Obamacare? what are your thoughts

MunoRN, RN · Apr 28, 2014

I don't disagree that there are those who will get something for free that the rest of us pay for (although about 2/3 of those without insurance prior to Obamcare actually do work).

But to cut out the costs those folks impose on the system requires eliminating the sources of those costs; primarily acute care. From a practical standpoint this would require some way of determining what a patient can potentially pay for. A patient who presents to the ER with a STEMI might not be able to get a heart cath based on their financial situation, they'll get a morphine drip and hopefully a quiet room to pass away in (I assume we'd be willing to at least provide that). It's frustrating, I get it, but we can't have it both ways.

Not_A_Hat_Person, RN · Apr 28, 2014

You're assuming that the better jobs exist. Advancing your education does NOT guarantee a job. And what is wrong with people using EBT (which many states use for unemployment and court-ordered child support) to buy groceries? I'm sure you have items in your grocery cart that other people don't like.

toomuchbaloney · Apr 28, 2014

Maybe I just don't see the big picture. I see the same drunks, addicts, and young adults with chronic illnesses, week after week after week. Changing nothing, and getting free health care via Medicaid.
I stand behind people who buy steak and crab legs with their LINK cards. It's a tired old story, I get tired of repeating it, just as much as some of you get tired of hearing it.
Maybe if I saw more of the working poor where I live, I'd be more on board with what some of you believe. But I don't. Very few of those who receive the services available, want to lose those services by getting a job. Or changing their jobs. Or advancing their education to attain a better job.
That's what I see where I live.

Perspective is everything.

The RN who works in high risk L&D sees pregnancy and childbirth as dangerous and life threatening.

The PICU professional sees children as future tragedies waiting to break a parent's heart.

The fireman sees homes as fire risk. The police sees potential criminals, etc. You see poor people who shouldn't eat steak or buy shell fish with their SNAP benefits.

We seem, as a country, willing to give a pass to crooks and criminals in the ruling classes but quick to condemn the fearful self preservation activity of the very poor. Lots of people are fearful about changing jobs or risking their status quo in today's economy.

imintrouble, BSN, RN · Apr 28, 2014

Perspective is everything.
The RN who works in high risk L&D sees pregnancy and childbirth as dangerous and life threatening.
The PICU professional sees children as future tragedies waiting to break a parent's heart.
The fireman sees homes as fire risk. The police sees potential criminals, etc. You see poor people who shouldn't eat steak or buy shell fish with their SNAP benefits.
We seem, as a country, willing to give a pass to crooks and criminals in the ruling classes but quick to condemn the fearful self preservation activity of the very poor. Lots of people are fearful about changing jobs or risking their status quo in today's economy.

Of all the posters on this entire website, you'd be the one who could make me think differently.

I see things the way you describe them. I then try to resolve those things with what I believe.

I resent people who can eat whatever they want for free. Placing in their cart things I can't afford, and I work two jobs. Tell me how I can get around that. Really, how can I NOT resent that? I'm not small, mean spirited, or miserly. I give to charities. I share what I have. But what I give, and who I give to are MY choices.

I'm taxed, so that the government can decide who gets my money. Sometimes who gets my tax money leaves me scratching my head....and resentful.

Lots of people are afraid of losing what they have. I'll agree.

I see a difference in someone afraid to lose a job, and someone afraid to lose their free ride. Two different kinds of people. Two different sets of values.

As far as the ruling class crooks getting a pass, I don't think I do that, but maybe I do.

MunoRN, RN · Apr 28, 2014

Of all the posters on this entire website, you'd be the one who could make me think differently.
I see things the way you describe them. I then try to resolve those things with what I believe.
I resent people who can eat whatever they want for free. Placing in their cart things I can't afford, and I work two jobs. Tell me how I can get around that. Really, how can I NOT resent that? I'm not small, mean spirited, or miserly. I give to charities. I share what I have. But what I give, and who I give to are MY choices.
I'm taxed, so that the government can decide who gets my money. Sometimes who gets my tax money leaves me scratching my head....and resentful.
Lots of people are afraid of losing what they have. I'll agree.
I see a difference in someone afraid to lose a job, and someone afraid to lose their free ride. Two different kinds of people. Two different sets of values.
As far as the ruling class crooks getting a pass, I don't think I do that, but maybe I do.

