Basically, I really love my Spanish speaking patients in every way. I'm talking about people born and raised outside of the United States. They have Old World manners, respect for elders, I love their family values. They really are great, and Americans can learn a lot from their old fashioned ways. I love the way they roll up their sleeves and care for their hospitalized family member.
I had a gentleman in his 50s, totally Spanish speaking, had been a farm worker but with too many health problems to work, most of which resulting from IDDM non-compliance leading to heart problems and renal insufficiency. Most of his family was back in Mexico, including his 7 (grown) children. He spoke very little English.
His nephew came in, he spoke English, he was nice as can be. He wanted to know more about what was going on, he gave me more background info. His Uncle had a greencard, wasn't able to work, had wanted to go back to Mexico but was only staying for the free medical care.
Ha ha, 'free medical care', I thought. . I think most Americans would disagree with that statement. I guess it is free for non-citizens with no means, and for other dirt poor people, but it's not really free, is it? It's really, actually, expensive.
Meanwhile, his uncle, who was very polite, appreciative, nice, was also irresponsible. According to the H&P he had been mostly non-compliant with his meds and treatment plan.
I think there is a disconnect in our system. There is very little personal accountablity. There is lots of talk about Patient Rights, and very little talk about Responsibilty. I'm not just talking about non-citizens who consider the U.S. the land of free medical care, but I'm talking about a system that rewards irresponsiblity.
If we ever get socialized medicine, I seriously doubt if the government will have the backbone to build in any system for accountability into it. I see people abuse their bodies to the point that they are unable to work, then expect the taxpayer to pick up the tab for their medical care, for life, while they sit back and complain what victims they are. I see this over and over again. It's a huge problem in America today, with no solution in sight.
I believe I, as a bedside nurse, have every right to have an opinion as to how limited healthcare dollars are distributed. I think I have an insiders point of view into how the system works, and as an American citizen my point of view is valuable.
It's valuable but you are preaching to the choir here, jlsRN. We have to take this knowledge to the press, to our neighbors, to people who, like ourselves, are tired of this and will jump on our lawmakers to change the laws. It does little good if we just vent here and discuss it among ourselves.
WOW, haven't been posting for awhile....too busy with school, but you guys have captured my attention.
I am not sure anyone without means can be considered non-compliant if they are unable to access care, obtain medication or perhaps don't have an understanding of the disease afflicting them. I have come across many Latin/Hispanic people who have a "little sugar"-there hasn't been a good grasp of the disease or the dangers imposed by having this disease known as sugar to them, but diabetes to us. Working in NJ I have exposure to a wide variety of people from around the world. There is no corner on foreigners being treated for "free".
My issues are simple-we have the means, we have the science, we have the technology-it is all being spent on other parts of the world, instead of on our citizens and for the greater good in THIS HEMISPHERE. Billions have found there way to the other side of the world in a fruitless effort to end hostilities which have existed for thousands of years. Wouldn't it have been nice if our elders didn't struggle to pay their bills, clinics were opened to manage illnesses-instead of EXPENSIVELY TREATING EXACERBATIONS, and medications were affordable like they are everywhere else.
Unless we are ready to begin practicing selective living-I am all for taking care of those that need it! I don't want to pick and choose who lives and is taken care of...do you?
The thing is, that socioeconomic status and health status are inextricably intertwined. The very people we label as "non-compliant" are the same people who are impoverished. Statistically speaking, those with means are healthier. So, it is a catch-22.
How many elderly people on Medicare do we see come into the acute care setting with CHF or COPD exacerbations because they were "non-compliant", when it turns out that "non-compliant" means that they stopped taking their meds because they could not afford them? They had to choose between eating and taking their pills.
I guess I see the man in the original post in a similar light. How is someone with diabetes, who has no money, supposed to buy a glucometer, pay for the strips, test four times per day, administer insulin when they don't know when or where their next meal will come from? Where will they keep their insulin if they have no refrigerator? What happens when they get pulled over by the police with syringes on their person, and because of their limited English speaking ability, cannot explain that they are diabetic? There are so many issues.
If he's been here for many years and has lots of family here, I doubt he's not homeless, he surely has a refrigerator, and he can say "dee ah baytees" to a policeman. Plus, he probably does speak fairly decent English. Glucometers are free and, if he's on welfare, so are the strips, I'd bet. And he does have some money, I'd also bet. Whatever he did not send back to his relatives in their country, he's got. Yes, there are some, I guess, who are as poor as you describe, but I think they are not as numerous as you might think. I could be wrong but my experience tells me otherwise.
The real question seems to be 'Who is truly worthy of healthcare?'
When we put ultimatums on equal access to healthcare we are saying 'You are worthy because you are middle class, working, morally right, white, black, working etc'
Healthcare should be a basic right for every human being, it should not be based on whether you were lucky enough to be born into white middle class.
I don't care what country you come from, a child's right to healthcare so they can grow up a healthy participating member of society is not an optional extra, it is fundamental.
Whether or not you agree with someone's morals, how can you say they are simply not worthy of healthcare? So society's moral ethics may be sliding in all western country's, does that mean we withhold basic healthcare, because essentially that is what people are saying here.
'I don't believe , so they shouldn't have decent primary care or affordable medications or input into their medical problems'.
You just made the case for a true single payer system.
