Is Health Care a Right? - page 30

Just want to see your opinion (friendly discussion, no flaming, please). Is health care a right that should be enjoyed equally here in the U.S.? If so, how would this be financed without breaking... Read More

  1. by   kmchugh
    Originally posted by JMP
    Where does it end? Hopefully with universal health care for your great nation. IT would be a wonderful start------not end.
    JMP

    This is the thing that worries both Susy and I, and you still ducked the question. It would only be the beginning. But then, maybe the question wasn't clear enough.

    It might be a wonderful start. But where does it end? What percentage of my salary taken away as taxes is enough? Currently, I pay about 40%. When can I say take no more? 50%? 75%? When? The question here is "what is the top limit (in percentage) that my salary can be taxed to support social programs?"

    You see, this is the real issue to me, and I think to Susy as well. We have lived with various welfare programs and such in this country since at least the 1960's. It started under President Johnson, and his Great Society programs. The idea was to "level the playing field, and give everyone equal opportunities to get ahead." Since then, we have seen the tax rates go up, and there is always someone with just one more entitlement, that without which, the poor are kept poor, and the playing field is not level.

    I have on this thread been called cold hearted and selfish. Fine, I can live with that charge, if ANYONE could back it up. If anyone could show me what is heartless about what I am saying. Why is it heartless to say I'm paying enough for others, now I want to keep the rest of what I earn for me and my family? And does there ever come a point where that is an OK thing to say?

    Or, can I never say that? Must I, in the name of equality, contribute an ever higher percentage of my salary in order to help those "less fortunate" than I? And if that is what I must do, who helps me when my contribution gets so high that I can no longer provide the kind of life for my family that I have worked so hard for? Who provides for my retirement when I can no longer save anything towards that? Who helps my kids when the majority of my money goes towards helping less fortunate families?

    And if you have a limit, what do we do when we reach that limit, what happens when someone comes along with just one more entitlement, without which there can never be equality? That is the real question, the real practical problem that those who support one social program after another can never answer. There is ALWAYS one more. When do we say enough?

    Kevin McHugh
  2. by   JMP
    Well Kevin, creating limits is part of a just and reasonable society. To approach the universal health care issue with "when and where will it end" is short sighted.

    It would be an enormous task to create a system for your country like the one here....the Canadian universal health care system has been in place since the 1930's. I live in a province that taxes quite heavily, everything ( with the exception of food ) is taxed at 15 percent.....so every item is taxed. THen I of course have payroll tax. These taxes pay for health care, social programs, roads, education ( which is heavily subsidised here in Canada, government, etc etc) Yes we pay alot of tax. However..... it is the society overall that I am paying for...knowing everyone is looked after. I never would want it any other way......


    THe system works here. It is something to be proud of. Similar systems are in place in Great Britian, Austrailia and parts of Europe (Sweden has a wonderful system)
    Last edit by JMP on Feb 6, '03
  3. by   fergus51
    Wasn't medicare later than that? I thought it was the 60s?
  4. by   fergus51
    Kevin, I think everyone gets to decide that. If we had a mandatory insurance plan (you want a car you have to have insurance, same principal with a body) we could lay out what is covered and everyone would have to contribute financially. Say it covers the same thing as a basic health insurance plan and none of the fancy frills. Immunizations, ph, home care, NP/GP visits, basic generic drugs, basic surgeries (can be outlined specifically to exclude the expensive ones).... whatever.
  5. by   Stargazer
    I've stayed out of this thread 'til now, because it seemed to me to reach the point of futility many pages ago; nevertheless, it is still going on, and some effort seems to be taking place to restore a modicum of civility.

    An economist on my other BB posted an excerpt today from a book called Darwinian Politics by Paul Rubin. Although the poster in question was using the book to discuss attitudes towards international trade, it struck me as very appropos in terms of this discussion and some of the points that JMP and fergus have been trying to make about universal health care or a national health service.
    ...The characteristics of the environment in which humans evolved must be considered. The relevant time period [called the Environment of Evolutionary Adaptedness, or EEA] is the Pleistocene, the period lasting from about 1.6 million years ago to about 10 thousand years before the present (BP)... Intellectually modern humans have probably existed for about fifty thousand years, with the first forty thousand spent as hunter-gatherers. Selection pressures for certain behaviors and preferences would have led to reproductive success in that environment. The argument in this book is that modern humans have retained some of those preferences and may exhibit some of those behaviors.

    One economic point is important in understanding the evolved nature of political preferences. In the EEA, there were probably very few gains from trade, except for exchange between men and women. That is, resources and incomes were probably relatively fixed, with little possibility of value increasing exchange or production, such as we see all around us today. Therefore, we may not be well adapted to think intuitively in terms of gains from trade. This explains why the results of the economic analysis of trade - that all parties gain from trade, that free international trade is welfare maximizing - are counterintuitive...

