politics & job scarcity - page 5

Okay, I've got two issues I'm wondering about--- Five years from now, does anyone have any insight/information to support the notion that there could actually be a glut of CRNA's on the market? ... Read More

  1. by   Qwiigley
    good job Anthony. Well said.
  2. by   u-r-sleeepy
    2 Atta-boyees for Anthony!

    The "real world experience" is that socialism never has, and never will work. It may last for a while, but it gradually ROBS the incentive of the average person working to excel. Why work so hard to succeed when you'll only be taxed to death if you ever "make it big"?

    My little side note - I think "fair taxation" is when EVERYONE pays the EXACT SAME RATE - as in percentage! I know the envious "pick the pockets of the rich" crowd will disagree with that one - it's my opinion and I've held it even when very poor.

    One more question for anyone still reading this thread:

    If it is "required" to give/supply the "poor, downtrodden crackhead" freezing his/her toes off on the street health care - merely because "they are HUMAN!!!" Please tell me then at what point do we (as individuals and a nation) stop our great giveaway? Should we clothe, feed, and provide healthcare for all of Mexico? How about working our way down to Panama? Those folks around the "Hollywood" part of Panama are very poor - I know, I used to live in Panama! All the way to Chile? How about Africa? Parts of that country are really missing out on the "high life"?? Where do you folks stop? We could bankrupt the country and give all of our EARNED wealth away to the "poor & downtrodden" around the globe, but it would never be enough.

    I think that kind of compassion is fantastic - just don't force me to do your bidding, OK? I grew up on the "mission field" where MY inheritance was spent on other people making incredible improvements in their lives - both spiritual and PHYSICAL! If you want to pontificate on the virtues of that kind of "giving" - please do it yourself and in a wonderful manner, but I disagree it is your "right" to essentially legislate picking my pocket to do it.

    Solution: Someone kept asking for "show me the SOLUTION!!!" Wish I had ALL the answers but I believe there are good opportunities for people w/o insurance to seek and find much or most medical help.

    1 - Call & ask in advance about payment options and tell them you don't have insurance - most places will work with you. I've done it in the past.

    2 - There is something called Medicaid - when you really don't have anything else, isn't this available? In Tennessee the TennCare program was created to improve upon Medicaid....

    3 - There are a number of places and groups around the country that will take people for free. No, I don't have a list, but when my child was needing one of her open heart surgeries, I remember someone telling me about St. Jude's and how they would "work with us" if $$$ was a problem. There were other opportunities like that.

    4 - When YOU'RE OUT and practicing:

    You (and I) will have an opportunity to "give something back" to those who are truly without. I have firm plans on doing so. I am already in contact with some people who do this kind of thing and I plan to REGULARLY schedule time to do this kind of thing each and every year. Anyone else thought of this??

    Enough for now -
  3. by   AL bug
    I have definite plans of doing charity work around the world. I have been on missions trips and they are life-changing and rewarding for all involved (the missionary and the one being ministered to). I have a heart for giving the talent God gave to me back to him in the form of helping the "least of these".

    With this said, I do not believe it is the place of the government to instill socialized medicine to "help the poor". I have been one of the poor and it is not a pleasant place to be. But I utilized Pell grants in the way they are designed to be used and worked my butt of to get through nursing school and then worked through the BSN program. I am fortunate now to have a husband to support us through CRNA school along with student loans. The use of government aid can be a very good thing, but it is abused too much. Being mentally ill or sick is one thing, but just being poor and not having the same "opportunities" does not constitute staying in the same lifestyle. By many standards, I did not have the opportunity to go to college and become as successful as I am now, but I did it anyway. And it has been hard. So I don't buy the "less opportunity" bit. It can be done. And we have no incentive for working so hard to get out of an oppressed lifestyle if the government keeps increasing the handouts. I liked the quote here earlier that said "I am not for handouts, but I am for a hand UP"

    ....my 2 cents
  4. by   MICU RN
    Could not agree more!!!
  5. by   Want2Bgasman
    Dito AL BUG
  6. by   London88
    Nicely put Al Bug. I am all for helping those who are trying to help themselves. But, you must want to help yourself!
  7. by   Tenesma
    2 things:

    1) job scarcity??? don't make me laugh... anesthesia will have more than enough jobs around at least until 2015... with the growing population there will be more surgeries and more critically ill patients. anybody studing for anesthesia right now, has nothing to worry about...

