Universal healthcare grassroots movement - page 2

IT'S TIME TO ESTABLISH A POPULAR GRASSROOTS MOVEMENT FOR UNIVERSAL HEALTH CARE As the economy slows down, and more Americans are facing the potential financial burdens of inadequate health... Read More

  1. by   RNed
    Well some thought provoking ideas and opinions. First, I do not have the answers. However, we could review a few issues presented.

    Natelie. Absolutely we should have a safety net. I have asked for years why this country does not have a heatlhcare progam for any child under the age of 18. Regardless of parental income. One would think we could all agree upon taking care of our young. However, we continue to fail in this regard. Why should the parents income be a factor related to medical services needed for a child. It shouldn't. Provide me with a program to accomplish this and you have my support. This program should include Bill Gate's children. Lets be fair, just because he has money doesn't mean he should have to pay for their healthcare.

    To some other points. The ethical and moral dilema. We as a society have a ethical and moral obligation to provide a safety net. However, that safety net can not equal the quality of those providing the safety net. If so, we might as well assume a socialist communistic society. If we need to pay for their house, grocerys and healthcare equal to ours - do we not take the incentive away to become educated, resourceful or dare to say "rich". If I can have no more or provide no more for my family than what the "have nots" can why am I working so hard !!

    Life is not fair. No disrespect intended but if we were to acheive fairness, I'm sure it would be based on the standard - is everyone equally miserable rather than - is everyone equally happy.

    Once again, insurance has been interchanged as healthcare. Insurance does not level the playing field. So, we do develop a universal insurance program. Will it have a deductible? If so who pays for the working poor. And if some services are not covered? Do the rich have an option of paying for that care out of their pockets? Is that fair to those without the money? Do we tell the rich guy sorry, you can't pay for that heart transplant out of your pocket. The poor guys can't have it, so you can't have it !

    My family rarely uses healthcare. We do healthy things and remain healthy. However, I pay a substantial amount of money to insure the family. Why should the alcoholic, drug addict or couch potatoe get to spend my healthcare dollars. He/she killed their liver, not me!! Unless, we can regulate human behavior healthcare will remain unfair.

    Liberty is Choice ! Everyone has a choice. The choice of going to school, getting an education, making money, making decisons based upon good financial planning, not smoking, not drinking, pregnancy and on, and on, and on. Life is choices. To limit this liberty or to deny one a choice is counter to all the freedoms we currently have.

    The act of being benevolent is wonderful. However, we can not mandate others to do so. It needs to be a free act otherwise it is not benevolent - it is taxation !!

    When we envy what other have and revel when taxation takes their wealth for the benefit of others, we stand against liberty.

    Healthcare is not a right, it is a choice, just like all the other choices life presents.

    Again, I am not against better access to healthcare. However, I do not think universal insurance is the best answer, nor will it solve the problems. There will always be the "have nots" and the "haves".
  2. by   JennieBSN
    Originally posted by RNed
    Liberty is Choice ! Everyone has a choice. The choice of going to school, getting an education, making money, making decisons based upon good financial planning, not smoking, not drinking, pregnancy and on, and on, and on. Life is choices. To limit this liberty or to deny one a choice is counter to all the freedoms we currently have.

    The act of being benevolent is wonderful. However, we can not mandate others to do so. It needs to be a free act otherwise it is not benevolent - it is taxation !!

    When we envy what other have and revel when taxation takes their wealth for the benefit of others, we stand against liberty.

    Healthcare is not a right, it is a choice, just like all the other choices life presents.

    Beautifully stated, RNed!! The crux of my argument exactly.

    July 6th was 'cost of government day.' This means that July 6th is "the day of the calendar year that the average American worker has finally managed to earn enough money to pay his or her share of the total cost of government - federal, state and local"(Neal Boortz). Universal healthcare would simply push that date back further. The social programs to help the indigent of our society are growing bigger every year, and the cost of those programs is passed down directly to those of us who exercised good decision making and responsibility for our actions. In essence, we are being penalized for good decision-making.

    I too think benevolence is a wonderful thing. However, I do not like being FORCED to be benevolent. No one ASKS me if I want to pay for the medicaid, AFDC, and SSI programs in my state and country, I am FORCED to do so through taxes. No one ASKS me if I want to pay for the free healthcare that the welfare brood mares receive in this country...I am FORCED to through taxation.

