Universal Health Coverage?

Nurses General Nursing

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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 it is, they only pay 30cents on the dollar, are slow to reimburse, most often clinics and hospitals struggle financially and often times have to write off alot of procedures d/t Medicare. I sometimes see Medicare as a reflection of what universal health coverage would be; not enough money and care down to the least common denominator. Canada, our neighbor, is also struggling as there isn't enough money to care for all of their citizens. What is everyone else's opinion on this? What IS the answer?

Here is a poem I came across that I thought I would share:

Taken from the International Conference in Medicine held in February 2001:

Draped in Disquise

Cries for medical care equal to Canada or Great Britain is fair

Everyone's much better there, so why not us? We want their care

NO, they say, it isn't so

Don't give up what you have for the lesser care within our society

Am I to believe it's a disguise? A mask claiming to be better for you or me;

confusion, disorder split in two which shall we choose?

One bringing change, or another bearing mediocrity

Our lives are too precious to be bound by the arms of bureaucracy.

Other nations have tried and failed leaving only discontent and disparity

Look forward to what can be.

Not their past except it's history.

Lest the burning desire of what we lust becomes the aftermath of only dust.

If we turn our backs and pretend not to see, no more will we the envy be, and the failures of others becomes our destiny.

Learn from their failure, for left unexplored creates another worse than before.

By Linda Tofanelli

I think nursing needs to reorganize, redefine ourselves, educate ourselves further, encourage further education like NPs, CRNA's, Educators, to help invoke health care change.

Absolutely! Now we have to think on the next step though. Compensation. How would that be accomplished in the current healthcare system that does not allow that? We have many nurses that could have an independent practice by virtue of their education, however that is not truly available because of the lack of direct compensation to those nurses. Much to think about. Yes? But doable, anything is doable if you want it bad enough.

Are you guys serious? Prison inmates are guaranteed healthcare but a 2 year old isn't? Wow...that's definitely something I hadn't thought about before.....

Specializes in LDRP; Education.

I may get tarred and feathered here :uhoh21: but I think for the most part, staff nurses can make some pretty decent income. I think the issue of compensation for nurses comes when we compare our salaries to those of other professions that we don't see as nearly as important or stressful. Pay isn't the only issue, as most nurses, myself included, left a fairly decent pay for lower pay. Why? Better conditions. I think if nurses had more autonomy, the "lower" pay that we see as compared to IT professionals would be easier to swallow.

As far as nursing as a whole: for one, I see our biggest opponent as the AMA. Time and again they create replacements for us: PAs, MAs, Anesthesia Techs; all professions that are fully supported by the AMA and designed to maintain control. Nursing needs to reorganize and gain lobbying power and influence through the ANA. I'm not saying that the ANA is the be-all, end-all, and I can't comment on its objectives because I don't know all of them, but I do know that we need a large organization designed to promote ourselves and make (demand) some changes. Simplly put we need lobbying power to ensure our abilities to directly bill for our services. We need lobbying power to promote our services so that insurance companies, or the general public, would prefer a nurse to a physician in some cases, or, at least, accept a nurse's care or opinion.

We can be a highly skilled, intelligent group of professionals. However, until we reorganize and redefine, encourage education and stop downplaying it, we won't get anywhere. And instead, Health Reform will come with or without us, and like James Huffman said a couple posts ago, someone ELSE will define us and it might not be in the best interest of the patient...or us.

Specializes in LDRP; Education.

Tracy,

Yes we do offer health care to our prison inmates and not necessarily to our children. Like I said, if we DIDN'T offer care to the inmates, someone would definitely make a big stink about that and call us inhumane.

Kinda like the extreme (and I mean extreme) pro-lifers who discourage abortion, but do nothing as far as helping the existing children in the world, or could care less about the death penalty.

Ass-backwards.

LOL! I love the expression ass backwards and I couldn't agree more! It is honestly something I never considered because I have never done correctional nursing either in Canada or the US...

Originally posted by Susy K

Kinda like the extreme (and I mean extreme) pro-lifers who discourage abortion, but do nothing as far as helping the existing children in the world, or could care less about the death penalty.

Ass-backwards.

LOL!! I remember seeing a political cartoon one time of a sooty-faced little kid in a ghetto-type neighborhood sticking his head out of the window of his apartment screaming very loudly, 'YOO HOO!!! OPERATION RESCUE!!' :chuckle

LOL!! I remember seeing a political cartoon one time of a sooty-faced little kid in a ghetto-type neighborhood sticking his head out of the window of his apartment screaming very loudly, 'YOO HOO!!! OPERATION RESCUE!!'
Hee hee! Exactly.

In skimming this thread, I have to say one aspect that I didn't see come up much was the issue of taxes. Countries who have universal health coverage generally tax quite a bit more heavily than the US. I don't know what our Canadian friends are paying, but I have a number of European friends who pay a hell of a lot more in taxes than we do. For example, I have a lot of Dutch friends who pay close to 50% of their income to taxes.

