Healthcare is NOT a basic human right.

[Asystole RN]

If one were to read the Constitution one would realize that the Constitution does not grant anyone freedoms, liberties, or rights. The Constitution only protects freedoms, liberties, and rights from transgressions on part of the government. A right is something that is inherent to the individual, comes from that individual, and is maintained by the individual. You are born with such rights like the right to speak freely, the only thing that can be done to that right is to have it infringed. No one can grant a right to another, only limit or impede the exercise of that right.

Healthcare is a human invention that does not exist in the natural environment. Only through the work of others and through the taking of resources from one party and giving to another does healthcare exist. You cannot force someone to give effort and resources to another and call that a right. In the absence of human intervention the individual would live their lives and succumb to the natural forces which would act upon their bodies.

Do I think we should provide preventative care and basic primary care? Sure. Do I think that we can? Maybe. Do I think that healthcare is a basic human right? Absolutely not.

[cdsga]

A lot of times ESRD is purely genetics. But economics and nutritional status and other diseases such as hypertension and diabetes take their toll. It's cheaper to eat processed, high NA, high GLU filled canned foods than buying fresh (not necessarily) organic. When you are at the poverty level-long term shelf items fit the bill as well as filling foods that are not the best for you over the long term.

So all that plays into the stats.

[RNfaster]

RNFaster-great entry. It's a sobering thought-and I too wonder where the money goes. I know when you put someone in a nursing home-someone has to be made power of attorney and all that person's assets with the exception of house and car are liquidated to be able to go on medicare/medicaid-any savings, investments etc, go to the long term care.

With the new ACA, even though they say there won't be death panels. I think it will be a matter of time, they may change the name, but the financial issues will prohibit large amounts of money spent on fruitless efforts to extend life. It will be called something like "Quality of life Panel" or something like that to make it sound politically correct and more sensitive, but no longer will they be able to put gobs of money into the terminally ill just so the family can adjust to the reality of their loved ones passing on.

It makes advance directives and durable power of attorneys so much more important. People don't want to face it-but each of us will have to make that determination one day, the more you discuss it the better everyone has a handle on how their loved one wants to live out their last days/months/years.

Thank you! I appreciate your thoughts as well!

I think fear causes people to come up with the term "death panels." After working in healthcare for a period, my views have changed relative to interventions as someone is nearing death. I think excessive interventions are often cruel...and often pressed on by the family (out of ignorance and hope) and/or system. I actually think that "Quality of Life Panel" would be an okay thing... In my current work, I do see doctors broaching the subject of end-of-life care, palliative care...and getting patients to think about things... I see that it often takes many discussions...

I agree with you on advanced directives, etc.

If I go back to original thread....healthcare as human right...I believe we have the right to it...and obligation as humans to administer it... I think the notion of "Quality of Life Panels" supports compassionate care... But I guess I could see how some folks could argue against such panels...and that a right had been infringed upon. This is a tough subject.

[withasmilelpn]

Exactly. Ethics committees can help when facing difficult choices - families so often struggle making decisions as if they are causing their loved ones' deaths instead of merely prolonging them.

[DoGoodThenGo]

THank you for the articles... I found the CBS story and the "Medicare Benificiaries - Costs of Care in the Last Year of Life" especially compelling. With regard to the CBS item, I think they presented several valid arguments that I better understand now that I have worked in healthcare and seen what I consider excessive interventions....things that end up just decreasing quality of life towards end of life... Here's a quote from the CBS article:

"Often the best care is saying 'Let's see how you do on this particular treatment for a couple of days. And see if you respond.' Not necessarily doing a lot of tests," Fisher said. "The best care may well be staying home with a trial of a new medication, rather than being admitted to a hospital where you can be exposed to a hospital-acquired infection. We have a system that rewards much, much more care."

I think we as a society should ensure the dying are cared for....

In the other article - Medicare Beneficiaries, I was struck by the fact that the poor were disproportionately affected by ESRD (something that significantly escalated costs).... I can't help but wonder if better care and education through their lives might alter those statistics.

I think it is good for us as a society to take the lead in intervention...and to provide healthcare... I can't help but think it will ultimately lead to lower costs if we are receive better care early on...

Looks like everyone is waking up and making some posts... :)

Amoung several problems with the United States healthcare system is that by and large providers are paid for doing *something*, not necessarily for treating an illness. Each intervention, treatment, medication, etc.. all bring revenue to someone (facility, provider, etc...) thus there is a powerful incentive to do as much as can be done. Sort of like billable hours for an attorney.

