CR 99 Universal Health Coverage - page 2

Hello to all my fellow nurse colleagues out there! I am a Graduate student in a large midwestern university; a group of students are involved in an activity to influence public health policy. ... Read More

  1. by   WayneRN
    Originally posted by fiestynurse
    I believe that health care is a basic human right, like food, shelter, and education.
    Please tell me what constitution guarantees you food, shelter and education? If they are a right, why do you work? I have to purchase my food, shelter and education, don't you? Where do you live? (I think I want to move there so I can play golf all the time)
  2. by   fiestynurse
    I am not talking about constitutional rights. I speaking of basic human needs. Do we not have a public educational system? Do we not have government subsidized housing, and programs to feed children, such as WIC and school lunch programs. Yet, we have 44 million uninsured citizens, who are not recieving even the most basic care. You find nothing wrong with that?

    Think about this:

    Fire protection only for those who can afford it?
    Police protection for only those who can afford it?
    Drinking water only for those who can afford it?
    Highways only for those who can afford it?
    Sanitation only for those who can afford it?

    Why do we have health care only for those who can afford it?
    Last edit by fiestynurse on Nov 5, '01
  3. by   WayneRN

    First off, "uninsured" does not mean that they are "not recieving even the most basic care." This number also includes people who pay for their own health care. I was one of those people for thirty-two years before I worked for a company that provided health insurance. All my basic health care needs were being met. My wife and I had our first child and paid for it out of our own pockets. That child didn't lack a thing! And to date, no one has done a study to find out what percentage of that 44 million are actually "not recieving even the most basic care."

    I can tell you that, in real life, I see many more people who are unemployed than I see of people who need health care and are not recieving it. Yet, statistically speaking, there are only half as many unemployed as uninsured. On top of that, if I were a betting man, I would wager that the majority of the adults in that 44 million uninsured people have a car, a TV, a VCR, cable and a stereo that they are making monthly payments on. If health care was as important to them as their entertainment needs, they would learn to ride a bike and play cards so that they could afford to pay for the care or insurance.

    I live near, and have worked on, the largest reservation in the nation. I've seen how "universal health care" works in real life. Many people from the reservation prefer to go off of the reservation and PAY out of their own pockets for their health care (what a concept! ).

    If we are going to pay taxes to improve health care in the USA, why don't we
    • Pay female drug addicts to NOT have babies?
    • Pay smokers to quit smoking?
    • Pay people to attend classes on preventive care?
    • Actually encourage people to take care of their families instead of pawning them off on some government paid LTC facility?
    • Teach philanthropy and volunteerism in schools?

    Yes, we do have public schools. That's why I chose to send my children to a private school. I cannot think of one thing that the government does better than private industry, other than what it was created for. Government does govern better than private industry, and they are able to sustain a better military.

    Hmmm, I was just wondering how many of that 44 million actually want universal health care. And of those, how many realize that it's really not free.
  4. by   fiestynurse
    There has been numerous studies on the quality of health care being recieved by the uninsured.
    Compared to insured children, children without health
    insurance are 6 times more likely to go without needed medical
    care, 5 times more likely to use the emergency room as a regular
    source of care, and four times as likely to have necessary care
    The uninsured have a 25 percent higher risk of mortality. To
    place these numbers in perspective, in a study of 699 uninsured
    people, 128 of the 699 died. If this group had been insured, the
    expected number of deaths would have been 103--25 fewer deaths.
    You were lucky that you were able to pay for your health care needs during those years of being uninsured. Many people, in a similar situation, when being faced with a catastrophic illness, end up filing for bankruptcy and losing everything they own. Healthcare Debt is becoming the number one reason why people file for bankruptcy in this country.
    In addition, what you experienced on the reservation is the very reason we need a national health care program, so this type of discrimination in health care does not occur.
    "Of all the forms of injustice, inequality in health care is the most shocking and inhumane."--Martin Luther King
  5. by   WayneRN

    They are not even sure of the number of uninsured people. Those are estimates (that change regularly depending upon which special interest group is quoting them). So, how could they possibly be broken down into the detail that you are trying to espouse. You throw around a lot of stats without any references. And, one thing that I learned in statistics, "Figures don't lie, but liars figure."