I don't think there is any expectation that you shouldn't be resentful, I think most people of all political views are resentful of those who take advantage of the system.

The question is how far we're willing to go limit the source of that resentment; are you willing to let someone die in order to limit them to only what they deserve? And how do we define what people are limited to? Those now entering medicare will cost 4 times what they put in, should only one quarter of them get care?

toomuchbaloney · Apr 28, 2014

Of all the posters on this entire website, you'd be the one who could make me think differently.
I see things the way you describe them. I then try to resolve those things with what I believe.
I resent people who can eat whatever they want for free. Placing in their cart things I can't afford, and I work two jobs. Tell me how I can get around that. Really, how can I NOT resent that? I'm not small, mean spirited, or miserly. I give to charities. I share what I have. But what I give, and who I give to are MY choices.
I'm taxed, so that the government can decide who gets my money. Sometimes who gets my tax money leaves me scratching my head....and resentful.
Lots of people are afraid of losing what they have. I'll agree.
I see a difference in someone afraid to lose a job, and someone afraid to lose their free ride. Two different kinds of people. Two different sets of values.
As far as the ruling class crooks getting a pass, I don't think I do that, but maybe I do.

I am not all that different from you, probably, in most ways that we measure life in this country.

I too, have watched SNAP recipients make choices that I would never make nor recommend. I have watched the desperately poor spend their last $5 not on a bag of rice and staple food but on cheap wine. I have cared for people who were ill or injured as a direct result of their own poor choices, some of them died. It is so easy to build resentment, especially over time.

I also have witnessed many many more of the working poor with great dignity and desire to do well. Those are the people that I spend more time with, by choice. I prefer to focus on how we might help good people.

As an aside, Senator Murkowski here in AK is complaining about the newer requirements for stores who accept SNAP. It is unreasonable to expect that the stores here would in general carry fresh produce or dairy products in order to accept SNAP cards.

imintrouble, BSN, RN · Apr 28, 2014

No, I'm not willing to let someone die in order to appease my sense of fair play.

But then you should agree that allowing 18 year olds on Medicaid, to call an ambulance to the ER for a HA, should have a finite amount of free trips.

As far as the Medicare question goes, there are abuses there too. When almost all of a persons health care dollars are spent in the last 6months?? of life, somebody's not speaking plainly to the family. Somebody's not saying the hard words, or making the tough choices.

ajw49886 · Apr 28, 2014

Really? We are going to bust out the age old food stamp myth that everyone you see using a food stamp card is a worthless bum. How do you know? So you ask each one? So they are buying steak and crab legs, at least they aren't eating junk but again who cares. People need to mind your own business. The amount of money that comes out of your pay check for welfare is around 30.00 a year.

imintrouble, BSN, RN · Apr 28, 2014

Really? We are going to bust out the age old food stamp myth that everyone you see using a food stamp card is a worthless bum. How do you know? So you ask each one? So they are buying steak and crab legs, at least they aren't eating junk but again who cares. People need to mind your own business. The amount of money that comes out of your pay check for welfare is around 30.00 a year.

You have effectively shut off a pretty reasonable discussion by suggesting I'm unreasonable in what I believe. Or that I'm a small minded busybody.

It's why we yell at each other all the time, or simmer in our own rage.

ajw49886 · Apr 28, 2014

Is it unreasonable to be tired of that discussion. Is it unreasonable to ask you if you personally know or ask everyone you see using a foodstamp card if they work. Do you watch people pay for their groceries because I can honestly say that I do not care enough to scrutinize how he people around me pay for their groceries. What I am say is yes it is unreasonable to generalize a whole system based on old wives tales that have been around since I was a kid. Maybe your offended by my comment because you know that it isn't something that you really see all the time. If you really want to have a reasonable discussion then yes, I had to use foodstamps while I attended college and I am beyond thankful for them because I am now in you opinion a contributing member of society since my first degree wasn't cutting it. Without food stamps I would probably still be poor and working for minimum wage instead of now middle class. And to bring this discussion back to obamacare, I am thankful for that too. Without obamacare my 62 year old mother whose 20 year position was eliminated so they could pay a 21 year old 30,000 a year less would not have health insurance. So I am relieved it is there for her now that she is a freeloader.

toomuchbaloney · Apr 28, 2014

No, I'm not willing to let someone die in order to appease my sense of fair play.
But then you should agree that allowing 18 year olds on Medicaid, to call an ambulance to the ER for a HA, should have a finite amount of free trips.
As far as the Medicare question goes, there are abuses there too. When almost all of a persons health care dollars are spent in the last 6months?? of life, somebody's not speaking plainly to the family. Somebody's not saying the hard words, or making the tough choices.

The expenditures in the last 6 months are the responsibility of the health care professionals, in my view. The families are acting on good faith and hope for the most part. The professionals have the moral obligation to provide the necessary information regarding quality AND quantity of life in those circumstances and they are failing miserably. The providers are the ones ordering the additional tests, the consultations, the surgical interventions, etc. Before we blame families we should be holding providers accountable for those expenditures.

Again, just like in SNAP or voting, the big fraud doesn't occur at the individual level. It occurs at the higher provider levels where there is serious money to be made.

Nothing is free. There are no free ambulance rides to the ED.

Put a number limit on the ambulance rides for the poor (no matter the age) and you simply insure that at some point they will not get to the health provider when they need to. Sure we can do that, we have been in the business of rationing care based upon money for some time now in the USA. There is a very real human cost to rationing that sort of access simply because it is expensive. The question is, from my perspective, is that how we want to quantify and qualify our health care in America?

We can simply determine that something is expensive and then limit access to it. Or we can determine that getting poor people to and from needed health professional interactions is a problem and then look for resolutions to that problem. Here in AK getting too and from clinics, EDs, and PCPs can be an expensive, stressful, and time consuming endeavor, especially if you are poor.

MunoRN, RN · Apr 29, 2014

No, I'm not willing to let someone die in order to appease my sense of fair play.
But then you should agree that allowing 18 year olds on Medicaid, to call an ambulance to the ER for a HA, should have a finite amount of free trips.
As far as the Medicare question goes, there are abuses there too. When almost all of a persons health care dollars are spent in the last 6months?? of life, somebody's not speaking plainly to the family. Somebody's not saying the hard words, or making the tough choices.

I completely agree that dealing with overall costs needs to be just as much a priority as dealing with how we divvy up those overall costs. But even if we manage to cut costs far more than seems realistic in today's political environment we still need a way to divide that cost burden, regardless of what it is, in a way that is compatible with our views that we're not going to just let people die while not also increasing that overall cost burden.

We do spend way too much on futile and torturous care at the end of life, although I don't see that changing anytime soon in the current political environment. The term "death panel" as popularized by the McCain/Palin campaign referred to a proposed change to medicare reimbursement rules that would have added end-of-life counseling as a reimbursable service. This basically meant that Physicians could get reimbursed for discussing what end-of-life care involves (aggressive ICU care vs comfort care) and documenting the patients wishes, which in many states means filling out a POLST/MOLST form. If just trying educate a patient about end-of-life care and documenting their wishes is essentially a political land mine, I don't see us making any progress on establishing more realistic futile care standards.

The problem with current way we try to save money by limiting access is that it doesn't actually save any money. We basically leave a portion of the population out of healthcare but only a part of it. We try to save money by not covering the management of someone's diabetes or high blood pressure but only in the non-acute, chronic management phase. Once those same conditions manifest themselves as something exponentially more expensive to treat, such as an MI, renal failure, or stroke only then do we decide to accept responsibility for the costs. In other words, we're actually choosing to pay significantly more than we may need to.