    The result is that humans in many cases now tend to base decisions on zero-sum thinking when other forms of analysis would be useful... Our minds are built for understanding a zero-sum society...

    Indeed, even when people do engage in mutually beneficial exchange, this mutual benefit does not motivate them. Rather, each aims at maximizing his or her own benefits. The fact that for trade to occur, both must benefit is irrelevant for each individual... Thus, there is no reason to expect that an innate mental module to measure gains from trade has evolved... Moreover, mental mechanisms work against this recognition of mutual benefit. Even in mutually beneficial trades, an aspect of competition is found. Both sides want to engross for themselves as much as possible of the gains... Therefore, in engaging in trade, an important consideration is to avoid being victimized. As a result, mental modules aimed at policing transactions have evolved. These modules focus on the zero-sum aspect of trade - that aspect dealing with the terms of the bargain, rather than the gains...

    I do not want to be read as implying that trade is artificial or that people must be taught to exchange... People engage in mutually profitable exchange when it is possible, and they do so automatically. But for the reasons discussed above, I do believe that people do not have an innate understanding of the benefits of such exchange... This understanding is an example of something that can be learned but is not innate.
    I think what fergus and JMP have been trying to say is that universal health care is not necessarily a zero-sum game. Your giving some, or more, does not necessarily equate to your getting less. It may be conceptually easier to look at health care as a pie to be divided up, but perhaps that's not entirely accurate.

    To use just one example, by improving preventative or maintenance mental health care for currently underinsured populations, we could end up spending significantly less on issues like homeless shelters, law enforcement, jails and prisons, acute psychiatric ER visits and inpatient admissions. To use another, how much money could we save in NICU care by making affordable prenatal care more available?

    I'm not saying this is THE answer, but I think it's a concept worth exploring. Are any of you who are arguing the "con" side at all open to the possibility that this is not necessarily a zero-sum issue? Why or why not?
    Last edit by Stargazer on Feb 6, '03
  6. by   JMP
    Stargazer

    Wow. Exactly.Agree.

    Giving more does not necesarily mean getting less.

    You are right on the message.
  7. by   Sally_ICURN
    Healthcare for all is a freedom. Let's forget about asking if it is a right. A single payer healthcare system in the United States will not cost a tax payer more, but that is what those who stand to lose something big would have you believe. What a single payer system would do is redirect the money that is already in the healthcare/social pool and stop the overhead by for-profit companies that drive up the costs of healthcare. It would not be managed by, only regulated by the government. It would be run by a single entity who's goals would be delivering quality, affordable, accessible patient care...not money. It would be less expensive AND everyone will have basic coverage, but will it ever happen? Change is on the horizon and it's coming to the forefront very very soon. It will be interesting to see what takes place in the coming months.

    These sites are PACKED full of information and very easy to read and navigate. Please check them out.

    http://covertheuninsuredweek.org/

    http://coveringtheuninsured.org/

    http://www.uhcan.org/

    It's frustrating that so many people are taken for a ride by the propaganda that politics puts out there. If only people could open their minds enough to see that healthcare in this country is not about the welfare of it's citizens, it's about money...not the taxpayer's money...the money that's exchanged in the political and corporate scene. With all due respect, the monetary exchanges and politics hurt people like Susy and Kevin so much more than the financial hurt that would be thrust upon them personally to help ensure health coverage for every single person in this country. I'm genuinely concerned and sad about that and know that there are millions who share the views that Susy and Kevin put out here.

    Facts:

    There are 41.2 uninsured people in the US. 10 million are kids.

    The uninsured represent 14 percent of the population.

    Eight out of 10 uninsured Americans are from working families

    9.2 million uninsured people have family incomes at or below the federal poverty level.
    13.8 million have incomes under $25,000.
    12.7 million have incomes between $25,000 and $49,999.
    6.4 million have incomes between $50,000 and $74,999.
    5.5 million have incomes that are at least $75,000.

    The ten leading Managed care companies hauled in profits exceeding 1.5 billion dollars last year.

    Pharmaceutical's = 20 billion in profits-more than auto and airline companies combined.

    Corporate CEO's take in hundreds of thousands of dollars annually in salary in addition to the millions in stock they hold in their companies.

