Still think we have the best Health care in the world?

HM2VikingRN, RN · Apr 1, 2007

Except with insurance cost shifting we are all paying far more for the care of the uninsured than we would with a single payer system (Which costs less and achieves better overall outcomes for patients.) We are the congress since we elect people to represent our interests in Washington. Congress has broad powers under article 8 to legislate for the common welfare to meet the needs of states and their citizens. Occasionally we the people have to use our government collectively to fix societal problems and/or achieve societal goals. Sick, vacation and health insurance all came to be a part of the benefit packages for jobs through collective pressure on business and government. It is very legitimate for we the people to use the legislative process to address societal problems and concerns. Progressive solutions have been shown in general to work better to solve the problems of society. A strong set of workplace protections sick, vacation, health insurance etc., for workers will strengthen our society as a whole. If arrived at through democratic means we all have an obligation to follow the rule of law.

Fuzzy · Apr 1, 2007

Nope! Until healthcare and I don't mean just emergency room care (and ER care is definately NOT AFFORDABLE), is available and affordable to all we are not the best in the world. If you have a disability or pre-existing condition, choose to work, not be on Social Security, you cannot get health insurance unless you are fortunate to work for a large corperation who we provide it for you as a JOB benefit. It's sad that ILLEGAL ALIENS receive more affordable healthcare than citizens.

Yep the system is broken.

Fuzzy

HM2VikingRN, RN · Apr 1, 2007

taxes are the dues we all pay for living in a civilized society. i found the following which certainly seems like a call for social justice and health care for all people.

http://www.ncccusa.org/poverty/biblespeaks.html

sa

turday, march 2 proverbs 14:31– those who oppress the poor insult their maker, but those who are kind to the needy honor him.
matthew 25:31-40
35 for i was hungry and you gave me food, i was thirsty and you gave me something to drink, i was a stranger and you welcomed me, 36 i was naked and you gave me clothing, i was sick and you took care of me, i was in prison and you visited me.' 37 then the righteous will answer him, "lord, when was it that we saw you hungry and gave you food, or thirsty and gave you something to drink? 38 and when was it that we saw you a stranger and welcomed you, or naked and gave you clothing? 39 and when was it that we saw you sick or in prison and visited you?' 40 and the king will answer them, "truly i tell you, just as you did it to one of the least of these who are members of my family, you did it to me.'

tencat · Apr 1, 2007

I'm suprised that no one has brought up the incredible cost of malpractice insurance for physicians. Depending on one's specialty, one can pay $60,000 in premiums PER YEAR (and probably more, that's just my personal knowledge of one physician's premium) And if a physician is sued, the premiums go higher. Physicians who practice in economically advantaged areas are more able to absorb the cost. But if one practices in a geographical area that is full of poverty, the cost is too much. I know of a couple of physicians in my small town who have quit working any specialty areas because they can't afford the premiums (and they don't drive Lexus or Mercedes, nor do they live in a huge house). If there were some kind of limits on frivolous lawsuits, maybe the price of healthcare would come down.

Much as I hate to admit it, we also need to tie welfare and medicare/medicaid to making the recipients responsible, contributing members of society. Instead of just handing out money and aid, we need to tie it to teaching work skills and work ethic. Sometimes there is a good reason why someone is unable to work (mental illness, physical illness), but there are a lot of mentally and physically able people who take aid but do not contribute back to society. Just in my little corner of the world there are so many things that need to be done that could become jobs for these people. That way they would get their aid, but they would also be providing a service to the community by cleaning up parks and roadways, for example. JMHO.

pickledpepperRN · Apr 1, 2007

I'm suprised that no one has brought up the incredible cost of malpractice insurance for physicians. Depending on one's specialty, one can pay $60,000 in premiums PER YEAR (and probably more, that's just my personal knowledge of one physician's premium) And if a physician is sued, the premiums go higher. Physicians who practice in economically advantaged areas are more able to absorb the cost. But if one practices in a geographical area that is full of poverty, the cost is too much. I know of a couple of physicians in my small town who have quit working any specialty areas because they can't afford the premiums (and they don't drive Lexus or Mercedes, nor do they live in a huge house). If there were some kind of limits on frivolous lawsuits, maybe the price of healthcare would come down.
Much as I hate to admit it, we also need to tie welfare and medicare/medicaid to making the recipients responsible, contributing members of society. Instead of just handing out money and aid, we need to tie it to teaching work skills and work ethic. Sometimes there is a good reason why someone is unable to work (mental illness, physical illness), but there are a lot of mentally and physically able people who take aid but do not contribute back to society. Just in my little corner of the world there are so many things that need to be done that could become jobs for these people. That way they would get their aid, but they would also be providing a service to the community by cleaning up parks and roadways, for example. JMHO.

