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- by jcasablanca Mar 6, '12This is a current discussion topic for a masters class. Is health care a right or privilege? What do you think? What do you think about the Affordable Care Act? Do we need universal health care? The answers to these questions will be used during a debate in a Nursing Ethics and Policy course. Your input would be greatly appreciated.
- Mar 6, '12 by neatnurse30Anything that cost is not a right. Healthcare is not a right, it is a commodity because it costs. If you go to the mall, or grocery store you know that you have to pay, nobody is arguing with the cashier about not paying. For some odd reason, when people go to the hospital, or a doctor, they don't want to pay the bill and believe that they can get healthcare services for free. Granted, health insurance is expensive and medical services are expensive, but people should be able to pay at least partial cost.
- Mar 6, '12 by great_buI am a UK nurse who has worked in the National Health Service (NHS) for my whole career (why am I posting on allnurses.com ? because I am in the process of emigrating to Baltimore to work at John's Hopkins), so I have a great familirarity with universal free (at the point of delivery, anyway) healthcare.
The biggest issue with delivering 'free'* health care is that there is a significant gap between the ethical ideal which we would like to be true and the reality of human nature.
In an ethically ideal world, the best solution for healthcare provision would be to have an NHS style system whereby universal taxation (based on ability to pay, i.e. the rich pay more than the poor) is used to fund a universally available healthcare delivery system (based on health need, i.e. the sick get more than the healthy, regardless of personal finances).
In the real world, unfortunately, this leads to the significant problem that healthcare is regarded as a right instead of a privilege. This means (and has meant for the NHS in the UK) that you are faced with significant problems in providing universal healthcare as the financial cost of that heathcare provision must still be met. The amount of money required to provide all the heathcare needs of every person that is eligible for it is far greater than the available funds raised from taxation.
This leads to the government having to choose between raising taxation to pay for it (and immediately losing the next general election) or somehow restricting the 'universality' of the 'free' healthcare.
As a result of this we have an organisation in the UK called the National Institute for Clinical Excellence (NICE) who's job it is to decide whether any given treatment is financially viable and the way they do this is (in a simplified form) to work out how much longer any given treatment will extend your life against how much that treatment will cost to administer and if each year of extra life costs more than a certain amount, then that treatment is not provided by the NHS. This seems like a good solution if you are a tax payer or your illness falls into the provided NHS treatment but would seem vastly unjust to a person who has paid tax into the NHS system for their entire life only to be told when they need care that it will not be paid for as the particular illness they have is too expensive to treat (even though there are treatments in existence for it).
This raises even more ethical issues around whether free NHS treatment should be given to people with what are perceived** as 'self inflicted' illnesses, such as smokers with lung cancer or IV drug addicts with endocarditis or overweight people with cardiovascular disease etc (and furthermore, where do you draw the line at what is 'self inflicted' ? Smoking ? Alcohol ? Joggers needing knee replacements ? Mountain bikers who fall off and break their legs ?)
Universal healthcare should be a right but in reality the cost of providing it means that it will never be an accomplisheable (is this a real word, only time will tell.....) goal.
My impresion is that at least a privatised insurance based system, whilst unequal across society on the grounds of personal wealth, at least encourages personal responsibilty for your own health as you will be billed for whatever the health consequences of your actions lead to (but on the other hand, doughnuts are nice.....).
*Not really free, of course, you pay for it with your taxes instead of directly.
**Perceived by society, not nescessarily by me.
- Mar 6, '12 by jcasablancaThank you, but may I further clarify. The actual assignment is to post a question using social media with the responses used during a class debate. With the advent of social media, the world has become very small, allowing interaction between individuals who may have never had that opportunity. Participation is not doing "other peoples' homework". It gives you a chance to weigh in on as you described "an interesting topic". It generates additional questions such as is health care an actual commodity, as described above.