The other problem is that Americans by and large, and this includes many physicans see death as something to fear and or do battle with. While there have been great strides in the past five or six decades in many areas of disease including formerly certain mortal ones (cancer, COPD, etc..) nature/God, who ever you want to belive in most always "wins" out in the end. The question then becomes how does a person get to that ending.

For instance the more we are learning about Alzheimer's disease it becomes clearer in many cases the disease itself is a slow process of the body "dying" as it were. In which case then at one point do you allow that process to take over, or decide to keep a patient "alive". If you choose the later then the paramount question should be alive for what? By that one means what will be their quality of life.

Posted a news link to a story a few months ago about one of the most expensive Medicare patients to date. He was a young transplant patient who looked promising at first but things began to go downhill, and continued thus until his long and painful death. You had physicans not on the same page about continuing care. This reached the family as the ball being in their court who (naturally) opted to continue all interventions as they heard what they wanted to hear; that their son would get well. Meanwhile the nursing staff was in moral dilemma because it was apparent to them the patient was in pain amoung other reasons. When told of this the family simply responded that their son was in one of the top US hospitals, if the nurses caring for him couldn't hack it they should step aside and let others who could take over. And so it went.

[DoGoodThenGo]

When you are talking end of life care you take into effect the percent of cost overall. I would suppose that the least amount of money would be spent on younger people, who are healthier. Of course catastrophic illness/trauma is very expensive but when you take into account vast population spreads-these situations are not as prevalent as elder care who need extensive therapy, continuous care, massive amounts of medication and are not ready for hospice or able to be taken care of at home. This is pretty general knowledge.

You hit it more or less on the head.

EOL costs drop as the treatment mode moves from interventions to prolong life/cure disease to palliative and or hospice care.

Medicine has found great ways to prolong life expectancy, however the downside has been persons are living longer with one or more diseases that probably would have killed them years ago. Often the interventions for this open up a window for that, and soon you've got a medical game of "whack a mole".

[DoGoodThenGo]

As a practical note seeing as a majority of nurses are women and speaking of healthcare as a "right" there is another crisis looming and that is to few Americans, especially females have any sort of longterm care insurance, lack of which can quickly deplete the assets/savings of many.

The baby boom generation for various reasons (divource, widowhood, spinsterhood, etc..) will start to see a trend that probably is only going to increase, single elderly women (some often childless) having to manage living very long lives but requiring skilled nursing care for a good part of the last part.

[FMF Corpsman, MSN, RN]

I'm sorry about your father... I am glad you and your sisters were able to be such a comfort to him.

I would like to learn more about where all the money in healthcare goes... Googled this..

.

Medicare Gaps Leave Many With Big Bill at End of Life, Study Finds: MedlinePlus

EXCERPT: "In the last five years of life, out-of-pocket co-payments and deductibles, and the high cost of home care services, assisted living and long-term nursing home care cause 25 percent of seniors to spend more than their total non-housing assets, the study found.

"The biggest problem for many families is covering long-term care," said study author Dr. Amy Kelley, an assistant professor of geriatrics and palliative medicine at the Mount Sinai School of Medicine, in New York City.

...

Kelley and her colleagues found that the average out-of-pocket health care spending by households of Medicare recipients in the last five years of life was nearly $39,000. And 10 percent of recipients spent more than $89,000, while 5 percent of recipients spent more than $139,000.

More than 75 percent of households spent at least $10,000, while 11 percent of single and 9 percent of married households spent more than $100,000.

The amount of spending varied with the person's illness. Those with Alzheimer's disease or dementia spent the most for health care, averaging about $66,000, more than double that of those with cancer or gastrointestinal disease, who spent about $31,000.

...

"To be 90 percent sure your expenses [at the end of life] will be covered," Mitchell explained, "you would need about $400,000, plus the cost of purchasing Medigap," an insurance policy sold by private insurance companies that supplements Medicare benefits, in an effort to cover the gaps in health care coverage."

END EXCERPT

I sure would like to know where all the money goes in long-term care... I worked in long-term care for a period...we were chronically understaffed and under-supplied...we were also in an old decrepit building...and we were underpaid... (at least I was...but it was good to have a job...)

I keep remembering the purpose of this thread..."is healthcare a human right?" Doesn't it seem that we should have the right to die with healthcare? Doesn't it seem that it's the right thing to do as a society?

