To all "medical coverage is a privilege" folks:

Nurses Activism

Published

You're presented with a five year-old who probably has appendicitis. The family is poor, does not have medical insurance, and they only have a small amount of money to cover diagnostics and treatment of their child. (Any veterinarians on this forum?)

Because of the OMG free market stuff, you can remove the child's appendix for a minimum of...$5,000. However, this child's family cannot afford that and are not eligible for that much credit.

...what do you do? What if you're presented with ten such cases over the course of a month?

Specializes in Hospice.
1) I am no Libertarian.

2) Rationality requires judgement; it is not terribly difficult.

3) "Vulgar"- per Merriam-Webster: In context, if one is not currently, or has not previously, contributed to the "social welfare", one cannot expect to withdraw from said welfare indefinitely, whether the paradigm is Humanism, theological, Fascist/Communist, whatever.

If one has means to purchase illicit recreationals, one may pay for healthcare, food, clothing and shelter. If one has funds for combo cable/dish/Netflix, cigs, and delivery pizza, but cannot make payments on an angio, that has nothing to do with "need".

If someone is able to demonstrate, using Erickson's, how providing care for every bit of dumbassery(see linked discussion on the impact of meth-kAbooms on burn units) contributes to the development of members of society in a positive manner, by all means. My personal assessment, after 20 years, is that we have a HUGE segment of society locked in early-middle adolescence, lacking in cause-effect relational modelling and in calculating cost in interpersonal acts.

I am unclear as to where aesthetics fit into the discussion. Choices have consequences. Americans have not experienced consequences, on a national scale, in 60 years.

You may not be a registered libertarian, but your post embodies the current randian libertarian party line ... I wasn't talking about you. I don't know you and don't care how you identify.

"gross", "pretentious" ... all esthetic - or if you prefer aesthetic - judgement calls as well, so QED. I think of it as the icky-poo response and picture an exquisitely groomed aristocrat holding a nosegay to his face to block the stench of the unwashed masses. Perhaps not what you meant but certainly how it came across to me.

And, similar to all the rand-o-philes I've read, you're glossing over the real message of what you're preaching: if you can't afford it, die already and get out of the way.

You just took way more syllables to say it.

I've been following this thread with interest but haven't commented so far because I'm not in the US. However I think Nicurn001 has a really good point. Even supposing a charity/community hospital could adequately treat everyone who is 'deserving' (and you then need a way of determining who really is deserving), what do you do with those who choose not to buy health insurance? Really truly absolutely deny them care?? What about any children they may have?

As an outsider looking in, it seems to me that the US already has a form of universal cover (as everyone actually does get at least emergency treatment), it's just that it's one without any of the advantages of those types of systems.

I can't imagine a voluntary system where everyone actually does contribute and everyone one actually does the right thing. That's just not human nature. I understand that some have a philosophical objection to 'forcing' people to buy insurance, but if so, does that hold in all circumstances? It's against the law here for a car to be unregistered and part of the registration fee is a mandatory third-party insurance. Is that the same in the US?

It's not essential to have a car but if you don't there's nothing to drive anywhere so you don't need the mandatory insurance. We don't tell people 'oh you really should get that car registered', we make it a legal requirement. I'd probably be tempted to go without car registration myself if that was an option. After all, I'm a careful driver, I'm never going to be involved in an accident. :rolleyes:

Unless the society is truly willing to deny treatment to those who could have afforded insurance but chose not to buy it, I don't see that a voluntary system can work. It seems that a system of deciding which patients can afford insurance (and they don't get treated) and which patients can't (they do get treated) would also be needed.

I think it was in this thread that someone said the US would face unique challenges if it introduced a system of universal coverage. I've been wondering what people see as some of the difficulties, and whether it's a logistical problem or something else?

Specializes in Psych , Peds ,Nicu.
a) this was what charity/community hospitals did, before there were requirement to accept 3rd party payors or all "indigent" emergents. again, no huge mystery, its a very clear historical record. the historical would also show this source never was able to meet the need , if it had there would have been no impetus to creat the modern method of financing healthcare .

b) what is the over-powering need to force people to buy insurance or have "adequate resources"? how does forcing myself, self-sufficient, middle-class, to support those who choose self-destructive behavior improve the situation? will the children of the enabled be better decision-makers for it, or will they see the entitlement benefit, and promulgate and procreate? again, history is extremely clear- enabling models do not work. you keep harping back onto those who make poor lifestyle choices , i would agree with you they should suffer the consequences , but unfortunately there will always be those who game any system , but if a person such as you describe " self supporting , middle class " does not ensure they can meet the financial burdens of any and every medical problem ,they have made an exceedingly poor lifestyle choice,they are not self supporting as they have shifted the risk of that medical emergency onto me and others who will have to meet the financial burden incurred on the providers who gave care who would become victims of thet persons poor lifestyle choice ie .the avoidance of personal responsibility to ensure coverage of the costs of their healthcare disasters .

to me the obsession with other peoples lifestyle choice is simply a cover / justification of avoiding paying for insurance , which works in healthcare financing as in other fields by spreading the risk between a large group in order to cover the liability incurred by any claimant ,in all fields of insurance you could blame the poor choices / actions of a claimant to justify your wish not to pay your premium .

we can debate this as much as you wish but from my perspective , you will never accept that those who choose not to be insured are a greater problem than those who play the system , because those that choose to be uninsured are also making me pay for their healthcare , but hiding behind a faux moral outrage about those others who get healthcare without paying for it !

