Should Healthcare Be Funded As A Basic Human Right? - page 4
by jayp 38,318 Views | 210 Comments
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- 5Quote from wannabecnlAgain, you pick and choose what you respond to. You said people would game the system of they could and I tell you that they don't but you ignore them. As a consequence, I am not surprised that you pick and choose what you want to hear about research as well. The fact is patients get better care when they are funded and further studies will simply demonstrate that.I just read a NYT piece about the Oregon study. Given my background in epidemiology and biostatistics, I was impressed with the "randomized controlled trial" nature of the work, but at the end of the day, it is looking at self-perception of health and a little deeper analysis of access, not actual health outcomes. It is a good start, but it is just a start.
This is the bit I am waiting to see: "The study is now in its next phase, an assessment of the health effects of having insurance. The researchers interviewed 12,000 people — 6,000 who received Medicaid and 6,000 who did not — and measured things like blood pressure, cholesterol and weight." THAT will be better analysis of the actual effectiveness of the care received by people who did not previously have insurance. Access is not the same as results. There are many studies about how more health care doesn't necessarily mean better outcomes (Google pretty much anything by Elliot Fisher, Gil Welch, Steve Woloshin, and Lisa Schwartz to learn about that). I'm glad the conversation has started, but the Oregon study just doesn't prove that people are healthier because they have Medicaid coverage.
Before I found that article, I had read a piece published this past July discussing another study by the authors who did the Oregon study. This was another well-designed study that compared mortality rates between states that had increased Medicaid enrollment and states that did not increase enrollment. It found a decrease in mortality in states that had increased enrollment. It looked at numbers on a county-by-county basis, not a patient-by-patient basis. The study adjusted for very important factors, such as age, sex, race, employment status, and income. Again, this was done at the population level, not for individuals.
The authors acknowledge that the second study does not show--and was not designed to show--a CAUSAL relationship between increased Medicaid enrollment and decreased mortality. Furthermore, it is pointed out that the only state where a STATISTICALLY SIGNIFICANT effect was found was New York, meaning that improvements in mortality rate in the other states might have improved that much randomly, irrespective of changes in Medicaid.
These distinctions matter a great deal. I'm going to try to download the actual studies for both of these to dig further into their design and results. It is possible that the coming study mentioned above will show an association between increasing coverage and better outcomes, or it may not. I'm not trying to keep poor Americans out of the doctor's office and the hospital (unless it's because of effective preventive care!), but my goal for my patients and others is better health, not more trips to the doctor.
As for causation and correlation, you have a background in epidemiology then you already know that causation is almost impossible to prove in research. Correlation is pretty much as close as we will get most of the time. I think munorn and I just had this discussion. Shocking how many people do not understand this basic truth of research!
Another example: women who have completely free access to birth control as teens have incredibly lower birth rates. (A study done in Missouri).
How are any of you (who are all sadly nurses) planning on addressing public health problems like herd immunity/vaccination? How about the societal costs of disabled children of mothers who get no prenatal care? Bottom line: 98% of the world knows that care is cheaper when we pool resources. Just one we do with fire and police as fires are a public safety concern.Last edit by VICEDRN on Dec 4, '12
- 2Quote from PRICHARILLAisMISSEDWe publicly fight fires because it can spread from house to house as health epidemics do. No point in vaccinating your child if the 19 other kids in the class doesn't have a vaccine. The theory is exactly the same!!
*sigh* Come on, now. "911" is a necessary expenditure. Obviously it is not included in "This or that." And as for calling the insurance company if my house caught fire, well I sure will because I pay the premium to the insurance company.
And by "This or that" I was talking about the ridiculous programs that are not necessities that the government pays for (For instance, I read up a few days ago on a program called "Does Jesus care for Klingons..." it cost just over a million $. YES, I'm serious. Those are the things we shouldn't be funding.
