Within the next few years the U.S. is going to have a nationwide, single-payer system - page 5

Liberals and conservatives may be duking it out over the issue of universal healthcare, but more than a few participants at the Health Industry Group Purchasing Association's 2007 International Expo,... Read More

  1. by   Jolie
    Quote from Dierdre
    The point of my entire post was that there are many people, that are either uninsured or underinsured, and that the government already believes that I make too much money for any kind of subsidy. I have left the job I held for three years, and moved to a new one where insurance is affordable, but that makes no difference to the nurses that are left behind at that job. I don't know how things work in your part of the world, but in Oklahoma if you work in a nursing home you can pretty much kiss any chance of having worthwhile health insurance goodbye; any type of retirement or disability is a joke. The LPN's, forced out of the 'all RN' hospital policy in the larger cities are struggling to find positions that offer decent pay and benefits. Many nurses are so fed up with a system that 'offers the best healthcare system in the world' to the patients that are either rich enough or poor enough to get healthcare and excludes them from having adequate healthcare (unless they can prevail upon one of the 'kind' docs that visits the nursing home to write them a 'script) that they've left nursing altogether. Hard facts to swallow: according to 2007's numbers there are approximately 12,000 LPN's in the state of Oklahoma, approximately 4000 of those are working in nursing.

    Why aren't LPN's working in nursing in Oklahoma? *points at the lack of pay and more important BENEFITS* Why kill yourself working sixty hours a week for an employer that's going to force you to quit work, go on welfare, and admit yourself to the same nursing home you were working in two weeks ago if you become seriously ill. Think it can't happen? Think again.

    Until the problems of employers that offer substandard healthcare and benefits at massively inflated cost is addressed, the government is going to feel more and more pressure from lower-middle-class families who want their kids to have more healthcare than going to the Health Department for immunizations and going to the ER for real, serious problems, then this debate will continue. I think my kids deserve adequate medical care including yearly well child checkups. My pap smear? If I was still working at the nursing home, my attitude would be "Well, it's been five years, if there was something really wrong, I guess I'd know about it by now."
    So, given the situation in your area of the country, would you support my suggestion? Instead of government sponsored healthcare for all citizens (many of whom don't need it), working people who can't afford insurance (and don't qualify for Medicare or Medicaid) would be given a subsidy in an account that can only be used for insurance premiums and/or healthcare expenses. They have money to spend in the manner that best meets their family's needs, just as those of us who are insured do.
  2. by   NavyVet
    Quote from CRNA2007
    Mr. Bush lives in the real world. He doesn't govern by polls and he doesn't govern by emotion he is a realist. I can guarantee troops hold him in much higher regard than the previous occupant of the white house.
    I don't know how to say this in a way that doesn't appear to be attacking you, but I'll try.

    Your assertion that President G.W. Bush is better liked by the troops than Bill Clinton was is so far off base that you must either be very naive, or have no basis of experience to speak from, or you are just one of those guys who likes to push their agenda on other folks. I was in the Navy from 1996-2005, 9 years and 3 months so I served under both of the Presidents you are speaking of. I don't know what your background is, but please bear with me while I explain what I saw as a military member and why civilians here in the U.S. don't get an accurate view of what a military member thinks.

    I've been involved in many assemblies where the troops are gathered to receive a 'pep talk' from V.I.P's and voice our 'concerns, thought's, feelings' on things. These V.I.P.'s have been various high ranking Admirals/Generals/Regional Commanders, the Secretary of Defense, and Congressmen. Before these V.I.P.'s came aboard the ship the entire crew would receive their orders from the Captain about what we were to discuss, what was acceptable and what was not, what sort of general impression we were to give (happy, gungho, mission ready, etc...) Prior to the assemblies certain people were given questions on paper to ask in a fashion that gave the appearance of 'spontaneity'. These were entrusted to the guys who the Chain of Command could trust to stick to the script and not ask questions that would 'embarrass' the Captain or call into question the loyalty of the average military member. Questions like, "WTH is my deployment being extended an extra 3 months" or "Why did we get underway underprepared and with broken equipment that I have to try and fix out in the middle of the ocean now.".....those are examples of questions we were to steer away from.

