Universal healthcare grassroots movement - page 3

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   jamistlc
    Originally posted by fiestynurse
    [BThe need for "wallet biopsy" before treatment would be eliminated; time currently wasted on administrative duties could be channeled into providing care; and clinical decisions would no longer be dictated by insurance company policy. Pressured by HMOs to increase profits, physicians are encouraged to spend as little time as possible with patients and often to undertreat them by not referring them to specialists. Cost-cutting measures allow critical health decisions to be made not by qualified medical professions, but by HMO administrators and managers. Why is it so surprising that doctors would be for a national health program? Many want major reform! [/B]
    I once worked in a Family Practice/Internal Medicine Physician Office. I did more paperwork in letter form for client needs than anything else. We would have to submit a letter and all the documentation and then resubmit it again (often the same papers) and with a consulting physician's report or get authorization for the consult. Then after going through all the mess we would usually get the approval for treatments or therapies. The check and balances do not add up! In addition the client suffered because an unlicensed rep. denied thier coverage after they had paid for the ins.

    Then yes the Doc would see about 100 clients in one day by himself and me as his writer/M.A. (I had 3 M.A.'s, an x-ray tech. and a front office person also). So what type of quality care were we provifing? As best we could as dictated by the Ins. companies profit margin. Most of our clients care had guidlines as to how much and how often we could treat them for this that or the other. Even Paps had standards that varried as to which test kit we could use....
  2. by   Mijourney
    RNcountry, I feel your post elaborated on some of the points I made in previous posts adding more depth to the conversation.

    There is no health and medical system that will be perfect, but the US system could stand to be greatly improved. I think it's clear that those who support a universal health insurance program expect for anyone who participates in the program to be able to get good quality care irregardless of socio-economic status. Good health can make a strong country stronger overall. Poor health weakens a nation overall. Look at the affect of health and medical services on the US GDP. This portion of the GDP can only increase as the boomers age and make more demands on the system.
  3. by   RNed
    I support a universal healthcare policy regarding our medical services in this country. How it is managed and who pays for such a system is critical to providing the care needed.

    There needs to be a national debate. The problem with the "grassroots" campaign for a universal healthcare insurance supports a "solution" prior to a true understanding of the problem.

    Our current medical leadership is providing studies, many are supported because they promote the supported solution. A solution which serves the provider of care rather than the "receivers" of care.

    Increasing the insurance pool solves the problem of funding, - it does not solve the problem of access, quality and the absence of healthcare for the "poor" and the "rich" in this nation.
  4. by   fiestynurse
    Here is a repeat of a previous post, which explains the single-payer system. I am not saying that this system would be perfect, just better. I certainly don't want to shove my viewpoints down anyone's throat, however, I am passionate about what I envision for Health care in America.
    I am on the Board of Directors for an organization here in California called "Health Care for All."(HCA) HCA helped to write and lead the lobbying effort for the passing of SB480 here in California. This bill moves toward a statewide study and debate on universal health coverage by requiring the Department of Health and Human Services to report on universal health care options. HCA continues to be a crucial player in the implementation of this study. It was a hard fought first step for us. Most of the members of HCA are concerned citizens. I am one of only a few health care professionals, who is actively involved. HCA is an example of a "grassroots" effort to promote change.
    The Congressional Budget office projects that single payer would reduce overall costs by $225 billion by 2004 despite the expansion of comprehensive care for all Americans. No other plan projects this kind of savings. There are states studying this system right now and determining how they can make it work.
    The program would be federally financed and administered by a single public insurer at the state or regional level. Premiums, copayments, and deductibles would be eliminated. Employers would pay a 7.0% payroll tax and employees would pay 2.0%, essentially converting premium payments to health care payroll tax. 90-95% of people would pay less overall for health care. Financing includes a $2 per pack cigarette tax. The General Accounting Office projects an administrative savings of 10% through the elimination of private insurance bills and administrative waste, or $100 billion in 1994. This savings would pay for providing medical care to those currently underserved.
    All Americans would receive comprehensive medical benefits under a single payer. Hospital billing would be eliminated. Instead, hospitals would receive an annual lump-sum payment from the government to cover operating expenses-a "global budget" A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc.
    Doctors would have three options for payment: fee-for-service, salaried postions in hospitals, and salaried positions within group practices or HMOs. Fees would be negotiated between a representative of the fee-for-service practitioners(such as the state medical society) and a state payment board. In most cases, government would serve as administrator, not employer.(this is not "socialized" medicine) Doctors would really have more freedom and say-so then they do now!
    Single payer would be the simplest and most efficiant health care plan that Congress could implement. So, what is keeping our elected officials from going forward with this? First of all, we need campaign finance reform. Secondly, we need a President who will put this at the top of his list of priorities. Secondly, we need a grassroots effort from every healthcare worker and concerned citizen. There are already many organizations and people endorsing this effort and fighting for this very type of healthcare reform. It is the only thing that makes sense!! I hope to see it become a reality in my life-time.
  5. by   Mijourney
    Hi feistynurse. Your post is what it's all about. We're learning from one another and expressing our opinions on how we would like to see health and medical care shaped. You are an activist in what you believe. I congratulate you on that. I appreciate everyone else's input on this important topic.

