How soon we forget.

[eriksoln]

http://news.yahoo.com/s/ap/20110131/ap_on_bi_ge/us_health_overhaul

Seems part of the arguement against Obama's bill is that people are going to be forced to purchase health insurance. Well........why not? A lot of states mandate buying auto insurance. Which one is more important? Doesn't seem like too much of a stretch to say you have to have it. Might help put an end to medical businesses having to give it away free.

So soon we forget. Many threads and even more posts comment about the "free care" we must provide in the ER and everywhere else. Seems to me this would be a step in the right direction to solve it. Whats the issue?

Eh, I'm all for it. Tired of running pain meds to a bunch of fakes who don't pay only to see another pt. with a real ailment get second rate care.

[Mars]

I don't think our constitution allows our government to force us to buy anything. I think the forced auto insurance is wrong too. We are becoming a society that wants everyone to take care of us and then we wonder why we don't feel good about ourselves. Self-esteem comes from mastery and mastery from doing, not waiting for someone to take care of us, protect us from our selves, or create a risk free existance for us.

[eriksoln, BSN, RN]

I don't think our constitution allows our government to force us to buy anything. I think the forced auto insurance is wrong too. We are becoming a society that wants everyone to take care of us and then we wonder why we don't feel good about ourselves. Self-esteem comes from mastery and mastery from doing, not waiting for someone to take care of us, protect us from our selves, or create a risk free existance for us.

I've said for a long time, its not terrorists or nuclear bombs that are going to kill America. Its the dying from the inside. Dying from laziness and sense of entitlement. I see mandating health insurance as a sort of................like a parent making their kid pay for the phone bill since the kid runs it up so high. Speaks volumes about the maturity level of the avg. American that we even have to consider mandating health insurance but.................if it walks like a duck and quacks.................

[KenH]

Fine do away with emtala

[lifelearningrn, BSN, RN]

Fine do away with emtala

If all citizens were covered there would be no need for Emtala!

[KenH]

If all citizens were covered there would be no need for Emtala!

[morte, LPN, LVN]

If all citizens were covered there would be no need for Emtala!

apples an oranges

[lamazeteacher]

From post #1"....................area of reform NEEDED is not being addressed... ie too few nurses,pcts, etc to the multitude of patients we see daily."

There will be a need for many more nurses in the many programs that the Reform of Health Care Act will provide.

NPs will be utilized far more, due to the high cost of physicians' care; and Nurse Educators will be needed to teach prevention and appropriate, compliant treatment of illness in classes, as well as doing telephonic oversite of chronocally ill patients (like diabetics, those with kidney disease, etc. and more home health visits will need to be done to determine proper use of medications).

Hopefully the preventive health care will bring fewer patients to hospitals for acute care, and druggy and other psychiatric cases will receive more and better treatment, due to equal emphasis for mental and physical diseases. Even hypochondriacs will have needed therapy, rather than placeboes.

The opposition that I've heard most to the Act, is that some of us who are on our feet, working and possibly disease free don't want needy others to get treatment that our income tax covers. That's just selfish, and has no ethical vacking, in my opinion. I've written to other topics how my friends and relatives in Canada cannot perceive why anyone wouldn't want care for others who are less fortunate.

Remember that stress causes many illnesses to become worse, and even present symptoms and pathology. Those without resources or employers to pay inflated prices for their own health insurance (due to the avarice of insurance executives and/or age) usually have much more stress in their lives, due to their inability to keep their homes, can't clothe themselves and their children for protection against the elements. The pride that comes from doing a job well is often missing from their lives, as their illnesses prevent consistent employment or their skills haven't been utilized.

[eriksoln, BSN, RN]

From post #1"....................area of reform NEEDED is not being addressed... ie too few nurses,pcts, etc to the multitude of patients we see daily."

There will be a need for many more nurses in the many programs that the Reform of Health Care Act will provide.

NPs will be utilized far more, due to the high cost of physicians' care; and Nurse Educators will be needed to teach prevention and appropriate, compliant treatment of illness in classes, as well as doing telephonic oversite of chronocally ill patients (like diabetics, those with kidney disease, etc. and more home health visits will need to be done to determine proper use of medications).

Hopefully the preventive health care will bring fewer patients to hospitals for acute care, and druggy and other psychiatric cases will receive more and better treatment, due to equal emphasis for mental and physical diseases. Even hypochondriacs will have needed therapy, rather than placeboes.

The opposition that I've heard most to the Act, is that some of us who are on our feet, working and possibly disease free don't want needy others to get treatment that our income tax covers. That's just selfish, and has no ethical vacking, in my opinion. I've written to other topics how my friends and relatives in Canada cannot perceive why anyone wouldn't want care for others who are less fortunate.

