Universal Health Coverage? - page 3

This topic came up last night in our seminar. Again, we struggle and struggle with this concept. I often times look at Medicare and how they handle things such as coverage, reimbursment, etc. As... Read More

  1. by   James Huffman
    I'm troubled by the feeling that, somehow, nurses should become less-expensive substitutes for physicians: like forcing a patient to see a nurse rather than a physician is a way of saving money.

    Is that what we are? This is probably for another thread, but I'll throw it in anyway. Part of nursing's crisis is that we have no clearly defined idea of what it is that nurses do. In my career guide for nurses, I finally came down to saying that nursing is what nurses do, but that's not satisfactory for the long-term.

    I have brought this up in other contexts when the discussion of nurse-practitioners came up. I have NOTHING against nurse-practitioners, and appreciate the work these folks do, but aren't all nurses "practitioners"? And are the concept of what I call the "hyphenated nurse" once again boxing us into a medical model of nursing practice?

    If we don't define ourselves, someone else will. Count on it. Nurses do nursing, physicians do medicine. Of course, there's going to be plenty of overlap on both sides, but if nurses just do some cheaper variant of medical practice, then there's no reason for us to be here. We can train (and pay for) technicians who can do that, and save everybody a lot of money.

    Jim Huffman, RN

  2. by   JMP

    I think you are wrong to say that part of the problem is that as nurses we "do not have a clearly defined idea of what we do".

    I work in a setting where I clearly know what I do and so do the others around me.

    Nurse practitoners are not meant to replace doctors. The idea is working as a health care team......NP's RN's MD's work together. The hospital I work at uses NP's for specialty areas like accute pain, palliative care. It is true that NP's are not used as much as they could or should be, like in ER, but it is political, some smaller hospitals, the docs are afraid of them, " taking over". But like I said it is policital.

    If you know RN's who don't have a clear defined idea of what they do, then, they are not working within their standards of practice, and need to take a refresher.
  3. by   rncountry
    HMO's DID NOT start out to make docs accountable, they started out as a way to contain costs, some of which was driven by docs and some of which was not. The true story of HMO's can be seen in California where they have driven one of the worst nursing shortage's in history because the profit driven motive was far more important then appropriate healthcare. Those that came up with the DRG system are not healthcare providers, nor even healthcare educated, they were accounts who were nothing more than bean counters. Do not confuse HMO's with healthcare. These companies were set up to take advantage of a way to make money. I wonder how much basic care could be paid for out of a 25 million dollar wage from a man that made that money by denying care to others. For some really good reading about it that will make your blood boil and have you questioning everything about our healthcare system read "Making a killing."
    For everyone with insurance that is afraid that universal healthcare will take your money and give it to some undeserving soul, truly what do you think is happening now? Those that are unisured go to the ER because it is the only place they can get care, of course there are people there that are not emergency cases. Not to mention docs with 9 to 5 hours, and urgent cares that close at 8p. What happens is that you pay for those that can't by higher insurance premiums. Trust me you pay one way or another.
    What is happening to my parents could happen to anyone of us. I do happen to believe that in a country as wealthy and as well educated as this country there is absolutley no reason not to be able to provide decent care to our citizen's. And no that does not include keeping a 90 year old woman on a vent. If a family chooses that type of care than they should have to bear the cost of that type of care. I do however take great offense to think that my parents can be treated as so much throw away garbage because they now have health problems. It is not as if they were not contributing members of society.
    The United States ranks 34th in the care of it's citizen's, well behind other civilized Western Countries, behind Poland for God's sake. Yet we also pay nearly double what other Western countries pay per citizen to get that type of care.
    As far as why aren't NP allowed to function better be it here or in Canada, same for midwives, the answer to that is easy and clear to me. The lack of political power and organization of nurses in nearly any country in the world you care to look at, the vast majority of nurses are females and while as a group we have come a long way we have a very long way to still go. The medical community does not want to give up one iota of power, earning abilty and certainly not to a bunch of women. Want more power? Than one has to speak up and take that power.
    American's don't want to use the public health dept? Take 10 people and ask them what the health dept could do to assist with their preventative care and I would bet maybe one could answer that. Why would they go somewhere when they have no idea what services are provided? And I don't know what may have been happening in other states, but the wonderful governor in Michigan has continued to cut back on public health until the system is so stressed now they can barely provide what they have traditionally provided, let alone anything else.
    I do happen to believe that decent health is a right. It should not simply be wealthy citizens, nor the lucky with a decent health policy at work, nor the very poor who can afford to be taken care of. There are 44 million uninsured people in this country, the vast amount of them are working people, those in the middle like my parents and children of working poor.
    I hope no one else has to experience what I have with my parents. It is heartrending, but also scary. And to say I am angry is an understatement. To act like those that want to be able to have decent health but don't have insurance are just looking for a free ride infuriates me. I would dare say that the tax money that my dad has paid since he was fifteen years old helped pay for federally subsidized student loans that I would dare say many nurses who yell not my money! used to go through school with. His tax dollars have paid for decent roads, for others medicare and social security. I wonder how many thousands of dollars my dad has paid in taxes for things that those of you who think people like my parents are a drain on the system you don't want to support, went for things that you happily enjoyed and had no thought that it was someone else's tax dollars that were providing it to you. How many of you went to a publicly funded college? If it wasn't a private college than someone's tax dollars helped fund YOUR education.
    How I am going to keep my parent's healthy and out of the poorhouse while I also manage my household and put my children through college is totally beyond me. Some of you see welfare moms with half dozen kids and never married when you think universal healthcare, and you run screaming NOOOO! I see people like my parents, like patients I see on a regular basis wondering how to care for their elderly loved one and still have a house to live in. I believe in helping others who cannot help themselves. I also believe in responsibilty of those same, not a handout. Yet a society that does not take care of it's elderly or children is a society that deserves condemnation. Not more of the same.
  4. by   Q.