    RNed, I do agree that health care and insurance are not interchangeable, and I don't believe that anyone necessarily tried to drive that home. In an earlier post, I admitted that I had errored in combining the two. In fact, I will go so far as to write that just today, I heard that managed care has essentially been a failure in making provisions for good quality care and access. So, that definitely indicates a need for further reformation of the US health care industry.

    Having wrote that, fiestynurse, I do have concerns about the version of the single payor program you support. You wrote that with the proposed single payor plan you support that doctors will have three options for payment. Wouldn't most doctors naturally gravitate to the fee for service if they could? Especially when they have someone advocating on their behalf? I wonder how the fee for service option will help keep overall costs down unless there was a predetermined cap on how much could be charged? I also wonder about controls on outpatient or ambulatory care costs since that seems to be where most of the health care dollars are going right now. Even though we know that physicians are the primary revenue generators for hospitals, why should everything continue to completely revolve around them? Shouldn't hospitals have options to request fee for service or daily charges? Are nurses and other staff now to become global fees instead of the current room and board?

    I feel that a program like single payor may play a role in helping to get more standardization in many aspects of the health care industry. I think that it was under this topic or another in which a poster pointed out the importance of information systems. A single software system used in the US that could handle all sorts of data including expansions and upgrades may do wonders to help increase the quality of care and access in health and medical services if done in a well thought out manner.
  6. by   fiestynurse
    First, all health care systems, including single payer, allow people
    to use their own money to buy whatever they want outside of the system. There are some procedures or types of care that would not be covered under a single payer program, for example cosmetic surgery.

    Second, I am not quite understanding what you mean when you say that quality health care insurance and quality health care are not interchangeable, and must be discussed separately. For me, they are so closely related, that I must always discuss both, and sometimes it does seem that I am interchanging the two terms.

    This is how the lack of insurance affect people's health?

    1) People without health insurance do receive some health care, but often too little and too late. Sometimes the neglect of chronic conditions in their early state leads to more expensive care later on.
    2) The uninsured are three times as likely to lack a usual source of care than insured.
    3) Children without insurance are nearly twice as likely not to receive medical care for acute conditions such as asthma and ear infections.
    4) The uninsured are twice as likely to have not seen a doctor even once in a year.
    5) The uninsured are only two-thirds as likely to receive preventive examinations such as mammograms, pap smears, prostate exams and physical exams.
    6) The uninsured are four times more likely to postpone care due to costs.

    Last edit by fiestynurse on Jul 21, '01
  7. by   Mijourney
    Hi feistynurse. It's true that the lines of distinction are blurred for quality health care and health insurance. But, I feel that you can separate what is paid for health care from what type of health care is delivered. You can clearly see if something is not paid for, then you may or may not get the service.

    For instance, in insurance, from my short experience, you're graded solely on whether you can make the numbers and keep the customers satisfied. Usually, that means making it more comfortable for them to go to h***. That's by and large how quality is measured. I'm not sure if there's any intrinsic value to that. I think you can separate that from providing true quality health care.
  8. by   RNed
    A single payer system only resolves the issue of funding. It does not change the quality or delivery of healthcare.

    Healthcare is a business line, a commerical product driven by profits and commercialization like any other business line in the States.

    A single payer system sounds like a good plan but if efficiency and reduced costs is the only measure of support than shouldn't we support auto insurance, life insurance and housing insurance with a general fund?

    Will it include increased risk premium for smokers, alcoholics, obesity and couch potatoes and/or will it include low risk discounts for joggers, vegetarians and the health wise.

    The point is we need a healthcare policy first. We need to see what is for sale - before we buy it.
  9. by   fiestynurse
    The single payer system does not only resolve the issue of funding. It will change the quality and delivery of care by taking the control of health care dollars out of the hands of private insurers. The single payer system eliminates corporate profit as an operating goal. You just cannot compare this to other types of insurance. What type of health insurance you have, if you have it at all, does effect the kind of health care you will recieve. And quality health care is a basic human need and a right of every citizen.
    The managed care system has been one big experiment, that has failed. Why do you want to hold on to it so tightly? Managed care cuts care and proliferates waste, doesn't provide adequate coverage, doesn't provide health care of a superior quality, and compromises the patient-physician relationship.
    While the numbers of uninsured continues to grow, you want to "study health care policy" to see what is for sale before you buy it? First of all, multiple health care policy studies have already being done, some spanning many years. We already know that we are paying up the wazoo for a crappy system. There is no way to improve delivery and quality within the present system--it's already been tried and it has been a dismal failure. We cannot continue to provide bandaide solutions to a dysfunctional system. We need MAJOR reform!!
    Last edit by fiestynurse on Jul 29, '01
  10. by   fergus51
    Okay kday, you already know that I'm a bit of a bleeding heart so bear with me. I have returned to Canada to work in this socialized system after spending a few years working in the States, and while I prefer it, it is anything but perfect. But something has to be done to help those in the States.

