How soon we forget. - page 9

Seems part of the arguement against Obama's bill is that people are going to be forced to purchase health insurance. Well........why not? A lot of states mandate buying auto insurance. Which one is more important? Doesn't seem... Read More

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    Post #8
    ".............massive influx of patients there may be lower standards of care. 1 family doctor may go from seeing 25 pts a day to 50 patients a day, shortening time with each patient and thus making it harder to supply each person with the undivided attention and customization.............."

    Uh, no. There will be more NPs seeing patients, probably taking more time with them and teaching preventive measures to avoid progression of diseases, as they go. The cost of care for nonpaying patients now, is much higher, since they tend to arrive in ERs with advanced illnesses requiring more hospital days more IVs, medications, etc. at far greater cost than the national coverage will allow.
    This is what is written in the Reform of Health Care bill:


    The term ‘‘qualified health benefits plan’’ means a

    health benefits plan that meets the requirements for

    such a plan under title I and includes the public

    8 health insurance option."

    It seems to me that those who don't like the idea of compulsory healthcare coverage, will imagine all kinds of unrealistic events as a result of it.

    Give it some slack, and see how it evolves. It is a huge gift to us, especially as we age and acquire illnesses as a result of that. It's the very rich who will be paying higher taxes to pay for it. They have so many loopholes gaping to avoid paying their taxes now, (many pay nothing as they hedge their money in "foundations", etc.)
    that they are panicked over the possibility that their control of where their earnings go, will end when those loopholes are closed, which angers them. The result is
    that they are behind a lot of the lies that have spread negative PR for the plan!

    President Obama has our interests in mind and is for the average people, which leaves less for the extremely rich ones..... The disparity in earnings can be traced to more money going to those who already have a lot of money. They hire tax avoidance professionals to keep all they have, invest it and make even more, which at this time is hidden in tax deductable assets (corporate planes, vacation homes, questionnablely necessary equipment, luxurious surroundings, etc., etc., etc.).

    Gates is the rare exception, building schools for the disadvantaged. However even he has his share of deductable assets.

    This is copied from the Reform of Health Care Bill, which shows that the public health insurance option will be in effect for anyone without coverage. This does away with private insurance companies for the uninsured. The opposition to the bill occurred partly because private insurance companies became insecure about whether their stranglehold would lessen when people saw the public option as equal or preferable.....
    You can imagine how much less the health care coverage our government provides, will cost taxpayers as it will remove the high cost of health insurance executives'
    salaries and bonuses. The payments for health care providers will be limited in the same way Medicare limits charges, and won't allow 20% of doctors' requested charges to be charged to patients.

    herring_RN and lindarn like this.

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  2. 1
    Quote from morte
    apples an oranges
    with regard to EMTALA - hardly...

    Admittedly the UK has similar provision in that it doesn't persue the for charge ineligible people for 999 ambulance call and Care while in the Emergency Dept, equally funding is built into the tariffs for these cases , especially where funding is based on per case attendance - as it is in the Emergency Department.

    the fundamental issues, which so many people seem blind to are;

    - With universal coverage there are no 'can't pay' patients- which means that there is no longer the requirement to build a 'profit' into the fees charged to those who pay themselves ( or who are currently covered by insurers) - which leads to a perception that the state funded care is is paying less than the going rate.

    - With universal coverage there is no longer a group of people who are contributing towards care which they cannot receive ( i.e. the majority of the tax paying public at large in the USA )

    - With Universal coverage there is less pressure on Emergency Departments to provide Primary care and funding streams to provide Out of hours 'Urgent' Primary care - this does not stop the hospitals from providing that care or providing facilities for that care, this also makes 'signposting' to alternative services to the ED from triage / after an initial practitioner assessment possible.

    - With Universal coverage there are / can be incentives for Primary Care Physicians to recruit, retain and promote the health / manage chronic conditions of a patient population, there is also the possibility to incentivise improved access - not only in terms of the length of the working day but also in terms of lead time for appointments.

    - There is no explicit requirement to remove the situation in the USA of using 'Other' Specialists to provide primary care ( e.g. the number of US women who regularly see a gynaecologist despite having no particular gynae problem i.e. for general 'women's health' stuff like cervical smears .... although other places do not use specialists for such careinstead Family Physicians with a specialist interest do it in primary care.

    -Funding streams for hospitals may be more stable, this however depends on the model used in paying providers, ifit continues to be purely fee for service there will be no change but if the system moves to advanced purchase or services, procedures and bed-days or assured volumes ....
    lindarn likes this.
  3. 1
    From post #81

    ............"- With Universal coverage there is less pressure on Emergency Departments to provide Primary care and funding streams to provide Out of hours 'Urgent' Primary care - this does not stop the hospitals from providing that care or providing facilities for that care, this also makes 'signposting' to alternative services to the ED from triage ..........."

