Universal Health Coverage?

Nurses General Nursing

Published

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 it is, they only pay 30cents on the dollar, are slow to reimburse, most often clinics and hospitals struggle financially and often times have to write off alot of procedures d/t Medicare. I sometimes see Medicare as a reflection of what universal health coverage would be; not enough money and care down to the least common denominator. Canada, our neighbor, is also struggling as there isn't enough money to care for all of their citizens. What is everyone else's opinion on this? What IS the answer?

Here is a poem I came across that I thought I would share:

Taken from the International Conference in Medicine held in February 2001:

Draped in Disquise

Cries for medical care equal to Canada or Great Britain is fair

Everyone's much better there, so why not us? We want their care

NO, they say, it isn't so

Don't give up what you have for the lesser care within our society

Am I to believe it's a disguise? A mask claiming to be better for you or me;

confusion, disorder split in two which shall we choose?

One bringing change, or another bearing mediocrity

Our lives are too precious to be bound by the arms of bureaucracy.

Other nations have tried and failed leaving only discontent and disparity

Look forward to what can be.

Not their past except it's history.

Lest the burning desire of what we lust becomes the aftermath of only dust.

If we turn our backs and pretend not to see, no more will we the envy be, and the failures of others becomes our destiny.

Learn from their failure, for left unexplored creates another worse than before.

By Linda Tofanelli

For House Concurrent Resolution 99:

http://www.house.gov/conyers/hr99.PDF

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.

Specializes in ICU/CCU (PCCN); Heme/Onc/BMT.

Fiestynurse . . .

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.

Cheers,

Ted

Efiebke - 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 care plans. 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.

On 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

JAMA

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:

http://www.commoncouragepress.com/himmelstein_bleeding.html

This is a great discussion!!

Specializes in LDRP; Education.

Wow, I just re-read this whole thread. It sure was a great one.

Susy, still some unanswered questions posted on the Is Health Care A Right? thread. ;)

I didn't read through every post, so excuse me if this was already brought up.

One of the problems with ED visits is EMTALA. Under EMTALA, if someone presents to the ED, they MUST have a medical screening. Initially, this was to prevent "dumping" pts. w/ no coverage to county facilities, but it seems to have gotten out of control. When you have a teenager coming by ambulance to the ED for menstrual cramps...well, I'm liberal, but even that makes my eyes cross...

Specializes in LDRP; Education.

Ahem. Stargazer. Was that a hint? Tee Hee.

I'll go catch up on that thread. ;)

:D
+ Add a Comment