    2) politics... etc... and health insurance for the poor...

    I really don't think health coverage should be seen as a right... and it should definitely not swallow more tax dollars. The federal and state governments shell out sooo much money to cover medicare and medicaid patients... the interesting thing is that 85% of medicare dollars are spent on the last 30 days of life in the elderly. If it were according to me, physician/committees would decide on medical futility (like they do in central europe) and declare people DNR... thus freeing up all those dollars that go towards keeping corpses alive in the ICUs, and instead spend that on providing better health care access....
    A lot of people complain about how difficult it is to get health care coverage on minimum wage --- this may outrage a few, but i think that is total baloney. People have all of their priorities wrong, i truly most people can afford most, if not all, basic medical insurance plans - but instead they would rather have a big screen TV, a DVD player, a good sound system, a nice car, nice clothes, etc... it just goes to show where most priorites lay. Health seems to be an afterthought, and then those same people then complain that their plan doesn't give them everything they want... what do they expect? when you buy a $10,000 dollar car will it come with everything you want... NO

    Now, I do believe all children should be covered to a certain extent, because they can't and shouldn't be held responsible for their parents poor decisions... Now for all those who want socialized medicine, you can go to canada or england where it takes 6 months to schedule a cholecystectomy or 8 to 9 months to get an MRI.
  8. by   Roland
    go to a socialized system the exact type of medical decisions that Tenesma is referenceing WILL be made. Now, Tenesma cites an extreme that most would agree with (having a DNR guideline for terminally ill patients in the last days of their lives). However, other similiar situations might cause even those of you who are ardent socialists to give pause. Right now there is medical rationing going on in the UK and Canada which is almost right out of Huxley's "Brave New World". In Denmark it is not uncommon for physicians to "assist" the terminally ill to their final destination. One wonders if subtle pressure is not placed on those who are a medical burden to "do the right thing".

    I do think that medical insurence should be more "easily" availible. When my wife and I had a mortgage company I found it impossible to purchase and individual policy for us do to my weight (240 pounds at six feet of height) at ANY price. What's more I tried to find a doctor who would take me "self pay" without much success (I called around ten doctors and finally ended up going to the ER for an infected big toe). Now at the time I had perfect credit, and was earning about 120K in NET income. It didn't matter, the physicians I talked with said that they didn't take on new patients who didn't have insurance. Keep in mind that with a GROUP plan (this is what most people have through their employers), I would be accepted with Stage IV glioblastoma into their insurance program. Obviously, weighting 240 at age thirty is not healthy, but its also not ACUTELY terminal (espcially since I don't drink, or smoke and eat an Ornish/Pritikin type diet 95% of the time).

    I truly believe that a big part of the problem with health care inflation can be attributed to the fact that most of us DON'T directly pay for the medical costs which we incur. Whether, it is through an employer (as with most group policies) or via the government (as in Medicare, and Medicaid) when we don't pay for something directly we tend to care less about it's price. As a result the vendor (or health care provider) has less pressure upon them to be maximally efficient and control costs. Thus, I would predict that if employers and the government started routinely providing medical insurance for pets that it woud only be a matter of time before vetrinary medicine bills were rising at a rate of several times the overall rate of inflation.

    I think one of the answers lies in focusing on catastrophic coverage that only kicks in after a considerable deductable. This can be encouraged via "medical savings accounts" and would be even more strongly facilitated if those accounts had even stronger tax advantages. In addition, I believe that individuals should more easily be able to access "group plans" via professional, and personal associations. Thus, I think that members of say the United Methodist Church should be able to negociate on the same basis with insurance providers as can Ford, or Eli Lilly.

