    Probably because many of what used to be (say, 1960) called "hopeless cases" now leave the hospital and go live healthy lives. Why do thousands of people come from around the world to be treated in the US? Because we push the parameters, and try the impossible, healthwise. Do we always succeed? Of course not. Do we sometimes make mistakes? Sure. But I'd rather see somebody make a mistake than rest on the old status quo.

    Why isn't there at least SOME effort to eliminate the useless CYA orders?

    The answer is simple, and it's called "lawsuits." One possible solution: go to the English system, where the plaintiff pays the defendant's legal fees if the defendants wins the case. Until there is a reform of the US legal system, CYA orders will be there.

    Why aren't people educated about when to see a doctor and when not to (I think a triage nurse should have the right to boot non-emergency folks out of the ER and tell them to call their GP)?

    a. Some people will never be educated, no matter how hard you try.

    b. ERs are seen as free health care. (And I'm told that a huge number of the names and addresses given in minor cases are false). What if -- let's say -- people had to pay cash out of pocket for minor stuff in the ER? Do you suspect they might go to their doc? Giving a triage nurse such authority is a waste of time: many of those cases could be treated by the time the nurse had finished diagnosing the problem. Just make people pay.


    I do consider healthcare to be a basic right like a high school education, and that may be because I spent my formative years in Canada and had some problems with our insurers when we lived in the US.

    What do you mean by "basic right"? What level of healthcare? Which type of caregivers? I'm sorry to burst everyone's bubble, but Canada's system is great, if we compare it to the US in 1948, say. Canada's healthcare is old, antiquated, and unresponsive to the public. It's no accident that so many Canadians come to Buffalo, Vancouver, and Detroit for things like CT scans and MRIs.

    Jim Huffman, RN

    www.networkfornurses.com
    1. Nurses in Canada are on salary precisely BECAUSE fee for service is more expensive. Nurses wanted a fee for service situation, but gave up when we had a medicare crisis in the seventies. I would recomend "Who Cares? The crisis in Canadian nursing" as a good book about this topic.

    2. NPs in the US are VERY different than here. NPs here seem to only be used in Northern communities that can't support a doc. There are NO NPs in this city (either in the hospital or in private practice) and I don't know of any in nearby cities either who are working as NPs. Again, I don't care if people don't want to see a nurse or not. This is not Burger King. Doctors are highly knowledgeable folks who are meant to treat the very ill. It is dumb to pay them a huge chunk of change to care for those who don't need their expertise. It's like paying the CEO 25 million a year to do a job a secretary could do.

    3. We don't have nurse midwives at all. Midwives here only became legal in 1997. They are not nurses and nurses are not encouraged to apply to the program. A lot of women here DO want midwives, but there aren't any. One of the main reasons they took so long to become recognized was OB docs' opposition. (They get paid a lot to treat healthy women who could give birth with a midwife, the CEO/secretary thing again). CNMs in the US are light years away from midwives here. We could learn A LOT from the midwifery system available to women in the US. I worked with midwives when I was in Washington as a L&D nurse, and they were excellent.

    4. The drug company patents here are VERY long, and they don't need to be that long for them to make a profit. But even if they do (I agree it does encourage them to make more new drugs), it isn't the only way to cut costs in the health care system.

    5. Are you actually telling me there is any hope that a 90 year old who is brain dead is going to make it (she was hooked up to machines for 9 days)? I would rather see everybody get basic care than one old brain dead woman be kept on a respirator. I am not trying to say money shouldn't be spent on research and medical development. I am saying there are cases that are a black hole of money for no benefit and we all know it. If research had shown some way a brain dead person might be helped, I say go for it. Until then, stop wasting the money!!!

    6. Couldn't agree more on the CYA orders lawsuit connection. That's why I think there needs to be reform. I don't think we have as many lawsuits against health care staff in Canada as in the US, but we have the same problem with the CYA orders.

    7. Maybe people wouldn't come to the ER if they had to pay. I don't know. I suspect it would just keep the poor out. Again, things are different here, because a visit to the doctor doesn't cost the patient any more than a trip to the ER (both are "free").

    8. I consider basic care to be things like seeing a doc when you have to, or an NP or CNM and having needed treatment if it can help you. Not cosmetic surgery, not respirators for the brain dead, not ER trips for stomach aches (though if people want to pay for these things out of their own pockets I have no problem with it). A basic right to me is something that citizens of a country are entitled to, like primary school or voting or freedom of speech.

