To all "medical coverage is a privilege" folks:

Nurses Activism

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Specializes in Critical Care.
If the family has no insurance, then that means they are not working. Maybe they should have thought about birth control before conceiving a child which they can't afford. Why should I feel guilty now for all the folks who are irresponsible - produce kids, don't work, do drugs, illegals? Do you expect me to pay for all of them? If you think that healthcare is a right, then go ahead and pay for all of these people, and we'll see how quickly you'll change your mind.

Most people's health insurance is tied to employment and if they lose their job most will not be able to afford health insurance and many may simply not even qualify for health insurance and companies currently deny anyone with a pre-existing condition.

I wonder what you'd do if that happened to you? Don't be so quick to judge others! It is ridiculous and immoral that we still don't have national healthcare for all. We should have basic national health insurance like medicare for all and then we could purchase any supplemental insurance as is already done with medicare. It would sure be an improvement from today and would cost less than what is spent for healthcare now, the govt doesn't spend millions for CEO's and their fatcats with bonuses, etc!

nicurn001

805 Posts

Specializes in Psych , Peds ,Nicu.
What about those like me who can't afford it? It would be the choice between taking food from charities or insurance, since it's the same cost as my food budget. I like to reserve the food boxes for those who are truly destitute.

I thought my intent was quite clear when I said "I don't think adults should be forced to pay higher insurance premiums to cover those who choose not to have health care insurance when they can afford it !. It may be easier on their pockets but not mine ". I've highlighted the relevant part ie. if your income is too inadequate to cover everyday living expense , then I support the idea of providing healthcare , but don't expect me to cover this cost if you have disposable income for the latest gadgets and lexus etc..

tntrn, ASN, RN

1,340 Posts

Specializes in L & D; Postpartum.

When I am taking care of a patient, I really don't care who is paying.....however, with the way our department works, it is impossible NOT to know because we do the admissions from the beginning, including "I need to copy your photo ID and insurance card."

However, that being said, when I discharge them to a nice pretty car, help them carry out their Coach bags (even if a knockoff or purchased from the outlet store), note their freshly painted and fancied up nails, can't help but notice the extensive highlights in their hair, that's when I have a moment........Seriously, I have discharged people with no insurance to cars newer than my own.....why can't others understand the unfairness of that?

Easy. The kids get the surgeries and the hospital accepts a payment plan for them after it's done. Sure, $5000 may take a lot of people years to pay off, but it's doable.

jmqphd

212 Posts

This thread has featured one of two basic scenarios depending upon the politics of the poster. One is the family/child/elder who is poor through no fault of their own. The second is the individual (and their dependents) who have refused to delay gratification and are poor because of poor choices.

In a perfect world there would be distinctions made between the first class of people and the second, especially when handing out free services. No one should be cut off, not even the intoxicated indigent found down on a frozen sidewalk. But the poor-through-no-fault-of-their-own group have potential. They have a higher likelihood of being set back on their feet. The others, not so much. A wise social policy would make some distinctions between the two. But the Grand Scheme to Federally Outlaw all Illness and Misery is a ridiculous sham. There is not one perfect solution. But there are thousands of small(er) ones.

The same thing applies to health care. We are not France. We are the most non-homogenous country that has ever existed. I live in NV. We have WAY more space than we do people. Nevada is not Manhattan. Good grief, the economics of health care are more complex than can be possibly imagined in your wildest dreams. Of course there can be a generalized, federal safety net dispersed to States in the form of grants. But let Illinois and Michigan do what works for them. Let the people of Texas and Colorado and New Jersey decide how to serve their poor.

I have no problem with the motives of those who disagree with me on the affordable care act. But I canNOT understand how you can look at the incestuous, out-of-touch bureaucrats in DC and the congress that regularly beclowns itself, and imagine that they can fix our health care on a national level. And if you think this congress is a bunch of clowns, go down the roles of history and find one that is better. (Hint: Start your internet search in a year that precedes the election of Harry Reid to national office.)

MunoRN, RN

8,058 Posts

Specializes in Critical Care.

Health care reform is not primarily about how to serve the poor. Our safety net for the poor (medicaid) is already administered at the state level. The purpose of health care reform is to make healthcare more effective and efficient for everyone that receives healthcare, not just the poor, in fact very little of it is aimed at the poor.