    Children are truly vicitms of circumstance. They are relegated to live the lives their parents have made for them. I agree with RNed that they should, therefore, have free healthcare...even the 'RICH' kids. This is not forced benevolence, it is taking care of those in our society who genuinely do not have a choice. Adults, however, DO have choices. If their choices lead them to poverty and poor health, so be it. TOO BAD, SO SAD. I shouldn't have to pay for someone else's indiscretions and poor decision making simply because I was more responsible and have the means to do so. That is communism/socialism. Last time I checked, America was a Republic.
  3. by   Mijourney
    Hi. I agree with some of the points that have been made by the posters who feel that health care should be a choice. For me, the issue is not whether health and medical care are funded solely by government, private industry or a combination of the two or something else. I just don't see having access to good quality health and medical care as limiting someone's freedom. In fact, I think having acess to good health and medical coverage is liberating. It has the potential of making the people in the world smarter, stronger, and thereby freer. I assume that most of us would like an opportunity or chance to have a choice. Choices are limited when you can't get access.
  4. by   Cdn_Psych
    Oh, where do I even begin to reply?

    I'm a Canadian RN & I'm astonished to learn that I live in a "communist" country because my healthcare costs are (largely) paid through taxes. One of the things that seems to be overlooked here is that whether you pay for your health care by taxes or by "choosing" to pay a corporation (to deny you care), you still pay.

    The beauty of the Canadian system is that it is a single-payer system (though that is slowly changing due to corporate pressure from the multinationals). As a result, our administration costs are much lower than the "free market" model in the USA, and the system covers everyone. We spend far less for health care than the USA does and everyone is covered. A universal, single payer system is much more *EFFICIENT* than the free market model of the USA.

    The other thing you may wish to consider is the fact that bacterial and viral pathogens do not respect socioeconomic status. It's easy to say that those poor people with TB got what they deserve (what a callous thought), but the fact is that if TB is allowed to flourish among those who are poor, the presence of this communicable disease is a threat to *YOU* because it is a communicable disease that can be passed on to *YOU*.

    Whether you pay the government through taxes, or pay an HMO for managed neglect, you still pay. The "communist/socialist" system we have in Canada is cheaper and universal.

    I think it's the sensible way to go.



    Originally posted by kday



    Beautifully stated, RNed!! The crux of my argument exactly.

    July 6th was 'cost of government day.' This means that July 6th is "the day of the calendar year that the average American worker has finally managed to earn enough money to pay his or her share of the total cost of government - federal, state and local"(Neal Boortz). Universal healthcare would simply push that date back further. The social programs to help the indigent of our society are growing bigger every year, and the cost of those programs is passed down directly to those of us who exercised good decision making and responsibility for our actions. In essence, we are being penalized for good decision-making.

    I too think benevolence is a wonderful thing. However, I do not like being FORCED to be benevolent. No one ASKS me if I want to pay for the medicaid, AFDC, and SSI programs in my state and country, I am FORCED to do so through taxes. No one ASKS me if I want to pay for the free healthcare that the welfare brood mares receive in this country...I am FORCED to through taxation.

    Children are truly vicitms of circumstance. They are relegated to live the lives their parents have made for them. I agree with RNed that they should, therefore, have free healthcare...even the 'RICH' kids. This is not forced benevolence, it is taking care of those in our society who genuinely do not have a choice. Adults, however, DO have choices. If their choices lead them to poverty and poor health, so be it. TOO BAD, SO SAD. I shouldn't have to pay for someone else's indiscretions and poor decision making simply because I was more responsible and have the means to do so. That is communism/socialism. Last time I checked, America was a Republic.
  5. by   natalie
    If you believe you are spending a good portion of your paycheck on the indigent, you're wrong. It had become popular political folklore to rail against the taking of our hard-earned cash to pay for these "low-lifes." And somehow, the hardworking poor that cannot afford healthcare got tagged as lowlifes. Medicaid accounts for less than 6% of the federal budget.

