Until that fateful November night, I never concerned myself with the politics of healthcare. I took my health for granted; I always exercised and ate a fairly balanced diet. My friends and I biked everywhere, and nothing ever happened. A few cuts and scrapes, but no major injuries.
Luckily, at the time of the accident I was still 21 years old and covered by my family's plan. But when I turned 22, I was dropped from my parents' healthcare coverage. Though I do have a required university healthcare package, it covers little more than my prescriptions and mental health needs. If I was ever in need of serious treatment, I am not sure what I could do. As a student I do not have the time to secure a job with benefits, and my parents do not have the means to support me beyond what they are already doing. I am mired in medical debt; my mailbox is full of second, third and last notices. I have no way of paying any of it off.
No, RN4MERCY, I probably won't join, unless we include mandatory prison sentences for ethics violations and total transparency for all decisions.
My experience with profit-driven healthcare, both as a consumer and as an employee, has left me massively unimpressed with the quality of the product.
But the sweetheart deal perpetrated by Medicare part D is an example of the equally massive failing of a government program to control costs. As is the onerous and increasingly expensive paperwork for both patient care and for reimbursement.
not everybody is convinced that the va is the model of care you suggest. i know. i know. president bush's administration vastly improved the care over what it was when i worked there, under clinton.
still.
(and what is this with you gaining on me in post counts? i take a little vacation from the computer . . . sheesh!)
~faith,
timothy.
its a conveneient restatement of reality. the appointee who started the reengineering of the va system was a clinton appontee.
by the mid-1990s, the reputation of veterans hospitals had sunk so low that conservatives routinely used their example as a kind of reductio ad absurdum critique of any move toward "socialized medicine." here, for instance, is jarret b. wollstein, a right-wing activist/author, railing against the clinton health-care plan in 1994: "to see the future of health care in america for you and your children under clinton's plan," wollstein warned, "just visit any veterans administration hospital. you'll find filthy conditions, shortages of everything, and treatment bordering on barbarism." and so it goes today. if the debate is over health-care reform, it won't be long before some free-market conservative will jump up and say that the sorry shape of the nation's veterans hospitals just proves what happens when government gets into the health-care business. and if he's a true believer, he'll then probably go on to suggest, quoting william safire and other free marketers, that the government should just shut down the whole miserable system and provide veterans with health-care vouchers.
...
president clinton signed a bill that planned, as he put it, to "furnish comprehensive medical services to all veterans," regardless of their income or whether they had service-related disabilities.
so, it may have been politics as usual that kept the floundering veterans health-care system going. yet behind the scenes, a few key players within the vha had begun to look at ways in which the system might heal itself. chief among them was kenneth w. kizer, who in 1994 had become vha's undersecretary for health, or, in effect, the system's ceo. a physician trained in emergency medicine and public health, kizer was an outsider who immediately started upending the vha's entrenched bureaucracy. he oversaw a radical downsizing and decentralization of management power, implemented pay-for-performance contracts with top executives, and won the right to fire incompetent doctors. he and his team also began to transform the vha from an acute care, hospital-based system into one that put far more resources into primary care and outpatient services for the growing number of aging veterans beset by chronic conditions.
except the reality is that as a system the va delivers better chronic illness care through its emphasis on primary care and evidence based practice.
i am not a pollyanna. no system designed by man will ever be perfect but i do think that we should look at what works and use that as a guiding principle for improving our health care finance and service delivery systems.
My experience with profit-driven healthcare, both as a consumer and as an employee, has left me massively unimpressed with the quality of the product.
But the sweetheart deal perpetrated by Medicare part D is an example of the equally massive failing of a government program to control costs. As is the onerous and increasingly expensive paperwork for both patient care and for reimbursement.
PHRMA wrote the part D bill. As part of the bill they managed to get the GOP congress to explicitly forbid bulk drug price negotiation for medicare. It is certainly ironic that PHRMA is so afraid of market forces that they managed to in effect write a subsidy into the law for themselves.
Health care costs are breaking the budget. For a really scary graph look here. Basically we hill have 50% of our budget deficit dedicated to health care issues by 2080 if we continue our non-system. The French will have zero deficits r/t health care costs. (If anything health care will be a profit center for them.)
There is a difference between single payer and socialized medicine.
Single payer-government transfers payments to providers, hospitals and clinics that remain privately owned.
Socialized medicine the providers are government employees AND the clinics etc are government owned.
One of the things that government does very efficiently is transfer funds from pont a to b. (Medicare admin costs are 3-5%. Private nsurance costs are roughly 10-15%.) Add in profit margins of 20% and that makes our health care 30-40% more expensive than the rest of the civilized world.
