To all "medical coverage is a privilege" folks:

[dirtyhippiegirl]

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?

[cnmbfa]

Neatnurse: You have no idea what you are talking about. My daughter lived in a rural part of a soluthern state for several years. She and her hubby both worked. NONE of the employers in that area provided insurance, except for two places: a university and a hospital, probably because they wouldn't have been able to hire faculty or health care staff without it. Everyone else in the area either was uninsured, paid $400 plus per month for mediocre coverage, or paid less for policies with a $1000-$5000 deductible and 20% co-pays for everything. Because so few people there made more than $10 an hour, in that community a major illness or accident meant bankruptcy. Unless desperately ill, everyone self-treated for any problems.They did everything they could to NOT get tests done because they didn't want to deal with the results. If you had a problem, you just got by and hoped your diabetes wouldn't ruin your kidneys before you got to 65 and could get Medicare.

This county showed up aon NY Times map as one of the many counties in the US where folks, especially black skinnned ones, now have shorter life spans that their parents.

Are you aware that 50% of the pregnancies in this country are unplanned, and that a good number of them are the result of BC failures? Should we say that all of those children shouldn't get health care because their parents had no business having sex if it meant risking a pregnancy? Or are you one of the GOPers who think we should no longer cover birth control, with the next step being to ban it outright? When will you be satisfied? When millions go hungry, including children, or when we revert back to living short, nasty, brutish lives of never-ending work?

[cnmbfa]

In most states, Medicaid only covers tooth extractions. I live in a city with 900,000 people. There are 4 dentists in this city who will take Medicaid to do extractions. Medicaid patients end up in the ER with severe pain and tooth abscess, so you and I can pay more to treat this ememrgency and clean things up enough to allow the tooth extraction to take place weeks later. I know of no charities here (other than discounted care through a university dental clinic with a 3-6 month waiting list).

Are you aware that untreated dental disease is a big risk factor for preterm delivery? I'd much rather, as a taxpayer, spend $100 for a dental checkup and cleaning once a year than $100,000 for an NICU stay.

[cnmbfa]

A key provision of the Affordable Health Care Act is premium support. If you make up to 4 times the poverty level, you will get help in paying premiums. There are thousands of businesses that are already getting tax credits to help pay the premiums if they choose to cover their employees. The goal of the act is to ensure that no one will go bankrupt over HC costs, and that none of us will ever need to spend more than 10% of our disposable income on health care.

To pay for this, they are doing several things: 1) Using electronic health records and billing to make it much easier to find and go after fraud (kind of like when your bank takes action if there is unusal activity on your account); and 2) By getting back some of the 12% annual guaranteed profit to private insurance companies George Bush promised them to get them to go into the Medicare Advantage business. The goal there was to siphon the younger, healthier seniors away from traditional Medicare. By doing that, costs per person in traditional Medicare are higher, and the GOP gets to then use that to talk about how inefficient it is, and to use that as a further excuse to kill it off.

The third thing is the mandate. This is a Republican idea, designed to address the "free rider issue". Free riders are actual two groups: the people who choose to take their chances and go uninsured, and employers who gain a competetive edge or who profit by refusing to ensure their employees. Once (not if) these folks get sick or injured, you and I pay their costs at least twice: in higher costs passed on to us to cover their uncompensated care, and in taxes when these folks end up destitue enough to qualify for Medicaid. We actaully pay in two other ways: thorugh auto insurance premiums in case someone we hit lacks health insurance, and through workmen's comp costs, which are passed on to us by businesses via higher prices for their goods and services. Can anyone give me a clear explanation of why they sould not be forced to chip in to the health care pool?

I worked for an emplyer who gradually shifted 75% of the cost onto their employees. The result was that ALL of the staff with kids making less than $30K a year went on Medicaid. The practice owners profited, and the state picked up the tab. Worse yet, they could undercut the costs of another practice that still covered their employees. Is that right? Should they be able to get away with not paying in to the system?

[RNChrissy4]

I work at a public hospital in NY, i see medicaid/medicare used, abused, and taken for all it is worth on a daily basis. It is honestly sickening. You may say that im heartless but i think after the age of 18 you are an adult, you and you alone should be responsible for your own healthcare whether that is cost or staying healthy as a preventative measure to avoid any cost. Under the age of 18 you are considered a child, i think all children deserve the right to have healthcare. Im sorry but if you ate yourself into a bed and now cant move, it is not societies responsibility to take care of you.