    Guess where the huge percentage of the budget is at? Senior citizens. They're the ones that vote more than any other group, and they're the ones that have received the beneficients of the elected leaders that want to become re-elected. Social security and medicare are prime examples of SOCIALISM alive and well in the US. They are NOT means-tested programs and are the ONLY non-means tested programs in this country. Don't get me wrong. I want my tax money to go to social security, but I want it to go to those seniors that need it. It's evolved so far from the original intent of FDR. He wanted to provide a safety net for the POOR elderly. At that time, the mortality average was somewhere around age 65.

    Social security and medicare account for 35% of the federal budget. 35%-that's huge. Do any of you know of well-to-do seniors? I know plenty. And they're all getting free retirement and free healthcare.

    Before anyone replies that they paid into the system and deserve it back, please know that the time paid in is equal to less than 5 years of benefits received. So they retire at age 63 and have used up their benefits before age 68. My in-laws did this and they are 75 years of age. They're not well-to-do, but are taking trips to Hawaii, traveling around the US, and buying a new car every 2 years. They're doing it off their SS monies.

    Feistynurse, appreciate all your expertise. Surely if we can afford these luxuries to financially-stable seniors, we can take a look at providing healthcare to the lowlife, hardworking slug that makes $8/hour. And surely we could provide decent end-of-life care for the seniors in nursing homes.

    This is a great org. that has been around a while.
    http://www.concordcoalition.org/
  6. by   fiestynurse
    Here is something else to think about. What about all the extra coverage that we pay for that could be eliminated by a single-payer system. You pay insurance premiums for your health care coverage and then you pay for car insurance to cover the medical expenses of injured drivers, then we have medicare and medicaide that you help finance through taxes and then there's workers compensation insurance that pays for medical expenses of an injured worker.... WE PAY FOR ALL OF THIS.
    A social insurance system that pays for all of this would be so much more efficient, with more money left over for actual care.

    In addition, did you know that medical care debt is quickly becoming one of the top reasons why people file for bankrupcy in this country. WE PAY FOR THIS TOO.
  7. by   natalie
    http://dailynews.yahoo.com/h/nm/20010704/hl/care_1.html

    US: Children of the Working Poor Lack Health Care
    By Alan Mozes

    NEW YORK (Reuters Health) - Children of American working families living at or just slightly above the poverty line--the ''working poor''--are the most likely to fall through the cracks in the health care system, according to a recent study.

    ``Children in working poor families were far more likely to lack health insurance coverage and to experience disruptions in insurance coverage compared to children of non-working poor parents and compared to children in moderate to affluent families,'' said study lead author Dr. Sylvia Guendelman.

    Guendelman and Dr. Michelle Pearl at the University of California at Berkeley analyzed data on close to 14,000 children of working poor, poor, and moderate to affluent families that had been collected in a 1997 US Census Bureau (news - web sites) ``National Health Interview Survey.''

    They found that 16% of the working poor children who were in less than excellent health had not visited a doctor within the past year, compared to 12% of the poor and 9% of the moderate to affluent group. They also found that overall access to all types of health care was much more difficult for children of the working poor, who were less likely to have a regular source of care.

    In addition, the researchers noted that children of the working poor were uninsured at four times the rate of the moderate to affluent children.

    In 1996, the poverty line was defined as an income of $31,822 for a family of four. The study authors defined the working poor as earning less than 200% of the poverty level.

    Guendelman and Pearl reported their results in the June issue of Archives of Pediatrics and Adolescent Medicine.

    Despite the implementation of the federal Children's Health Insurance Program (CHIPS) in 1997--designed to provide insurance at the state level to about 5 million uninsured children of the working poor--barriers to enrollment still exist. Guendelman and Pearl stated that the program has suffered from insufficient outreach and too much red tape, forcing a large portion of eligible children to delay or completely miss receiving the care they need.

    Guendelman told Reuters Health that about 25 million American children live in working families that earn less than 200% of the poverty line. And she suggested that federal welfare-to-work policies implemented over the past few years should take responsibility to ensure that these children get and are able to maintain health care coverage.

    ``The working poor have received far less attention than welfare folks, and studies such as mine begin to portray the realities of this often neglected population,'' Guendelman said. ''Our findings were not unexpected given that until recently poor working families were given few incentives and have not been eligible for means-tested programs such as Medicaid.''