    I'm a little confused. I read that HMO's ( namely, the birth of Blue Cross) was in an effort to contain costs, yes, but in an effort to have physicians accontable for the tests they perform.

    JMP - no I don't think nursing has a clear role or function. We can't even really describe what nursing is to the general public, therefore they define us FOR us. Bedpan emptying, etc. That is the one thing that people identify a nurse with, yet, that is the least thing we do. We more so educate, collaborate, manage, decide, advocate. No one associates a nurse with THAT.

    I think nurse's have a role in primary preventative care - not necessarily substituting for physicians, but in providing BASIC care.
  5. by   fergus51
    Originally posted by JMP
    . Yes, sometimes we end up the 90 year olds on VENTs ( they are not called respirators, they ventilate pts not respirate them) .
    Can you tell I am not an ICU nurse?:imbar :roll It was a friend's grandmother and fortunately they finally let her pass away peacefully. Frankly, I think it's a feat I even knew it was helping her breathe after all this time in L&D

    James, I think the point of not turning nurses into mini-docs is very justified. But, in reality midwives (whether nurses or not) and NPs can and do perform a lot of the same jobs for less money, and money is a real concern for those of us who do want to maintain universal health care. I personally would prefer to see a nurse practitioner like I used to because I liked how she focused on the whole picture and on prevention, which I think a lot of docs need to get on. I think that's how they bring nursing into their role.

    RNs have a lot to offer too, especially in preventative care.
    Last edit by fergus51 on Apr 27, '02
  6. by   JMP

    I disagree. I see nursing in a clearly defined role.....and I have no trouble describing my role to the public or anyone else. But then, maybe that is because I am in a specialty area and when people hear ICU they understand my role, people can identify with it more easily maybe?? Just a thought.

    Ferg- I had it banged into my head that vent's vent- and if anyone asked me about L&D...... I would be hopeless.......nursing has become so specialized, which is not such a bad thing really.
    Helps us define what we do and what group we do it to!
  7. by   fergus51
    JMP, I am so glad nursing is specialized. It only took me 2 days in ICU as a student to know I didn't belong in ICU...Too many sick people.
  8. by   nurs4kids
    Originally posted by RNed
    Once again, insurance is not healthcare. We continue to use these words as interchangeable. They are not !!

    Having insurance does not mean having healthcare. And the cost of insurance is NOT the cost of healthcare.

