politics & job scarcity

CoreyB · Nov 11, 2002

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.

Roland · Nov 12, 2002

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.

MICU RN · Nov 12, 2002

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.

Roland · Nov 12, 2002

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).

CoreyB · Nov 13, 2002

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?

Roland · Nov 13, 2002

most preventive "benefits" come more from life style changes rather than from routine primary care useage. I could go to the doctor every day for free and it wouldn't do half as much for my health as losing fifty pounds. Unless, the doctor volunteered to give me gastric bypass surgery there is little he could do to ameliorate my major health issue of obesity.

WntrMute2 · Nov 13, 2002

Lifestyle changes are fine but how about treating HTN, IDDM, cancer screening, just to name a few.

catmom · Jul 21, 2005

i ahve a nephew who is 23 years old and has been diabetic since he was 15, he has diabetic neuropathy in his feet and it hurts him to stand for a long time, his eyesight is poor, he is in and out of the hospital for dka, he has no insurance and when he gets a job he cant keep it for long because he is hospitalized or cant perform the duties because of the neuropathy. Our social security will not approve him and they wont give him medicaid , does anybody have any suggestions for him, he is running out of insulin and has no way of getting anymore.

athomas91 · Jul 21, 2005

not that anyone really cares - but i tend to agree w/ Kevin and Tenesma -

First of all - we must be realistic - socialized healthcare will NEVER come about in the US - there is more money made than we can even fathom by the powers that be by our current system. right or wrong - that is how it is and it will not change - the majority of those in the US who vote would never allow it. Secondly, you might consider being careful of what you wish for - yes Canada and others have socialized medicine - but you may wait a year to have a surgery that you could have done yesterday in the US.... just food for thought. I actually know some Canadian RN's who shared actual stories of this with me.

Last but not least - the US does have a system in place - it definately needs revamped - but to weed out those who abuse it. If the abuses of the system were to end - there would be plenty for those in need. I will not go into the stats because I frankly do not have time, but have done the research for school - you would be amazed at the BILLIONS and BILLIONS of US dollars wasted on those who choose to take it (are not truly in need) and those who are not truly citizens and don't even contribute to the system - only take from it. BILLIONS AND BILLIONS.... Texas alone it was like 33 BILLION. The money is there - it is just misused out of the "goodness" of our hearts - or perhaps out of our own inability to rationally look at the facts and make a change.

have a good one.

ICRN2008, BSN, RN · Jul 21, 2005

I would like to say that I agree with Kevin 100%. Also, I would like to address two topics that have been mentioned here:

First, I think that end-of-life decisions should be made by the patient or whoever has power of attorney for healthcare. We will start down a very slippery slope if we let ethics committees and government regulations decide who lives or dies. As healthcare providers, our primary concern is to provide care to our patients. If we are suddenly under pressure to deny care in order to save money, we will lose the trust of our patients and their families. How would you feel if you were sick in the hospital and had to worry about some "concerned" doctor "accidently" giving you an overdose because he didn't think you'd make it? How would you feel if you were not ready to give up the fight, but the government deemed you a "lost cause" and sent you to hospice anyways? We must first and foremost have it our goal to be an advocate for the patient. If he or she decides that hospice is the right choice for them, then by all means offer them that option.

Second, not all those who are poor and downtrodden are there because they "never had a chance". My father was a good example: he chose to drink and drive and became paralyzed as a consequence. I felt bad for him, of course, but I also knew that his choice had landed him in that situation. There are many other people who are in similar situations because they made poor choices, and we as a society are not responsible for that. Same goes for teenage parents; there is a decision that happened along the way to make this possible. That being said, there is a necessity for government programs to provide healthcare for those (elderly, disabled, children, those in poverty) who cannot obtain it themselves. I do not think that it is the role of the government to provide healthcare coverage to everyone, because in my opinion this will cause more harm than good. Do we really want to be put on a 2 year waiting list for surgery the way they are in Canada? I believe that there is a legal battle going on there right now, because people are not allowed to purchase health insurance for services already covered under the national plan.

http://www.freerepublic.com/focus/f-news/1420034/posts

One of the fundamental rights set forth in United States Declaration of Independence is LIBERTY, and I believe that a national healthcare system would seriously infringe upon this right.

ICRN2008, BSN, RN · Jul 21, 2005

Here's the whole article if you're interested:

Northern Exposure: A court ruling could unravel Canada's health-care system.

By Grace-Marie Turner

The supreme court of Canada struck down a Quebec law on Thursday that had banned private health insurance for services covered under medicare, Canada's socialized health-care program.

"This is indeed a historic ruling that could substantially change the very foundations of medicare as we know it," Canadian Medical Association president Dr. Albert Schumacher said after the ruling. The ruling means that Quebec residents can pay privately for medical services, even if the services also are available in the provincial health care system.

"Access to a waiting list is not access to health care," the court said in its ruling.

A courageous Canadian doctor, Jacques Chaoulli, challenged the constitutionality of the Canadian ban on private payment. He argued that long waiting times for surgery contradict the country's constitutional guarantees of "life, liberty, and the security of the person."

He was joined in the case by his patient, Montreal businessman George Zeliotis, who waited a year for hip-replacement surgery. Zeliotis, 73, tried to skip the public queue to pay privately for the surgery but learned that was against the law. He argued that the wait was unreasonable, endangered his life, and infringed on his constitutional rights. The court agreed.

The case involved the Quebec Hospital Insurance Act and technically only applies to that province-but it will surely shake up all the other provinces, where private insurance is also banned. The court split 3-3 over whether the ban on private insurance violates the Canadian Charter of Rights and Freedoms (the Canadian equivalent of our Bill of Rights). Clearly this was a difficult decision since the court delayed a year in issuing its verdict.

The United States has been a safety valve for Canadians unwilling or unable to tolerate the long waits for medical care in their country. Now, the Canadian government must face the music about the long waiting lines, lack of diagnostic equipment, and restrictions on access to the latest therapies, including new medicines.

According to the Canadian Broadcasting Corp., in an almost laughable defense, "Lawyers for the federal government argued the court should not interfere with the health-care system, considered 'one of Canada's finest achievements and a powerful symbol of the national identity.'" Dr. Chaoulli had persevered in spite of two lower court-rulings against him that had ruled that the limitation on individual rights was justifiable in order to prevent the emergence of a two-tier healthcare system.

Supporters of the prohibition against private contracting in Medicare in the United States should take note because our own law has the same effect, making it almost impossible for Medicare recipients to pay privately for services covered by the program.

darienblythe79 · Jul 22, 2005

God bless capitalism