One of the reasons that I support single payer is that it will force medical care away from specialty focused to a primary care/evidence based system AND make the providers compete for patients based on quality of care.
don't even get me started on that aspect for our little rural hospital . . . . . .
i'm with tim and jolie and even heron in some aspects. " having worked in the public sector i can tell you that efficiency, cost controls and ethics are no better than in the private."
i do not understand why people think the government is the panacea, (the goddess of healing).
steph
well, i think we should look at ethics. yes, there are individuals who cheat the government, but it's not the government, "we the people," who set out to cheat anyone. we can deal with the few individuals who abuse the system separately as we catch them. there's no moral reason to hold up the benefit of a single payer system for the millions of us who need it because of a few.
we provide for the common good...schools, libraries, national parks, clean water, regulatory enforcement services, etc., so why do we not provide tax supported coverage for health care as a non-profit social service as well? however, the evidence is in and corporate insurers have systematically and fraudulently cheated the government and individuals for their benefit at the expense of the rest of us. their greed is never satisfied. there's no added value to having insurance middlemen, only diversion of precious health care dollars away from the provision of actual care, and into administrative and marketing overhead, and the pockets of shareholders and the inflated bonus checks for wealthy executives.
if we have a single payer, social insurance program, (not socialized medicine), where the government is the payer, and a publicly accountable system for determining payment for services, then urban, rural, public, or private providers will be paid equitably for providing medically necessary care. collectively we can invest in the care that people need in a more equitable and transparent system. resources and technology can be placed in communities that need them. currently, people with money may be getting more tests and procedures than they need, while those without money go without needed treatment.
look at fire and police protection as socialized protection. your house has been busted into, and the perps set the house on fire before fleeing the scene. doesn't matter where you live; the fire department puts out the fire, but you and your neighbors and the businesses that operate in your community pay taxes and contribute to protect your property. why should you pay to put out someone else's fire? because you'd want them to help you; it's sound public policy that contains cost and minimizes the risk for increased damage and injury.
so you're injured and sick? avian flu, meningitis, drug resistant tb? doesn't it make sense to be able to receive treatment for illness when it's least expensive to treat, before it spreads and causes even more damage? it just makes sense to participate in a tax-supported plan and pay only once (no co-pays, deductibles, exclusions), with guaranteed benefits.
Because our elected officials sold out tax-paying U.S. citizens and LET them. Why on earth should we believe that any future government program would be handled any differently?
Although, I'm wondering the accuracy of the statement about Duke. When I worked there, we had about 2000 nurses. I'm finding it hard to believe there are over 2000 billing clerks.
Actually, the article says
Professor Uwe Reinhardt, who is also on the board of trustees of the 900-bed Duke University Hospital, used Duke to illustrate the problem: "We have 900 billing clerks at Duke. I'm not sure we have a nurse per (each) bed...
A further quote from this article:
In August 2003, Drs. Woolhandler, Campbell and Himmelstein published a study of health-care administrative costs in the U.S. and Canada. They stated that administrative expenditures in the U.S. stood at 31 percent of overall health-care costs.
A look at this study prompted some further studies, as reported in the New England Journal of Medicine:
However, the Canadian single-payer system results in chronic shortages of medical services because of underfunding.
Because our elected officials sold out tax-paying U.S. citizens and LET them. Why on earth should we believe that any future government program would be handled any differently?
Because we're going to commit to being more vigilant. If we unite collectively and repeatedly drive our message home and refuse to allow our interests to be hijacked, we can change things. We took it to the streets and raised a mighty voice in the voting booth. No rubberstamp on the status quo. That's how we ended slavery. That's how we won the right to vote for women. That's how we ended segregation and discrimination on the basis of color and gender and demanded equal educational opportunity. We can't let special interest politicians cut enforcement budgets and look the other way when a lack of public oversight hurts people. The government should and does exist for the benefit of the governed. We can't deprive the government of resources and then call it a failure.
Because our elected officials sold out tax-paying U.S. citizens and LET them. Why on earth should we believe that any future government program would be handled any differently?
The GOP congress was voted out with the next election cycle. The political process is going to solve this problem. We simply can't continue to have the double digit health care inflation year in/year out.
Because we're going to commit to being more vigilant. If we unite collectively and repeatedly drive our message home and refuse to allow our interests to be hijacked, we can change things.
Would that change include support of the Representatives and Senators who, just 3 months ago, voted $700B in bail-outs to the banks without oversight as to the use of that money? The very same legislators who are now kicking, screaming and beating their chests because the banks (and the businesses that became banks just to get their hands on bail-out money) have used those funds, not to extend loans to qualified consumers, but to remodel offices, fly corporate jets and pay handsome executive bonuses because they were not subject to oversight by the boneheaded lawmakers who handed them our money?
Do you really believe that the politicians in Washington are looking out for the best interests of the taxpayers? Isn't this a pretty strong indicator that they are not, either out of indifference, stupidity or outright greed?
Do you really want these people to devise a health care system and mandate you to use it and pay for it?
If so, God bless you.
I don't. I wouldn't trust them with the Girl Scout cookie fund.
The GOP congress was voted out with the next election cycle. The political process is going to solve this problem. We simply can't continue to have the double digit health care inflation year in/year out.
Your response made me chuckle.
Unlike this week's House vote on the $ trillion stimulus package, Medicare Part D Bill passed with bi-partisan support. I vividly remember both Reps and Dems rushing to the microphone to congratulate themselves for passing this debacle of legislation, wanting credit for their compassion for seniors, even though anyone who had researched the legislation at all knew that it was a mess in the making.
heron, ASN, RN
4,635 Posts
No, RN4MERCY, I probably won't join, unless we include mandatory prison sentences for ethics violations and total transparency for all decisions.
My experience with profit-driven healthcare, both as a consumer and as an employee, has left me massively unimpressed with the quality of the product.
But the sweetheart deal perpetrated by Medicare part D is an example of the equally massive failing of a government program to control costs. As is the onerous and increasingly expensive paperwork for both patient care and for reimbursement.