Universal healthcare grassroots movement

RNed · Jul 10, 2001

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 !

rncountry · Jul 10, 2001

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 bullshit.

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.

jamistlc · Jul 10, 2001

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.... :rolleyes:

Mijourney · Jul 11, 2001

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.

RNed · Jul 11, 2001

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.

fiestynurse · Jul 12, 2001

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.

Mijourney · Jul 13, 2001

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.

fiestynurse · Jul 21, 2001

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.

Mijourney · Jul 24, 2001

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.

RNed · Jul 27, 2001

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.

fiestynurse · Jul 28, 2001

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!!

fergus51 · Jul 28, 2001

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:) )