Universal Health Coverage? - page 4

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.
    Hi Helen,

    I actually have been doing reading (well, trying to keep up with reading and projects) on our healthcare system and certain benchmarks. The text I am using is Health Care USA: Understanding Its Organization and Delivery, 2000.

    Perhaps I shouldn't use HMO and Managed Care as interchangeable as I do.

    What I was referring to was the birth of Blue Cross, when "health insurance" per se was originally started as an income base during WWII and the Depression Era. Physicians originally were opposed to this idea as they thought it would decrease their incomes, however, once incomes were dropping d/t the depression, Blue Cross was a welcoming income source for them and the hospitals as it guaranteed a certain amount of admissions.

    In 1973 when HMO's were started with the HMO Act, they were expected to hold down costs by promoting wellness - thereby making physicians in a sense accountable. Utilization reviews were added, limiting referrals to specialists, clinical practice guidelines, etc. In an effort to make them accountable for tests, procedures and diagnoses, HMOs and managed care have gone out of control, now determining physician compensation by how well he or she meets or exceeds expectations of patient visits and resources and referrals, and instituting Hold Harmless Clauses.

    That is what I meant by Fergus's idea of turning people away from the ER if the visit isn't warranted; good idea in theory, like Managed Care was, but if left unchecked, like Managed Care is, can cause MORE problems.
  2. by   Q.
    I still don't see how having the government involved in healthcare is going to be a good thing. Medicare as it is now is HORRIBLE; if that is any indication in the world of how government run health care is, my god, what is??
  3. by   fiestynurse
    The main problem with medicare is that it takes care of the sickest and neediest portion of our society and attempts to do it with very little funding. In a single-payer system, medicare would be eliminated. The entire pool would be enlarged to include everyone. It would be much more efficient than our present medicare and managed care system.
  4. by   Q.
    Unless you tax even MORE (and already as it is, people such as my husband and I with a home and no children and dual incomes pay a disproportionate amount of the US taxes) there is no way that we can afford to give everyone the best healthcare in the world. I just don't see it happening. In order to accomodate everyone, I see health care dropping in standards: 6 month waiting list for mammograms, braces only if your teeth are crooked by a certain degree, say 20degrees?.

    As a citizen who is in the state I am in, who came from a very poor family as well as my husband, I want to be able to get my mammo NOW when I have a lump, not 6 months later.
  5. by   rncountry
    I agree with all that Suzy, but I strongly think that we can't simply ignore what is happening either. I sincerely love where I am working at because not only am I able to practice what I know and do it well but because we don't have mandatory overtime. The nurses are treated like knowledgable human beings. That said however, my company was formed a few years ago to fill a particular niche. The patient that can't wean, the patient with big wounds that can't be handled at home, the patient with long term ABT because of massive infection. We take only certain patients that meet our criteria, as well as the insurance criteria. We do not accept any medicaid patients. The idea is to make money not to provide healthcare. Providing healthcare is the byproduct of making money. I think that is wrong. There may be much said for survival of the fittest, but I would submit the human population is far past that need instead we should function by morals and ethics that do not allow us to decide that someone doesn't get to have a chance at a healthy life based on the amount of income they make.
    It is my thought that we have, not only in this country, but worldwide, an aging baby boom population that is going to impact our world even more so than they have through the 60's and on down. We can chose to be proactive and deal with it intelligently or we can not.
    Everything you wrote about the history of blue cross is certainly correct, that doesn't mean that it continues to be an appropriate model for our coming issues, any more than how things were done was an appropriate way to continue post depression and WWII. Nursing homes in Michigan are struggling to be able to do what little they do now and the Governor just decided two weeks ago to make medicare and medicaid cuts again. In the meantime we have nursing homes that do not come close to providing even basic care, let alone more than that, based primarily on how much staff they are willing to hire due to cost. I think it is evil and sinful to lock away our old people that not only were productive members of society but who actively fought for and saved the freedoms that all us and Europe enjoys. We allow them to wander the halls of a nursing home with wet underwear, poor nutrition, soiled clothes, unwashed bodies and uncombed hair, and all in the name of cost control. It is disgusting. And while we do that we put some poor 90 year old woman on a vent because someone will pay for that.
    The biggest issue to me is education of the public. For the most part it is not docs that will take that lead, they are concerned about their earning power, the AMA was not formed as simply a professional group but as much as a guild to protect their territory and earning ability as anything else. However now you have a situation where the group that was supposed to help control costs and the docs are now the ones in need of the same all based on the same premise, money and their earning power. The only way I feel it is feasible to rein in all groups that are intent on making baloney amounts of money on someone else's misery is a party that has no vested interest in making money, but instead on getting people, all people, decent healthcare at a reasonable cost. A headache yes, difficult certainly, but a worthwhile endeavor I feel has to take place.
  6. by   fergus51
    I don't get why we're so afraid of change. We don't wait six months for a mamogram here despite universal health care. Waiting lists are always the first scare tactic used to fend off universal health care. I don't know anyone who has waited for emergency/urgent treatment.

    Yeah, if we attempt reform some things could turn out badly. They could also turn out better.... I don't see who we are protecting by maintaining the status quo in health care.