    For the poorest Americans I believe that private charities, foundations, and interests should maintain clinics that provide health care services to anyone and charge on a sliding scale basis afterwards. There is a place for government in supporting these institutions with additional monies so long as this support doesn't come with red tape that inflates the cost of providing these services exponentially. Americans are the most generous people on earth in terms of charity donations. I have no doubt that if these clinics are properly presented to the American people that they will receive considerable support. As a conservative I believe in helping people myself and NOT just passing the buck to some faceless government institution for the price of a higher tax to do the job for me. THAT's why I believe that the argument that conservatives don't care as much is simply not correct.
  9. by   CoreyB
    Roland, I'm going to have to disagree with your theory on healthcare inflation. It's probably true that many people do not pay enough attention to what they and their employer spend on healthcare. However, if you ask any physician or hospital administrator if they feel pressure to cut cost, I think the answer you'll get is an emphatic YES.

    The HMOs put enormous pressure on physicians to cut cost. We may be paying more for healthcare than we used to, but if you ask the Docs I'm sure they'll tell you it isn't going to them. It seems to me that the inflation is in large part due to for profit HMOs maximizing profits by increasing premiums on the one hand while they contain or cut costs on the other. If by "vendor" you meant the HMOs feel little pressure to keep their rates down, I agree. I really believe, even though it seems the majority of you are probably against it, that Govt regulation of the HMOs could be beneficial to consumers and providers. I'm talking about regulation like the regulation of utillities, in most states.

    I think you're right about medicare and medicaid. Fraud cases involving Billions of dollars (1O billion in fraud, estimate 1992), are well documented. But to argue from the point of view of the ethical hospital admisitrator, for all the money they earn on patients where the cost of care was less than the IDC dollar amount medicare reimbursed them at, there are many patients who's cost of care will exceed (sometimes far exceed) what medicare reimburses them.

    I think another big source of inflation is all the care provided in ed/trauma and subsequently in the ICU that isn't reimbursed by anyone. The Govt says you have to treat everyone in an emergency regardless of their ability to pay, but they don't fund that mandate. So ultimately if a facility maintains an ed and a trauma dept they have to pass those costs on to the paying customers.

    I think Tenesma is absolutely right about end of life decisions. It makes so much more sense to allow hospital ethics committees and physicians to make intelligent decisions about dnr status than to throw money and resource away on a lost cause. I also think more physicians should start pushing hospice care for patients who's prognosis would indicate it as an option. It's a lot cheaper than the hospital and they're set up to provide better experiences for the patient and the family than hospitals usually do.

    For those of you who are against Docs and ethics committees making end of life questions, I would like to ask why? and espcially as those decisions relate to people on medicare. If the majority here are against Govt entitlement programs, why would you be against an initiative to reduce the amount of tax dollars we spend on medicare? Since it is one of the biggest Govt handouts there is, shouldn't we be allowed to draw the line on how we spend our money (and I mean draw the line in the context of allowing physicians and ethics committees to make end of life care decisions). Now if you're terminal and wealthy, then of course you can do whatever you want. If healthcare isn't a right shouldn't we treat it accordingly across the board.

    Having associations other than employers negotiate ins coverage is a great idea, but I'm going to have to disagree on the medical savings accounts. If the biggest strain on the healthcare system is the uninsured (poor), then it doesn't seem likely that private accounts would help especially since the people putting the most stain on the system are not likely to participate in the savings accounts, whether it's because they can't afford it or because they rather spend their money on big screens and marlboros.
  10. by   Roland
    allows. However, let me take a shot anyway.

    I believe that the greatest INFLATIONARY strain upon healthcare comes not from those without insurence, but rather from those with excellent coverage. I make no distinction between government and the private sector here. In fact, if anything those with really good private coverage might place even greater inflationary pressures upon the system because of the ease in which they can access health care services. My central hypothesis/tenet is that because of the relative EASE in which many if not most Americans can access healthcare services they are in fact doing so to a great extent. When people engage in ANY activity without being subject to the restraining influence of high prices which THEY have to personally pay, it often causes the DEMAND for that product or service to increase. This in turn creates inflationary pressures upon that sector of the economy.