    Until we can adequately define the difference there is not going to be a solution. We can not pay for all the healthcare needed in this society. Some may say or believe we can. However their answer to this equation is to take money from others for their cause. I doubt this will be given freely. Healthcare is not a "right" and insurance cost is not the cost of healthcare.
    Do you HONESTLY think we (the working) aren't ALREADY paying for healthcare for all????? Also, how do you figure insurance cost isn't directly impacted by the cost of healthcare??? I also tend to differ...I do think that in a civilized, non-barbaric society, that healthcare should be a "right"..I just also tend to believe work should be a requirement for the protection of one's "rights".
  9. by   rncountry
    Suzy, read "Making a Killing." Also it would be good to investigate how the full healthcare system works, that does not always mean HMO's. Look at the history of Tenet Healthcare, one of the largest providers of healthcare in California. This company has also had more medicare and medicaid fraud problems than Columbia/HCA. In fact their name was not Tenat to begin with, they changed it after a major indictment by the federal government for fraud. The reputation of this company was so bad that when Australia looked at changing some of their system into for profit and Tenat rushed there, there was a grassroots effort by healthcare providers to keep them out of Australia. This included realms of court papers as well as testimony. The Australian government opted to keep them out.
    Columbia/HCA made a habit of laying off nurses in the hospitals they took over, and they took over many in the late 80's and early 90's. It was the way they controlled cost. While they were at it they managed to get busted for medicare fraud and had one of the largest fraud settlements with the government to date. Yet the CEO of the company was allowed to resign, with a $9 million dollar settlement, he then went on to start a consulting company on healthcare. By the way this man didn't even hold a degree in anything related to healthcare. I wonder how many nurses could have provided care for that $9 million.
    It is not just HMO's that drive the system. The fee for service system was blamed for skyrocketing healthcare costs, and docs were the main culprit in this scenio. DRG's and HMO's were created primarily as a cost fighting measure. Who in their right mind would think it was appropriate to send an open heart patient home in three days but someone who has not treated those with complications. It was accountants that came up with DRG's. They wanted to make mastectomy's a 24 hour stay for God's sake.
    The whole thing is quite complicated and I couldn't begin to give it justice here. But for somone that comes across as intelligent and well read as you do, I definately suggest that you do some research and reading. A universal healthcare system would likely save money, not increase costs. Though it would seem it would increase costs in the beginning but that is because of the rapidly aging population, not because of universal healthcare.
    By the way I believe that France already pays it's physicians a salary.
    It's time to stop looking at nursing and medicine as two different branches of the same tree. It is an old model that has very little place in the upcoming world. Look at the old nursing uniforms, has it occured to anyone that they look just like the uniforms worn by women servants of the house from the same English period of time? Nursing has come a very long way from it's beginnings. It is not inappropriate to think that nursing could easily take over duties previously held by medicine. We do it already, we just don't acknowledge it. In an ICU in the middle of the night and a patient codes it is not a doc that is running the code, and it seldom is the resident that the experienced nurses think is a twit running the code either. It is the nurses. ACLS nurses make life and death decisions without a physician holding their hand all the time, in fact that certification requires you to act, if you did not and simply stood there waiting for a doc to give instruction when you were already educated what to do the legal repcussions could be severe. I routinely give recommendations regarding appropriate wound care, and have several physicians I work with that don't want me to call for wound orders, instead they rely on me to make that choice and let them know what I am doing. However that does not make me a physician, it means I am actively collaborating with the physicians who respect my knowledge of the chosen area in which I practice. It is my belief that when there is muddy water regarding what nurses do it is because of nurses who are not strong enough to make a definative role for themselves. There are many areas inside nursing, thank God. How boring it would be otherwise. Would nurses be less expensive then physicians? Likely yes. However I would think that should be based more on what the abilities of the person treating would be, more than a nurse vs. physician role. A physician had dissected a human, seeing what the actual organs look like, exactly where they lay and how other organs attach. Nurses do not do that. While I am perfectly capable of looking at a patient, their labs, x-ray's etc... and know that patient is in left sided heart failure, I am not capable of doing a heart transplant. Therefore diagnosing and treating the simple leftsided failure would fall to me, while the patient requiring transplant would fall to the physician. I would instinctively feel that the more complicated work would automatically receive greater pay, and the physician would likely be doing the more complicated work as they are educated to do so. The engineer that designs the car is paid much better than the guy putting it together, even though the guy putting it together could tell you how the car works. Nurses are not physicians, but that does not mean we do not have an extremely important role to fill beyond passing meds and reporting labs to physicians. That in itself takes very little thinking or skill. The greatest challange to having nurses fulfill a greater role than we do now is not only physicians who would feel a threat to their power and earning ability, but of nurses who feel we should not step out of the traditional "servant" role where the profession first started. All things change and evolve as the need for that change becomes apparant. Nursing is no different. Not only could nursing potentially help control healthcare costs, we could also finally have a greater voice in the delivery of care as well as controlling our own profession instead of looking for physicians to do it. What a concept!
    Sorry I am windy. Suzy do me a favor and do some reading. I think you will find that there is so much more behind the scenes that drive healthcare costs. Those that are making out the most here are not physicians, certainly not nurses, but those that control the citizen's access to healthcare. And those that run the business side of hospitals. Then they stand up there and pose that they know what is best for the countries citizen's when the only experience they have in healthcare is attempting to keep costs down by discouraging or outright denying care. It is my thought that it is time to realitistically look at the coming demographics, realize a crisis is brewing and be proactive about it. The nursing shortage is not going to get better if nursing itself does not change and offer more opportunity to incoming woman who are socialized to be more than a handmaiden to some egotisical male physician, and that is true whether legislation to ease the shortage passes or not. And the aging population is not going away no matter what. And you are going to see more and more people who are stuck like my parents. The baby boomers have already had more impact on the social rules of this country more than any other generation before, just wait until they routinely can't get healthcare and then see what happens. So we can be proactive and put the system together well now before it is a crisis or we can bury our heads in the sand and wait until we have to hodgepodge the system together.
  10. by   OC_An Khe
    Before we answer how we as a society are going to finance health care, and for how many members of society will be covered. We have to decide if health care is a right for everyone without regard to their "economic station in life".
    If health care is not a right, nor a responsibility of community (civilization) then each individual is responsible for the cost out of pocket. If it is a right then universal coverage must be implemented.
    I favor health care as a right as it allows for the greater protection of all members of society. hich is what civilization/ community is about. Creating more protection and safer environment for the members of that community
    Last edit by OC_An Khe on Apr 28, '02
  11. by   Q.
    Originally posted by nurs4kids

