Universal Health Coverage? - page 8
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
May 3, '02God, I hope the United States never goes socialist health care.
Take England for example. A cancer patient has to wait half a year for treatment. George Harrison didn't stick around in England to take care of his cancer. He was treated in the US.
Canadians who can afford it come down to the US to have their health problems treated.
My sister works for the Intestinal Disease Foundation and she received a call from a woman from Canada for information on the symptoms she had and my sister suggested she visit a gastrologist. The woman said she had a few months before and because of the health care, she could only visit him once a year.
May 3, '02Originally posted by Stargazer
Prior to April 15th, there was a long thread on another (fairly international) board I post to regarding taxes. Some of the Americans whingeing (isn't that a great word? Brit-speak for whining) about their high taxes were practically laughed off the board--and then informed by their non-American counterparts that paying, say, 14 - 20% or so, on average, of one's income doesn't constitute "high" taxes anywhere else in the world but the US.
If it's just Federal, when we calculate our taxes, we need to remember State income tax, Social Security, Medicare, sales taxes, real estate, personal property, local income taxes, and all those tiny little taxes added to our utility bills. Have I missed any taxes?
May 3, '02Originally posted by mattsmom81
Forgive me if someone has mentioned these points already.
I have a group of British girlfriends who came to the US in the 70's during the 'nurse invasion' brought on by the shortage then. They all became citizens here, eventually raising families, because in Britain, their salary is little more than minimum wage under national healthcare. They tell me they could not support themselves independently on their salaries in Britain! Are US nurses willing to take such a cut in pay should we go to a similar system? I sure can't see US docs taking ANY pay cut, so you know we would....!!
With the current move towards BSN as mimimum, who will go into a 4 year program to make little more than minimum wage?
I remember the last healthcare plan....and Hilary's famous quote about a main problem in our healthcare system being the 'overpaid handmaidens' in nursing.....but how quickly some forget.
I'm sorry, but where is it written that we have a right to health care? Where is it written that we have a right to education?
Life is not fair - not in this imperfect world. And I'm still reluctant to have Big Brother doll out my pills and medical care. The road to Hell is paved with good intentions.
May 3, '02The Washington Post
August 11, 2001
"Burton's German Trip Protested"
By Juliet Eilperin
"Rep. Dan Burton (R-Ind.), chairman of the House Government Reform Committee, arranged for an unusual government-paid trip to Frankfurt and Bonn this week to investigate the German postal system. He is also visiting his wife, who is receiving medical care in Frankfurt, according to the congressman's aides."
There are very serious problems with our health care system, especially in access and coverage in a system that is infamous for wasting our abundant resources. Our national policies continue to favor the entrepreneurial elements in the health care system while continuing to neglect the unmet needs of the people. Unfortunately, the rhetoric continues to drive the displacement
of our national priorities, as if the unmet needs were merely a nebulous construct, rather than real needs of real people.
Now, to the difficult part of this message. We need to look at the
actions of Rep. Burton, a man who is now deeply and intimately involved with the real needs of a real person. This overriding issue makes it impossible to fault his actions. He is making the best decisions he can in a very difficult, trying situation. He has walked away from "the best health care system in the world" and gone to another country that offers some of the best care available. He has walked away from "the most advanced research and technology" to another nation that likewise has advanced research and technology. With FEHBP coverage, he has his choice of any care within the limitations of his plan, but he elects to go to a country that happens to assure that care is covered and accessible for essentially everyone, with virtually no restrictions on providers. At home, he continues to work with elements in our society that want to keep government out of our health care. Yet he accepts a government funded health plan, and even is not above accepting government transportation for a combined personal and quasi-government-business trip. Apparently Rep. Burton does want the government involved in health care when it is providing him and his loved ones with access and coverage.
Real people have real needs. None of our needs are met by rhetoric. In health care, they are met partly by our own personal efforts. But clearly most of us by ourselves can never assure that we can meet the financial demands of catastrophic illness, nor the public health protections that can be provided only on a population basis, nor the assurance that the health care infrastructure will be there when we need it, nor the assurance that our resources will not be frittered by Wall Street and by the technological and pharmaceutical firms that have their own priorities which they have placed higher than the public good. Real people with real needs can expect those needs to be met only with a combination of personal effort balanced with a public effort that places reality above rhetoric.