[romie]

I was one of those unfortunate nurses who went to a liberal school which believed that basic health was a human right and that our practice as nurses should not at all be affected by how much insurance one or one doesn't have. Believe me, I have protested to the administration when we discharged patients home who could barely walk or even answer a phone to their homes yet let those patients with fancy insurance languish for days while we waited on them hand and foot because their insurance paid for it and they were perfectly capable of taking care of themselves and did not need nursing care.

Healthcare is a right, not a gift. Those nurses who think otherwise are lucky to have their jobs.

[romie]

I was getting report on a patient and the nurse mentioned that the patient (according to their suspicions) was homeless. My response was, "How is this relevant?" I actually don't give a ****** about how the medical bills are paid for . That is why I became a nurse instead of a physician. People ask me all of the time " why do you spend all of those years in school and you are ONLY a nurse and not a doctor? (I have over 10 years of higher education under my belt and I'm only an RN and proud of it). My response has been " I care about taking care of people and unfortunately being a physician these days is more about being a figure head and less about caring for people, so I am very happy being an RN."

So I could give a s***** about how the bills are being paid, I am doing my job taking care of people in need. Let the nasty dirty money people do their job after I'm done bringing your mother back to life.

[tntrn, ASN, RN]

I would,think that fact would be extremely relevant to the patient's emotional well being and certainly would be a factor in discharge planning.

[romie]

Maybe in your suburb it's acceptable to be a discriminating RN, but in my home town of Chicago, you take care of people regardless of their ability to pay

[romie]

I used to use Allnurse.com as a touch stone for what nursing is, But some days I cannot believe some of the nasty crappy things that RNs say or feel about their patients. It makes me really sad. If you feel so entitled as an RN spend a couple more years in school, become an MD and then pass judgement. My patients love me because I care about them, not because I care how they are paying their bill.

[grpman]

I believe that food is a basic right and I give money and food accordingly which buttresses my beliefs. Likewise, those in favor of socialized health care should give of their resources and time to help those not insured. With all the support that this topic has, I'm sure that those in favor could raise a lot of money. However, it's often hard to give up gym memberships, new model cars, or a drop in our standard of living. I wish we weren't so hypocritcal, myself included, yet we are.

[nicurn001]

I believe that food is a basic right and I give money and food accordingly which buttresses my beliefs. Likewise, those in favor of socialized health care should give of their resources and time to help those not insured. With all the support that this topic has, I'm sure that those in favor could raise a lot of money. However, it's often hard to give up gym memberships, new model cars, or a drop in our standard of living. I wish we weren't so hypocritcal, myself included, yet we are.

This is a typical conservative BS answer , which is spurious , this is already being addressed by the support systems we have ( welfare , TANF etc.) , so really not a problem like healthcare financing is .It really doesn't matter whether you view healthcare as a right or need , the answer I would like is what are we to do about paying for the healthcare of the uninsured , because you either have to answer that question or be honest and tell us what you are going to do when a person without money or insurance turns up at the ER , are you going to treat them (if so how will that care be financed ) or are you going to withold treatment even if it means they will die ?

[grpman]

This is a typical conservative BS answer , which is spurious , this is already being addressed by the support systems we have ( welfare , TANF etc.) , so really not a problem like healthcare financing is .It really doesn't matter whether you view healthcare as a right or need , the answer I would like is what are we to do about paying for the healthcare of the uninsured , because you either have to answer that question or be honest and tell us what you are going to do when a person without money or insurance turns up at the ER , are you going to treat them (if so how will that care be financed ) or are you going to withold treatment even if it means they will die ?

That wasn't BS or from a political view and I attempted to phrase it tactfully knowing that I have a hard time myself living up to my own ethics. However, I do have an answer: solve the problem by reducing all government employee's pay to raise funds (but Congress hasn't taken a pay cut in over 77 years), layoff enough government workers to raise the funds (USA Today reported that federal employees are more likely to die of natural causes than suffer a layoff), or raise taxes (I hope they start with those who call giving more money and time to charity a BS answer). We could also shuffle money from government pensions, defense, welfare, and social security to make it happen. Or maybe we could say that the 15 trillion dollar debt and 1.3 trillion deficit yearly amounts to a drop in the bucket. Most of us can't quantify much past $100,000 so I can see how all the zero's can look similar, but trust me, it's a lot of money.

Now...that was BS.