Remember that stress causes many illnesses to become worse, and even present symptoms and pathology. Those without resources or employers to pay inflated prices for their own health insurance (due to the avarice of insurance executives and/or age) usually have much more stress in their lives, due to their inability to keep their homes, can't clothe themselves and their children for protection against the elements. The pride that comes from doing a job well is often missing from their lives, as their illnesses prevent consistent employment or their skills haven't been utilized.

Hmmm. You seem to have a lot of faith in the bill. In essence, you are saying both quality (druggy and other psychiatric cases will receive more and better treatment) and quantity (everyone, on their feet or not, will receive care) will rise significantly. IDK about all that.

I see the quantity of patients that must be cared for going up, but IDK if the medical facilities are going to adjust their budgets to accommodate them. If your current doctor makes reservations to be seen a week in advance, they will now require three weeks. Hospitals will not staff much better, and will point to the limited payments they receive from the new plan as their reason. I see things improving staffing wise, but not enough to make up for the boom in admits..............and certainly not enough to raise the "quality of care."

I think we will take a step back before we take a step forward. But, unfortunately, its necessary.

[lamazeteacher]

Post #8

".............massive influx of patients there may be lower standards of care. 1 family doctor may go from seeing 25 pts a day to 50 patients a day, shortening time with each patient and thus making it harder to supply each person with the undivided attention and customization.............."

Uh, no. There will be more NPs seeing patients, probably taking more time with them and teaching preventive measures to avoid progression of diseases, as they go. The cost of care for nonpaying patients now, is much higher, since they tend to arrive in ERs with advanced illnesses requiring more hospital days more IVs, medications, etc. at far greater cost than the national coverage will allow.

This is what is written in the Reform of Health Care bill:

".....(20)QUALIFIED HEALTH BENEFITS PLAN.--

5 The term ''qualified health benefits plan'' means a

6 health benefits plan that meets the requirements for

7 such a plan under title I and includes the public

8 health insurance option."

It seems to me that those who don't like the idea of compulsory healthcare coverage, will imagine all kinds of unrealistic events as a result of it.

Give it some slack, and see how it evolves. It is a huge gift to us, especially as we age and acquire illnesses as a result of that. It's the very rich who will be paying higher taxes to pay for it. They have so many loopholes gaping to avoid paying their taxes now, (many pay nothing as they hedge their money in "foundations", etc.)

that they are panicked over the possibility that their control of where their earnings go, will end when those loopholes are closed, which angers them. The result is

that they are behind a lot of the lies that have spread negative PR for the plan!

President Obama has our interests in mind and is for the average people, which leaves less for the extremely rich ones..... The disparity in earnings can be traced to more money going to those who already have a lot of money. They hire tax avoidance professionals to keep all they have, invest it and make even more, which at this time is hidden in tax deductable assets (corporate planes, vacation homes, questionnablely necessary equipment, luxurious surroundings, etc., etc., etc.).

Gates is the rare exception, building schools for the disadvantaged. However even he has his share of deductable assets.

This is copied from the Reform of Health Care Bill, which shows that the public health insurance option will be in effect for anyone without coverage. This does away with private insurance companies for the uninsured. The opposition to the bill occurred partly because private insurance companies became insecure about whether their stranglehold would lessen when people saw the public option as equal or preferable.....

You can imagine how much less the health care coverage our government provides, will cost taxpayers as it will remove the high cost of health insurance executives'

salaries and bonuses. The payments for health care providers will be limited in the same way Medicare limits charges, and won't allow 20% of doctors' requested charges to be charged to patients.

[ZippyGBR, BSN, RN]

apples an oranges

with regard to EMTALA - hardly...

Admittedly the UK has similar provision in that it doesn't persue the for charge ineligible people for 999 ambulance call and Care while in the Emergency Dept, equally funding is built into the tariffs for these cases , especially where funding is based on per case attendance - as it is in the Emergency Department.

the fundamental issues, which so many people seem blind to are;

- With universal coverage there are no 'can't pay' patients- which means that there is no longer the requirement to build a 'profit' into the fees charged to those who pay themselves ( or who are currently covered by insurers) - which leads to a perception that the state funded care is is paying less than the going rate.

- With universal coverage there is no longer a group of people who are contributing towards care which they cannot receive ( i.e. the majority of the tax paying public at large in the USA )

- With Universal coverage there is less pressure on Emergency Departments to provide Primary care and funding streams to provide Out of hours 'Urgent' Primary care - this does not stop the hospitals from providing that care or providing facilities for that care, this also makes 'signposting' to alternative services to the ED from triage / after an initial practitioner assessment possible.

- With Universal coverage there are / can be incentives for Primary Care Physicians to recruit, retain and promote the health / manage chronic conditions of a patient population, there is also the possibility to incentivise improved access - not only in terms of the length of the working day but also in terms of lead time for appointments.

- There is no explicit requirement to remove the situation in the USA of using 'Other' Specialists to provide primary care ( e.g. the number of US women who regularly see a gynaecologist despite having no particular gynae problem i.e. for general 'women's health' stuff like cervical smears .... although other places do not use specialists for such careinstead Family Physicians with a specialist interest do it in primary care.