    I was also one of the working poor who didn't have great access to health care. I have a chronic condition (not serious or debilitating when treated), but I never really got treated when we finally went to the doctor in the US (I was about 13 at the time). He pretty much just dismissed my parents concerns and sent us on our way. A few years later we moved back to Canada and saw a doctor again because we could. My doctor ordered tests (which cost money, presumably the reason my last doc didn't) and found out about my condition. I have to take pills and changed my diet a little. Because I got it under control at such a young age, I will be absolutely fine. I found out though that if I didn't, my risks of having an MI would skyrocket, as well as my risk of having a deformed baby or going blind. While the tests may have cost the health care system some money, they will save it a lot more money if I don't have a heart attack or whatever. An ounce of prevention....

    I believe that the uninsured in the US run the risk of not seeking treatment early and then wind up costing everyone a lot more money to care for them when their health has gotten much worse and they finally have to go to the hospital. This is the benefit of a single payer plan.

    Playing devil's advocate a bit, how do you all propse to institute a single payer sytem that avoids the problems we have? (like people going to the doctor when they stub their toe, cause hey, it's free! or the fact that we can't offer nurses the wages you can so they are leaving in droves, etc) There are a lot of problems with this system other than the philisophical issue of liberty and all that (sorry kday, that stuff is just over my head )
  11. by   fiestynurse
    Yes, statistically Canadians get more doctors visits (even for a stubbed toe), but they also get more hospital days, more procedures, more bone-marrow transplants. In the U.S. we are not only rationing high-tech health care (to people who can get health coverage), but primary care. At Cook County Hospital in Chicago, there are 10,000 patients on the waiting list for
    primary health care.

    National health insurance actually helps nurses. When hospitals aren't seeking ways to make a profit or come up with millions for their CEOs salary, there is more money for the actual delivery of care and for nursing. Public demand for quality medical care is the main factor working for nurses in an accountable system, because then good staffing becomes an issue of public policy.

    In addition to national health insurance, we also need more
    unionization of health care workers. In Canada virtually the entire
    health care workforce is unionized (compared to 16% in the U.S.)
    And when you really look at the actual salaries nationwide, Canadian RNs salaries are equal to those of RNs in the U.S. Also,
    for every level below RNs, Canadian wages are higher. U.S. wages in nursing homes (a major employer of African American women) are only 62% of what they are in Canada. Over 500,000 U.S. health workers live in poverty.




    Last edit by fiestynurse on Jul 28, '01
  12. by   fergus51
    Our salaries here are higher than in the States?! Not when I was in the US! I took a fair sized pay cut to come back here. The highest paid nurses in the province make 18$ an hour US. How are we better paid? Am I missing something? Are these figures after the zillion hours I worked in OT or based on hourly wages or do they include benefits, educational subsidies, signing bonuses, relocation expenses, etc.? I am really curious to know where that figure came from.

    Anyways, we are also short of primary care here. There are not even enough GPs in our city of 70 000. It's been reported that up to 10 000 people have to rely on clinics rather than having their own family docs. We are also losing specialists (lost a plastic surgeon to Minesota recently). And there is the outflow of nurses. I don't think a system that is used by all citizens can pay the salaries that nurses and Mds get in the US. Believe me, when I see some people post what they're making in the US I am very tempted to go back....

    I do think that universal health care should be present in any country as rich as Canada or the US. I just think that a lot of changes need to be made.
  13. by   fiestynurse
    I am talking about salaries NATIONWIDE, not just the areas that are attracting Canadian nurses. Hey! I don't make this stuff up! Also, Canada does not put enough money into their health care system. Canada spends $2095 per capita on health care expenditures and the U.S. spends $4090 per capita. (Those are very reliable OECD statistics)

    Here's another statistic for you. Applicants per Medical School place in Canada were 5.5 in 1999, in the U.S. applicants were only 2.4. Medical school enrollment dropped for the first time in 40 years. U.S. doctors are discouraging their children from going into medicine. ( JAMA; 282:892; Canadian Education Statistics, 1999:150.)

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