___________________________________________________________________

With props to RN Faster, Please read this entire page as one article, keeping in mind, "just because you are paranoid that doesn't mean they aren't out to get you." Looking at these figures is mind boggling, and it makes me think that the only reason they charge such astronomical amounts is because they think they can. It goes back to the law of supply and demand. I mean, what else are you going to do, go get another body that isn't disease ridden or doesn't have Alzheimer's? They have you between a rock and hard spot and they know it and they can bleed you dry. No pun intended, because that's exactly what most of them do, and then they toss you away, like an empty blood bag or so much bio-waste, that no one else can touch, because you are dried up and useless to anyone else now, you have no more money. It isn't like you can go the Hospital and ask to see the menu, and say I think well have the such and such treatment for the metastatic cancers ravaging my wife's body, and since we are getting the three of them can we get a bulk rate? It's little wonder so many people take the 357 treatment for both the husband and the wife. I'm certainly not advocating that by any means, I'm just saying I can understand when people take that option. As another blogger has already said, when it's my time, I'll both spell it out DNR, and put it in long hand, DO NOT RESUSCITATE. When my body says it's done, it's done, leave me be. We need to institute a system of checks and balances in the Health care world. Do away with the disposable $800.00 fracture pan if necessary go back to the stainless ones we used to use. Yeah, I know, most of you are saying, say what? Yeah, it's true. Every hospital in America has an autoclave to sterilize instruments. We could go back to the way it used to be done, and do away with everything being disposable, that should save about a gazillion dollars a year. Yeah, we need people to run the autoclaves and pack the trays, but that is nowhere near the cost of disposables. I'd be willing to bet most of the Hospital still have most of the instruments stored away anyway. So they wouldn't even have to buy them. The hardest part to replace will be the GREED, and in the for profit hospitals, the stock-holders getting used to lower returns on their investments.

[lindarn]

I am personnally tired of this whole thread, about whether or not health care is a right, and who is going to pay for it, blah blah blah.

The AMERICAN TAXPAYER is paying for EVERYONE ELSE TO HAVE HEALHCARE, from our elected officials, prisoners, down to Illegal ALiens, who not only don't belong in this country, do not deserve ANY social services, to our elderly and disabled who can access Social Security, and Medicare. The AMERICAN TAXPAYER paying for the heathcare of our military and their families. But the TAXPAYERS are cut off. Why?

The AMERICAN TAXPAYER, paid for the Federal Research Grants that discovered most, if not all, of the lifesaving medicines, and medical devices used in hospitals and prescribed to American Citizens. AMERICAN TAXPAYERS are paying for the money that is given to hospitals to keep their doors open.

The AMERICAN TAXPAYER is paying for foreign countries to provide for their OWN CIIZENS!

WHY is the AMERICAN TAXPAYER cut off from their own taxdollars to fund their own healthcare?

You are afraid of Government Funded healthcare? You don't hear our elected officials complaining about their healthcare, do you? That is Government funded healthcare. You don't here our military complaining about their healthcare, do you?

Our elderly and disabled, don't complain about their healthcare. Why should/would, you?

This country is in desparate need of a single payer health care system. We are crashing and burning with our present system.

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

[FMF Corpsman, MSN, RN]

I think excessive interventions are often cruel...and often pressed on by the family (out of ignorance and hope) and/or system. I actually think that "Quality of Life Panel" would be an okay thing... In my current work, I do see doctors broaching the subject of end-of-life care, palliative care...and getting patients to think about things... I see that it often takes many discussions...

RNfaster; In your quote above "... I do see Dr's broaching the subject of end of life care...," I can't help but wonder, if you don't ever discuss these topics with your patients or their families. I know it is extremely delicate topic, but as nurses we are sometimes in a better position to counsel the families than the Doctors as we've established more of a rapport with them coming in and out during visits and them stopping and talking about their loved ones care, I’ve also had them tell me that it was easier for them to talk to me than it was to talk to the Doctor, he just "always seemed like he wanted to escape.” And that was true, Doctors do seem like they are always in a rush, and that is a terrible impression to leave on a dying patients family. With my younger patients in traumas, I always hated these conversations, but I had to ask for permission to harvest their organs, that is if they hadn't already signed an organ donor card, and most of my teenagers and young people hadn't done that. They always feel like they are ten feet tall and bullet proof. But, they never are...

[FMF Corpsman, MSN, RN]

Exactly. Ethics committees can help when facing difficult choices - families so often struggle making decisions as if they are causing their loved ones' deaths instead of merely prolonging them.