    That's why in resort towns you generally see higher prices for goods and services (espcially tourist related and espcially in resort areas like Hilton Head which are business orientated). We see the same trends that are present within the health care industry mirrored within higher education. In this case the government has facilitated easy access to student grants, and espcially low interest student loans. This has in turn decreased price pressure upon post secondary institutions and perhaps more importantly exponentially increased demand. As a direct consequence (according to my hypothesis) we have seen double digit inflationary growth in tuition prices for at least the last decade. Now, there are positive aspects to these trends. Many would have less access (myself included) to higher education and healthcare were it not for governmental assistence and private sector funding. However, we should also be cognizent of the inflationary aspects of these issues.

    With regard to the issue of those in elite positions making life or death decisions with regard to access to healthcare I'm against the idea in MOST cases. I find it hard to argue precisely why, but it strikes me as in some sense nefarious. I tend not to trust "elite" types, and believe that in many cases their intellectual tendencies over take their basic moral compass as human beings. I realize that's not a very logical argument so I'll try and give it some additoinal thought.
    Last edit by Roland on Nov 12, '02
  11. by   MICU RN
    Very good hypothesis Roland, I would only add that in regards to medical service and cost ,without a third party insurance pool I don't think most Americans could afford to be hospitalized. Especially in an ICU for any extended period of time. SO what do we do? I don't feel a totally socialist state is the answer, but how do we keep up with the increased cost of healthcare? I think this will continue to be a major issue and will call for eventual reform. I personally pay about 2800.00 for medical insurance and my employer, the state of Louisiana pays about another 2800.oo. At this rate I can see the day when medical insurance cost will be a very big issue for the working middle class. Up until this point I feel most people looked at the issue as most affecting the poor and unemployed. However, I now see it affecting the middle class and hopefully pressure will be put on our political leaders to help solve the problem. What is going on now is a psuedo type of socialized medical system were the insured are paying for their services and for the uninsured in the form of higher prem.s and taxes. The other reason I think whole scale reform is needed is because of the abuse in the system, which I have commented on extensively in the past. This will be a hard nut to crack but the sooner we address it the better we will be as a nation.
    Last edit by MICU RN on Nov 12, '02
  12. by   Roland
    but that is precisely what medical savings accounts attempt to address. Thus, with this system you purchase a "catastrophic" or "major medical" policy that only kicks in after a considerable deductible (say $2,000 or GREATER) has been met. Thus, there is a stonger price incentive (disincentive) with regard to routine medical procedures. These "major medical" policies are considerably cheaper than the premiums of a regular "group" policy (in the range of thirty to fifty percent). The idea is to put the difference into a tax exempt account from which "minor" medical bills are paid. You get to keep any savings not spent on the day to day medical care bills.

    As someone who has experienced both excellent and NO medical coverage I can attest to the fact that having to pay for services DOES influence the way medical care is utilized. I am much more likely to take echninacia, garlic, and goldenseal for a minor infection or cold now than when I had comprehensive coverage. Of course my experiences are merely a "point estimate" and cannot necessarily be generalized to a larger population.

    There, are also issues relating to simply being able to ACCESS routine medical care without having "group" coverage. Thus, I related an experience above where despite earning an above average income I was unable to find a doctor who would take me on as a patient despite being able to pay cash on the spot for treatment, (thus I was forced to use the ER for routine care. I sometimes hear nurses and Dr's grumbling about people using ER's for routine care and it makes me want to shout back that sometimes they don't have any alternatives even when they CAN afford to pay).
    Last edit by Roland on Nov 13, '02
  13. by   CoreyB
    I just wonder whether encouraging people to use less healthcare, which is probably what will happen if they have to pay for all the minor and routine stuff, won't inadvertently end up raising cost for ins co. If people don't take care of the little things, isn't it likely that a lot more people would be tapping into the major (catastrophic) coverage, because the only time they would see a md/np is if it were serious and covered?

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