Health Affairs May/June 2002
Phantoms In The Snow: Canadians' Use Of Health Care Services In The United States
Surprisingly few Canadians travel to the United States for health
care, despite the persistence of the myth.
by Steven J. Katz, Karen Cardiff, Marina Pascali, Morris L. Barer, and Robert G. Evans
A tip without an iceberg?
This study was undertaken to quantify the nature and extent of use by Canadians of medical services provided in the United States. It is frequently claimed, by critics of single-payer public health insurance on both sides of the border, that such use is large and that it reflects Canadian patients' dissatisfaction with their inadequate health care system.
All of the evidence we have, however, indicates that the anecdotal reports of Medicare refugees from Canada are not the tip of a southbound iceberg but a small number of scattered cubes. The cross-border flow of care-seeking patients appears to be very small.
Our telephone survey of likely U.S. providers of wait-listed services such as advanced imaging and eye procedures strongly suggested that very few Canadians sought care for these services south of the border. Relative to the large volume of these procedures provided to Canadians within adjacent provinces, the numbers are almost undetectable. Hospital administrative data from states bordering Canadian population
centers reinforce this picture. State inpatient discharge data show that most Canadian admissions to these hospitals were unrelated to waiting time or to leading-edge-technology scenarios commonly associated with cross- border care-seeking arguments. The vast majority of services provided to Canadians were emergency or urgent care, presumably coincidental with travel to the United States for other purposes. They were clearly unrelated either to advanced technologies or to waiting times north of the border. This is consistent with the findings from our previous study in Ontario of provincial plan records of reimbursement for out-of-country use of care. Additional findings
from the current study showed that a small amount of cross-order use was related to proximal services, primarily in rural or remote areas where provincial payers have made arrangements to reimburse nearby U.S. providers.
Finally, information from a sample of "America's Best
Hospitals" revealed very few Canadians being seen for the magnet referral services they provide.
These findings from U.S. data are supported by responses to a large population-based health survey, the NPHS, in Canada undertaken during our study period (1996). As noted above, 0.5 percent of respondents indicated that they had received health care in the United States in the prior year, but only 0.11 percent (20 of 18,000 respondents) said that they had gone there for the purpose of obtaining any type of health care, whether or not covered by the public plans.
Despite the evidence presented in our study, the Canadian
border-crossing claims will probably persist. The tension between
payers and providers is real, inevitable, and permanent, and claims that serve the interests of either party will continue to be
independent of the evidentiary base. Debates over health policy furnish a number of examples of these "zombies"-ideas that, on logic or evidence, are intellectually dead-that can never be laid to rest because they are useful to some powerful interests. The phantom hordes of Canadian medical refugees are likely to remain among them.
Comment: This excellent study refutes the false generalizations that have been extrapolated from the embellished anecdotes of Canadian medical refugees in the United States. Debates on health care policy should be based on the best factual information available regardless of whether or not those facts support individual ideological viewpoints. This important study should be downloaded and made readily available to refute those that insist that single payer approaches should be
dismissed immediately without further consideration merely because of the fictional massive medical migration from Canada into the United States.Last edit by fiestynurse on Jun 2, '02
May 5, '02For House Concurrent Resolution 99:
The resolution calls for legislation by October 2004 that would guarantee that every person has access to health care that meets fourteen specific criteria that we all support. Read it, and then contact your Congressional representative to enlist his or her endorsement.
May 5, '02Fiestynurse . . .
You are one cool person. Your concern and compassion is evident in what you write and advocate. I'm glad you're a nurse!!!
Healthcare is an extremely complex issue. Bottom line, though, healthcare is a right. Sadly, it is a right not provided to a lot of hard working, tax paying citizens of this country.
May 5, '02Efiebke - You are right! Health care policy is a complex issue.
I am always glad to see it come up as a topic of discussion on allnurses.com. Nurses need to educate themselves in this area because it will require public RN response.
Here is something else to think about as we discuss health care reform:
Professor Donald W. Light on Price Discrimination:
An old, dishonorable practice needs to be seen in a new light, namely making people without health insurance pay far more than others for needed health care. This especially affects immigrant groups, and among them, Latinos have the highest rate of uninsurance.
For decades, providers and especially hospitals, have kept raising their charges, far higher than their costs, in order to raise their "profile" for discount payments from government programs and insurers. Each year they raise the charges, and each year the payers respond by lowering the percentage of "charges" they will pay.
