Within the next few years the U.S. is going to have a nationwide, single-payer system

The point of my entire post was that there are many people, that are either uninsured or underinsured, and that the government already believes that I make too much money for any kind of subsidy. I have left the job I held for three years, and moved to a new one where insurance is affordable, but that makes no difference to the nurses that are left behind at that job. I don't know how things work in your part of the world, but in Oklahoma if you work in a nursing home you can pretty much kiss any chance of having worthwhile health insurance goodbye; any type of retirement or disability is a joke. The LPN's, forced out of the 'all RN' hospital policy in the larger cities are struggling to find positions that offer decent pay and benefits. Many nurses are so fed up with a system that 'offers the best healthcare system in the world' to the patients that are either rich enough or poor enough to get healthcare and excludes them from having adequate healthcare (unless they can prevail upon one of the 'kind' docs that visits the nursing home to write them a 'script) that they've left nursing altogether. Hard facts to swallow: according to 2007's numbers there are approximately 12,000 LPN's in the state of Oklahoma, approximately 4000 of those are working in nursing.

Why aren't LPN's working in nursing in Oklahoma? *points at the lack of pay and more important BENEFITS* Why kill yourself working sixty hours a week for an employer that's going to force you to quit work, go on welfare, and admit yourself to the same nursing home you were working in two weeks ago if you become seriously ill. Think it can't happen? Think again.

Until the problems of employers that offer substandard healthcare and benefits at massively inflated cost is addressed, the government is going to feel more and more pressure from lower-middle-class families who want their kids to have more healthcare than going to the Health Department for immunizations and going to the ER for real, serious problems, then this debate will continue. I think my kids deserve adequate medical care including yearly well child checkups. My pap smear? If I was still working at the nursing home, my attitude would be "Well, it's been five years, if there was something really wrong, I guess I'd know about it by now."

Also, just as an aside, I am paying for people that can't afford healthcare. Yep, that's right, my tax dollars go to subsidize healthcare for low income families and their visits to the ER while lower-middle-class families try to decide if they can afford to take their sick kid to the doctor or if it's just a virus and can be waited out. After all, going to the doctor is sometimes a choice between paying the bills on time, or getting behind on the *insert name of bill here.* For people who live paycheck to paycheck having adequate healthcare is just a pipe dream at this point.

Whether we use Clinton's plan, Obama's plan, or some other plan is completely unimportant. What is important is that the close to 20% of underinsured Americans are given access to the healthcare that they need.

I don't know what strikes you as harsh about my statement. I am not "bashing" Dierdre, or anyone else. I am fully aware that working people pay taxes to support SS, Medicare, and other social programs. I was simply making the point that help can be provided to those in need without adding every American to the roles of government programs, a move that would be unnecessarily expensive.

So, given the situation in your area of the country, would you support my suggestion? Instead of government sponsored healthcare for all citizens (many of whom don't need it), working people who can't afford insurance (and don't qualify for Medicare or Medicaid) would be given a subsidy in an account that can only be used for insurance premiums and/or healthcare expenses. They have money to spend in the manner that best meets their family's needs, just as those of us who are insured do.

I don't know how to say this in a way that doesn't appear to be attacking you, but I'll try.

Your assertion that President G.W. Bush is better liked by the troops than Bill Clinton was is so far off base that you must either be very naive, or have no basis of experience to speak from, or you are just one of those guys who likes to push their agenda on other folks. I was in the Navy from 1996-2005, 9 years and 3 months so I served under both of the Presidents you are speaking of. I don't know what your background is, but please bear with me while I explain what I saw as a military member and why civilians here in the U.S. don't get an accurate view of what a military member thinks.

I've been involved in many assemblies where the troops are gathered to receive a 'pep talk' from V.I.P's and voice our 'concerns, thought's, feelings' on things. These V.I.P.'s have been various high ranking Admirals/Generals/Regional Commanders, the Secretary of Defense, and Congressmen. Before these V.I.P.'s came aboard the ship the entire crew would receive their orders from the Captain about what we were to discuss, what was acceptable and what was not, what sort of general impression we were to give (happy, gungho, mission ready, etc...) Prior to the assemblies certain people were given questions on paper to ask in a fashion that gave the appearance of 'spontaneity'. These were entrusted to the guys who the Chain of Command could trust to stick to the script and not ask questions that would 'embarrass' the Captain or call into question the loyalty of the average military member. Questions like, "WTH is my deployment being extended an extra 3 months" or "Why did we get underway underprepared and with broken equipment that I have to try and fix out in the middle of the ocean now.".....those are examples of questions we were to steer away from.