    SOURCE: Archives of Pediatric Adolescent Medicine 2001;155.651-658.
  8. by   Cdn_Psych
    Here is a direct link to the Portland (Maine) Press Herald story previously mentioned by CaronRN58:

    http://www.portland.com/business/sto...8buckley.shtml
  9. by   JennieBSN
    Cdn: Your system IS socialist. That's why it's called socialized medicine. Glad you like it. Keep it in Canada.

    Also, no duh I can get communicable diseases. Here's the catch...I WORKED HARD to develop a nice savings, a nice cushion to my checking account, to become debt-free, and to have a job that offers healthcare that I pay for. SO...if I get TB, I will not be asking the rest of the country to ante up to pay for my infection.

    Call me callous, call me whatever...that's also another beauty in America that's now fading thanks to the p.c. movement...FREEDOM OF SPEECH.

    As for what we pay for others' healthcare via taxes, what about the mark-up we get in our regular hospital/medical care to pay for those who 'can't.' Don't give me this 'working poor' junk. My family WAS the 'working poor.' They sacrificed cable tv, nice cars, nice clothes, name brand food, pets and lots of other luxuries most people think of as 'necessities' to get by. I was one of the 'working poor.' I baked my own bread in 25 cent loaf pans I bought at the salvation army. We pinched EVERY PENNY. My one 'luxury?' A $4.98 bag of bird seed once a month so I could sprinkle it on the patio to watch the wild birds eat it. Since we couldn't AFFORD a pet, this was my way of having a 'pet.'

    My sister worked for the state government before she had a baby, and she saw firsthand the amount of waste and fraud plaguing the already inept system we have. If I wanted to, right now, I could drop everything and live on the govt. dime. This 'not having access' is bull. It's called being LAZY. Like my friend who got pregant out of wedlock at age 16, and when questioned why she didn't go ONE MILE down the street to get FREE ocp's? "It was too far." You bet your butt once her baby was born, however, it wasn't 'too far' to go get her WIC check, food stamps, and AFDC money.

    Sob stories don't cut it for those of us who have been poor and gotten out of it through hard work and saving. It just makes me nauseous, all this bleeding heart mess. My own FATHER came out of IMMENSE poverty and horrible physical abuse in his family. He CHOSE to get grants to go to college, study, get a good job, and SAVE. He CHOSE to get counseling and delay having children so he wouldn't perpetuate the cycle of abuse with his own children. He and my mother CHOSE to pinch pennies and cut corners to give a decent life to me and my sister.

    Whatever. Think what you want about the indigent of this society. Just don't ask/force me to pay for them.
  10. by   Mijourney
    Originally posted by fiestynurse
    Here is something else to think about. What about all the extra coverage that we pay for that could be eliminated by a single-payer system. You pay insurance premiums for your health care coverage and then you pay for car insurance to cover the medical expenses of injured drivers, then we have medicare and medicaide that you help finance through taxes and then there's workers compensation insurance that pays for medical expenses of an injured worker.... WE PAY FOR ALL OF THIS.
    A social insurance system that pays for all of this would be so much more efficient, with more money left over for actual care.

    In addition, did you know that medical care debt is quickly becoming one of the top reasons why people file for bankrupcy in this country. WE PAY FOR THIS TOO.
    Yes, fiestynurse. I'll look at this from another standpoint. I guess you could say that even though copays, deductibles and other costs are not formally called taxes, in fact they ARE taxes. Well, you say you're being taxed by choice? I'd much prefer to have a system, since I'm going to pay taxes one way or another, where I'm paying less out of my pocket for good quality coverage and services. A more refined, efficient system I feel should reduce alot of the sucking sound we hear coming from pharmaceuticals, overpaid execs, managed care organizations and the like. You say that you're paying premiums by choice? I can imagine that an unforeseen major catastrophe in effect would consume all the money you ever paid into your insurance. Once you've maxed out your health insurance, it's over. Once you go broke you may end up at the mercy of the government anyway.
  11. by   Cdn_Psych
    kday,


    Wow, are you always this hostile?

    I don't understand why you're so opposed to having a single-payer system. If you have a choice of paying taxes to pay for your health care, or paying much more to a private corporation, why on earth would you choose to pay more? It hardly seems wise or reasonable to me.