    Thank you for your comparative observations, ZippyGBR

    I couldn't tell if you're still in GBR or here in the US, and I've been in the US for 55 years, with distant recall of how the single party payor system in Canada (my homeland) began and stories from there that my family tells, of more than adequate coverage and availability of their own doctors.

    It seems that things here were allowed to deteriorate drastically before reining in was allowed to proceed. After Hilary Clinton's plan was ribaldly turn down, no one else in politics dared to raise the issue. False
    proclamations disclaimed the single payor model. Lack of respect for authority made any replacement of it impossible during her husband's term.

    There still exists a rather pioneer attitude in the US of fending for oneself through great effort (the regrettable gun laws) and "if I can do it, anyone can" spirit (hence the reticense to pay for less fortunate others' needs). Also doctors have assumed a martyr attitude that permits them to do outrageous disinterested referral to the ER of anyone who cannot see them by appointment, by not even seeing their patients (except for surgeons) while they are hospitalised.

    That causes extensive sometimes 20 hour+ waiting times in ERs with subsequent increase in morbidity and mortality. I myself was brought by ambulance at 4:30 one afternoon, to my community's only hospital, with a repeat gastric hemorrhage, heard the report given to staff and wasn't seen by anyone - not a nurse or doctor, for 4 hours as I drifted in and out of consciousness....... While that went on a radiographic test might have revealed the site of bleeding, but lucky for me, the bleeding slowed, allowing me longer cognitive life, but without specific surgical treatment as an option.

    Also the fees charged by physicians have become so outrageously high (which no other country equalled), supported by insurance and pharmaceutical companies' similar abuses, that appropriate fee for services/products has disappeared. Due to fierce lobbying in Washington DC and unending funds for legal representation of hospitals and physicians, little recourse for inappropriate health care providers' actions has been one reason for the acceptance of most people of inferior health care provider service.

    This ocurred after malpractise premiums soared in the early '70s, yet I've heard little mention of that since that was all my OB wanted to discuss at my appointments with him, while I was pregnant in 1972-3. What I do hear about, is the closing of doctors' office doors earlier and earlier in the afternoons, and their refusal to take evening and night shifts in their group practises. In other words, if the political party (and those who support it) disagree with their dispensation of health care, they act like spoiled brats! The patients suffer disregard, disrespect, neglect of symptoms, and are secondary to their doctors' needs to live royally.

    There is a lot to be said for the Reform/Affordability of Health Care Act, if only that it actually passed! However along that path many compromises to what is actually needed fell by the roadside (such as the national/universal plan's availability for anyone who wanted it). Now that is only there for those who are unemployed or disabled and unable to work, who cannot pay todays inflated premiums.

    My hope is that those who seek to be medical students today will enter their
    school with the attitude that monetary reward is secondary to the satisfaction of having served their communities well. Certainly they've been warned that "there's no money in it" by today's bunch of materialistic, self interested doctors, so others means of vocational rewards should occur to them.
    Last edit by lamazeteacher on Feb 10, '11 : Reason: addition, better phrasing, spacing
    lindarn likes this.
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    Doctors certainly should be compensated for their service to the community, especially considering the kind of money it costs them to become doctors in the first place. People assume doctors are rich- this doesn't happen for upwards of decades in many cases, if it happens at all. Med school is outrageously expensive. There needs to be some return on that investment. (Not to mention the time put into it)

    It's not the 'American' way to expect anyone to have a 'capped' income. BUT there are definitely abuses of this philosophy in which Americans pay the price. In many countries, there is a cap a pharmaceutical company can sell a given drug. Does this mean the company doesn't sell or sell less in these countries? No, they sell at the reduced/cap rate just as much of the meds as they sell to us.. only WE pay the difference since they can charge us anything they want. America subsidies medications for many other developed nations.

    This is only ONE area where we get the shaft in the medical industry. We also get the shaft from current private insurance companies that can charge us higher fees and offer less coverage, higher co-pays and deductables. These same insurance companies can decided whether or not we get treatment for anything they want basically, and outright refuse coverage to anyone they want.

    The system IS broken. All I've seen from the naysayers is "this isn't going to work" or "this won't change that" or "this isn't the answer".. but what I haven't seen from any of them is any other solutions. None. It's also amazing to me that people can see the future and claim to know what is or isn't going to work and what is or isn't going to change since we haven't even begun to TRY this program yet.

    I'm so tired of the 'this isn't going to work- and lets just let it stay broken' attitude.
    lindarn likes this.
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    Quote from post # 83
    "The system IS broken. All I've seen from the naysayers is "this isn't going to work" or "this won't change that" or "this isn't the answer".. but what I haven't seen from any of them is any other solutions. None. It's also amazing to me that people can see the future and claim to know what is or isn't going to work and what is or isn't going to change since we haven't even begun to TRY this program yet. "

    I'm very happy to see your slant on the situation regarding the Reform of Health Care Act! It is seldom that doctors see through the naysayers' hype. It is the wish of those opposing President Obama as President, for various unrelated reasons to discredit programs which have been presented through intensive work by medical and financial experts on respected committees. The fact that the opposers project continuing increases in costs of health care in 10 years, based upon the current place health care is, reflects their expectation that the changes won't occur.