    Now that was just my personal experience with these things. However, it leads me to believe that the soldiers talking with reporters on T.V. are being given guidelines of what they are to say as well. Same thing when it comes to the Secretary of Defense saying things like the troops are happy, they are proud of their mission, they feel they are making a difference...blah blah blah. If the troops who can think for themselves are being told what to say to the Defense Secretary, then it stands to reason that the information he gives to the civilian public is going to be skewed. While I'm thinking about it, what the hell does an 18-21 year old really know about the world and how can they say they are happy with the work they are doing? They have no life experience to use as a frame of reference to evaluate their actions.

    The point I'm trying to make is that YOU WILL NOT GET AN ACCURATE VIEWPOINT FROM ANY MILITARY MEMBER ON T.V. You may ask "Why NavyVet, if you are such a freethinker why don't you and the others who feel the same as you speak up at these assemblies?" Plain in simple, the answer is fear. Fear of reprisal and fear for what that reprisal will do to your family and their finances. Many military members are married with children at home waiting on them. Enlisted military members get paid just enough to be lower middle class on the wage scale. So, when we get in trouble and lose a 1/2 months pay for 2 months and are not allowed to leave the base for 30-45 days due to NJP, well it kind of puts you into a bit of a moral quandary. Do you speak your mind and then tell your wife that we are going to be behind on bills for 2 months and tell your kids that you have to live on the base for the next 6 weeks away from them because Daddy wanted to make a point, or do you shut your mouth and take whatever crap is thrown at you and just count the days until your enlistment is over to protect your family?

    Well, needless to say, I wasn't happy with what I saw going on around me and decided to vote my conscious with my feet as a fair amount of other military members have. For the record, of the thousands of military members I came into contact with while Clinton was in office, very few of them had anything bad to say other than the diehard ultraconservatives who tend to be a tad biased:trout:. Sure the base closings and restructuring upset some people, but if you are trying to insinuate that the average military member gave a ratsass that he had an extramarital dalliance then you would be incorrect sir. I got my paycheck 2x a month and wasn't asked to persecute a groundless war that I found morally repugnant. So yeah, you could say I liked President Clinton a little better. If the approval ratings are anything to go by it seems America liked President Clinton better as well. President Bush's approval rating is in the mid 30's I believe......60% of Americans can't be wrong can they?
    Also, before labels start getting thrown around, I consider myself an independent and voted for Bush in 2000 and against him in 2004.

    I apologize if I seemed to be ranting anywhere in there, I'm just getting real tired of stubborn people supporting a corrupt administration and a failed ideology.
  3. by   HM2VikingRN
    Thanks NAVYVET.

    I just do not understand how anyone can continue to defend our non-system that delivers worse results at lower costs. Providing insurance subsidies is an inefficient and more expensive way to provide insurance in the long run.
  4. by   NavyVet
    On the topic of Universal Healthcare Coverage.....

    It shames me to admit it, but I am currently without health insurance. We aren't necessarily poor, but still can't afford it. In the Navy I think I made $34K a year at my high point and used the military healthcare system without any problems. I got medical attention in a timely fashion with very few complaints in 9 years. Both of my children were born in military hospitals with no problems and no financial burden. (that is the closest thing to Universal Health Coverage I could come to in the U.S. even though it only covers a small amount of the American population 500,000 or so)

    Now that I'm out and a student (wife is an agency RN) my family will make about $75k this year. Her employer doesn't offer insurance so we had to find some on our own. To get very crappy insurance for my family is about $500 a month. To get insurance comparable to what a hospital offers its employees...or what I had in the Navy....costs about $800 a month. I just can't afford that with my mortgage, car payments, credit card payments, college costs, and the cost of running a household. Even though we do 'okay' financially, I still feel like we are part of the working poor. I can't imagine how it is for others with similar debt loads and a lower income.

