OPRAH "Sick in America: It can happen to you"

[pickledpepperRN]

Did you watch Oprah?

Sick in America: It can happen to you:

http://www2.oprah.com/index.jhtml

Healthcare crisis:

http://www2.oprah.com/world/health/slide/20070927/health_284_101.jhtml?promocode=HP22

[sanctuary, BSN, MSN, RN]

For all who feel that a "Government Run Health Care System" will be more expensive, or hugely invasive , remember that our dear elected officials, from the Prez on down to the newest house member all have it, for free, no co-pay, no problem, and they are not complaining.

[sharona97, BSN, RN]

The Washington D.C. boys club generally don't complain about their federal benefits. The successful players IMO work hard to change whatever in their own state. Or work to pass bills in D.C..

[jmgrn65, RN]

People don't die waiting on Heart Surgery in the US, if they need it they can get it immediately.

The reason there is a long wait to get into see a specialist is simple, not enough specialists.

We at least have health care available. 3rd world countries don't have insurance they don't even know what that word means. if they don't have money then they don't get any care. Unless they are lucky enough to get to a clinic. Yes I have been to 3rd world country.

There is no easy answer. I beleive that every child is entitled to health care. I don't know how I feel about all adults, because there is too much abuse of the system. IMO

[HM2VikingRN, RN]

from don mccanne at pnhp:

kaiser daily health policy report

september 25, 2007

employers, health insurers increasingly use care managers to review

physicians' treatment plans, ensure they conform to evidence-based

practices

a growing number of employers and health insurers are using care

managers, or integrated health managers, who "essentially audit an

employee's health care and look for ways to both improve outcomes and

save money," the wall street journal reports. according to the

consulting firm deloitte & touche, there are more than 200 care

managers in the u.s. who provide "programs designed to save employers

and health plans money by reviewing employees' health care claims and

targeting high-cost cases for special management," the journal reports.

care managers often review physicians' treatment plans to ensure they

are following established evidence-based practices and help

coordinate care for people with serious illnesses. based on the

reviews, "the companies then may nix certain drugs or procedures,"

the journal reports.

critics say that some of the programs "intrude into the private

relationship between patients and their doctors and that they add yet

another layer of bureaucracy, while saving money mostly by denying or

switching specific drugs and procedures," according to the journal.

other critics say that care managers can be inflexible and ignore

differences between individual patients and the judgment of

physicians and nurses.

cecil wilson, immediate past chair of the american medical

association, said, "the patient's physician should ultimately be the

one in charge," adding that cost-saving should not be the main goal

of care managers (mcqueen, wall street journal, 9/25).

http://www.kaisernetwork.org/daily_reports/print_report.cfm?

dr_id=47740&dr_cat=3

comment: big brother is watching you. only he is not from the

government. he is an agent of the invisible hand.

intrusive micromanagement of health care today is not coming from an

oppressive government, but rather it is an innovation of the free

marketplace.

rather than micromanaging health care, the stewards of a government-

administered single payer system would macromanage the funds to pay

for health care. health care micromanagement decisions would be left

to patients in consultation with their health care practitioners.

of course, oversight of the spending of public funds would be

essential to be certain that they are not inappropriately diverted

through fraud and abuse. but that would be at arms length and not

through disruptive intrusions.

again, the private industry is foisting off on us yet more of its

primary product: wasteful administrative excesses.

[lamazeteacher]

Nova Scotia is a smaller, rugged province with people who are accustomed to not getting all the things they want. Because there are less people working, less money is in the budget than there is in more highly populated provinces. The terrain makes rapid travel difficult. It saddens me to think of someone dying while waiting for bypass surgery, and the management of your uncle's care was deficient. That said, I wonder what symptoms may have gone unreported, since there was obviously great anger with a physician who was "too busy". Surely a primary care provider should have been keeping track of him in the meanwhile, in case additional circulatory problems of his heart happened (which could have been the case). Or, and this is bold of me, was the anger preventing him from seeing anyone?

Regarding the family member who suffered pain while awaiting PT, having to travel far for it. Was no analgesia given? Could home health PT have been provided? And was it said that PT would diminish or abolish the pain, if only it was closer?

I certainly sympathize with the scenarios you presented, and hope they are exceptions and not the rule, in Nova Scotia, which is gorgeous. I've visited it and travelled most of Cape Breton Island, have friends there whose adult children have moved away, for lack of job opportunities. Alexander Graham Bell invented the telephone there (probably due to frustration with the lack of communication).

As I've said, I've seen the system working well in larger provinces, and occasionally my family there has needed to remind healthcare providers that they're out there, waiting, in need of care while waiting. They get it.

[HM2VikingRN, RN]

Food for thought:

Americans already pay for national health insurance — they just don’t get it. In this 2002 Health Affairs paper, David Himmelstein and Steffie Woolhandler point out that the standard accounting miscategorizes two major public health expenditures as private: the tax credit for private health insurance and the cost of the Federal Employees Health Benefit Program.