Sorry to repeat myself, but no one will argue that healthcare delivery is different in rural areas that in urban areas, but the basic principles of treating heart failure don't change from state to state. It's unlikely that 50 individual versions of reform would be more efficient, but at this point we'll take anything other than "let's not do anything", so let's leave it to the states, what would Nevada's version of reform look like?

tntrn, ASN, RN

1,340 Posts

Specializes in L & D; Postpartum.

The basics of treating heart failure may be the same whereever you go (but really, things do differ from area to area), but the logistics of getting that care differs vastly. Distances make a huge difference.

Many people who have chemo or radiation have the distinct advantage of going 10 or 15 minutes down the road for their daily or weekly treatments. My husband benefitted from that 4 years ago.

My dad, OTOH, for his chemo and radiation in the recent months, traveled 130 miles round trip. And that is the closest place to his town. Some people from that town, travel more to get to other centers that are not that close. It is a hardship that must be addressed in ways that people who live in much more populated areas can't imagine.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.
The basics of treating heart failure may be the same whereever you go (but really, things do differ from area to area), but the logistics of getting that care differs vastly. Distances make a huge difference.

Many people who have chemo or radiation have the distinct advantage of going 10 or 15 minutes down the road for their daily or weekly treatments. My husband benefitted from that 4 years ago.

My dad, OTOH, for his chemo and radiation in the recent months, traveled 130 miles round trip. And that is the closest place to his town. Some people from that town, travel more to get to other centers that are not that close. It is a hardship that must be addressed in ways that people who live in much more populated areas can't imagine.

There's no doubt that healthcare delivery in rural areas is different than in urban areas, but is the delivery of rural healthcare in Texas completely different than rural healthcare in Oklahoma?

tewdles, RN

3,156 Posts

Specializes in PICU, NICU, L&D, Public Health, Hospice.

Should the access to rural health care be completely dependent upon your ability to pay? That rural farmer (insert other self employed person) does NOT have the same access to health insurance as does the person working for the factory or hospital or other company with group benefits. So, you add the round trip expenses to the very expensive care (which may or may not be covered by the individual insurance policy) and "boom" you are on the pathway to financial devastation or perhaps the pathway to complete absence of care because you cannot even afford to get to the care AND pay for it too.

jmqphd

212 Posts

You're right of course. The PPACA was something intended for all Americans (except those exempted by HHS... which puzzles me, but oh, well.) At the same time, there is a huge amount of pandering going on. The middle class people who are dubious about it are told they are heartless and bigoted since this legislation is going to provide coverage for the 35 million folks who have none. Read the posts here and you'll see the issues of the poor do get mixed in with the "working poor" as well as the "I want that new pickup therefore can't afford insurance" crowd.

Looking to DC for a solution to something this complex is manifest foolishness. Same can be said about many state capitals. But some States will be innovative and raise the bar for the rest. If we keep talking about the helpless asthmatic child dying in the street for lack of medical care (or "breathalizer" as our splendid leader calls it) we will only be mud-slinging and denigrating each other. Let there be thought and innovation.

You ask what NV's version of reform would look like. Well, first of all, we are the hardest hit state in the union. Big headline in our paper today was celebrating the fact that our unemployment rate is all the way down to 12.9% (Whoo hoo! Break out the bubbly!) Let me tell you about my city. The poor get seen in ER's of course. But there are also clinics supported in part by the county, and in part by the largest hospital in town. There is also a pregnancy center where patients pay on a sliding scale. No baby need be born here without prenatal care. There is also a Blue Cross plan advertised for the uncovered family members of the working poor. It isn't free, but it is more than just catastrophic coverage. Medicaid reimburses the hospitals for folks that can't pay.

We're getting by. It isn't great but I haven't stumbled over dead people in the streets, yet.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.

Representative Ryan sells the idea of medicaid block grants as a way of allowing states to administer medicaid funds in the way that works best for them, which sounds great as a general idea. This would seem to imply that currently medicaid is rigid and only works in a single demographic, such as urban areas. Although medicaid already has mechanisms to serve the unique needs of various areas such as rural areas; transport outside of the patients community for care can qualify under medicaid, there are special programs to supplement reimbursements in rural areas that don't have the benefit of patient volume to adequately cover costs for things like doctors and CT scanners.

What Rep. Ryan means when he says that block grants would allow states to administer medicaid in a way that works for them is that it would allow states to drastically cut coverage. In Nevada for instance, Ryan's block grant proposal would force 136,000 Nevadans off of medicaid. Mississippi governor Barber loves the idea, even though it would boot 247,000 out of medicaid in Mississippi by 2021. By "do what works best for them" Rep Ryan appears to be referring to drastically increasing the number of poor who lack health care coverage.