    I sometimes wish that all of the universal health care proponents would move to where universal health care already exists and let the free market do the repairs to our broken system.

    Anyway, I'll go ahead and let you dominate the rest of this thread. I don't really care to engage in anymore "he said/she said." Another thing that I have learned from engaging in internet discussions, "A person convinced against their will is of the same opinion still."

    Have a beautiful life
  6. by   fiestynurse
    I thought we were having a healthy debate. Sorry if I have offended you. Your love-it-or-leave it mentality is more at home in a totalitarian regime than here in the land of the free, that's why I won't suggest that you leave. The majority of Americans want a National Health Care program. We are the only industrialized nation without universal coverage.

    Here is the study that gets quoted most often regarding the number of uninsured:

    This is a more recent estimate based on census data:

    And with the impending recession and the rising number of unemployed, the number of uninsured is expected to rise to over 60 million.

    Here are some of my sources for the statistics that I have previously mentioned. (I don't usually provide them because it is a lot of work for me to dig them out) But, I certainly don't want to be portrayed as a liar.
    Growing evidence from large observational studies underscores the strong relationship between quality and access/ insurance status:

    1)The hospitalized uninsured are 2.3 times more likely to suffer adverse iatrogenic events. ( Burstin HR, Lipsitz SR, Brennan TA. Socioeconomic status and risk for substandard medical care. JAMA. 1992; 268: 2383-2387.)

    2)The loss of Medicaid coverage has been associated with a 10-point increase in diastolic blood pressure and a 15% increase in the hemoglobin A1c level in diabetic patients, increasing the odds of dying within 6 months by 40%. ( Lurie N, Ward NB, Shapiro MF, Brook RH. Termination from MediCal: does it affect health? N Engl J Med. 1984; 311: 480-487.)

    3)The uninsured poor are twice as likely as those with private insurance to delay hospital care; among those delaying care, hospital stays are longer and death rates are higher.
    (Weissman JS, Fielding SL, Stern RS, Epstein AM. Delayed access to health care: risk factors, reasons and consequences. Ann Intern Med. 1991; 114:325-331.)

    4)Being uninsured was associated with twice the 15-year mortality (18.4% vs 9.6%); even after adjusting for major health risk factors, mortality remained 25% higher. ( Franks P, Clancy CM, Gold MR. Health insurance and mortality: evidence from a national cohort. JAMA. 1993; 270: 737-741.)

    5)Lack of health insurance is associated with failure to receive preventive services, including blood pressure monitoring, Papanicolaou tests, breast examinations, and glaucoma screening. (Woolhandler S, Himmelstein DU. Reverse targeting of preventive care due to lack of health insurance. JAMA. 1988; 259: 2872-2874.)

    This profound connection between quality and access extends far beyond simply underserving the uninsured. Access problems threaten quality for those with insurance who encounter delays and overcrowding in emergency departments overflowing with patients lacking primary care. For the insured, limitations on benefits, including financial barriers (such as co-payments, restrictions in coverage, and rationing via administrative obstacles), increasingly obstruct care. Most important, quality is distorted when ability and willingness to pay become the criteria for determining which services are provided. Marginally effective or even harmful treatments for the well-insured affluent take priority over more needed and appropriate services.
    Last edit by fiestynurse on Nov 6, '01
  7. by   RNed
    We can study, report and provide many statistics related to under-insured, non-insured and its relationship with poor health and/or lacking healthcare. All these numbers can be made to support universal healthcare. However, this is only part of the review necessary to "predict" expected outcomes.

    We need to review and predict the behaviors and actions of the individual(s), groups and governing bodies which will interpet this new funding source. I present for an example:

    If medical care is funded through universal healthcare funding and healthcare is deemed a "right". Wouldn't there be a substantial increase of healthcare visits and use? We can immediatley add 44 million more users.