    I really think the 'free market' system that is in place and some are advocating here, really is broken. I badly sprained my ankle 10 weeks ago...perhaps broke it and had to make the decision whether or not to go to the emergency room. I mean I was black and purple from heel to midcalf and because I know how to care for a sprained ankle, I decided not to go to the emergency room and spend $1500 bucks to find out if it was broke. I hoped it was a sprain and treated it as such. This was a mistake since I still have pain/joint popping 10 weeks later, but it was a lot of money to spend on a 'maybe'. If something were to happen to one of my kids or my wife....I would be screwed and just have to pay it out of pocket and hope and pray.

    Surely with how much we spend on taxes already we could get a system set up to allow everyone who needs it to seek care. If we have $100 billion to spend on war, surely we could find the money to spend on the people who pay these taxes. Its all a matter of priorities. If the cost of Universal Health Coverage is a 4 hour Emergency Room visit or that an 80 year old man has to wait 3-6 months to receive an elective hip replacement, then I am fine with that. If it means the middle class won't have make the decision to seek treatment based on the cost of treatment, or that maybe perhaps people will seek preventative treatment instead of emergency treatment all the time...well I see all that as a positive. You need funding for that? Stop prosecuting large scale imperialistic invasions with my taxes. If that's still not enough, then I'm willing to have my income taxed say 1-2% more to pay for it. There has to be a solution somewhere because what we have isn't good enough.
  5. by   FireStarterRN
    George W Bush lives in the real world? What world is that, the "Silver Spoon on Velvet Cushion World" that exists in the alternate dimension of "Silver Platter"? That's a place where the law of Karma gets delayed until your next life, and you get to go to an Ivy League university, barely make passing grades, snort lots of coke, sleep with many babes, then you get to be president!!!
  6. by   Jolie
    Quote from NavyVet

    I really think the 'free market' system that is in place and some are advocating here, really is broken. I badly sprained my ankle 10 weeks ago...perhaps broke it and had to make the decision whether or not to go to the emergency room. I mean I was black and purple from heel to midcalf and because I know how to care for a sprained ankle, I decided not to go to the emergency room and spend $1500 bucks to find out if it was broke. I hoped it was a sprain and treated it as such. This was a mistake since I still have pain/joint popping 10 weeks later, but it was a lot of money to spend on a 'maybe'. If something were to happen to one of my kids or my wife....I would be screwed and just have to pay it out of pocket and hope and pray.
    I don't understand why it was an "either, or" decision. Either the ER, at exorbitant cost, or no treatment at all. If you (understandably) wanted to avoid the cost of an ER visit, why did you not choose to go to your primary care provider at the first possible opportunity, where an evaluation and X-rays would have cost a fraction of an ER visit, yet you would still have received appropriate treatment for your condition.

    I understand your concerns over costs. I am insured, and I still face the same decisions. We have a high-deductible plan that requires us to pay the first $4000/year of medical expenses. We budget so that we have that much money available for medical expenses. So, when faced with an ER versus cheaper source of care decision, you can bet that we go for the cheaper source whenever possible. In 21 years of marriage, with 2 kids, we have only been to the ER twice, once with a child's head injury, and once when EMS insisted that an ambulance ride to the ER was warranted for a leg injury.

    Twice this year, we have had injuries that would not have been inappropriate for ER management, yet neither involved unmanageable pain, bleeding, or risk of permanent injury, so I opted to wait until morning when we could be seen in the doctor's office instead. The first time, I was out the door with a $45 bill, and the second time I was not billed at all, since I had just seen the doctor recently for a routine visit.

    I am sorry that you are continuing to have pain and instability with your ankle. I sincerely hope that you will consult with your PCP, as it is my experience that many are quite reasonable about treating and billing patients who they know are paying out of pocket.