Now that was just my personal experience with these things. However, it leads me to believe that the soldiers talking with reporters on T.V. are being given guidelines of what they are to say as well. Same thing when it comes to the Secretary of Defense saying things like the troops are happy, they are proud of their mission, they feel they are making a difference...blah blah blah. If the troops who can think for themselves are being told what to say to the Defense Secretary, then it stands to reason that the information he gives to the civilian public is going to be skewed. While I'm thinking about it, what the hell does an 18-21 year old really know about the world and how can they say they are happy with the work they are doing? They have no life experience to use as a frame of reference to evaluate their actions.

The point I'm trying to make is that YOU WILL NOT GET AN ACCURATE VIEWPOINT FROM ANY MILITARY MEMBER ON T.V. You may ask "Why NavyVet, if you are such a freethinker why don't you and the others who feel the same as you speak up at these assemblies?" Plain in simple, the answer is fear. Fear of reprisal and fear for what that reprisal will do to your family and their finances. Many military members are married with children at home waiting on them. Enlisted military members get paid just enough to be lower middle class on the wage scale. So, when we get in trouble and lose a 1/2 months pay for 2 months and are not allowed to leave the base for 30-45 days due to NJP, well it kind of puts you into a bit of a moral quandary. Do you speak your mind and then tell your wife that we are going to be behind on bills for 2 months and tell your kids that you have to live on the base for the next 6 weeks away from them because Daddy wanted to make a point, or do you shut your mouth and take whatever crap is thrown at you and just count the days until your enlistment is over to protect your family?

Well, needless to say, I wasn't happy with what I saw going on around me and decided to vote my conscious with my feet as a fair amount of other military members have. For the record, of the thousands of military members I came into contact with while Clinton was in office, very few of them had anything bad to say other than the diehard ultraconservatives who tend to be a tad biased. Sure the base closings and restructuring upset some people, but if you are trying to insinuate that the average military member gave a ratsass that he had an extramarital dalliance then you would be incorrect sir. I got my paycheck 2x a month and wasn't asked to persecute a groundless war that I found morally repugnant. So yeah, you could say I liked President Clinton a little better. If the approval ratings are anything to go by it seems America liked President Clinton better as well. President Bush's approval rating is in the mid 30's I believe......60% of Americans can't be wrong can they?
Also, before labels start getting thrown around, I consider myself an independent and voted for Bush in 2000 and against him in 2004.

I apologize if I seemed to be ranting anywhere in there, I'm just getting real tired of stubborn people supporting a corrupt administration and a failed ideology.

On the topic of Universal Healthcare Coverage.....

It shames me to admit it, but I am currently without health insurance. We aren't necessarily poor, but still can't afford it. In the Navy I think I made $34K a year at my high point and used the military healthcare system without any problems. I got medical attention in a timely fashion with very few complaints in 9 years. Both of my children were born in military hospitals with no problems and no financial burden. (that is the closest thing to Universal Health Coverage I could come to in the U.S. even though it only covers a small amount of the American population 500,000 or so)

Now that I'm out and a student (wife is an agency RN) my family will make about $75k this year. Her employer doesn't offer insurance so we had to find some on our own. To get very crappy insurance for my family is about $500 a month. To get insurance comparable to what a hospital offers its employees...or what I had in the Navy....costs about $800 a month. I just can't afford that with my mortgage, car payments, credit card payments, college costs, and the cost of running a household. Even though we do 'okay' financially, I still feel like we are part of the working poor. I can't imagine how it is for others with similar debt loads and a lower income.

I really think the 'free market' system that is in place and some are advocating here, really is broken. I badly sprained my ankle 10 weeks ago...perhaps broke it and had to make the decision whether or not to go to the emergency room. I mean I was black and purple from heel to midcalf and because I know how to care for a sprained ankle, I decided not to go to the emergency room and spend $1500 bucks to find out if it was broke. I hoped it was a sprain and treated it as such. This was a mistake since I still have pain/joint popping 10 weeks later, but it was a lot of money to spend on a 'maybe'. If something were to happen to one of my kids or my wife....I would be screwed and just have to pay it out of pocket and hope and pray.

Surely with how much we spend on taxes already we could get a system set up to allow everyone who needs it to seek care. If we have $100 billion to spend on war, surely we could find the money to spend on the people who pay these taxes. Its all a matter of priorities. If the cost of Universal Health Coverage is a 4 hour Emergency Room visit or that an 80 year old man has to wait 3-6 months to receive an elective hip replacement, then I am fine with that. If it means the middle class won't have make the decision to seek treatment based on the cost of treatment, or that maybe perhaps people will seek preventative treatment instead of emergency treatment all the time...well I see all that as a positive. You need funding for that? Stop prosecuting large scale imperialistic invasions with my taxes. If that's still not enough, then I'm willing to have my income taxed say 1-2% more to pay for it. There has to be a solution somewhere because what we have isn't good enough.