    As for keeping "socialized medicine" in Canada, well, I feel no urge to export the Canadian system to the USA (even though I think it is vastly superior to the US system). I'm far more interested in seeing the US system stay out of Canada, because it's not as good as what I already have (by just about any measure - cost, universality, or morbidity & mortality).


    Originally posted by kday
    Cdn: Your system IS socialist. That's why it's called socialized medicine. Glad you like it. Keep it in Canada.

    Also, no duh I can get communicable diseases. Here's the catch...I WORKED HARD to develop a nice savings, a nice cushion to my checking account, to become debt-free, and to have a job that offers healthcare that I pay for. SO...if I get TB, I will not be asking the rest of the country to ante up to pay for my infection.

    Call me callous, call me whatever...that's also another beauty in America that's now fading thanks to the p.c. movement...FREEDOM OF SPEECH.

    As for what we pay for others' healthcare via taxes, what about the mark-up we get in our regular hospital/medical care to pay for those who 'can't.' Don't give me this 'working poor' junk. My family WAS the 'working poor.' They sacrificed cable tv, nice cars, nice clothes, name brand food, pets and lots of other luxuries most people think of as 'necessities' to get by. I was one of the 'working poor.' I baked my own bread in 25 cent loaf pans I bought at the salvation army. We pinched EVERY PENNY. My one 'luxury?' A $4.98 bag of bird seed once a month so I could sprinkle it on the patio to watch the wild birds eat it. Since we couldn't AFFORD a pet, this was my way of having a 'pet.'

    My sister worked for the state government before she had a baby, and she saw firsthand the amount of waste and fraud plaguing the already inept system we have. If I wanted to, right now, I could drop everything and live on the govt. dime. This 'not having access' is bull. It's called being LAZY. Like my friend who got pregant out of wedlock at age 16, and when questioned why she didn't go ONE MILE down the street to get FREE ocp's? "It was too far." You bet your butt once her baby was born, however, it wasn't 'too far' to go get her WIC check, food stamps, and AFDC money.

    Sob stories don't cut it for those of us who have been poor and gotten out of it through hard work and saving. It just makes me nauseous, all this bleeding heart mess. My own FATHER came out of IMMENSE poverty and horrible physical abuse in his family. He CHOSE to get grants to go to college, study, get a good job, and SAVE. He CHOSE to get counseling and delay having children so he wouldn't perpetuate the cycle of abuse with his own children. He and my mother CHOSE to pinch pennies and cut corners to give a decent life to me and my sister.

    Whatever. Think what you want about the indigent of this society. Just don't ask/force me to pay for them.
  12. by   RNed
    Fiestynurse, Natalie and our Canadian post correctly identifies there are social systems within many forms of government and it does not indicate we live in a socialist/communist society.

    However, we must remain cautious when it appears the resolve to our problems can "only" be a defined social program. How much is enough? At what percentage are the working class going to be mandated to pay the nonworking or working poor to correct their problems?

    Generally, we have defined them in this post as the "haves" and the "have nots".

    Should there be a limit of support and why is it important that healthcare be designated a "right" rather than a "choice"?

    We continue to accept insurance and healthcare as the same words. This mistake has wasted time and resources needed to institute a fair healthcare policy. A policy needed, but, one I do not support as a "right". I do not believe providing "insurance" to society provides "healthcare" to society.

    Can we streamline healthcare, consolidate services such as medical auto insurance, etc. to reduce cost ? yes. But, if we choose this as the option to make it more palatable for the taxed, shouldn't we do it for college education, as well. Isn't there as moral an obligation to education as there is to healthcare. Shouldn't we pay for every child to receive a college degree?

    Although, Kday says it with more flames. Many are tired of mandated programs benefiting the "have nots" and punishing the "haves". Like her, I have experinced the "poor", "have not" environment. It was the opportunity to succeed that reversed that position. Everyone has the same opportunity and this is what Kday relates too ! If the choice is not to exercise it, it is not the fault of society. Our responsiblity and obligation is to provide opportunity, it does not guarantee success nor should it guarantee rewards for failure. Some would say the "have nots" do not have choices or options, however, having been a "have not" I know this is not true!!