Prior to April 15th, there was a long thread on another (fairly international) board I post to regarding taxes. Some of the Americans whingeing (isn't that a great word? Brit-speak for whining) about their high taxes were practically laughed off the board--and then informed by their non-American counterparts that paying, say, 14 - 20% or so, on average, of one's income doesn't constitute "high" taxes anywhere else in the world but the US.

I agree that Medicare and Medicaid funds aren't being well or wisely used now--and of course there are still problems with existing universal health care models such as Canada's and the UK's systems. But I think Americans are in for a big reality check if they think that any kind of universal health care can be instituted here without digging a little deeper in our pockets. I'm not saying I like it! --but I do think it's going to require a different mindset.

Stargazer, I am in Canada now and have lived in the States. When I compare the extra I pay in taxes here to the amount I was paying in health insurance there, the difference isn't big at all.

Frankly I think the gov't could afford it without raising taxes if we stopped paying for all the crap we do now.

fergus, as someone who's lived with both systems, what do you see as the major differences? How does Canada handle the inappropriate ER use that's been mentioned here so frequently, for example?

And I have to say, despite what someone said upthread, that waiting lists ARE an issue. My hospital was one of four, back in the early '90s, who did CABGs on 50 Canadian patients (per hospital) sent to us who had been waitlisted for almost 2 years. And in my current job, I have to find ways to get around the waiting game in the UK for our Brit employees who need specialty care or non-emergent surgeries.

Specializes in LDRP; Education.

One of my biggest gripes is increase taxes. And as I've stated before, as a married, dual income, no children homeowner, my husband and I get taxed quite heavily and NO tax breaks, other than our house.

Waitlists are an issue for non-emergency surgery cases, yes. I think that has more to do with our improper management of the resources we have. But like I said, we have dual citizen Americans coming back here to get prescriptions and treatments as well. My great uncle is dead because he didn't want to pay for a trip to the ER.

Our emergency room just started a fast-track area to try to get the non-emergency cases out faster and there has been a big promo about the nurse-line (telephone triaging thingy) and the walk in clinics. It is still a BIG problem and needs reform.

The reason I like this system better is because everyone can see a doctor when they need one and they don't have to worry about paying. The problem is there is a lot of overusage because of that. I work L&D, and I saw women in the States who came in all the time with no prenatal care because they didn't qualify for assistance but didn't have enough money for health insurance either (I think you all call them the working poor?) and would wind up in really bad shape when it would've been easy to treat if caught early. You don't see that nearly as often here. You also can't be discriminated upon because of pre-existing conditions. You don't have to worry about what plan to get or if your insurance from your last job will cover you until you get another or what payment plan is set up for your premiums or if your kids can get covered under it, etc. I think these plans are a LOT of beaurocracy and are so confusing and adept at denying care to people, that even those who HAVE health insurance have a hard time getting it to work! I think health care in the US is just such a maze for patients, and it creates a lot of needless waste.

I just can't imagine denying someone care, or forcing them into bankruptcy to pay for it. It's tragic how many people in the US fall through the cracks and can't afford to access health care. I think that's something we would expect from a third world country, not from one of the world's leaders.

Who really pays for employer-provided health insurance? Employees and taxpayers do. Most people accept limited health care choices because they think someone else--employers or government--is paying for their health insurance. But that is a misconception. As is true of every other commodity or service, there is no such thing as "free" health insurance. Employer-sponsored health insurance plans lead employees to believe they are getting free coverage, but economists show that workers actually forgo higher wages in lieu of health benefits.

Economist Charles Phelps argues that "every dollar paid for health insurance is a dollar not paid in wages. This means that workers want to be careful in their selection of insurance, because they really are paying for it, even if the employer is making the payments on paper." John Goodman, president of the National Center for Policy Analysis, puts it this way:

Health insurance is a fringe benefit which substitutes for wages in the total employee compensation package. The more costly health insurance becomes, the smaller the remaining funds available for wage and salary increases. The ultimate victims of waste in the medical marketplace are employees. This is one reason why take-home pay has been relatively stagnant over the past two decades, even though total compensation has been rising.

Although workers' total compensation has increased over the past few decades, Goodman notes that workers' take-home pay actually fell by 6 percent between 1973 and 1991, during which time employer-sponsored health insurance benefits increased. Workers--not employers--clearly bear the burden of high health care costs in the form of lower take-home pay.

A study by the Center for Health Economics Research explains why workers bear most of the burden of high health care costs and mandates.

When faced with higher health care costs, businesses have three choices: (1) raise prices--placing the burden of higher costs on consumers; (2) accept lower profits--putting the burden on owners of companies; or (3) reduce wages and other labor compensation--shifting the burden to employees.

Source: Jerry Cromwell et al., The Nation's Health Care Bill: Who Bears the Burden? (Waltham, Mass.: Center for Health Economics Research, 1994).

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