So long as no one is terminated from their job to great a "working for a welfare check" job I think this is a great idea.

We need levees in all our flood plains, earthquake retrofitting, and other infrastructure repair. We need child care workers, police, nurses, and farm workers. Why not give a tax break to employers who hire people who are on welfare? And have a modern day WPA to pay people to do needed work?

Perhaps let workers keep their Medicaid until and unless employer health insurance is in effect?

We once had a $30.00 and $30% where people who got jobs got a welfare check with the amount of their wages deducted. except for either $30.00 or 30%. To get to keep 30% the worker had to pay that money for child care or transportation such as bus fare to work.

For job training child care was paid and up to $30.00 a month. I know many who earned their LVN this way because there was a 1 year limit on this before being put to work.

Working is so much better than just just getting a check.

Simplepleasures · Apr 1, 2007

Your stepfather was a stinker, true. What a jerk. And yes, you did get where you are by the sweat of your brow. Many of us have done it, as best we could. And those of us who were taught that we weren't supposed to work outside the home, those of us who were taught that we were supposed to be homemakers, wives, mothers, volunteers in the community, transmitters of culture to the next generation, and helpers of our husbands, those of us who have had to spend our entire adult lives working AND homemaking know the schizophrenia of having to do, every damned day, something that, after all these many years, is still foreign to our self-concept.
We have worked and worked, saved and lived frugally, stayed within our budget, not gotten so far into debt that we could not get out. We have been the pillars of our community, the cornerstone of our families, the reliable, sturdy employees of our hospitals. We have sacrificed sleep, family time, holidays, even our health so that we could provide for our families and ourselves. We care for aged parents, we live the way we were taught was upright and honorable. We provide for our retirement years so as not to burden our children. Don't think, Tim, that we don't know where you are coming from.
But there are others of our fellow citizens who are less capable of self-care because of physical and/or mental infirmities, some self-inflicted, some God's decree. I don't think anyone is dismissing your accomplishments. We can probably relate to you pretty well, as we have done the same thing - we faced up to being poor and we did something about it. We worked, we lived honorable lives.
BTW, I want to thank you for your military service.

Trudy, SO SO true.I have felt that some posters, believe that despite having worked HARD for almost 30 years, it still was my own fault that I can no longer work and that I did not "TRY" hard enough, or whatever. Life DOES have a way of turning even the best most well planned life on its head. Catastrophies DO happen to good people, people who were once the hardworkers. What would the truly disabled, the elderly whose savings were depleted by one of life's dirty tricks, do? The streets would be full of homeless, sick people, I think we might look like Calcutta.I thank God that our government is one that does place some value on their citizens health and well being, not perfect by any strech, but CAN be improved.Those who think they are insulated from life's dirty tricks, by "perfect" planning, think again.

Simplepleasures · Apr 1, 2007

While I too am reluctant to totally trash what little bit remains of our precious, already gasping-their-last American freedoms, I think it is ironic that Jefferson, whom you quote, was a slaveholder. He and so many of his compatriots didn't mind compromising the rights of their slaves so that he and his pals could live in freedom.
About your fear that you would have to relinquish your own freedom so that others might have a fair shot - I'm not sure just how it would all work, how a universal health care program would come about. Taxes, I guess. How do other countries do it? But I can't help but think that you are in the strongest group right now, i.e., those who are healthy enough to provide for yourselves by the sweat of your brow. You might think differently if you were less healthy, weaker, less able to keep the wolf from your door, Tim. Some people are born with better health than others, they avoid illnesses and injuries that cripple and lay others low. So many of my patients have illnesses, for instance, that render them basically shut down as early as their teen years. They can no more fend for themselves than can an infant. Same with those who, like yourself, work hard, build up their lives for years and years, then find that advancing age or a sudden catastrophe, not necessarily even of their own making, cuts the legs out from under them, so to speak.

BRAVO Trudy! Keep coming back to these debates on healthcare, you are a voice of reason, we need you.Jefferson was a human being that had some great ideas, but he was flawed, slave owning was not included in his "freedom" phylosophy I guess.

ZASHAGALKA, RN · Apr 1, 2007

This will be a long post, maybe two.