    I have to take exception to the idea that our health care is similar to yours in the 40s. Yes, people go to the US to get MRIs and CTs if they're rich because then they don't have to wait in line. I don't think this is any different from Americans (often dual citizens) coming here to get their drugs, or treatment because they can't afford it in the US. My mom's uncle died on a plane going to Winnipeg because he didn't want to pay for an ER visit in his home state. I have never received substandard care since returning to Canada (I am a dual citizen). I agree the US has some of the best medical care available in the world, IF (and it's a big if) you can pay for it. For every great advanced hospital you have there is a hell hole you wouldn't want your dog in.
    Last edit by fergus51 on Apr 27, '02
  11. by   fergus51
    Originally posted by Susy K
    Tracy,

    I like that. The only thing I see wrong with that system is when it starts to get out of control.

    HMO's started out, initially, as a third party who made physicians accountable for the tests they ordered, the billing they did to ensure safety and consistency. Thus, HMO's would question this test or that test, in the interest of the patient. Only now things are out of control. NOW you have an insurance company that denies paying for vioxx, though the person is on coumadin, and vioxx is the only NSAID-type that is safe to use with coumadin.

    As Registered Nurses are replaced and more and more UNlicensed people are put into place, I see THOSE people sending potential life-threatening situations OUT of the ER.

    How do we ensure that this doesn't happen?
    Man I am feeling like a windbag!!!

    Ok, I must make it clear, I don't have all the answers here. I don't know how we could safeguard against this. (I also don't have a definition for what is basic care and what isn't. I do believe it could be defined and applied though, just not by me on a bb). The wierd thing is it's in the US that I've seen the most "unliscenced personel" used. I have never worked with unliscenced personel here in the hospital doing patient care. L&D/PP/NICU/ICU/ER/OR are all RN staffs for patient care. We don't have UAPs, MAs, PAs, OB techs or even LPNs on those floors. The only place we have CNAs is in geriatrics. To be honest I was REALLY confused when I went back to the States after graduation to work.

    Maybe pass legislation that says only registered nurses with an ADN, Diploma or BSN from an accredited school of nursing, who hold a liscence in that state could triage patients in the ER....I dunno....

    Have you done a lot in school about the principals of primary health care? I think that's what we need to move to and if we did this system would be sustainable.
  12. by   JMP
    when I went for a job interview last year in Arizona, I was coming from Canada. It was certainly an eye opening experince.

    I remember every cab driver, I asked each and every one of them about their health care. Man, was that an shock! NONE of them had access to health care...... except for one, who's wife was covered at her work.

    The one cab driver I remember most was a woman, in her 30's who was a diabetic. She said she could NOT get coverage, due to her diabetic condition since teenage years. I asked her, what if she gets sick? And she told me she often did....... well she is **** out of luck, since she can not get coverage, and prays every day she does not get sick. Pre-exsisting health problems are BIG problems for poor Americans. I felt for her, it put a face on the problem for me. A personal point of view.

    That experience showed me how lucky we are in Canada to have UNIVERSAL health care coverage. Yes, we pay more in taxes, but EVERYONE in this country gets EVERYTHING covered, EVERYTIME they need it, regardless to their economic background, heritage,etc.


    In the ICU setting I work in, pts are all treated with the same aggressive EXPENSIVE treatment, no matter if they are the CEO of the hospital, or a drug addicted poor soul who is septic due to needle use. You must get my point here. Yes, sometimes we end up the 90 year olds on VENTs ( they are not called respirators, they ventilate pts not respirate them), but each and every patient is treated as a separate case, and I could not be more proud of our system.

    That being said, it is not perfect. Yes there are waiting lines for some tests and procedures. But I still believe in universal health care for all. It makes me proud to be a Canadian.

    I too take exception to the idea that the Canadian system is old and out of date. We have up to date equipment, good doctors, good hospitals and provide health care to EVERY citizen.
    Last edit by JMP on Apr 27, '02
  13. by   JMP
    I have been looking at the US and New Zealand and Australia for an adventure in nursing. Before I go, I will do my homework. Looking at access to health care for citizens is certainly part of that homework.

    I believe in universal health care.

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Universal Health Coverage?