    I don't believe this is strictly an insurance vs. non-insurance issue, since many insured people face the same decisions. I think it is a matter of choosing the most appropriate and cost-effective source of care, which, with the exception of immediately life- or limb-threatening illness or injury is rarely the ER.
  7. by   NavyVet
    I must admit you make some good points on the decision to seek medical treatment.
    I guess it has something to do with how I was raised. I grew up in a fairly poor family and we never had a Primary Care Physician, we only sought out medical treatment through the ER when we were injured, cracked skulls, broken bones that sort of thing, even then we had some form of insurance through my parent's employer. Through my time in the military I was treated by whoever was available whenever I was sick enough to warrant the time off of work to talk with a Doc....had pneumonia for a week before I was able to get to sick call

    Anyways, back to the point, I've sort of carried those bad habits into adulthood and never got a Primary Care Physician for my family. To be honest I have no idea what it costs to do business with them since my main form of care has been through the ER, or I've had insurance to take care of things previously. I shall certainly look into what PCM's are charging in my area. Thanks for the alternate viewpoint and giving me something to think about.
  8. by   Jolie

    Thanks for your reply. It is helpful to understand how other people arrive at decisions regarding their healthcare, especially issues like when to use the ER or not.

    Clearly, your injury warranted medical treatment. I know it can be difficult for healthcare professionals, let alone lay persons, to know whether an illness or injury is serious enough to warrant an ER visit or can wait for a non-emergent doctor's visit. But there are also a number of people who abuse the ER, and that is one aspect of a national healthcare plan that I fear would quickly spiral out of control cost-wise. Let me give an example.

    I have a neighbor who is insured by the same employer as I am, with the same plan. She is intelligent, and well educated (has an MBA), so it is not an issue of failing to understand her benefits or financial responsibilities. With her, it is all a matter of convenience, and "I want it now!" She recently went to the ER for a pregnancy test. She has a primary care doctor and an OB/GYN. She lives around the corner from a drug store where she could have purchased an OTC test for less than $10. But she wanted a "reliable" answer NOW, so she went to the ER and got indignant when they stated that they could not just run a pregnancy test without a doctor's order. The ER staff asked if they could call one of her doctors and arrange for a test in their office. She refused and insisted on being seen by an ER doc so that she could get an answer NOW. She hasn't told me the amount of the ER bill, but I'm sure it is several hundred dollars. Our insurance will require her to pay at least the first $250, depending on the status of her deductible, but won't refuse the charges outright.

    With a national health plan, ideally, everyone would choose a PCP and utilize that office for non-emergent visits. But in reality, I think it is likely that frivilous ER visits will INCREASE because of people like my neighbor who want it NOW. Placing responsibility on the individual for frivilous ER visits likely won't happen because ERs can't refuse to treat anyone, and individuals can't be dropped from national health care for failing to pay their portion of their bills.

    I don't pretend to know all of the answers for healthcare funding, but I am certain that without individual responsibility for choosing treatment and paying the bill, costs will never be brought under control.
  9. by   pickledpepperRN
    I know that more than one hospital ER if the triage nurse assesses that the patient does not need to be assigned to a nurse a volunteer accompanies the patient to the outpatient/urgent care center across the street. It is staffed with two physicians, LVNs and techs.
    ERs are not required to do more than stabilize a patient.

    I don't think that will change when everyone is covered.
    Why should the ER do a pregnancy test on an otherwise healthy person in the ER?
    I don't understand why it was the most convenient and reliable.
  10. by   ZASHAGALKA
    Quote from NavyVet
    Sure the base closings and restructuring upset some people, but if you are trying to insinuate that the average military member gave a (redacted) that he had an extramarital dalliance then you would be incorrect sir.
    No, I think the average military member had a severe problem with President Clinton's "peace dividend" AKA "screw the military".

    However, wrong topic, wrong thread.

    Timothy (U.S. Navy, 1987-1993)
    Last edit by ZASHAGALKA on Nov 17, '07
  11. by   NavyVet
    Ahhhh, I think I'm remembering what your talking about now...