George W Bush lives in the real world? What world is that, the "Silver Spoon on Velvet Cushion World" that exists in the alternate dimension of "Silver Platter"? That's a place where the law of Karma gets delayed until your next life, and you get to go to an Ivy League university, barely make passing grades, snort lots of coke, sleep with many babes, then you get to be president!!!

I don't understand why it was an "either, or" decision. Either the ER, at exorbitant cost, or no treatment at all. If you (understandably) wanted to avoid the cost of an ER visit, why did you not choose to go to your primary care provider at the first possible opportunity, where an evaluation and X-rays would have cost a fraction of an ER visit, yet you would still have received appropriate treatment for your condition.

I understand your concerns over costs. I am insured, and I still face the same decisions. We have a high-deductible plan that requires us to pay the first $4000/year of medical expenses. We budget so that we have that much money available for medical expenses. So, when faced with an ER versus cheaper source of care decision, you can bet that we go for the cheaper source whenever possible. In 21 years of marriage, with 2 kids, we have only been to the ER twice, once with a child's head injury, and once when EMS insisted that an ambulance ride to the ER was warranted for a leg injury.

Twice this year, we have had injuries that would not have been inappropriate for ER management, yet neither involved unmanageable pain, bleeding, or risk of permanent injury, so I opted to wait until morning when we could be seen in the doctor's office instead. The first time, I was out the door with a $45 bill, and the second time I was not billed at all, since I had just seen the doctor recently for a routine visit.

I am sorry that you are continuing to have pain and instability with your ankle. I sincerely hope that you will consult with your PCP, as it is my experience that many are quite reasonable about treating and billing patients who they know are paying out of pocket.

I don't believe this is strictly an insurance vs. non-insurance issue, since many insured people face the same decisions. I think it is a matter of choosing the most appropriate and cost-effective source of care, which, with the exception of immediately life- or limb-threatening illness or injury is rarely the ER.

Jolie,
I must admit you make some good points on the decision to seek medical treatment.
I guess it has something to do with how I was raised. I grew up in a fairly poor family and we never had a Primary Care Physician, we only sought out medical treatment through the ER when we were injured, cracked skulls, broken bones that sort of thing, even then we had some form of insurance through my parent's employer. Through my time in the military I was treated by whoever was available whenever I was sick enough to warrant the time off of work to talk with a Doc....had pneumonia for a week before I was able to get to sick call

Anyways, back to the point, I've sort of carried those bad habits into adulthood and never got a Primary Care Physician for my family. To be honest I have no idea what it costs to do business with them since my main form of care has been through the ER, or I've had insurance to take care of things previously. I shall certainly look into what PCM's are charging in my area. Thanks for the alternate viewpoint and giving me something to think about.

NavyVet,

Thanks for your reply. It is helpful to understand how other people arrive at decisions regarding their healthcare, especially issues like when to use the ER or not.

Clearly, your injury warranted medical treatment. I know it can be difficult for healthcare professionals, let alone lay persons, to know whether an illness or injury is serious enough to warrant an ER visit or can wait for a non-emergent doctor's visit. But there are also a number of people who abuse the ER, and that is one aspect of a national healthcare plan that I fear would quickly spiral out of control cost-wise. Let me give an example.

I have a neighbor who is insured by the same employer as I am, with the same plan. She is intelligent, and well educated (has an MBA), so it is not an issue of failing to understand her benefits or financial responsibilities. With her, it is all a matter of convenience, and "I want it now!" She recently went to the ER for a pregnancy test. She has a primary care doctor and an OB/GYN. She lives around the corner from a drug store where she could have purchased an OTC test for less than $10. But she wanted a "reliable" answer NOW, so she went to the ER and got indignant when they stated that they could not just run a pregnancy test without a doctor's order. The ER staff asked if they could call one of her doctors and arrange for a test in their office. She refused and insisted on being seen by an ER doc so that she could get an answer NOW. She hasn't told me the amount of the ER bill, but I'm sure it is several hundred dollars. Our insurance will require her to pay at least the first $250, depending on the status of her deductible, but won't refuse the charges outright.

With a national health plan, ideally, everyone would choose a PCP and utilize that office for non-emergent visits. But in reality, I think it is likely that frivilous ER visits will INCREASE because of people like my neighbor who want it NOW. Placing responsibility on the individual for frivilous ER visits likely won't happen because ERs can't refuse to treat anyone, and individuals can't be dropped from national health care for failing to pay their portion of their bills.

I don't pretend to know all of the answers for healthcare funding, but I am certain that without individual responsibility for choosing treatment and paying the bill, costs will never be brought under control.