End of life decisions are very difficult to begin with and usually aren’t taken lightly, which is why I was appalled at the behavior of both the Hospital Administration and the staff of the floor I used to work that Hospital when my mother had a series of strokes. I asked for her to be placed on the floor I had worked, because I knew they provided excellent care. It had been a number of years since I worked there, but most of the staff was still the same, and I thought I still had friends there, little did I know. Mom and I had long ago discussed what she wanted done on just such an occasion; I didn’t have the paperwork as her Healthcare Surrogate with me, but as her next of kin, I advised them of her DNR status and asked for comfort measure only before I left for the night. When I got to the Hospital the next morning, she wasn’t in her room, so I asked the Unit Secretary where she was and I was informed she was in the OR for a gastric feeding tube. I about went through the roof before I asked them what part of comfort measures that fell under. I called a friend of mine who always dressed in a business suit and worked just a few minutes from the Hospital to run over and act like a lawyer, while I threatened to sue them if they didn’t stop what they were doing, before they did it. Luckily, they hadn’t started the placement yet, so she returned to her room unscathed and blissfully unaware of anything going on around her, but I’d certainly managed to p*ss off the staff just a little more. I gave them the Surrogacy paperwork and got that established, I thought anyway, and went to my mom’s room where I found her up in the chair unattended, without any restraints of any kind and slipped way down in the chair almost prone and she had by all appearances extended her stroke, as she was totally flaccid on left side now, whereas she had a moderate amount of tone previously. I turned on the emergency light to get some help and after standing out in the hall for about 6 minutes I finally managed to call someone to get some assistance. All of this and this is in the number 2 hospital in the area and a Level 2 trauma center. When they finally assembled the troops to get her back in the bed, they asked me to stand in the hall while they did this of course, but I over heard one of the staff tell her, “Don’t worry honey, we’re not gonna let him kill you.” And this was at a great Catholic Hospital. I called Hospice and requested the transfer her to their facility that afternoon, which they did. She passed about a week later, in the comfort and care of Hospice, in a coma, don’t know if she needed it or not, but she was on a Morphine gtt. so she wasn’t in any pain. I never knew why my old floor why my old floor had a attitude with me, but I couldn't care less now, I certainly know why I have one for them. Great old friends, yeah right.

[msn10]

You are afraid of Government Funded healthcare? You don't hear our elected officials complaining about their healthcare, do you? That is Government funded healthcare. You don't here our military complaining about their healthcare, do you?

Our elderly and disabled, don't complain about their healthcare. Why should/would, you?

This country is in desparate need of a single payer health care system. We are crashing and burning with our present system.

Although you made some good points in your post (illegal aliens getting free health care instead of Americans), I disagree with you on a single payer.

I don't think many politicians complain, but they won't let us have their system anyway. However, there are plenty of military personnel and elderly complaining about their care. My father died because of a Medicare issue (won't go into now) and with Medicare getting cut another 15% next year across the board, MD's and NP's are starting to refuse patients. Medicare is the closest thing we have to a single payer system and it is run horribly. Funny when they say that the administrative costs are so low - that is because the system expects nursing home personnel and seniors to do all the paperwork with the least amount of reimbursement.

Also, CNN just had a very good documentary about the lack of health care for our veterans in our country - sometimes waiting up to 2 years to be approved for treatment. A single payer system won't solve our problems, but cracking down on people who come here illegally, stop bleeding Medicare, and stopping Medicare and Medicaid fraud (by both the hospital/physician/nurse system and the patients) are some things that will help. Won't go into all my ideas, but our country needs a culture change before any insurance product will solve our problems.

[lindarn]

I did not say that these programs are perfect. All I meant was that they are there for the elderly and our /veterans.

Tricare has taken over the military health care. Tricare allows military personnell, and their families to see civilian providers in the local community. Yes, you can go to a military hospital or clinic. But you don't have to.

I am a nurse in the AFR, and I have Tricare Select for Reservists. Yes, it is subsidized, but I pay $54 a month for my health care, which includes, doctor visits, pharmacy- I get prescriptions free at the base clinic, or I pay $12 for a name brand drug at a local civilian pharmacy, or $6 for a generic.

I also have dental insurance from the AFR which costs me $12 a month, and paid better than private dental insurance when I had to have crowns placed.The cost will go up dramitically when I retire in January to $400 a month for Tricare.

I have had more than one military doctor, state that the government should put everyone on Tricare. There are different Tricare regions around the country. This month's newsletter from the National Nurses United, had an article about the VA System, and how it is the most efficient health care provider in the country, and how there have been study after study, on how the VA System delivers the best care in the nation. They have modern improvements, that for profit health care policies only wish they had, etc.

So, government run health care may not be that bad afterall. If I can find a link to the article,I will post it here.

I am sure that there are VA Systems that are not as efficient as others, but that is true in everything.

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW