National Health Care, Your Thoughts

pickledpepperRN · Sep 17, 2007

I read the BBC website's health section regularly. There is no paradise. Nurses are having a difficult time over there. Many nurses opt out of the National Health and go work for agencies. Doctors do too.
Americans have a different culture than the Europeans, and I do not think most people would tolerate rationed medical care.

Of course there is no health care paradise. I do think we need to actively work for a system in the United States.

I think nurses can be the leaders of creating an American style health care system.

Great Britian has a socialized system based on the democratic idea that votes noy solely money can improve lives. With the vote a regular working person has an equal vote with the wealthiest.

Canada has a single payer system administered by each province.

Some provinces seem to do better regarding waiting times than others.

I imagine access is less in rural areas than in cities too.

bakpakr · Sep 18, 2007

I am all for universal health care. Although I feel it will never happen here in the US. The insurance and pharmaceutical companys are to entrenched in the government to allow it to happen. If we could get them out of the politicians pockets then it would stand a chance of happening.

As for Canada and other countries that have it in place we need to look at those. When we do we can pick and choose what works for us. There is no one size fits all. Also one thing that always comes up is the wait times in Canada. "Gerard Anderson, a Johns Hopkins health policy professor who has spent his career examining the world's healthcare, said there are delays, but not as many as conservatives state. In Canada, the United Kingdom and France, 'three percent of hospital discharges had delays in treatment,' Anderson told The Miami Herald. 'That's a relatively small number, and they're all elective surgeries, such as hip and knee replacement.' John Dorschner, Miami Herald, June 29, 2007.

A recent study of emergency care in Ontario found that overall, "50% of patients triaged as CTAS I [most acute] were seen by a physician within 6 minutes and 86% were seen within 30 minutes of arriving at the [Emergency Department]. In contrast, the 50% of patients triaged as CTAS IV or V who were seen most quickly waited an hour or less, while 1 in 10 waited three hours or more. Understanding Emergency Department Wait Times: How Long Do People Spend in Emergency Departments in Ontario? Canadian Institute for Health Information, January 2007.

One of the talking points is that to do it we will have to raise taxes. I do agree that taxes would have to go up. Now what I have found that gives the naysayers fits is when i bring up the point that we the citizens would really not see much if any decrease in take home pay due to the tax increase. The amount that taxes would increase would be offset by the fact that the increased taxes would be covered by the amount we are nolonger spending paying for health insurance.

I don't feel HSA's are the answer due to the fact that I have experience with them. I have found that a number of individuals put off seeing a MD due to having to pay for the care. Even though the money comes out of the savings. A friend of mine was experiencing chest pain. But due to having to pay for a DR visit refused to go. When he passed out at work having a heart attack we called 911. He went ama from the ed because he did not feel he could afford the care. Needless to say he passed that evening. Also that employer later stopped offering the HSA due to the cost. They found it to be more expensive than traditional health insurance.

Sorry so long but this is a big issue for me.

clee1 · Sep 18, 2007

Here's a thought: why wouldn't a system similar to what we use for auto insurance work?

Health insurance would be required, with a certain minimal coverage for preventive, chronic, and catastrophic services established by law. Then, the the private sector would have to compete for customers; based on price per service rendered. If payments from insurance were made to consumers, rather than to providers, then, consumers would be forced to shop for coverage and services, ensuring the best "bang for the buck". Add to this that providers would have to ADVERTISE their prices before service is rendered rather than afterward, enabling people to "vote with their wallets" Include in this legislation punitive fines for insurance companies doing crooked things like denying payment for an "unapproved" medication or a test/procedure deemed necessary by a MD. Now we are starting to get somewhere!

This way, a retired couple with grown children would not have to pay for maternity or substance abuse coverage. Neither would a single man need maternity coverage. You can see where I'm going here. The private sector would have to cultivate individual consumers, rather that the current system whereby a company gets all the business available from an person's employer; and one or two sizes of coverage would have to fit all those employees. Coverage would be portable, and the costs would be reduced for all due to the necessary competition for customers and the efficiency of operation required to remain profitable.

OK.... so what about the indigent, disabled, working poor, "high risks" (d/t chronic conditions) etc.???? EASY! A "high-risk" pool just like the auto insurance industry has, with the payments made to private insurers either via the welfare/medicaid mechanism or with tax credits directly to consumers indexed by income or means-testing.