How? A single payer system will still see my taxes paying for those that do not. I often see you use the single-payer system as the answer, but where will the funding come from if not from additional taxes? Where do the taxes come from if not from working citizens? Who pays the most taxes? Those who have worked hard to climb up and make the most money. My household is technically wealthy (legal term). This means that we pay almost 40% of our earnings back to the feds and state. It also means that our tax money was used to stimulate others while we got zip back. It also means that any raising of taxes (payroll or income as my husband is a small business owner) means more money out of my pocket.
I have three kids to send to college who are not eligible for any aid. We are eligible for no tax breaks. My husband and I both have advanced degrees and work very hard for our income. Why can't we keep more of it for ourselves instead of having to fund others' bad choices? Why does that make me an evil person?
Also, I live in California--a very nanny state. Guess who made us that way??? It wasn't conservatives.
Charity begins at home, or so they say. How many people in this country, including those who have served this country, lived and worked in this country, and are born citizens are denied simple care due to our system? I have had friends treated in foreign countries that WERE NOT BILLED FOR MEDICAL CARE, I had one friend who was seriously ill and spent several weeks in an Italian hospital WITH NO RESULTING BILL. I also have a local guy who works at a gas station that received a bill for laparoscopic gallbladder removal-same day $14,000.00-he's paying if off. Charity care and offices try to recover costs. This poor guy works, is honest and will not be eating ,and working 24/7 to pay this bill.
Someone also mentioned out of wedlock children and young, welfare mothers. They don't allow that anymore in NJ due to Clinton politics-welfare to work was instituted during his tenure as president. Definately not a conservative President! I am assuming this is the case in every state. While I can't speak to a whole population, I can say I know a bunch of young women who had babies as teenagers-I work with them....THEY BECAME NURSES.
Someone also mentioned out of wedlock children and young, welfare mothers. They don't allow that anymore in NJ due to Clinton politics-welfare to work was instituted during his tenure as president. Definately not a conservative President! I am assuming this is the case in every state. While I can't speak to a whole population, I can say I know a bunch of young women who had babies as teenagers-I work with them....THEY BECAME NURSES.
Maisy
We have a family cap in NJ - no more cash benefits for second or subsequent children. But we also have food stamps, free school lunch, Section 8 housing, low income housing, heating assistance, and Medicaid, and those benefits increase or have increased eligibility with increased household size. Not to mention foster care payments to relatives raising children in their parents' place.
While some unmarried teenage mothers become nurses, and more power to them, many do not mature to productive employment, and neither do the fathers.
As for low-income, working immigrants, legal or illegal, I think we have to look at employers that fob off health costs on the taxpayers, and at the legal and social system that permits this subsidy.
How? A single payer system will still see my taxes paying for those that do not.
The thing people fail to see is that we already all pay for all this care. Some pay more then others, but we all pay. We pay in co-pays, taxes, we pay in by purchasing products from companies that supplement their employees. The real travesty is that we pay more because we need to finance all those insurance companies, and we pay more because those with our insurance wait longer to go in, get sicker, can't be seen at the clinic because they can't pay, then end up in the ER with more complications and problems. What would have been better for us to pay- the $100 clinic visit when the illness started, or the $3000 ER and admission bill when the illness went unchecked for too long?
That's true, we all pitch in ultimately, you make a valid point.
There is no perfect system. But the American system is decidedly disjointed and convoluted.
Then there's the fact that healthcare is becoming more and more impersonal, fast-paced, and dependent of highly expensive machinery and technologies. Couple that with a self-indulgent, out on shape consumerist society where many people have a strong sense of entitlement. Then ad to the mix that the planet has a large 'have-not' population lacking the wealth and know how to offer such medical miracles, and you end up with the quandries that we face and discuss so often at this website.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
How can I say to an illegal immigrant "You shouldn't have been born in a corrupt nation where poverty is the norm and health care is essentially nonexistent, so therefore, you do not deserve this life saving treatment."?.
In a perfect world that would be great. But money and healthcare resources are finite. And while we are providing these illegal immigrants ongoing, expensive care for chronic diseases, we are ignoring a large segment of our working poor. Those that have no insurance, but do not quite meet the poverty guidelines for assistance. These are the people that fall through the cracks. I know as I have been there before and it is a scary place. While taxes came out of my measly paycheck to support others, I couldn't afford insurance for myself or my family. That is a lesson I will never forget.
In a perfect world that would be great. But money and healthcare resources are finite. And while we are providing these illegal immigrants ongoing expensive care for chronic diseases, we are ignoring a large segment of our working poor. Those that have no insurance, but do not quite meet the poverty guidelines for assistance. [/quote']
Historically, the cause of the national debt has been paying for war, beginning with the American Revolution. Illegal immigrants are not bankrupting us. They do make convenient scapegoats, though.
I know as I have been there before and it is a scary place. While taxes came out of my measly paycheck to support others, I couldn't afford insurance for myself or my family.
The majority of taxes taken out of your measly paycheck were not used to support others; at least, not poor people.
. I think most Americans would disagree with that statement. I guess it is free for non-citizens with no means, and for other dirt poor people, but it's not really free, is it? It's really, actually, expensive. .thumb.jpg.755b83f43c9f3860c778e2fcb2022ecb.jpg){kind=small}
Vito Andolini
1,451 Posts
It's valuable but you are preaching to the choir here, jlsRN. We have to take this knowledge to the press, to our neighbors, to people who, like ourselves, are tired of this and will jump on our lawmakers to change the laws. It does little good if we just vent here and discuss it among ourselves.