    Does anyone know how many Americans don't have health insurance, or the number of Americans who declare bankruptcy every year because of hospital bills, etc.? Maybe I am completely off base here, but I would imagine the costs in NOT having universal health care are similar to the costs associated with having it....

    And can anyone do a real assessment of the quality of patient care between America and other countries like Canada or Britain who have a universal system?
    Last edit by fergus51 on Apr 28, '02
  7. by   fergus51
    Many people believe the uninsured are also the unemployed. This misconception masks the fact that eight out of ten uninsured are employed

    This scares me. Got it from feistynurse's weblink.
  8. by   fiestynurse
    Here's an interesting twist to add to the debate.

    Recently, this was reported in a local newspaper:
    An uninsured paraplegic was in need of some very critical and urgent medical care. He had applied for every possible government sponsored program, but was turned down. So, he robbed a bank at gunpoint, because he knew this would land him in jail. The incarcerated are the only U.S. citizens with a constitutional right to health care through the 8th amendment.
    He knew that he would get the necessary care in prison!
    The article pointed out that this is not an isolated incident and becoming quite common among the elderly?!

    (Wish I could find the actual article, to provide the link for you)
  9. by   Q.
    I've heard of that too. There was one case on 20/20 or Frontline that was talking about a man who could not afford to even be put on the waiting list for a heart transplant, yet, a prison inmate was given a heart, fully paid for out of our taxes. What a tangled web we weave.

    One of the physicians interviewed stated that it is not their duty to decide WHO gets a heart; if a prison inmate qualifies, then he qualifies. By eliminating health care to prison inmates we would be going down a whole 'nother slippery slope. Again, this goes back to my question of what IS "basic" medical care? As technology advances, that line gets fuzzier and "basic" gets moved up a notch.

    I see our medical system partially being fixed by the following:

    *Instill government regulations into HMO's and Managed Care plans. There was once an Act that didn't allow HMO's to decline coverage based on pre-existing conditions; however the HMO's found a loophole by not compensating their agents if they sold policies to such individuals. That needs to be stopped and more heavily regulated by the government.

    *Strengthen our Public Health Departments. These are vehicles that are quite capable of providing basic services to ANYONE, with a focus on preventative, primary care.

    *Tighter regulations on pharmaceutical companies. While I agree a profit needs to be made to compensate for the development of new drugs, the profit margin they are realizing is incredible. That should be curbed.

    *Nursing as a profession, I believe holds the key to a portion of Health Care Reform. We are an educated, collaborative, skilled group that can provide care, education and services to a population without heavy expenditures. Completely nurse-run clinics generally see more patients and have less overhead than standard physician run clinics. I think nursing needs to reorganize, redefine ourselves, educate ourselves further, encourage further education like NPs, CRNA's, Educators, to help invoke health care change.
  10. by   rncountry
    I think nursing needs to reorganize, redefine ourselves, educate ourselves further, encourage further education like NPs, CRNA's, Educators, to help invoke health care change.



    Absolutely! Now we have to think on the next step though. Compensation. How would that be accomplished in the current healthcare system that does not allow that? We have many nurses that could have an independent practice by virtue of their education, however that is not truly available because of the lack of direct compensation to those nurses. Much to think about. Yes? But doable, anything is doable if you want it bad enough.
  11. by   fergus51
    Are you guys serious? Prison inmates are guaranteed healthcare but a 2 year old isn't? Wow...that's definitely something I hadn't thought about before.....
  12. by   Q.
    I may get tarred and feathered here :uhoh21: but I think for the most part, staff nurses can make some pretty decent income. I think the issue of compensation for nurses comes when we compare our salaries to those of other professions that we don't see as nearly as important or stressful. Pay isn't the only issue, as most nurses, myself included, left a fairly decent pay for lower pay. Why? Better conditions. I think if nurses had more autonomy, the "lower" pay that we see as compared to IT professionals would be easier to swallow.

    As far as nursing as a whole: for one, I see our biggest opponent as the AMA. Time and again they create replacements for us: PAs, MAs, Anesthesia Techs; all professions that are fully supported by the AMA and designed to maintain control. Nursing needs to reorganize and gain lobbying power and influence through the ANA. I'm not saying that the ANA is the be-all, end-all, and I can't comment on its objectives because I don't know all of them, but I do know that we need a large organization designed to promote ourselves and make (demand) some changes. Simplly put we need lobbying power to ensure our abilities to directly bill for our services. We need lobbying power to promote our services so that insurance companies, or the general public, would prefer a nurse to a physician in some cases, or, at least, accept a nurse's care or opinion.

    We can be a highly skilled, intelligent group of professionals. However, until we reorganize and redefine, encourage education and stop downplaying it, we won't get anywhere. And instead, Health Reform will come with or without us, and like James Huffman said a couple posts ago, someone ELSE will define us and it might not be in the best interest of the patient...or us.
    Last edit by Susy K on Apr 28, '02
  13. by   Q.
    Tracy,

    Yes we do offer health care to our prison inmates and not necessarily to our children. Like I said, if we DIDN'T offer care to the inmates, someone would definitely make a big stink about that and call us inhumane.

    Kinda like the extreme (and I mean extreme) pro-lifers who discourage abortion, but do nothing as far as helping the existing children in the world, or could care less about the death penalty.

    Ass-backwards.

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Universal Health Coverage?