Posted responses from individuals working in countries who have nationalized health care is an invaluable insight that I may not have had access too. (The problems in the UK health care system are the same problems the US will encounter as the health care dollar shrinks.) So, the participation of everyone is greatly appreciated and will help to illuminate this difficult topic.Last edit by jcasablanca on Mar 6, '12 : Reason: additional information
- Mar 6, '12 by WoodenpugThank you, great_bu. That is the best argument against universal healthcare I've read. I'm still in favor of universal health care, but your point is understood.
BTW. Actionable is a word in the U.S.A.: Accomplishable - definition of Accomplishable by the Free Online Dictionary, Thesaurus and Encyclopedia. And, thanks again for a rational, well thought, response. Even though, I'm not taking that master's course.
- Mar 6, '12 by great_buThis thread just struck a chord with me as when I had my original telephone interview for the post I am coming to at JHH, the interviewer was at some pains to emphasise the significant amount of pro-bono work that JHH provides (a good thing) as she clearly thought that as an NHS trained nurse I would be in favour of universal free healthcare. I am a supporter of the priniciple but unfortunately I have yet to come across a system that would be properly fair and viable without unlimited funds.
Another related issue that arises for the NHS is one of abuse of the system - UK citizens are aware that the NHS cannot turn them away if they arrive at a hospital sick, and many less pricipled members of our society will present at hospitals and complain of symptoms which are indicative of hard to diagnose conditions (general abdominal pain, chest pain, that sort of thing) which they know will guarantee that they are admitted to hospital for a few days of free meals, clean bedding and warm heating (and the timing of these admissions often bears a striking similarity to any scheduled appearances in court that they may be due, as soon as the court date passes and in re-scheduled, they are miraculously cured and discharge themselves - this from my actual experience on more than one occasion, and I suspect the willingness to do this would be significantly impaired if we billed them the ~$1000 per day it costs the NHS just to keep them as an in-patient (never mind any actual tests we might foolishly want to do on them)).
On top of this, we also enjoy a rising tide of 'Health Tourism' - foreign nationals who just happen to develop an expensive to cure disease within hours of stepping off of the airplane on their holiday to the UK, knowing full well that even if we know they are foreign nationals with no right to free NHS healthcare we will treat them first then try to bill them for it, at which point they are straight back on the 'plane home, never to be seen (or paid from) again. On the flip side, of course, I know that as a UK citizen I am never more than a plane ticket away from a free heart bypass, however many doughnuts I scarf when I get stateside (Drive-Thru' Dunkin' Donut stores tht are open 24 hours a day and take credit cards !!!! That's civilisation ! )
Don't get me wrong, there are many excellent advantages to nationalised universal healthcare - no-one* ever went bankrupt because of health costs in the UK, the inequalities in life expectancy due to wealth are significantly smaller here than in the US etc. but the illusion that US politicians are trying to sell Americans about how wonderful the NHS is is a politician's truth**.
*except the government
** a lie
- Mar 6, '12 by WoodenpugGreat_Bu, your most recent post is about a problem that exists, likely to a greater extent, in the privatized system here in the US. In fact, it's a very old problem. The fifth or sixth edition of the Merk manual, before it became useless, had a diagnoses "hospital bums."
I would hope that eventually, we will reduce those leaches on the health care system. Under the privatized system the only difference is who pays. Now the hospitals get no compensation, under universal health care the hospitals would be paid. Currently, in the US, those people pass along their costs to those who pay for insurance. Under universal health care the taxpayers would pay for those people. Likely, the same people paying the bill, but I hope it will make it more obvious.
- Mar 6, '12 by JolieQuote from jcasablancaThank you for clarifying. We'd still like to hear your inputThank you, but may I further clarify. The actual assignment is to post a question using social media with the responses used during a class debate. With the advent of social media, the world has become very small, allowing interaction between individuals who may have never had that opportunity. Participation is not doing "other peoples' homework". It gives you a chance to weigh in on as you described "an interesting topic". It generates additional questions such as is health care an actual commodity, as described above.
Posted responses from individuals working in countries who have nationalized health care is an invaluable insight that I may not have had access too. (The problems in the UK health care system are the same problems the US will encounter as the health care dollar shrinks.) So, the participation of everyone is greatly appreciated and will help to illuminate this difficult topic.