    To an extent money is liberating and freedom. This is the liberty we lose if we continue to mandate increasing taxes. The liberty to spend our hard earned dollars as we see fit and not mandated by others, who believe their moral obligation supercedes and thus defines our moral obligation. If we are free to travel anywhere in this nation, but our government takes all our disposable income to the extent we are unable to travel have we not limited our freedom.

    Now, how does big business get healthcare defined as a "right" and thus develop a large funding source, mandated to be filled by the working class, "rich". Sway public opinion !! First don't call it, "Insurance" it has a bad connotation - call it Universal Healthcare. Make words interchangeable and find something that all can agree upon. Example "healthcare = insurance" and "children = compassion". We all have compassion.

    " Children in working poor families were far more likely to lack health insurance coverage and to experience disruptions in insurance coverage compared to children of non-working poor parents and compared to children in moderate to affluent families,'' said study lead author Dr. Sylvia Guendelman."

    The above statement does not say children did not receive care. We see people daily in the ER and urgent clinics with "coupons" receiving healthcare. However, the writer wishes to imply the lack of insurance "is" a lack of healthcare. Present to any ER a sick child and care is provided. Insurance does not guarantee healthcare and is not an interchangeable word. Did you see the word, "children"? Where is your compassion?

    " In addition, the researchers noted that children of the working poor were uninsured at four times the rate of the moderate to affluent children."

    Again, uninsured does not mean absence of healthcare. However, they are swaying public opinion suggesting that the lack of insurance is equal to the lack of healthcare. Does this also read as, "across economic differences three out of four children are insured." Could the statement be made, "poor children were uninsured at four times the rate of the moderate to afflluent children." or are they saying, "poor children are four times not likely to have insurance than the moderate to affluent children who do not have insurance." Why did the author decide to mix prepositional phrases? Why did the statement, "children of the working poor" get used? We should think of these things before we blindly accept them as fact. Do we need more studies, yes ! Not affordability or numbers of insured or uninsured - we need to study access and affordabilityof healthcare. Insurance is not what we need to study. A sincere honest review would be appreciated.

    If there is a "grass roots" movement, it should be to require those who conduct and publish studies be mandated to clearly define their use of the words, access, healthcare and insurance. I for one, am not interested in how many people including children are not insured. It means absolutely nothing to me !!!

    I am interested in how many people have not received medical care, when that care, would have prevented a life-long condition lessening the opportunity to succeed in life or when the lack of that care resulted in death.

