Libertarian Nurses View on Core Measures

[bluelion]

I am wondering if there exists any opposition to core measure standards and what Libertarian Nurses think? I have been a nurse for several years and I am currently a core measure abstractor. There are huge manuals that guide what we do and they site studies at the end of them. I am starting to lean politically Libertarian after years of believing health care has been ruined by the private sector and that there needs to be more private sector control over it. After 20+ years in the biz I've come to see that medicine is the most heavily regulated industry along with banking, and things have just gotten worse. Even the studies from these manuals that I have been able to trace funding back to either are directly done by the govt or directly funded by the govt. I come to also realize we haven't had a free market in health care in decades. I am not completely against many of the core measure standards, but Ive seen too many cookie cutter scenarios that seem too punitive. Through my lens, we have govt trying to solve problems that are main caused by govt involvement.

[bluelion]

What sway does a review have if all arrant there to participate. There is no delineation between the govt and a private entity because at that time they are paid to do the bidding of the one who pays they. I do t know if these studies are good or bad...maybe those studies are perfectly fine.... My contention is there are usually entities left out ...a pretty frequent happening in a centrally controlled system. A free market would police itself...much like underwriters laboratories did with products it dealt with for decades. In other words there were independent reviewers instead of one centralized entity enforcing one standard. I think it best that we have an equal voice for all standards and let the best be duplicated and the worst be trashed

[MunoRN, RN]

Core measures already come from private, non-governmental groups, no core measures are made up from scratch by the government. For instance, the next core measures to come out are for sepsis, these will be largely based on the best practice guidelines of the privately run Surviving Sepsis campaign and the Society of Critical Care Medicine. MI core measures come from best practice consensus of the AHA and the American Society of Cardiology. Stroke core measures come from the AHA/ASA. Post OHS core measures come from the Society of Thoracic Surgeons and other private practice improvement groups, etc. So I'm still not sure what you're suggesting should be done differently.

[heron, ASN, RN]

I'm confuzzled, frankly. How is forcing what is essentially a square scientific process peg into a round economic philosophy hole going to produce anything resembling sense?

[Emergent, RN]

This merging of hospitals, and mega-hospital chains run by big corporations, is not how health care got started in this nation. Originally, hospitals got started by religious groups, or communities. There were also county hospitals that often served the needy. They were run for the good of the people, not to line pockets.

One of my jobs is at a hospital that was formerly a Catholic hospital, and now on it's second corporate owner. I worked under all three entities and take my word for it, for profit is ruining things. These corporations are ruthless.

[toomuchbaloney]

If you are working in any hospital system in the US you are working for a "corporate entity" with the level of caring you describe. Healthcare in America is oligarchic, nearly monopolistic the way it stands now. None of this psuedo-fascist corporatism is acceptable under libertarian values.

As a libertarian I believe a decentralized health care system would serve everyone better, especially the lower economic classes.

It is pretty clear that you do not know what libertarians think. That's fine, as it goes, but please refrain from commenting until you do. Questions are welcome.

I am pretty confident that any person may comment here with or without a question for you.

I am a Libertarian, paid dues and carried a wallet card for many years.

Rather than insulting other posters as if you are the AN police, why not explain what you believe to be the Libertarian thinking on health care, government's role in the health of the populace, and the role of best practices in delivery of health care?

I'll wait.

[Farawyn]

I am pretty confident that any person may comment here with or without a question for you.

I am a Libertarian, paid dues and carried a wallet card for many years.

Rather than insulting other posters as if you are the AN police, why not explain what you believe to be the Libertarian thinking on health care, government's role in the health of the populace, and the role of best practices in delivery of health care?

I'll wait.

Pssst, baloney...I think you'll be waiting awhile.

[heron, ASN, RN]

We've already waited a while. The same invitation was posted elsewhere. The only response was ***crickets***

(At which point, the thread went happily sideways.)

[CryssyD]

I have a question! How, exactly, has government been in control of healthcare for years?

I mean, I understand that government has imposed restrictions and regulations, almost invariably to protect the public from abuse (good thing), or to placate some powerful lobby in a way that isn't too obvious (generally not a good thing), but otherwise how does government run healthcare? It's always looked like a fee-for-service, modified corporate system (some constraints to prevent total monopolies, and restrictions on interstate commerce [as in every other business in this country]) to me. Can you libertarians explain the evils of our past system vis-a-vis the evils of ACA--which is worse, and why? How, exactly, is government taking over a system by mandating the purchase of private insurance, which is prevented from swindling the public with fine print and policies that throw people out when they get sick?

[chopwood carrywater]

Getting here late to the party...

I don't believe that maximization of profits and humane, effective healthcare can coexist. I'm not saying that profits and healthcare are incompatible, but in healthcare as in so many other areas, making as much money and gathering as much power and control have become the goal. And not just here in the USA- ask VW....

Yes government and miles of red tape are a problem; but between big pharma, insurance companies, medical device manufacturers, and hospital corporations, there is plenty of red tape and inefficiency.

I also think that there is a big problem when there is so much back and forth between government regulators and researchers, and the entities that they are supposed to be supervising. I may be simplifying the issues but I think I've stated the essence of my issues and concerns with allowing the 'free market' to be in charge of, and to determine, best practices in healthcare.

[1edwood79]

You are describing the system we have now, not a free market system. The situation you describe, including corporate red tape, happens because Government, Big Pharma , Insurance and Big Hospital Systems are colluding, eliminating competition, driving prices up and efficiency down.

Entities in competitive systems can't set prices too high because if they do someone else will offer lower prices and take their business away. Competition also encourages quality. Even our central planners accept that as evidenced by their attempts to artificially inject competition into various parts the system. Ever worked anywhere they want you to treat anyone you interact with, even your coworkers, as "customers?" It's a common practice these days.

Where I live big health systems are rapaciously gobbling up smaller hospitals and systems. They are also buying large shares in insurance companies. Stand alone hospitals are rapidly becoming a thing of the past. This is happening mainly because current health care law encourages it. It smacks of monopolization and oligarchy, things previously abhorred by Americans. Our great trust busting Teddy Roosevelt must be rolling in his grave over this perverse use of American law.

VW did what they did because of the perverse laws they are acting under. That is not to excuse their behavior. I'd also point out that they are paying heavily for their transgression. And even cheating, they were making desirable high quality product because of the competition they face.

Do you believe that a tightly controlled health system behaving in similarly egregious manner would be treated the same way by the powers that run it. The more Government controls something the less likely it is to fess up to its mistakes. We've seen this again and again. Look at what's happened to the Vet.

Getting here late to the party...

I don't believe that maximization of profits and humane, effective healthcare can coexist. I'm not saying that profits and healthcare are incompatible, but in healthcare as in so many other areas, making as much money and gathering as much power and control have become the goal. And not just here in the USA- ask VW....

Yes government and miles of red tape are a problem; but between big pharma, insurance companies, medical device manufacturers, and hospital corporations, there is plenty of red tape and inefficiency.

I also think that there is a big problem when there is so much back and forth between government regulators and researchers, and the entities that they are supposed to be supervising. I may be simplifying the issues but I think I've stated the essence of my issues and concerns with allowing the 'free market' to be in charge of, and to determine, best practices in healthcare.

[elkpark]

Stand alone hospitals are rapidly becoming a thing of the past, mainly because of the ACA.

"Mainly" because of the ACA? In the areas in which I've lived over the last 20 years or so, this process was well underway long before Obama was elected or anyone was even talking about healthcare reform.

[1edwood79]

The new system is less responsive, less innovative, more intrusive, and more expensive.