I'm going to start with a Bible lesson: TODAY'S Bible lesson in my Bible class. Hang on, it's pertinent.

The lesson: the meaning of the 2nd Great Commandment - Love your neighbor as yourself. (The first Great Command being to Love God with all your heart and soul.)

We broke down what love means in regards to a neighbor. See if you agree:

1. Love sees with eyes of compassion.

2. Love does deeds of deliverance.

3. Love invites inclusion.

4. Love confronts exclusion.

An essential part of this equation is the concept of Justice. Love struggles to ensure justice for others. By the same token, love tolerates injustices towards self (turn the other cheek). This is intended to be an impact barrier, if you will; a cushion against ill will. By extending justice to others while simultaneously extending patience AGAINST injustice: the effect is to to create a 'buffer zone' that protects the peace within your own soul.

Pretty good lesson, I think.

Now many of you might be thinking: At LAST! Poor Zashagalka has finally been informed on this issue in a way that we have all been trying to tell him, for some time.

Instead, let me assert that this was NOT a new lesson for me, and in fact, it perfectly CONFORMS to my beliefs and postings on this topic.

My point with this is that, for all the allegations and assertions of mean-spiritedness, I WANT the above for the most people possible. As I have no doubt, so do you.

We are NOT at odds with our goals vis a vi poverty, or, healthcare. We are at odds with the methods to bring it about.

The first definition of love, above, eyes of compassion, while an act, is as much an attitude. Compassion should inform our actions towards others.

The second, deeds of deliverance is on point to this discussion. How, exactly, do you do that? We aren't merely talking about aid, but about DELIVERANCE from untenable situations. Example: if you see a begger on the street, and you give him 10 dollars, have you done ANYTHING to deliver him from his situation? Can you even be sure that he won't go buy a bottle of cheap wine, thereby further entrenching his situation? This is a conundrum that affects each of us when we see those begging for money: would it be HELPING them to give a handout, or possibly, HURTING them?

Now, let's look at the war on poverty (it's a prelude to discussing healthcare). (For the moment, I am talking about the 'intractable poor', and I'll discuss what that means as I go.) Have we offered ANY level of subsistance, in ANY gov't program, that actually and truly delivers the poor from being poor? If so, then why haven't poverty levels changed? (I'm not talking about the potential upward mobility of any potential poor person here, but rather, the level of entrenched poverty) Haven't we provided JUST enough aid with JUST enough restrictions to remove incentive to better one's self? Haven't we, in effect, far from delivering our neighbors from poverty, further entrenched them? And THEN, we have added restrictions that all but prohibit marriage and all but prohibit gainful employment. We have made 'idle hands' that have exploded the drug trade and fatherless children. How, has that addressed this problem with the 'eyes of compassion'? How, has creating successive generations of children unprepared to enter society been creating 'deeds of deliverance'?

How compassionate is that?

In fact, I believe that our actions to 'aid poverty' have violated our 3rd and 4th definition above. We have actively discouraged inclusion and fostered exclusion. I see welfare as a form of "you are not capable of living in our society, so take your check and good luck to you". We have not created programs with rules that foster inclusion, deliverance. We have created programs that have amounted to exclusion.

Why?

Because with the power of the purse, we have also sent powerful messages. We have all but told the intractable poor that they don't belong. We have established restrictions that actively resist efforts to overcome poverty obstacles. We have not been compassionate.

We have utterly failed to provide the incentives that could lead to deliverance into inclusion and away from exclusion.

Could we have done it differently? Of course. We COULD have decided not to penalize marriage, statistically a potent means, through combination of incomes, to rise above poverty. We COULD have slowly phased out benefits as someone approached the poverty line, and even marginally past that line, making earning more money more attractive at each level of benefit. If the poverty line for a family of 4 were say, 23,000 (I don't know what it is, off hand), we could have created NO penalty in receiving benefits for any employment up to 20,000 and phased out benefits over the range of 20-26k, where at each point in the process, the benefits of the extra income outweighed the extra gov't benefits at a previous level of income. (in fact, the gov't is QUITE adept at this concept, when it wants to be. Many tax benefits 'phase out' over an income range.)

In other words, compassion for compassion's sake and without incentive is just not compassion. It isn't compassion because, ultimately aid without deliverance is not inclusive, but exclusive. And deliverance requires not depriving, through penalty in action, the incentives we want to INSTILL.

We WANT our poor to be motivated and enabled to rise to their highest levels, no matter where that be, and to support them in THAT. What we WANT, is deliverance. That however, is not what we've designed.