This game is fine for those in them, and conversations about those not in them usually focus on Sheiks. In a recently conversation, a sub-specialist at a famous hospital was
explaining how only millionaires and Sheiks pay full charges - they are so outrageous - and these windfall sums help pay for the uninsured.
But first, the uninsured are billed the "standard charges" (which no insured person pays). Then, when they cannot pay, bill collectors are sent, who attach their credit cards or homes (if they have one), and who threaten to report them to the INS. These charges are typically 3-6 times greater than what is normally collected from HMOs, insurers, and managed . I
recently experienced this personally, when a routine blood test was deemed not covered. The lab (a large national company) normally collects $85 for the test from discount contractors, but because they were billing me as an individual, their itemized bill was $401, more than 4 times greater. I got my physician to write a note and the bill was adjusted down to $85. If this had been for a hospitalization, the bill might have been $8500 to a plan
or insurer, but $40,100 to an individual.
These practices have been documented by Consejo De Latinos Unidos, and they have a class action suit against Tenet, the huge managed care corporation, for ethnic discrimination. They have even shown in what unsystematic data they have been able to gather, that a hospital recovers more income from uninsured Latinos than from HMOs, i.e., the collection agents get them to
pay a third of the bill, or $12,000 before taking them to court and/or getting them deported, when a routine payment would be $8500. Their material include a number of case studies that are an embarrassment to read.
Of course, Tenet replies they are doing what they always do, and that is correct. That's "how the system works." The judge on the case happened to speak about it off the record and comments that courts are not set up to change systems. In short, a dishonorable old practice of charge inflation has tragic consequences for the uninsured and especially for immigrants.
All discussions about the uninsured, and about individualizing health care by having employees get health insurance for themselves, need to include these issues and practices.Last edit by fiestynurse on May 5, '02
May 6, '02On NPR tonight on my way home from work, "The coming health crisis will be a trainwreak that all will gape at and wonder what happened because although we can all see the two trains headed directly toward one another, no one is willing to either stop or at least slow one of the trains."
This piece went on regarding the aging babyboomers, increasing insurance rates in just the past year, average of 11 to 15% though typically 25% in California. The jump in prescription drugs, and the critical nursing shortage that is anticipated by 2008. Made for grim radio but something that is needed to be put out there. It noted that the bill fiestynurse talked about as well as a meeting that is being held next month regarding how to fix the system. The person being interviewed talked about managed care, and actually laughed while saying there was nothing managed or even remotely organized about it.
The one good note here is that a gal at work that does the marketing and patient recruiting has a master's in health admin. she told me that as long as my parents are covered with insurance now than Blue Cross and Blue Shield are required to pick them up as individuals as part of the deal that allowed BCBS to even exist. They cannot deny coverage based on prexisting conditions as long as they were previously covered. I called BCBS and found this to be correct. They will be sending an information packet in the mail to me. The big question is whether this is at a rate my parents can afford. I hope so. In the meantime I am studying and learning. The resources given here, particularly by fiestynurse have been helpful. Thanks. Helen
May 7, '02JAMA
May 1, 2002
Book Review by Jerrold P. Schwartz, M.D.
"Bleeding the Patient: The Consequences of Corporate Health Care" By David Himmelstein and Steffie Woolhandler with Ida Hellander Common Courage Press
"The seven years since the failed attempt of the Clinton administration to enact health care reform have seen the burgeoning of for-profit corporations in all aspects of health care. Giant health insurance and pharmaceutical corporations, for-profit hospital corporations with hundreds of hospitals, hemodialysis and nursing home chains, mental health and home care corporations, and many others less visible, such as quality-of-care and credentialing companies, are now well entrenched in our uniquely American system of health care and are profiting handsomely. But in the free-enterprise free-for-all, how are patients, nurses and doctors faring? To find out, read this book."
"Judging by the tone of the book, the authors clearly uphold the US ideals of democracy and egalitarianism."
"As advocates for our patients and to preserve the ethical underpinnings of our profession, all US physicians and nurses should read this compelling argument for medicine as a public service."
"Bleeding the Patient" is available from the publisher, Common Courage Press at:
Feb 8, '03Susy, still some unanswered questions posted on the Is Health Care A Right? thread.