    What we have DOES NOT work. When will it end?
    Last edit by Sally_ICURN on Feb 6, '03
  8. by   maureeno
    you better believe we've got a drug problem in this country and i'm not talking about dope. checkout www.familiesusa.org and download their publication "profiting from pain: where prescription drug dollars go". using annual financial reports submitted to the sec they review corporate profits and spending. read and weep!
    on average of the 9 companies studied the revenue [net sales] gets allocated 11% r&d, 18% profit, 27% marketing and advertising.
    annual median executive income exclusive of stock options over $11,000,000. median value of unexcercised stock options $42,000,000.
    drug companies receive special tax credits for research and experimentation bringing their effective tax rate down from 35% to 17%. meanwhile studies show they are providing the public with fewer and fewer new drugs having significant clinical improvement over existing therapies. most 'new' drugs are reformulations, 'knock-offs' to be aggressively marketed. name-brand drug companies employ 81% more people in marketing than in research. between 1995 and 2000 marketing staffs increased by 59% while research staff decreased by 2%.
    big pharma practices profits over people...big time.
  9. by   fiestynurse
    I have been working for many years fighting for Universal Health Care in this country. I hope to see it become a reality in my life time. I am currently working with an organization called Health Care for All - California. We sponsored SB480, which mandated a study of various health care options. The single payer system came out on top for improving quality, saving millions, and providing health care to everyone.

    Senator Kuehl is introducing a single payer health care bill this year. An RN, Judy Spelman, is assisting her in it's drafting.

    Check it out on the HCA Website:

    http://www.healthcareforall.org/
  10. by   fiestynurse
    Think about this: The incarcerated, who have the fewest rights, are the only US citizens with a constitutional right to health care through the 8th amendment.

    An excellent book on this topic: http://www.trhs.org/bobsbook/

    Physicians for a National Health Program:
    http://www.pnhp.org/
  11. by   Q.
    Stargazer,

    Clearly I can see the point in the excerpt of the book, and I totally agree with and support mutually beneficial "trades" or exchanges.

    Interestingly though, when I read through the old thread I started almost a year ago, "Universal Health Care?" I had described how despite efforts to increase preventative care and other less costly health services to avoid the costly ones later (such as NICU stays), people will indeed do as they wish to do. As a matter of fact, I just recently read an article in JOGNN that detailed how African-Americans don't percieve prenatal care as important, and also don't relate the connection between lack of it and poor birth outcomes. So basically, what happens if we decide to pay for prenatal care for everyone, but not everyone utilizes it? Who pays for the NICU visit then? And then how is this a mutually beneficial exhange for me?

    Don't get me wrong: I am all for preventative health care and feel that nurses are the key to solve some of the health care problems, particularly in that area. I've read study after study that details how education and prevention, in theory will decrease tertiary cost, but that only works when patients actually utilize them. We can't force people to utilize them and clearly, they don't.

    What then?

    Also, what about the option to opt out? We all know of people who refuse some preventative measures; immunizations for one. I myself, despite not ever having nor being immune to varicella have refused the vaccine. If I didn't have health insurance, or, if I were covered under a universal plan, and I didn't want the vaccine, and and I got pretty sick with varicella, who would pay for that visit? And more so to the point, doesn't that in fact take away my autonomy in health care decisions (ie: make this decision or else you won't be covered later?) Is that even ethical?
    Last edit by Susy K on Feb 8, '03
  12. by   fiestynurse
    Another good book:

    "A Perfect Storm: the Confluence of Forces Affecting Health Care Coverage" by Joel E. Miller, National Coalition on Health Care

    Excerpt: "The confluence of powerful economic forces, fueled by the terrorist attacks of September 11, have unleashed a 'perfect storm' that could increase dramatically the number of uninsured people in the U.S.-- with as many as 6 million people in total losing their coverage in 2001 and 2002."
  13. by   Stargazer
    Susy, as to your first point, I think it just underscores the point that priority has to be given to education as well as actual health care. A parallel that immediately sprang to mind for me is that my company's CEO places a high value on medical care, but interprets this to mean buying new equipment. In concrete terms, this has meant that he is willing to buy AEDs, but does not understand and will not fund the necessary training for personnel to actually operate the AEDs. It's an ongoing struggle to educate him on and convince him of the relationship between the two.
    I just recently read an article in JOGNN that detailed how African-Americans don't percieve prenatal care as important, and also don't relate the connection between lack of it and poor birth outcomes.
    I think this is always something that we face in health care, and it ties in a bit with your second point too. To use another parallel from my own career, we offer free flu vaccinations to all employees and aim for as close to 100% compliance as we can manage. There are always a number of people who are, as a group, prima donnas and drama queens who refuse the shot. About a month ago a large group of them got very sick indeed and many of them missed work. Their colleagues who HAD gotten the vaccine stayed healthy. All of a sudden they understood the correlation and were willing to be vaccinated. It's a matter of finding the right way to educate them on the sequelae. Yes, there are often cultural or economic biases or barriers, but they're not insurmountable.

    As to your 2nd point, people certainly should be able to opt out, but all actions have consequences. As someone pointed out in another thread, insurance companies are now starting to refuse payment when clients have documented noncompliance with recommended medical treatment. I don't see this as unethical at all. Your choice, your risk. A simple release documenting a patient's understanding of the possible results (medical and financial) of refusing treatment and their signature noting that they are assuming that risk & responsibility voluntarily would go a long way towards covering that issue.

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