Specializes in Infectious Disease, Neuro, Research.

We can debate this as much as you wish but from my perspective , you will never accept that those who choose not to be insured are a greater problem than those who play the system , because those that choose to be uninsured are also making me pay for their healthcare , but hiding behind a faux moral outrage about those others who get healthcare without paying for it !

I believe we are in agreement, barring slight semantic differences- choosing not to be insured, without advanced personal financial planning, is gaming the system, just a slightly different track.;)

Community/Charity hospitals were always fairly "rough" by comparison, but they were also cyclic, as with any other supply and demand system. It wasn't until the early 80s, when a progressive, permanent, wave of closures and for-profit Chpt. 11 acquistions were seen.

Sociologically, the drive for the current system is the securing of a constituency.

I can't imagine a voluntary system where everyone actually does contribute and everyone one actually does the right thing. That's just not human nature. I understand that some have a philosophical objection to 'forcing' people to buy insurance, but if so, does that hold in all circumstances? It's against the law here for a car to be unregistered and part of the registration fee is a mandatory third-party insurance. Is that the same in the US?

You are absolutely right. Our problem is that we do not have the Constitutional requirement of, "fair and equal protection", being enforced. Its no surprise, and the social devolution is exactly what de Toqueville warned against.

Specializes in Infectious Disease, Neuro, Research.
You may not be a registered libertarian, but your post embodies the current randian libertarian party line ... I wasn't talking about you. I don't know you and don't care how you identify.

Remember- the first debater to refer to the other as "Nazi" loses.;) With the understanding that both the National Socialist German Workers' Party and the Proletarian Revolutionaries had the penchant for applying labels, and saying, "youareyouareyouare...", I'm wondering who's standing where...?

In any case, if one has no consideration, or concept of, the other party's frame of reference, one is unable to objectively evaluate the relative arguments. The, "possession bias", is too high.

"Gross" and "pretentious" have clearly defined, demonstrable, objective meanings, as did the protests against "conspicuous consumption", 40-odd years ago- the considered,determined and wide-spread destruction of a given resource(s), for the purposes of self-gratification.

Specializes in Hospice.
Remember- the first debater to refer to the other as "Nazi" loses.;) With the understanding that both the National Socialist German Workers' Party and the Proletarian Revolutionaries had the penchant for applying labels, and saying, "youareyouareyouare...", I'm wondering who's standing where...?

In any case, if one has no consideration, or concept of, the other party's frame of reference, one is unable to objectively evaluate the relative arguments. The, "possession bias", is too high.

"Gross" and "pretentious" have clearly defined, demonstrable, objective meanings, as did the protests against "conspicuous consumption", 40-odd years ago- the considered,determined and wide-spread destruction of a given resource(s), for the purposes of self-gratification.

So many words, so little sense.

The easiest way to avoid saying what you really mean is to say nothing at all in as complicated manner as possible.

Every state in the U.S. has a CHIP program- children's health insurance plan, a federally subsidized program whereby children can get medical insurance coverage. See Children's Health Insurance Program (CHIP) | Medicaid.gov

It has been in existence since 1997 and is specifically for children whose families make too much to qualify for medicaid, but cannot afford private insurance. If given such a scenario as in the original post- I'd keep the toll-free number handy or make a call to the hospital social worker.

http://www.insurekidsnow.gov/professionals/reports/chipra/2010_annual.pdf

More info about CHIP. I'm always surprised not only by how many families don't know about their state's subsidized program for child health insurance, but how few professionals know about it or understand it or know who qualifies.

Hi Everyone... I'm entering into this conversation nearly a year after you all made your statements on healthcare policies. I am a student that needs to write a "position" paper on the Affordable Healthcare Act. I'm getting some info off the internet, but not enough feedback from people - other providers, nurses, etc. If anyone wants to chime in on how you feel nearly a year later and if you've changed your opinion or not and why? This would add some spice to my paper that is missing...

Thanks in advance!

Specializes in Hospice, Case Mgt., RN Consultant, ICU.
If the family has no insurance, then that means they are not working. Maybe they should have thought about birth control before conceiving a child which they can't afford. Why should I feel guilty now for all the folks who are irresponsible - produce kids, don't work, do drugs, illegals? Do you expect me to pay for all of them? If you think that healthcare is a right, then go ahead and pay for all of these people, and we'll see how quickly you'll change your mind.

Or they were working and lost their jobs! Or they are working for companies that don't provide health insurance! Or their pay rate is so low they really can't afford health insurance! Pay attention and you could become aware that the gap between the rich and the poor continues to widen.

Specializes in Hospice, Case Mgt., RN Consultant, ICU.
neatnurse30 what a load of B*!.

Yes some of the uninsured are those you describe ,but many are employed but cannot afford the healthcare plans offered by their employers .Some are employed and could easily afford ahealthcare plan but because they are healthy , they shift the risk they will get sick onto us , by chosing to be uninsured . The last are the worst group as far as I am concerned , as they know the risks and are selfish enough to expect me to pick up their tab when they get ill and end up in the ER.

Agree. It bugs me to see people who ride motorcycles without helmets so the air can blow through their hair and never think what will happen if they are in an accident. How many end up in a vegetative state requiring tons of money to care for them!

Specializes in Geriatrics, Telemetry, Med-Surg.

Forgot to quote...

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