I'll continue in a little while . . .

~faith,

Timothy.

allnurses Guide · Apr 1, 2007

tim . . . . . i'm sitting here eating my lunch at work and i enjoyed your post . . . . .

"for i was hungry and you gave me food, i was thirsty and you gave me something to drink, i was a stranger and you welcomed me, 36 i was naked and you gave me clothing, i was sick and you took care of me, i was in prison and you visited me.' 37 then the righteous will answer him, "lord, when was it that we saw you hungry and gave you food, or thirsty and gave you something to drink? 38 and when was it that we saw you a stranger and welcomed you, or naked and gave you clothing? 39 and when was it that we saw you sick or in prison and visited you?' 40 and the king will answer them, "truly i tell you, just as you did it to one of the least of these who are members of my family, you did it to me.'

******************************************

the above is what we do at good samaritan medical mission. we are putting on a clinic in the bay area this month to practice what we will be doing in vietnam in june/july.

my thought is that we the people ought to be responsible for "doing unto others".

leave the government out of it.

steph

Simplepleasures · Apr 1, 2007

tim . . . . . i'm sitting here eating my lunch at work and i enjoyed your post . . . . .
"for i was hungry and you gave me food, i was thirsty and you gave me something to drink, i was a stranger and you welcomed me, 36 i was naked and you gave me clothing, i was sick and you took care of me, i was in prison and you visited me.' 37 then the righteous will answer him, "lord, when was it that we saw you hungry and gave you food, or thirsty and gave you something to drink? 38 and when was it that we saw you a stranger and welcomed you, or naked and gave you clothing? 39 and when was it that we saw you sick or in prison and visited you?' 40 and the king will answer them, "truly i tell you, just as you did it to one of the least of these who are members of my family, you did it to me.'
******************************************
the above is what we do at good samaritan medical mission. we are putting on a clinic in the bay area this month to practice what we will be doing in vietnam in june/july.
my thought is that we the people ought to be responsible for "doing unto others".
leave the government out of it.
steph

does this mission accept any government funding?if not , how wonderful, but realisticly, could you see most health care facilities and programs that accept government money to be able to keep its doors open by private funding alone?

ZASHAGALKA, RN · Apr 1, 2007

We want to motivate and encourage the poor to rise to their highest level. How do we do that?

I believe that freedom is an essential element of that equation. I know that many of you dismiss free markets as 'trickle down' economics. In reality, it is 'wide open dam' economics. It's convenient to villify the rich. However, the rich, motivated by their own self interests, MUST enable a middle class.

First, they have to have places to invest their money so it will grow. Where do small mom and pops get the money to start business? From the bank, yes. Where do the BANKS get that money?

How can the 'rich' become rich except by having a middle class to buy their goods and services? Did Bill Gates become rich by 'exploiting' the middle class, or by providing a valuable product that has exploded the ability of the middle class to better manage their lives?

How many jobs and services and benefits have attained to society, and to YOU personally, because of the personal computer. (Thank you Bill Gates, for allowing the eventual creation of AllNurses!) IBM was a bunch of stiff corporate idiots. When their junior contracted employee told them that the future of computers was in software, they scoffed. And so, they were displaced in the market of ideas, to the great benefit of each of us.

For all his products have done for society, Bill Gates DESERVES to be rich. In order to maintain that wealth, he and his company strive daily to find ways to reach a middle class with new products. In doing so, they help CREATE a middle class. They create that middle class by the employees they hire and by the jobs created by their products.

The chief benefit of a free market is that goods and capital freely flow back and forth, without regulation, benefiting all parties along the way (given the FREE ability to trade with another or not, individuals will only trade with others when it is in their best interests to do so).

The problem with gov't intervention is that it takes money OUT of the free market system. Every single dollar the gov't uses is taken away from the free transactions that spur the growth that creates and sustains a middle class. As that taxation becomes excessive, it decreases incentive. Quick example, and many of you understand this concept completely. IF I work an overtime shift, I get a big bump in my pay. A 2nd shift and I get a moderate bump in my pay. 3rd shift? Almost no difference in my pay. It's just counterproductive and a disincentive for me to work at the point that the gov't takes away more of the proceeds of that labor. In this way, HOW MANY of you refuse to work extra shifts, NOT because you aren't motivated to make more money, but because increasing gov't taxation acts as a disincentive?

In fact, granted more free market incentives, many of the poor do not remain poor at all. There are two definitions of poor that come into play, and the distinction is critical. There are transient poor, that DO rise above being poor, and then there is the intractable poor.