I hope this clarifies things
- 5Quote from PRICHARILLAisMISSEDWow, incredible is right! How dare the people of this country have the nerve to expect some of their tax dollars be spent on ensuring their health and thus continued investment into this countrys future economy. We already put in the tax dollars...I can't even imagine how most of our tax dollars are actually spent.I swear, the sense of entitlement in this country is absolutely mind boggling. And I don't want to hear that some people cant afford it. The ones who TRULY can't afford it qualify for medicaid.
And it amazes me how so many people think medicaid covers everyone who needs it, well I've got a surprise for you, it covers a lot less people you think. Me for one...as a matter of fact I could go out now and get two low wage jobs (all I would qualify for now until I graduate/I am a full-time RN student) and still not be able to afford health insurance. Medicare require a person to make about 25% of poverty level or less to qualify...between me and my husband we make about $700 a month and we do not qualify, not even close.
I am worried about graduating and being able to manage my job until I qualify for insurance because I have been having a lot of joint problems the past year. I am only in my thirties yet I have severe bilateral plantar fasciitis and my right hip joint has a deep ache that I feel in my bone all the way down the my knee and together it makes it impossible for me to even walk around the grocery store without limping. I know have carpal tunnel in both of my wrists, especially my right one, which has made it difficult for me to even right notes in class. And I have had flare ups in my left shoulder and right elbow that have left me in tears. Sometimes I can't fall asleep because my wrists are aching so bad. I am not excercising or straining my joints in any way so I don't know what is going on. NSAIDS and heat/ice help, but it never goes away.
Now what if I didn't have the possibility of insurance once I graduate? I wouldn't be able to find out what was actually wrong with me and persue possible treatment...instead I would have to self medicate with NSAIDS until the pain became too much and then would come the visits to the ER because I can't afford the $60 exam fee required by the local doctor office and then the pain pills...and since pain pills won't cure the problem, it will only get worse, leading to tolerance and dependence and so on. I will become angry and bitter and hateful and frustrated and my life would revolve around my pain pills....hmmmm, sound like any patients you may have come across?
- 6[QUOTE=PRICHARILLAisMISSED;7056797]Then don't worry, because most of them ARE perfectly willing to stay poor and take the free bees. QUOTE]
Most don't want to stay poor, but it is VERY difficult to come off of government assistance unless you make a big change, such as graduate from college or obtain some other type of employment that pays more than $9-$10/hr, which is more than what most people on assistance could ever obtain anyhow. I will give you a real life example and that is of my family.
As I mentioned before me and my husband are full-time students, my husband switched to working from a job that paid only minimum wage to one that paid a whole $9/hr. We lost all but maybe $100 of our food stamps, which is for three people, he now had to pay an extra $60-80 per week to cover gas to get to his job which is in the next town, which is where the only jobs around here are. So to make a long story short, his switching jobs to one that made more money left us IN THE HOLE...we couldn't even afford to feed ourselves.
- 3Quote from PRICHARILLAisMISSEDOh, I don't know...maybe it has something to do with the people suffering daily health problems that they can't get taken care of because they don't have insurance, such as overwhelming depression because of the struggles they are going through, perhaps it could also have to do with the fact that they can't improve themselves without some type of education, which involves a time commitment many don't have because they are most likely working well over 40 hours per week if not working more than one job and may be a single mother with no one to help with kids and housework so she can do homework after working a ten hour day. Many don't know they can do any better because their life is all they know and is passed down through the family, they don't know the resources available to them, they are completely overwhelmed and feel helpless...the list goes on....the world is not black and white PRICHARILLA.You see this? The last part of your quote really says it all. But let me ask you this-Why should a grown adult even have to be coaxed to "Try harder" and take care of themselves vice having the rest of society take care of them? They are not being "Penalized" by losing a free bee. They are simply being taken off their cushion and being put on the same keel of others who do not qualify for the free bee.