    Geat discussion, great ideas. This has been interesting. Fiesty nurse, Natalie and Cdn-Pysch, I would like to share my 18 y.o. daughter supports your position. What you have failed to say, I am sure she shared. She is rather a sassy lass and has been somewhat less kind to her father than your excellent post here !
    Last edit by RNed on Jul 10, '01
  13. by   rncountry
    The most expensive point of entry into the healthcare system is the ER. Do not think that insured persons are not already paying for those that are not insured. You are. You pay it in increased premiums, you pay it with decreased access to resources you may need.
    Think this, everyone always compares the Canadian system to the American system. Why not take a look at the systems they have in England, Australia or New Zealand. England provides healthcare at just over $1000 per person in that country. Our country spends over $4000 per person, yet England has a much lower infant mortality rate then we do, as well as a slightly higher length of life. There may be different viables that make it so, not just universal healthcare, but one cannot help but wonder how having access to healthcare for all matters.
    Kday, I have to say that my dad came out of absolute poverty, as well as an abusive home. His favorite saying was "Can't never did nothing. " He was such a hellion when he was young that he was asked to leave high school in the tenth grade and not come back. At 17 he joined the Navy, and got the discipline his life had lacked up to that point. He spent 33 years in the Navy, going back for a GED and eventually a bachlors in business. He is someone in my mind to emulate. However that said I don't think that providing healthcare as a universal system is taking from the haves to give to the havenots. At present it is truly the insurance companies that are running healthcare now. Despite managed care premuims have continued to increase, this country has one of the most expensive healthcare systems in the world, yet we rank 37th in what kind of healthcare our citizens recieve. My point is that financially we are not getting what we pay for. We are making a very select few incredibly wealthy though. Not to mention that those select few are getting wealthy by denying care to people who need it. I will dare say to those that deserve it. We have many, many vets from what Tom Brokaw calls the greatest generation in our nations nursing homes. Have you ever worked in a nursing home? It is the true underbelly of the healthcare system, and it is our nations shame that amount of people who are making money and living large on the backs of vulnerable elderly patients who have no other choose than to be where they are. Most have lost everything that they worked hard to have and achieve, because there is no other way that they may recieve a medicaid benefit. The system that we currently have has also badly impacted on Your profession. As cost cutting became the name of the game it was nurses who were the first and the last to feel the pain of it. Nurses are about 20% of the costs for any facility. It is one of the largest controllable costs therefore when push comes to shove it is the nurses who lose jobs, who are then told they will pick up more patients than can be realisitically cared for, who are told that we will accept unlicensed personnel doing jobs that were previously ours alone, and not only that they are to do that under your license. Can you imagine the outcry that would happen if nurses were allowed to diagnose under a physicians license? Yet that is essentially what happens when an unlicensed person is allowed to place foleys etc... under your license.
    The system that we currently have is not simply about reallocting monetary resources so that poor people have better access to healthcare, it is taking a look at how the system in place impacts all of healthcare. Labor is considered a controllable cost, so get rid of the housekeepers and the nurses can empty the trash after hanging blood. Get rid of resp. therapy and the nurses can pick that up, get rid of registered dieticians and nurses can do that. Get rid of the unit clerk and nurses can learn to imput orders in the computer and so on, and we can do all that at the same time as we are also doing what we were educated to do, and get water, put patients on bedpans and fluff pillows because the UAPs are doing what we should be doing. And while you wait and wait for a raise that reflects the amount of responsibility you hold the top paid HMO executive is hauling in his $54 million telling you that a raise cannot be done right now. The balanced budget act has cut into his profits too much.
    I appreciate all that each person has said about this country providing opportunity, but think just a little about this issue as more than those of us who work and work hard giving our money away to those that don't, but as something larger than that. Realize that the managed healthcare system is killing our profession and the ability of a physician to be able to do what they know should be done for a patient. Is it purely coincidence that California is one of the most heavily managed care states, and they are also the most short of RNs? The national average is 782 RNs per 100,000 persons, in California that drops to 500 RNs per 100,000 persons. When the name of the game is bottom line healthcare it affects YOU and YOUR Profession, whether it affects your access to healthcare or not. When healthcare crisises are not handled well it will always affect nursing. Cannot anyone think that it is possible that the AIDS crisis did not affect nursing? I think so, maybe it is not politically correct to say this, but how many young people do you think may have been influenced not to go into a career field where you are exposed to blood and bodily fluids while the national news talked about AIDS? How many thought it is not worth my life to do this type of job? How many where influenced by seeing the amount of layoffs of nurses that took place as managed care came in more and more, thinking it was not a job that would be immune from market forces anymore than any other job, so why put yourself out there and at risk as every single one of us do each day we work? Nursing is in crisis now, and it is a healthcare crisis. To fix what needs to be fixed is going to require looking at the healthcare system as it stands now and being realisitic about ALL of the poor influences our our career field. To me that means looking at what managed care has done to my profession and my ability to provide appropriate care to my patient. In the end I don't care if the patient I am taking care of has insurance or not. I do care that I have a patient that is dying, that needs more nutrition than he is currently getting PO in order to heal and live, but we can't put in a feeding tube because the insurance won't cover it because he can still swallow. This man was a productive member of society until he picked up that nasty bacteria that eats your flesh. He has an internal abcess from it, will not heal the open wound he has now without proper nutrition, he is so painful he is sleep deprived, he is having hallucinations and we can't get him to eat. But some damn insurance company is going to dictate that we cannot put in a tube feeding to help him. Because he can still swallow. And the laugh all the way to the bank. Oh, and they will only pay for a certain amount of TPN. The physician and I had a long talk about all of this the other day. The physician sat there and ran his hand through his hair repeatedly, so frustrated that it poured off of him. This should not happen, for an insurance company to be able to dicate what type of care you can give your patient. It is ********.
    So when you think about universal healthcare take more of a look than I don't want to pay for those that should be doing something for themselves. The issue is much more than that.

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