Let's look at that: In actuality, at all levels of income, there is rampant income mobility.

(a quintile is a 20% increment of the population as it relates to wage earning).

http://www.house.gov/jec/middle/mobility/mobility.htm

"According to the tax data, 85.8 percent of filers in the bottom quintile in 1979 had exited this quintile by 1988. The corresponding mobility rates were 71 percent for the second lowest quintile, 67 percent for the middle quintile, 62.5 percent for the fourth quintile, and 35.3 percent for the top quintile."

Do you understand the significance of this? Vast majorities of whole segments of population, with the highest levels being at the bottom of our economy, are upwardly mobile within a 10 yr period. Then how does the bottom 20% remain the bottom 20%? Simple, influx of immigrants combined with new workers entering the economy are added to the intractable poor, those that do NOT rise out of the lowest 20% of the economy.

The vast majority of the poorest 20% of our population, 85.8% move out of the lowest 20% of the economy over a ten year period. THESE are the transient poor. Those that didn't move up? Intractable poor.

Want another surprise: "Of those in the much discussed top 1 percent (in 1979), over half, or 52.7 percent, were gone by 1988." The upper 1% is subject to quite a bit of mobility, as well. Or rather, many don't stay in the upper 1% for long because they either fail in the marketplace, they die and their assets are divided, or they are surpassed by others more upwardly mobile. In addition, over a 10 yr period, 35.3% of the highest 20% of wage earners had migrated to a lower quintile. Fascinating!

Another point in the link: as you get into the middle quintiles, many people move upwards while some do move downwards. There is strong upward mobility INTO the middle class, with some variability up or down within the middle class. That sort of make sense, though.

But all of this is as a result of opportunity! Many can and DO take advantage of their opportunities, all the time. When many of you think of the 'poor', you think of the 14.2% of the lowest 20% that are intractable and don't realize that, for 85.8%, being poor is a temporary condition. You see it ALL the time: how many anecdotes do we have about students taking welfare while in nursing school but fully expect to be very upwardly mobile in the next few years? It's an EPIDEMIC of people improving their lives! What a great nation this is!

Apparently, for many, there is a real incentive to reach up into the middle class, and many do, quite successfully. And yet, recently in this thread, I have been scorned for having access to opportunities that others do not! Pishaw.

As a matter of compassion, the best thing we can do for the 85.8% of the upwardly mobile poor is to grease the slids upwards where we can, and otherwise, get out of the way!

For the intractable poor, we must ensure that our aid is compassionate by providing the incentives for them to move upwards. For too many of the intractable poor, there is no hope of advancement. They just can't see it. Why SHOULD they, when Uncle Daddy has thrown money at them and basically dismissed them as incapable. It's not that they aren't able-bodied; it's that they aren't able-hoped. LOVE requires deeds of deliverance. HOW do we help them, not just to eat, but to become enabled with hope? Are our current programs sending them a hopeful message, a message of deliverance?

Search your soul on that. Listen to the metamessages about the incapability of the poor to perform without the gov't paying their way. Are we really sending a message of hope? Are we actively fostering deeds of deliverance?

More to follow . . . (sadly, I must go to sleep for a few hours now so that I can work tonight. I WILL follow up on this line of thought, as soon as practical, but it might be tomorrow.)

~faith,

Timothy.

pickledpepperRN · Apr 1, 2007

This will be a long post, maybe two.
We are NOT at odds with our goals vis a vi poverty, or, healthcare. We are at odds with the methods to bring it about.
~faith,
Timothy.

This is why this discussion is so important.

I appreciate your thoughts talent in communicating.

I think "We the People" are the government. Why not work together to create a healthier country?

How is providing a single excellent standard of healthcare for ALL from the sports star to the guy who mops the floor telling anyone they cannot make it.

Bill Cosby, Oprah, more nurses than I can count, some physicians, singer Jewel, and countless others are successful after being on welfare.

Most credit a teacher, clergymember, scout leader, or other mentor for their confidence.

My uncle had many welfare kids in Cub and Boy Scouts. He had only integrated troops as early as 1955 and the first Eagle Scouts in town. In fact most of his scouts from 1955 to 1993 became Eagle. Those I know of are successful in spite of growing up on relief.

My uncle could provide discipline, inspiration, fun, and love. He could not provide their Maslow Hierarchy needs or healthcare. The government did that so they were healthy enough to benefir from the love and attention of an amazing man.