    Would the behavior of the patient and patient's family change? Who tells them no when it is their "right".

    Would alcoholics demand the next liver transplant and after receiving this liver what is his risk of drinking again.

    How many smokers would want the next lung transplant?

    How many patients would sue because healthcare is a "right" under the universal healthcare program.

    Would there be an increase of mental health, alcohol and drug abuse programs and hospitals?

    Would there be a substantial increase in nursing home beds needed for our elderly, which currently is provided by family members. As a son with an elderly mom, I am ready for the government to take this financial burden from me, at least pay for her drugs.

    If we are going to fund this healthcare plan. How many alcohol rehabs, smoking cessation programs, birthcontrol programs, drug abuse programs, parenting programs, teenage pregnancy programs, WIC programs are needed to meet the medical need.

    Universal heatlhcare numbers are presented as though this given proposed amount of funding will fill all the needs and yet save money. However, England and Cananda have unmet needs, why?

    Who pays for medical research ? What is the incentive to develop better drugs and procedures?

    We have a gentleman here, who has been admitted 37 times in the past 10 years and used 1.3 million medical dollars. He has been homeless for that many years and currently is homeless and continues to drink. How is it he gets medical care but there are 44 million people who apparently can't?

    The point made is - the studies are reviewing medical dollars spent in todays healthcare system using todays healthcare usage. These studies do not measure behaviorial change in society when society "believes" their healthcare is free and fully funded.

    The insurance industry wisely knows without co-pays and deductibles as dis-incentives the users of medical care would financially ruin their company. Does this not give us a clue to future behaviors under a universal healthcare plan?

    Fiestynurse, I agree this is a nice debate and I have truely learned from yours and others post. I wish universal healthcare was a reality at least for "our children". I am discouraged every time I see a needed bone marrow tranplant for a child which provides a 80% chance to a full life not funded by our government and instead pleaded for donations on our local news stations.

    We need to ask social scientists to predict behavior changes under a universal healthcare system. We need to add those changes to the proposed universal healthcare plan to determine a more accurate reflection of the number and statistics.

    Do we have a study presenting this type of comparison?
    Last edit by RNed on Oct 26, '01
  8. by   fiestynurse
    Universal coverage should increase the use of health services by the uninsured. According to the Lewin/ICF Health Benefits Simulation Model, approximately $36 billion of the $567 billion in 1991 spending projected under current policies will be accounted for by care for the uninsured, including free care at public hospitals, uncompensated care at private facilities cross-subsidized by insurance revenues, and services purchased out-of-pocket. The Lewin/ICF model estimates that an additional $12.2 billion would be required to increase the utilization by the uninsured to levels commensurate with those of the insured (Needleman et al10 and J. Sheils, oral communication, October 1990).

    The NHP will not only assist the uninsured, but will also cover services (eg, preventive) and payments (eg, deductibles) that many insurers currently exclude. Would this more extensive coverage "induce" a surge of utilization among those currently insured? The RAND Health Insurance Experiment found that costs for persons assigned to a plan with no cost sharing were approximately 15% higher than the age-adjusted, per capita health care expenditures for the United States as a whole." However, a more natural experiment, a study before and after the implementation of an NHP in Quebec, failed to detect the overall utilization surge predicted by the RAND experiment. Although the use of physician services in Quebec rose among those with lower incomes, the increase was counterbalanced by a decrease in utilization among the affluent. The net effect was convergence of utilization rates (adjusted for health status) among income groups, with no change in the overall rate.

    Would an across-the-board increase in utilization be desirable? In the RAND experiment, lower-income patients with medical problems who received free care had better outcomes than those in cost-sharing plans. At the same time, many medical services currently provided are of no or of extremely marginal benefit, and it is not the intent of the NHP to inject an additional bolus of such unnecessary care into the health care system.

    All these factors make it difficult to predict the level of overall utilization that would result from the NHP. For this analysis, we have added on the full $12.2 billion cost of bringing utilization rates of the uninsured up to those of the insured.