    I also tend to differ...I do think that in a civilized, non-barbaric society, that healthcare should be a "right"..I just also tend to believe work should be a requirement for the protection of one's "rights".
    Rock on.
  12. by   fiestynurse
    Let's blame this failing health care system on those "stupid" people that seek basic health care in the hospital ER! Or those greedy doctors! Why is it so hard to accept the fact that our system sucks and we need major reform, such as Universal Health Care! In many respects, by supporting the maintenance of the American health system as we know it now, we play a lethal game. For the most part, the system itself is rotten to the core and not worth reforming or saving.

    Rudolph Mueller, M.D., author of "As Sick As It Gets":

    "... and, then, the other thing we do in this nation is we blame it on the individual. If someone dies prematurely, it's their fault. If they have a bad outcome, it's their fault. If they have a job that doesn't provide insurance, it's their fault that they didn't get a well paying job that had insurance. If they come in and their diabetes is uncontrolled, they didn't take their medicines, it's their fault they didn't take their medicines. No, it's more... They don't have insurance. They don't have prescription coverage. They can't afford their medicines. Their employer doesn't provide
    health insurance because they need to be profitable."

    Dr. Mueller critiques the U.S. health care system in this 11 minute video that can be downloaded at:

    Last edit by fiestynurse on Apr 28, '02
  13. by   rncountry
    Children cannot work, do we decide to not cover them? How about people like my dad that have worked for years? Where do we make that cutoff? There will always be those that do not work, that will be lazy as a fat coon happy to lap at the tray of others, however could someone explain to me how that is different from what is happening now? Do you not understand that already you are paying for those that do not want to take responsibility for themselves? You pay through higher and higher premiums, you pay through procedures that are not covered, you pay by not being able to access specialitists that could make a difference in the potential outcome that you have. You pay by the huge growth of office workers that have had to come into being just to handle all the various paperwork that is now required from the umpteen different companies and their rules, how do you think their wages are paid? You pay by having a physician who doesn't actually know you, you pay by having a needed test denied to you because some person in an insurance company thinks it is not necessary, often times it is not a physician or a nurse making that decision.
    Everytime a decision is made to do something that declines that ability of the nurse to take care of patients in the name of cost cutting you are paying. Does it not bother you in the least that there are people literally making millions by cost cutting, read denying care to others? I think it is sick and wrong for that to be going on. How about handicapped children with working parents that fall into that working poor catagory that have no insurance through work or no insurance because they can't afford it? Do we decide that we will throw away that child? To not take care of our children and our old people make us not so far away from the barbaric practices of ancient societies that left children to die in the elements or through wild animals. Hell we don't even have that much compassion because we force them to live anyway with nothing. This does not even begin to address the social cost of wasted lives, the moral cost of teaching our children that only those that have a job are worthy of being taken care of or the ethics only those with money are worthy of having healthcare. What do you suggest about people who have lost jobs because the economy goes into the toilet? Already we tell them tough ****, guess you shouldn't have had to stupidity to work somewhere you might get laid off, shame on you for not anticipating that and your wife pregnant and all. Tsk, Tsk. Cross your fingers and hope nothing bad or untoward happens to you or to those in your lives that you love, because crossing your fingers will probably bring you more than expecting a social safety net.
    Last edit by rncountry on Apr 28, '02