This misperception that everyone who is poor is just lazy and looking for a handout is rampant and wrong, maybe you should get down here in the trenches with me and see for youself instead of sitting up on your high horse and judging people you know nothing about accept what you see on TV or hear from other people whose opinion mirrors your own. I mean, everyone who is fat is just lazy too, right?
- 0Dec 4, '12 by HM-8404Quote from VICEDRNThat is a myth that keeps getting repeated.Look at the study done in oregon when they did a medicaid lottery. there are better outcomes here in this country for patients that are funded...
second, arguing the legality of the law is kind of silly when the president is a professor of consitutional law, don't you think?
In an Aug. 8, 2004, column in the Chicago Sun-Times they criticized Obama for calling himself a professor when, in fact, the University of Chicago faculty page listed him as ďa senior lecturer (now on leave)."
- 2Quote from HM-8404Frankly, there isn't a point in splitting hairs over lecturer and professor. One is tenured; the other is not. The fact is the man teaches law to law students and his area of expertise is constitutional law. Ridiculous to argue with a scholar, especially as lay people.
That is a myth that keeps getting repeated.
In an Aug. 8, 2004, column in the Chicago Sun-Times they criticized Obama for calling himself a professor when, in fact, the University of Chicago faculty page listed him as a senior lecturer (now on leave)."
- 6Dec 4, '12 by martinalpnShould healthcare be provided for as a basic human right? My answer may shock you no way around it, in this life i have learned you can pay for it on the front end or the back end but it will be paid for. I also believe an ounce of prevention is worth a pound of cure. Having said that i propose a 1% tax on every thing that we buy. Everyone makes purchases and bigger families spend more and smaller families usually spend less. Whether you work or not you have to spend and make purchases. Plain and simple every person in america will have contributed to the healthcare fund.
- 4Dec 4, '12 by VBRNJD99I have been an RN for 13 years. I was wrongfully terminated from employment last December. I was unable to find full time employment with benefits for 6 months and was working per diem as well as receiving partial unemployment. I got married a week after the termination so that I could go on my husbands health insurance. I was lucky that I could do that.
My out of pocket expense for continuing coverage under my old group policy would have been $950 per month, in addition to the $500 a quarter I spend on insulin, pump supplies, test strips, and other meds. In the free market, I was offered a "better" plan for $1200 per month.
I live with the assumption that one life is not more valuable than another merely because of what one can afford. "Access" to healthcare does include visits to the ER, but I don't think it should end there. One 3 day trip to the hospital for DKA can pay for a years worth of diabetic supplies.
I can choose not to pay for insurance, not get my insulin, and if I'm lucky, I'll slip into a coma in a few hours. Or, I could go into renal failure, be taken to the hospital, placed on dialysis for a month, go into LTC for 3, and then I would qualify for Medicare for the rest of my life. Oh, and SSI.
But, no, healthcare, medicine, primary care, immunizations, mammograms, pap smears, etc. shouldn't be a right. Nor should public education, roads, snow removal, EMS, or any other public service It's just like cable TV, cellphones, and 2 cars. Save it for the people who can pay for it.
- 1Dec 4, '12 by chiromed0Hmmm...what if single payer healthcare takes effect and this "basic human right" is now heavily governed with nurses and doctors salaries fixed/capped/controlled to cover everyone. How does that sit with everyone?
I think there are things which everyone would want to do for everyone but the practicality of it is impossible. Holding a standard that "healthcare" is a right when we can't enforce that is a problem. Instead of being at fault for committing malpractice when you do something wrong how would you like to be charged/prosecuted/sued for denying someones civil rights b/c you refused to provide care? Right now nobody can force you to care for someone as a patient but if they have a "right" to "your" services then can you refuse? Whether on the clock or not?
How can you afford rights for people we don't even know exist yet? Does this right exist b/c you are a human or a citizen? How can you budget for millions of illegals?
People get cared for now b/c of the basic goodness of others. Forcing "utopia" on people is a recipe for disaster.