-Funding streams for hospitals may be more stable, this however depends on the model used in paying providers, ifit continues to be purely fee for service there will be no change but if the system moves to advanced purchase or services, procedures and bed-days or assured volumes ....

[lamazeteacher]

From post #81

............"- With Universal coverage there is less pressure on Emergency Departments to provide Primary care and funding streams to provide Out of hours 'Urgent' Primary care - this does not stop the hospitals from providing that care or providing facilities for that care, this also makes 'signposting' to alternative services to the ED from triage ..........."

Thank you for your comparative observations, ZippyGBR

I couldn't tell if you're still in GBR or here in the US, and I've been in the US for 55 years, with distant recall of how the single party payor system in Canada (my homeland) began and stories from there that my family tells, of more than adequate coverage and availability of their own doctors.

It seems that things here were allowed to deteriorate drastically before reining in was allowed to proceed. After Hilary Clinton's plan was ribaldly turn down, no one else in politics dared to raise the issue. False

proclamations disclaimed the single payor model. Lack of respect for authority made any replacement of it impossible during her husband's term.

There still exists a rather pioneer attitude in the US of fending for oneself through great effort (the regrettable gun laws) and "if I can do it, anyone can" spirit (hence the reticense to pay for less fortunate others' needs). Also doctors have assumed a martyr attitude that permits them to do outrageous disinterested referral to the ER of anyone who cannot see them by appointment, by not even seeing their patients (except for surgeons) while they are hospitalised.

That causes extensive sometimes 20 hour+ waiting times in ERs with subsequent increase in morbidity and mortality. I myself was brought by ambulance at 4:30 one afternoon, to my community's only hospital, with a repeat gastric hemorrhage, heard the report given to staff and wasn't seen by anyone - not a nurse or doctor, for 4 hours as I drifted in and out of consciousness....... While that went on a radiographic test might have revealed the site of bleeding, but lucky for me, the bleeding slowed, allowing me longer cognitive life, but without specific surgical treatment as an option.

Also the fees charged by physicians have become so outrageously high (which no other country equalled), supported by insurance and pharmaceutical companies' similar abuses, that appropriate fee for services/products has disappeared. Due to fierce lobbying in Washington DC and unending funds for legal representation of hospitals and physicians, little recourse for inappropriate health care providers' actions has been one reason for the acceptance of most people of inferior health care provider service.

This ocurred after malpractise premiums soared in the early '70s, yet I've heard little mention of that since that was all my OB wanted to discuss at my appointments with him, while I was pregnant in 1972-3. What I do hear about, is the closing of doctors' office doors earlier and earlier in the afternoons, and their refusal to take evening and night shifts in their group practises. In other words, if the political party (and those who support it) disagree with their dispensation of health care, they act like spoiled brats! The patients suffer disregard, disrespect, neglect of symptoms, and are secondary to their doctors' needs to live royally.

There is a lot to be said for the Reform/Affordability of Health Care Act, if only that it actually passed! However along that path many compromises to what is actually needed fell by the roadside (such as the national/universal plan's availability for anyone who wanted it). Now that is only there for those who are unemployed or disabled and unable to work, who cannot pay todays inflated premiums.

My hope is that those who seek to be medical students today will enter their

school with the attitude that monetary reward is secondary to the satisfaction of having served their communities well. Certainly they've been warned that "there's no money in it" by today's bunch of materialistic, self interested doctors, so others means of vocational rewards should occur to them.

[lifelearningrn, BSN, RN]

Doctors certainly should be compensated for their service to the community, especially considering the kind of money it costs them to become doctors in the first place. People assume doctors are rich- this doesn't happen for upwards of decades in many cases, if it happens at all. Med school is outrageously expensive. There needs to be some return on that investment. (Not to mention the time put into it)

It's not the 'American' way to expect anyone to have a 'capped' income. BUT there are definitely abuses of this philosophy in which Americans pay the price. In many countries, there is a cap a pharmaceutical company can sell a given drug. Does this mean the company doesn't sell or sell less in these countries? No, they sell at the reduced/cap rate just as much of the meds as they sell to us.. only WE pay the difference since they can charge us anything they want. America subsidies medications for many other developed nations.

This is only ONE area where we get the shaft in the medical industry. We also get the shaft from current private insurance companies that can charge us higher fees and offer less coverage, higher co-pays and deductables. These same insurance companies can decided whether or not we get treatment for anything they want basically, and outright refuse coverage to anyone they want.

The system IS broken. All I've seen from the naysayers is "this isn't going to work" or "this won't change that" or "this isn't the answer".. but what I haven't seen from any of them is any other solutions. None. It's also amazing to me that people can see the future and claim to know what is or isn't going to work and what is or isn't going to change since we haven't even begun to TRY this program yet.

I'm so tired of the 'this isn't going to work- and lets just let it stay broken' attitude.