This is bad not just in terms of a bleeding heart sympathy for the poor, but because it actually costs us a lot more money. At some point everyone ends up on medicare, either due to old age or disability. Just like private insurers, the goal of states is to keep as much of the costs of care out of their budget as possible, which unfortunately often means suboptimal or even non-existent care for common, relatively easily treatable conditions such as diabetes and hypertension. So we avoid the cost of $50 worth of meds a month and then the patient has a stroke and ends up in a Nursing home for the rest of their lives which puts on the medicare budget, or they need 3x week dialysis, which again moves them into medicare coverage. The problem is that while states save the $50 without having to pay for the exponentially more expensive consequences, wherever the money gets filtered through it all comes from us in one way or another.

That should be the goal, spend a little now to save a lot later, even if that means medicare and those responsible for it (the Federal government) needs to take a more proactive role in making the changes needed so that medicare inherits patients with reasonably well maintained health when they graduate from insurers, medicaid, etc, and enter into medicare, rather than inheriting a neglected and very expensive to care for population.

kcmylorn

991 Posts

i for one would like to know what all the healthcare dollars are paying for and why nurses and doctors are being laid off, wethe hospitals in america are so understaffed with nurses, doctors and ancillary employees? $4 million dollar salaries to pay for this crap, while 50 million americans are uninsured, under-insured and cannot access healthcare, have to file bankrupcy, forclosure and the healthcare benefits of working class america are being cut to the bone or removed. but some lout can finance and 'access' his mistress anytime he wants.

and to make matters worse- this story made it across "the pond" to england.

" the british tabloid the daily mail, has more details and pix of those involved. three's a crowd: top health insurance ceo fired from $4million salary job after fight with girlfriend's husband | mail online "

posted: sun, apr. 1, 2012, 2:42 pm

highmark ceo fired after assault charges

by darran simon

inquirer staff writer

ceo of pa. insurer highmark charged with assault

[/url]

highmark inc.'s kenneth r. melani, ceo of pennsylvania's largest health insurer who was supposed to take over that same post at independence blue cross under terms of a merger that never happened, has been fired, highmark announced sunday.

melani 58, had been on unpaid leave from the pittsburgh insurance company, where he was also president, following his arrest on charges stemming from a fist fight with his mistress' estranged husband last week.

his termination followed a meeting sunday of highmark's board of directors, the company said in a statement.

melani was charged with simple assault and criminal trespass, both misdemeanor offenses, after the alleged attack last sunday at his mistress' home in oakmont, a pittsburgh suburb. according to authorities, melani said that if the police had not been there, he would have killed melissa myler and her husband, mark.

"the board has reviewed this situation thoroughly and has taken decisive action to address the matter," said highmark's board chairman j. robert baum, who was named acting ceo when melani was placed on leave four days after trading punches with mark myler.

melani is "deeply disappointed and upset" by the board's move, according to a statement by his attorney, robert g. del greco, jr.

"we will be reviewing the legal propriety of dr. melani's dismissal and will act accordingly," del greco said.

melani had led highmark since 2003.

during that time, he "grew to become one of the most respected and successful healthcare organizations in the nation," del greco said.

the board, however, is "moving forward to identify a long-term successor to the ceo position," baum said in the company's statement.

under the merger proposed in 2007, melani was to become independence blue cross's new chief executive and joseph frick, who headed that company, was to assume the number-two spot.

but in one tense hearing on the merger plan, melani appeared angered when then-u.s. sen. arlen specter raised questions about his compensation. after stiff resistance, the two insurers withdrew their proposal in 2009.

melissa myler, 28, told oakmont police that melani had hired her last october. three weeks later, they started a romantic relationship. the two moved in together after melani's wife, tracy, told mark tyler about the affair in january, according to a copy of the police report.

two months later, melissa myler said she learned that melani was having her investigated by a private detective, the report said.

last sunday, melani showed up at the myler house, the police report said, and accused melissa myler of cheating.

"it's all about my money," he said, according to the report. then, he refused to leave.

mark myler took melani by the arm and got him outside on the front porch. that's where the fight broke out.

both men "had some swelling about the face and also had some minor bleeding," the police report said.

on sunday, liz williams, a spokeswoman for independence blue cross, cited the company's "strong, productive relationship with highmark." she added: "we continue to have confidence in the talent and

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