When these costs are accounted for, it becomes evident that Americans already pay the world’s highest health care taxes. In fact, the amount of public health spending in the U.S. is greater than the combined public and private spending of nations which provide universal comprehensive health insurance. A single-payer system could provide such coverage to all Americans with no need for additional health dollars.

http://www.pnhp.org/publications/payingnotgetting.pdf

Source: http://www.pnhp.org/publications/payingnotgetting.pdf

[HM2VikingRN, RN]

i'm from canada, and the system does not work there, do not assume that in comparing government vrs insurance systems that by eliminating the money issue for the consumer that money issues disappear.

each hospital is given a certain amount of money to run each year, and if it is a bad year they get by without essential staff and equipment. if we have a good year there will absolutley be a cut in funding the next year. the government does not deny services, but they do put you on a waiting list for virtually every procedure you might need, and many die waiting, or get sicker. you can lose your job and go bankrupt waiting as easily as when you have high copays. waits are long because there is not enough money in the system to provide timely care.

an elderly person suffers an acute injury and needs nursing home care. there is an eighteen month waiting list to get into a nursing home in nova scotia. each hopital deals with this by setting aside a unit to take people waiting for a nursing home. there is even a six month wait to get on the hospital unit. people die and decline because they don't get the stimulation a nursing home provides, hospital nurses give sick patients priority care (as they should).

my uncle needed a cardiac bypass, and after seeing the cardiologist was on the waiting list for 4 months. the cardiologist was too busy to see him again until the surgery. he died the weekend before surgery was scheduled.

my mother needed physiotherapy but the closest office was 90 minutes away, and the waiting list to get in was 6 weeks. she had to move in with relatives so she would be close enough to tolerate the drive, and wait in pain for the 6 weeks.

a september 2007 newspaper article talked about a 29yo female who suffered a brain injury four years ago, and is still waiting to get into rehab. (the article requires payment the link, sorry)

in the canadian system money still rules, and long wait lists weed out lots of patients. it is illegal to set up private care that would give the rich an advantage. if borrowing or selling would save a loved one's life i'd do it, but i wish we had that option.

no system is perfect. although cathy crimmins in "where is the mango princess" clearly states the opposite about brain injury care in canada vs the us. she is an american who became a single payer advocate following her husbands brain injury while visiting canada. he received much better care in canada than he did upon return to the us.

from a population outcomes viewpoint the canadian system produces better results. see:

objectives. we compared health status, access to care, and utilization of medical services in the united states and canada, and compared disparities according to race, income, and immigrant status.

methods. we analyzed population-based data on 3505 canadian and 5183 us adults from the joint canada/us survey of health. controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care, and as a predictor of disparities in these measures.

results. in multivariate analyses, us respondents (compared with canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. disparities on the basis of race, income, and immigrant status were present in both countries, but were more extreme in the united states.

conclusions. united states residents are less able to access care than are canadians.vuniversal coverage appears to reduce most disparities in access to care.

(am j public health. 2006;96:xxx-xxx. doi:10.2105/ajph.2004.059402)

source: http://www.pnhp.org/canadastudy/canadausstudy.pdf accessed 10/2/2007.

[HM2VikingRN, RN]

further resources about the disadvantages of "for profit" systems:

for-profit, investor-owned hospitals (link 11, 22, 33, & 44), hmos5 and nursing homes6 have higher costs and score lower on most measures of quality than their non-profit counterparts.

1. editorial by david himmelstein, md and steffie woolhandler, md in the canadian medical association journal

2. devereaux, pj “payments at for-profit and non-profit hospitals,” can. med. assoc. j., jun 2004; 170

3. devereaux, pj “mortality rates of for-profit and non-profit hospitals,” can. med. assoc. j, may 2002; 166

4. himmelstein, et al “costs of care and admin. at for-profit and other hospitals in the u.s.” nejm 336, 1997

5. himmelstein, et al “quality of care at investor-owned vs. not-for-profit hmos” jama 282(2); july 14, 1999

6. harrington et al, “himmelstein, et al “quality of care at investor-owned vs. not-for-profit hmos” jama 282(2); july 14, 1999,” american journal of public health; vol 91, no. 9, september 2001

source:

http://www.pnhp.org/single_payer_resources/pnhp_research_the_case_for_a_national_health_program.php

[lamazeteacher]

Your questions are the very ones that concern The Physicians' Working Group for Single Payer National Health Insurance (thank you HMViking, for making us aware of their existance).

Until a plan is actually completed, it can't be presented for opinion. I doubt that hospitals will be bought, as they aren't owned by anyone from whom they could be bought. They say they're Board directed, non profit making organizations, and should be happy to have funds they've been lacking from payments not made. The only purchases of hospitals that happen now, are by huge conglomerates, like Sutter, Kaiser, etc. Their CEOs make enormous salaries that would need to be cut down, as they take care away from people, and enable those organizations to lobby against a Single Payer Plan for that reason.

Other countries with similar programs, do have government employed doctors. Looking around, I see formerly government employed retirees having great retirement benefits......

Of course each doctor wants to run the show, and has differing opinions about everything from treatment modalities to dress, behavior, and need for adjunctive care, and everything under the sun and moon. I have a particularly nasty URI presently, which needed medical care Sunday last. I saw a doctor at an urgent care facility of Sutter's Health Care Foundation. He gave me great service, including an aerosol treatment. The next day I went back for another treatment, and the PA there dissed everything the doctor had done. Then I saw another doctor who had another opinion. No wonder the public gets confused and angry! I was lucky to have a handle on my own needs, and what meds are contraindicated for me (short version of a longer story).

[HM2VikingRN, RN]

Nova Scotia also illustrates the importance of federally funding a universal health care system with management being done at the state or provincial level.