    Savings of the NHP

    The administrative efficiencies of a single-payer NHP offer the opportunity for large savings during the implementation of the program. Providers would be relieved of much of the expense of screening for eligibility, preparing detailed bills for multiple payers, responding to cumbersome utilization review procedures, and marketing their services. In 1987, California hospitals devoted 20.2% of revenues to administrative functions, in contrast to 9.0% spent by Canadian hospitals (L. Raymer, Health and Welfare Canada, written communication, April 1990). (These figures exclude malpractice premium costs and administrative personnel in clinical departments such as nursing.) The 11.2% difference is attributable to Canada's simplified hospital payment method, a method we propose for the United States.

    If we adopt a government-run, national health care system, won't we stifle innovation and the introduction of new technology?

    No. The government can and should provide funding to research and develop new technologies. Technology can be "world class," even if sponsored by the government, witness our state of the art weapons industry--all paid for and managed in the public sector.
    Last edit by fiestynurse on Oct 26, '01
  9. by   donmurray
    Services are provided based on clinical need, potential health benefit, and ultimately, available funding. There are many areas where conflicts arise, for example, plastic surgery. Should this be available in a Universal scheme? Many factors will come into play, not least public involvement in the determination of which treatments are on offer.
    To return to my example, Anyone suffering from a disfiguring injury, or a birth defect/ genetic malformation or psychological problems related to the above may be treated, whereas, say tattoo removal, or liposuction, although these treatments might be thought to be good for the patients' wellbeing, their behaviour may be seen as contributory to their condition, and tratment would have to be at least part-funded by the patient.
    All emergency treatment for life-theatening illness is determined by clinical need, not an insurance clerk's opinion
  10. by   semstr
    Fiesty nurse, keep the good works going!!
    You are absolutely right in saying its a basic human right to get the health care you need.
    Since I grew up (in the Netherlands) and now live (in Austria) in countries, where this is a basic law for all people living there, I have difficulties understanding the US-system.

    I know a little bit (tiny little bit) about it, since my husband works for Americans.
    He has to pay a lot of money for his insurance, but then when he gets sick, he can only be sick for as long as he worked for getting sick-hours (don't understand how they calculate those hours)
    when he is sick for longer time, he can take his vacationhours, and when they are gone, they sack him. Now who wants to be scik that bad? He would be so sick he won't be able to get another job.................. so there he is, can't afford his insurance anylonger................ another leach in society? (see that thread here?)

    O boy, thank God I am working too, and I have the benefits of a government-employed-nurse!

    Take care, Renee
  11. by   Mijourney
    Hi. What I've found is that many observers of the US economy and our way of life feel that our values are directly tied to money. There are very few countries, although the list is growing, where every extrinsic value and many intrinsic values are tied directly to money. Therefore, the support for national health insurance receives significant resistance even though support for the government military efforts at this time are near majority.

    I see this battle to push the passing of national health insurance to be long and and all up hill for the supporters. The only way I feel we'll end up with any more direct government involvement in health and medical care is when the middle class and above start really hurting in the market. For instance, when the boomers start to really hit the health and medical care industry hard and out of pocket costs become unbearable, there may be more support for national health insurance. This should be an interesting cliffhanger.
  12. by   disher
    This is a very interesting debate! As a Canadian nurse I have always believed health care should be accessible to all. However, our system costs $95 billion a year, finding ways to fund this without increasing taxes or cutting programs is extremely difficult. Canadians are debating whether the next step will be to apply user fees and allow some privatization. Before September 11th I would have said Canadians would fight against user fees and privatization, but now that the public supports spending more money on defense, I think we are more likely to see user fees implemented.
    Another point I found interesting was the thought that litigation would increase if Americans felt equal access to health care was their right. I always thought Americans had higher incidence of litigation because of the free enterprize.
  13. by   CATHYW
    Mijourney, interesting thought about the impact of the babyboomers (I am one) on the healthcare system as we age. One would wonder how this will impact the thinking of the majority...