There may be some bugs in my proposal needing work, but I think this is a far more workable method than "universal healthcare", single-payer, socialized medicine, or our current, inequitable, system.

The free market WILL work, if we allow it to!

HM2VikingRN, RN · Sep 18, 2007

If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone.

Don McCanne

HM2VikingRN, RN · Sep 18, 2007

Clee,

Malcolm Gladwell discussed your idea

see:

The biggest difference between the two accounts, though, has to do with how each views the function of insurance. Gina, Steve, and Loretta are ill, and need insurance to cover the costs of getting better. In their eyes, insurance is meant to help equalize financial risk between the healthy and the sick. In the insurance business, this model of coverage is known as "social insurance," and historically it was the way health coverage was conceived. If you were sixty and had heart disease and diabetes, you didn't pay substantially more for coverage than a perfectly healthy twenty-five-year-old. Under social insurance, the twenty-five-year-old agrees to pay thousands of dollars in premiums even though he didn't go to the doctor at all in the previous year, because he wants to make sure that someone else will subsidize his health care if he ever comes down with heart disease or diabetes. Canada and Germany and Japan and all the other industrialized nations with universal health care follow the social-insurance model. Medicare, too, is based on the social-insurance model, and, when Americans with Medicare report themselves to be happier with virtually every aspect of their insurance coverage than people with private insurance (as they do, repeatedly and overwhelmingly), they are referring to the social aspect of their insurance. They aren't getting better care. But they are getting something just as valuable: the security of being insulated against the financial shock of serious illness.

...

There is another way to organize insurance, however, and that is to make it actuarial. Car insurance, for instance, is actuarial. How much you pay is in large part a function of your individual situation and history: someone who drives a sports car and has received twenty speeding tickets in the past two years pays a much higher annual premium than a soccer mom with a minivan. In recent years, the private insurance industry in the United States has been moving toward the actuarial model, with profound consequences. The triumph of the actuarial model over the social-insurance model is the reason that companies unlucky enough to employ older, high-cost employees—like United Airlines—have run into such financial difficulty. It's the reason that automakers are increasingly moving their operations to Canada. It's the reason that small businesses that have one or two employees with serious illnesses suddenly face unmanageably high health-insurance premiums, and it's the reason that, in many states, people suffering from a potentially high-cost medical condition can't get anyone to insure them at all.

...

The issue about what to do with the health-care system is sometimes presented as a technical argument about the merits of one kind of coverage over another or as an ideological argument about socialized versus private medicine. It is, instead, about a few very simple questions. Do you think that this kind of redistribution of risk is a good idea? Do you think that people whose genes predispose them to depression or cancer, or whose poverty complicates asthma or diabetes, or who get hit by a drunk driver, or who have to keep their mouths closed because their teeth are rotting ought to bear a greater share of the costs of their health care than those of us who are lucky enough to escape such misfortunes? In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem.

http://www.gladwell.com/2005/2005_08_29_a_hazard.html

clee1 · Sep 18, 2007

If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone.
Don McCanne

The problem is... personally, I am not convinced of that. Furthermore, I doubt if you'd ever be able to convince the overwhelming majority of citizens that you'd have to convince to make that option a reality.

I have seen, countless times, the inefficiency and costs of compliance in the current medicare/medicaid system: at all governmental levels AND by the provider(s). Add to that the rampant abuse of the system that now occurs; both by the consumers that use ER's as their PCP as well as by providers that perform unnecessary tests/procedures - secure in the knowledge that their chances of an audit are minimal. Then you have those providers that now refuse to serve medicare/medicaid consumers, d/t the pitiful reimbursement rates that system provides. (I have had several MD's tell me that the reimbursement they get does not pay for the time, materials, and compliance costs incurred) And we really want to expand this current system exponentially? Personally speaking, I believe that would make a bad situation worse....

Our system of government, by it's very design, is terribly inefficient. Our Founders intended it to be that way. (They also thought that Government should be able to "pay it's own way" without taxation directly upon the citizenry, but I digress.)

Sorry, my friend, but I am a long way from convinced that a government-run system is the best way we could go; or, for that matter, that such a system will ever be more than a pipe dream.

Addition:

I just saw your latest post... I'll look into it.

teeituptom, BSN, RN · Sep 18, 2007

Here's a thought: why wouldn't a system similar to what we use for auto insurance work?
Health insurance would be required, with a certain minimal coverage for preventive, chronic, and catastrophic services established by law. Then, the the private sector would have to compete for customers; based on price per service rendered. If payments from insurance were made to consumers, rather than to providers, then, consumers would be forced to shop for coverage and services, ensuring the best "bang for the buck". Add to this that providers would have to ADVERTISE their prices before service is rendered rather than afterward, enabling people to "vote with their wallets" Include in this legislation punitive fines for insurance companies doing crooked things like denying payment for an "unapproved" medication or a test/procedure deemed necessary by a MD. Now we are starting to get somewhere!
This way, a retired couple with grown children would not have to pay for maternity or substance abuse coverage. Neither would a single man need maternity coverage. You can see where I'm going here. The private sector would have to cultivate individual consumers, rather that the current system whereby a company gets all the business available from an person's employer; and one or two sizes of coverage would have to fit all those employees. Coverage would be portable, and the costs would be reduced for all due to the necessary competition for customers and the efficiency of operation required to remain profitable.
OK.... so what about the indigent, disabled, working poor, "high risks" (d/t chronic conditions) etc.???? EASY! A "high-risk" pool just like the auto insurance industry has, with the payments made to private insurers either via the welfare/medicaid mechanism or with tax credits directly to consumers indexed by income or means-testing.
There may be some bugs in my proposal needing work, but I think this is a far more workable method than "universal healthcare", single-payer, socialized medicine, or our current, inequitable, system.
The free market WILL work, if we allow it to!

The free market WILL NEVER work for anyone but itself

If it would work, it would have worked by now, It hasn't yet, so it never will.

Free market isnt free at all, now is it. Paying for UHC would be a far site cheaper

jjjoy, LPN · Sep 18, 2007

Just a little vent here...

I hate to see such a thought-provoking thread be hijacked by generalizations about "free markets" and "government ineffiency" and the like. In general, free market principles often increase access and affordability and government programs often suffer from ineffiency. Free market principles also often encourage resource exploitation and monopolization. Private companies also often suffer from ineffiency and some government programs are run efficiently.

On a positive note...

I'm enjoying this thread and some of the specific ideas and possibilities for changing the way health care is funded and how health insurance could work. There are pros and cons and potential pitfalls and I appreciate exploring those as opposed to just tossing off this idea or that idea because "free market never works" or "government programs always go wrong" or the like.

deeDawntee, RN · Sep 18, 2007

Another twist on this issue: the people who need health insurance the most, the disenfranchised, the poor, those in poverty, are the very people who need to be empowered to vote. We would have no problem electing the next president with a good universal health care proposal and other elected officials if we could support voting from all who needs change the most.

What are the statistics on the actual voting turn-out in this country?

We are entrenched in a system that clearly does not work. But there is no will to change it. Without the political will, it will stay the same. I am concerned about my own retirement, if I will be able to afford my medications and long term care, given I am single, with no children and have some chronic illnesses which have made it difficult for me to have a good retirement plan etc. I have a vested interest in seeing things change.

marvelous_truth · Sep 19, 2007

The free market WILL NEVER work for anyone but itself
If it would work, it would have worked by now, It hasn't yet, so it never will.
Free market isnt free at all, now is it. Paying for UHC would be a far site cheaper

Sadly many are misinformed and mislead to tyhe historical facts. First anyone who actually believes we have had a free market in recent years is not educated in the history of monetary policy and cartels that have had control over such. That is the purpose of my website which is a resource to Historical Facts and FREE education regarding principles of freedom. Blaming Free markets (which we DO NOT currently have , nor have we had a TRUE FREE MARKET in recent years), is a mistake and deception that many of us have missunderstood. Watch the excellent free video and invite other TRUE PATRIOTS and truth seekers to serve our country and promote Honesty in government and economics.

June55Baby · Sep 19, 2007

I haven't read all the posts on this thread, so I don't know if this has been mentioned. If we think patient care is tough now with all the Joint Commission and CMS regulations, just wait until the government gets it's hands on healthcare... I am afraid health care providers will be so deep in documentation and inane rules and regulations and sending reports to government agencies, that we won't have time to care for our patients.

pickledpepperRN · Sep 19, 2007

JCAHO is not a government organization. Hospitals prefer spending &&& to actually providing safe, effective care in a clean hospital.

How much do providers pay for insurance coders?

Does anyone know?