    Rapid acceleration of doctors' fees happened when malpractise insurance premiums went ski high, following humungous monetary awards to patients who suffered greatly through neglect, lack of attention to their needs, and faulty communication. What most people don't get, is that lawsuits have to pass through legal procedures that rule out "frivilous" cases. Only those wherein actual damage has occurred will be heard in most courts.

    What many physicians haven't appreciated is that they need to sharpen their communication skills and actually listen intently to their patients' perspectives of the care they expect doctors to provide. When a doctor projects a sense of sincere interest and empathy for their patients' unique situations; and describes their plan of care in ways that patients can easily perceive - when they are not in shock over just receiving their diagnosis (no matter how serious/or not), lawsuits seldom happen. Active listening techniques such as repeating what the patient was heard to say, helps.

    I cannot understand why it is that doctors lack respect for their patients' rights. An example I can give from my experience, is a physician who was uncomfortable when his patient said in her first trimester that she wanted an abortion if her baby was not "normal". She was 36 years of age and no amniocentesis was done! When her baby arrived with the distinct facial signs of Downs' Syndrome the nurses were flabergasted to hear that doctor say that the baby was perfectly normal! Lying is a "cardinal" sin when relating to patients, and while the lack of the amnio was an "oversight", it certainly didn't cause the genetic deficit. It is doubtful that a court of law would rule against a doctor who upheld laws/their religious beliefs that discourage abortions.

    Why that physician didn't truthfully explain why he/she was reticent to have the amnio done, and commiserate with the woman's unwillingness to have a baby with developmental disabilities I'll never know. That communication failure resulted in anguish for that healthcare provider and the patient and her family. He could have discussed his religious aversion to abortions and refer the patient to someone more in tune with that aspect of care. He chose to blame the patient, and ultimately a lot of money was spent on lawyers (who are after all, are the winners in high award cases).

    While it is necessary to budget time spent with patients, the way to do that, is to hire a well qualified responsible team member in their offices and delegate such things as H&Ps, schedule surgeries, write/call in prescriptions, and arrange home health services, etc. A "medical assistant" with 3 weeks to 2 months of education in a technical teaching program after high school and little knowledge of essential aspects of patient care, is unable to be that person!
    Last edit by lamazeteacher on Feb 15, '11 : Reason: various re-phrasing needs and grammatical and typo errors
    NRSKarenRN and lindarn like this.
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    I have read through several responses, and am surprised to say how divided even the medical community is on this issue. Both good arguing points to both sides.
    Now, we all have an opinion, so....
    I think everyone continues to look at this issue (as with many other "big" issues) totally limited to what is on the plate right now. This issue isn't being forced to pay or that being unconstitutional, I mean no one really wants to be forced to do anything. We all want to make decisions for ourselves. While I would never say being made to get health insurance or be fined was constitutional, because let's face it, it's not - the bigger deal is the fact that the government feels its hands are tied (and won't think outside the box). The ER came up alot in responses. People are just not honest, they feel they are hurt and deserve free healthcare at a moment's notice when they come into the ER. The issue isn't whether someone has insurance, it's whether they pay for the service they were given. I have been in the ER a couple of times since I left home, I did not have insurance, but I paid for the services that were charged me. I moaned & complained of the individual billing & the high costs, but it got paid. Hospitals I've been in, spoken with, all seem to be fine in allowing the patient to setup arrangements to pay if uninsured. The chasmic problem is: the number of people who do not pay is so significant it is causing problems. The other side to this is the insurance itself. WHile private companies are private, there has got to be more regulation of rates, what is included in each tier of cost and what is not. It is by far too expensive,especially right now for a family of three to five to spend 700-1000/month for health insurance they probably only use 3-6x/year, mostly on things such as routine visits. The whole system needs an overhaul, not some quick fix to make the government thinks it's actually solving a problem. WE THE PEOPLE are the problem, you guys really have something against the healthcare reform, start making calls not just to the senators & reps in your state, call washington, write speeches and call your local news, post emails to big news media anchors, and start thinking outside the box on ways that will help all the way around. I may be a nurse, but I am still poor when it comes to finances. I do not overspend or overextend my credit, but I barely have enough to get buy. I will not be forced to get health insurance nor will I pay a fine for it, there is another way, a better way & only together as Americans in the HUMAN race will we find it. Unity has been shown in the past to make us stronger, we don't need a war or terrorists or some major trajedy to unite us, we simply should see that we are united in that we are all human and solve not only this problem but the other ones we face as well. While debates are fun & can be constructive & make us think, in reality they leave us no better off than where we began. Debating the issue of something that has already come, and we'll probably see go, doesn't solve anything. So start thinking, find a way to solve the problem for us all.
    edrnbailey and lindarn like this.

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