Universal Health Coverage?

[Q.]

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

[rncountry]

All I can say is this.

My stepdad is disabled from diabetes, he had to quit working about a year and a half ago. He is legally blind in one eye, and the other is not much better, he has had lazer surgery on it several times. Had a fem-pop bypass in October, last month the incision line became infected. Likely from the osteomylitis that had not cleared from his foot when he was discharged home in October. At that time he lost the three toes between the great toe and the little toe. The physician had him doing whirlpools on that from the time it happened till he reinfected. I am a wound nurse and that was inappropriate, though could not convince the doc of that. Hell I only do this for a living. Anyway he was sent home this time with open wounds after an Incision and drainage at both the calf and the thigh, opened on both sides. He had half of his left foot amputated as well. I have been doing all the care, not only do I prefer to do it, I save my parents the billing of a home care nurse that would be partially covered by insurance. The insurance that has covered this is under the cobra insurance he was able to carry after he quit working. It will cover only the next 4 four months. After that my parents have no insurance. My dad is now on SSI but there is no medicare benefit until next April. However that still will not cover my mom, who has severe COPD and is oxygen dependent. My parents are not elderly, they are in their late 50's, but they do have significant health issues. My mom was a homemaker, she chose to stay home and take care of her kids and husband and for that she is penalized by social security. She is not eligible for disability because my dad makes too much money, the whooping $1100 a month he gets from SSI. She is not eligible for regular social security because she never worked. I don't even want any money, just a way to cover my parents on insurance. The cobra insurance my dad is currently carrying costs them over $800 a month, what savings they have is nearly gone.

I have been through nearly every thing you can in order to find some sort of insurance to no avail at this time. Possibly they may be able to pick up a spend down insurance through the state of Michigan but so far because my mom can't provide a letter from social security that she meets disability criteria they can't get the spend down insurance. She can't get that letter from social security because she is not eligible, like I said because of my dad's income and because she had not worked, so of course they aren't going to take the time or the money to run her through the system just to say she meets some disability criteria, that would be foolish. Yet, this stupid woman from the county insists this is what we do. The people at social security have been very nice but are clueless as to what this woman is doing. In the meantime my parents are worrying out their guts about what they are going to do, and I am as well. If we can't get something my mom will be without insurance for 4 years until she can be covered under medicare through my dad.

Do I think all of this is bullshit? You bet. My dad has worked since he was 15 and worked until it was no longer safe for him to. He was a butcher and when he couldn't see good enough not to cut off his own hand he had to quit, not to mention the osteomylitis that was eating the bones in his foot. Even though over $800 a month is going to keep the cobra insurance, my parents would gladly continue to pay it if they were allowed to keep the insurance. But they aren't. Over the last nearly two years of dealing with all this I have dipped into the savings I had for my kids college again and again to help keep my parents afloat, college will likely be through Strafford loans now. I have listened to my dad make statements like it would have been better if he was dead because then at least my mom would have something. In the meantime as I have become involved with activism in nursing I know the top paid CEO of an HMO made 25 million dollars.

The arguments against universal healthcare have been you can't pick your own doctor. Like that is something new.

Those who work would be paying for deadbeats that don't. What do you think you are doing now? Plus you are also paying millions of dollars into the pockets of those who make money by denying care.

Look at medicare and how it runs. I say look at the aging population and we had better pull our heads out of the sand now and make some significant changes to the entire healthcare system or we are all in a world of hurt.

Either universal healthcare or force insurars to actually have to insure everyone. Like I said my parents would gladly pay to have insurance, it's just no one will do it.

[fergus51]

Bull shit we don't have enough money. We have enough money, we don't spend it properly! We have just gone through another round of cuts that will really affect patient care because of the mantra that universal health care is unaffordable. BULL!!!

Why don't we ever look at real cost saving measures, like eliminating the fee for service system and putting doctors on salary? (and we do get to pick our doctors here). 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)? 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)? Why are drug companies given such ridiculous patent rights here so each pill costs the health care system about 3$ when it's new? Why can the gov't afford to spend BILLIONS of dollars on crap (like studies looking at why noodles are sticky)? 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)? Why isn't there at least SOME effort to eliminate the useless CYA orders? 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)?

I HATE hearing people say we can't afford to provide basic health care to our citizens. It just isn't true. We choose not to. In a country as rich as the United States I think it is absolutely disgusting that millions of people are uninsured. 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. At the very least, every child should be covered, whether their parents can afford it or not.

[fergus51]

Oh and that poem is nice and all, but are you actually trying to tell me that mediocrity or lesser care is linked to universal health care and isn't a reality for a lot of Americans? I worked in one fab hospital when I lived in the US. The second one I worked at was closer to a sweat shop. We jokingly called it Northern Mexico.

[nurs4kids]

Originally posted by fergus51

Bull shit we don't have enough money. We have enough money, we don't spend it properly! We have just gone through another round of cuts that will really affect patient care because of the mantra that universal health care is unaffordable. BULL!!!

Why don't we ever look at real cost saving measures, like eliminating the fee for service system and putting doctors on salary? (and we do get to pick our doctors here). 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)? 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)? Why are drug companies given such ridiculous patent rights here so each pill costs the health care system about 3$ when it's new? Why can the gov't afford to spend BILLIONS of dollars on crap (like studies looking at why noodles are sticky)? 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)? Why isn't there at least SOME effort to eliminate the useless CYA orders? 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)?

I HATE hearing people say we can't afford to provide basic health care to our citizens. It just isn't true. We choose not to. In a country as rich as the United States I think it is absolutely disgusting that millions of people are uninsured. 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. At the very least, every child should be covered, whether their parents can afford it or not.

well said, tracy..and I couldn't agree more!

[joyflnoyz, LPN]

Why is it right to force someone to pay for another person's care? You are simply taking the property of one person, by force, and giving it to another person.

If gov't would get its big fat brotherly nose out from where it doesn't belong I think our health care system would be a whole lot better.

[nurs4kids]

Originally posted by joyflnoyz

Why is it right to force someone to pay for another person's care? You are simply taking the property of one person, by force, and giving it to another person.

If gov't would get its big fat brotherly nose out from where it doesn't belong I think our health care system would be a whole lot better.

Do you honestly think we aren't paying for another persons healthcare NOW????

But to answer your question... The elderly, the disabled (truly disabled) and most of all, the innocent..the kids, DEFINITELY deserve care at our expense. The cost of not providing care would be much greater than the cost of providing. The cost of not providing needed medical care would further destroy humanity. If your parents were in the same situation that RNcountry describes above, would you not feel they DESERVE to be cared for?? A child born into welfare doesn't DESERVE to be cared for??

[MollyJ]

Americans suffer from the "want it all" syndrome and we simply cannot afford "want it all".

I really believe that Universal Health Care is an inevitability but, God willing, it will include SOME effort to define essential care. This has always been the sticking point.

The bottom line is that we can generate more health care than we can pay for. The sooner we get with this reality the better. And, as a nation, there is care that, when provided, benefits the nation as a whole. Traditionally this includes vaccinations, contraception, prenatal care, and some infectious disease care (ie TB).

My best guesses:

Essential care will include a whole lot more palliative care and whole lot less interventional care on seniors and some chronically ill individuals of all ages.

Diabetes care, hypertension management, weight control, smoking cessation are all types of care that keep generally health individuals healthy longer and functional, that is, working.

Some procedures that we all hold near and dear will become "self pay" procedures: breast reduction/reconstruction, alot of craniofacial work [even some on children], CABG's etc on people over a certain age etc.

Things I worry about: The standard of care for common illnesses is getting so expensive that is hard for indigent care settings to keep up with it. ie diabetes care, prenatal care, hypertension care, etc.

I noted that one poster feels resentful that her funds are taken to care for others. We really are all in the same boat, the good ship planet earth, so our fates are inter-related. Believe me you have a vested interest that some types of care are received even by the poorest of the poor. ie vaccinations, some infectious disease, water sanitation, global climate control.

[Q.]

Ok, so you say we're paying for "deadbeats who don't work" NOW. Yeah, I agree with that. And what am I paying for now? Let's see....expensive tertiary care. We don't pay for prenatal visits but we WILL pay for the NICU stay of the mom that we didn't see in the beginning.

I want to see a shift to preventative, LESS EXPENSIVE care. BASIC health care services should be available to all; but in my mind, the key is getting these people to utilize them.

Bottom line: we can provide all the free services we want, and we do. We have free clinics here, alot of nurse-run clinics where we charge only $20 bucks for a pap and pelvic and mammo, give away sample medications, etc. But you can't FORCE people to utilize these services. You can educate and educate and offer services and do all this, but if a person doesn't wanna be seen at that time, ultimately they will go to the ER 'cuz "they wanna." I have a hard time when I hear a person complain about the $20 co-pay they had to pay for their pills or the $50 copay for the ER visit, but have NO problem paying $400/month for their car.

My only concern with universal health care is this: my husband and I work right now. We have a pretty good income, pretty good insurance because the company he works for is a Fortune 100 company. Are we lucky? Sure. But at this point we can AFFORD the most expensive care for ourselves and our family if we choose. And we want that ability to choose that if we need it.

[fergus51]

Susy, from my experience, health care in the US wasn't any cheaper than here. The extra that we pay in taxes here, I was paying to an HMO there. The only real difference was that I had to deal with the HMO....(and you don't want to get me started on my HMO!!!:))

[fiestynurse]

California has just completed a series of symposiums on health care options. Two of the reform options studied were single payer systems. Single payer sytems have proven to be cost effective and provide quality health care to everyone.

http://www.healthcareoptions.ca.gov/

We are the only industrialized country without a universal health care plan. Millions go without basic health care in this country, yet few seem to give a damn. We are ranked 37th by the World Health Organization because of the poor quality and inefficiency of our system.

[Q.]

The US also has the highest infant mortality rate as well. I don't think that's a reflection necessarily of our equity of health care per se; but could it be related to the high teen pregnancy rate? The smoking? The drinking?

And the teens getting pregnant aren't always poor. Some are kids of wealthy families who drink, smoke, and do drugs, leading to poor infant mortality.

Again, I still maintain that even if EVERYONE had access to free, basic medical services, you would still have those who choose to use the ER. Then who pays for that?