    Clinton was president for 4 years before I joined in '96 and I do remember some grumbling going on about the downsizing or rightsizing, whatever PC term it was given. Some people who wanted to stay in the service were not allowed to re-enlist. Is this what you're referring to? I recall that there were quite a few guys considering taking the early retirement option around that time too. Anyways, I guess I should qualify my prior statement in that neither I nor the people in my peer group (E-4 and below at that time) had a problem with Clinton. It certainly wasn't a topic of conversation for us at least. I can see how some of the guys coming up for re-enlistment or close to retirement may have had a problem with his policies around that time though.

    I guess overall, I was a lot happier working for Clinton rather than the Bush administration and that will color my perception of events. I'm just so frustrated with how the past 7 years have gone politically and ready to put this dark age of American politics behind us.
  12. by   ZASHAGALKA
    Quote from NavyVet
    I guess overall, I was a lot happier working for Clinton rather than the Bush administration and that will color my perception of events. I'm just so frustrated with how the past 7 years have gone politically and ready to put this dark age of American politics behind us.
    Well, I for one, consider it an honor to have served under Ronald Reagan as my CINC.

    It was an honor and a privilege to be one of the last 'cold warriors'. The Berlin Wall fell on my watch. Even if I was only a small part of it, I was a part of it. The world turned and I was not only there to see it; I was on duty.

    Clinton? There is a reason why my service ended in 1993. I went into the reserves from active duty in 1991. I was on my 2 week drill Jan 20, 1993, when, at lunchtime, I was walking from the chow hall and the thought struck me cold: William Jefferson Clinton was NOW my CINC. That was one turn in the world too much for me.

    I left the reserves very soon after.

    But, to link that to THIS thread. AT THAT TIME, the Co-Presidents were already talking about their national healthcare that was coming 'in the next few years'. It didn't happen then; it won't happen now. President Clinton himself noted that 'the era of big government is over'. Why would he do that? Simple. Political expediency.

    The whole chimera of government, from Nixon forward, has made the American people distrustful of gov't in a way that hasn't taken hold in other nations - nations WITH gov't restricted care. Maybe it's the two-party 'gotcha' system we live under. When the 'other guy' is always the devil, incarnate, then it's hard to trust a gov't that will someday place the devil in charge of whatever charge you give to it. Americans are jaded on government. Whatever the case, I just don't see Americans trusting any government enough to place the kind of trust that it would take to bring about such a system.

    Both major Democrat candidates are stressing that they only want to incrementally 'tweak' the system. Even THEY know this nation isn't ready for gov't restricted care.

    FDR thought it was too bold an idea get passed. LBJ thought it was too bold an idea to get passed. HRC thinks it's too bold an idea to pass. Anybody here that thinks it's a plausible idea to pass 'in the next few years'; you just aren't paying attention. I wouldn't place too much faith in an idea that even the leaders of the movement have consistently feared is much too bold.

    Look at Great Britain: they only passed the NHS after such a change in gov't that there was no political resistance. Even at the Democrats' best, during LBJ, that was STILL not enough to do any more than Medicare. The Great Society wasn't great enough for gov't restricted care.

    Democrats just don't have any margin of error on this, much less a large one. A 51%/49% Congress means nothing will pass that isn't such a severe compromise that it simply wouldn't be a single-payer anything.

    The gov't would have to change in a very lopsided way for that to change, anytime soon. Americans like divided gov't, for this reason. Give the Democrats back the WH in '08 and the American People will give the Republicans back the Congress in '10. We don't want any of them to have enough power to do ANYTHING to us. We aren't a very trusting lot when it comes to gov't intentions.

    Thank God.

    Last edit by ZASHAGALKA on Nov 18, '07
  13. by   NavyVet
    Interesting well thought out post devoid of acrimonious political rhetoric. I may not agree with everything you have to say, but I can respect the intellect it takes to put forth your ideas and support them in a classy way. You sir get a gold star I'm too tired to continue tonight, but rest assured I shall give some thought about the points you made.