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ZASHAGALKA RN

Critical Care
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ZASHAGALKA has 15 years experience as a RN and specializes in Critical Care.

44 male, wonderfully married, 3 boys and a girl

ZASHAGALKA's Latest Activity

  1. A free market will rise to meet demand. There are billions of cell phones on the market and in use - right now. Nobody had to ration them, and the competition to put them in YOUR hands have made them cheap: cheaper than that black rotary-dial phone was 30 yrs ago. Here's a four-part plan to make health care affordable. The number one aspect of any such plan is that it must be primary-payor: the user must retain control of the dollars in order to maintain cost-conscience choice. 1. End employer tax breaks for coverage. Employer provided coverage would fall to nothing inside of 3 yrs. Good. You shouldn't be forced to keep a job to keep insurance. 2. Give citizens a 2-fold tax break. A. - a $5,000/person Health Savings Account (HSA) tax deduction that allows a pool of money to grow tax free for use in health care. Similar to the cafeteria/flex plans many employers use now, but able to "rollover" year to year. When the average person is healthy - in their 20's, this account will build as it's not used much so that, when you're 50-ish, and more prone to chronic problems, you have a relatively big account to pay for care. B. - Make a catastrophic plan tax deductible as well. 3. Catastrophic Insurance. - Covers only big expenses. Your car insurance doesn't pay for gas and tune-ups, and neither should health INSURANCE. Today's Health Insurance isn't insurance at all; it's pre-paid health care. Make it Insurance: 5k/yr deductible (conveniently the size of your HSA) - when your HSA is depleted, catastrophic coverage kicks in. But. Not before. 4. Gov't pro-rated coverage for anybody in the gap - make it a % of income so that, at about 50k for a family of four, it becomes cheaper to get your own, using the methods above. That gov't asst would extend to the chronically ill. For example: It's cheaper for society to ensure that a diabetic has access to the right primary care than it is to treat them for non-compliance. ~~~ Right now, Geico, State Farm, Farmer's, All State - they all market heavily to YOU for their business. Why is that? They must compete TO you for YOUR dollars. Why doesn't Blue Cross have a gecko hawking health care to you? You don't count; your employer provides your insurance and YOU have no say. THAT could change. Give people control over their own dollars and watch health care change. With most routine care being paid "out of pocket", there will be competition for those dollars. "Come to OUR ER, and any CT scans will be free!" LOL. There are better methods than gov't run care. There are even better methods to universality than gov't run care. Gov't run care isn't about being fair - or universal. It's about lobbyists having more of a say in what kind of care you get than YOU do. Money is power and gov't restricted care is about a few in gov't having access to the power that is 1/7th of the economy. AND. NOT. YOU. ~faith, Timothy.
  2. 1. I think you will see 'pay as you go' (no insurance) clinics in Walmarts, etc., be a standard of care within 10 yrs. It's already starting. Just as $4 generic prescriptions didn't need a huge gov't bureaucracy to become a standard with lots of big-name pharmacies. The free market does the best job of mitigating price while expanding quality and cutting edge. 2. Who wants things to remain the same? I advocate for the government to become LESS intrusive in health care. Gov't restricted health care advocates for MORE restrictive gov't interference. I don't know anybody that wants more of the same. 3. What I specifically advocate is that the gov't end tax breaks for businesses to provide for health care and instead provide those breaks directly to consumers. That would break the back of gov't supported (with lobbiest infested rules for care) tax breaks to businesses and put health care back in the hands of individuals. Combine that with health savings accounts and catastrophic insurance, and you would have a model that would control pricing and bring health care to the masses. I don't depend on my employer for my car insurance, and I shouldn't need to for my health care. Nobody should be forced to keep a job in order to keep health insurance. THEN, after the gov't gets out of the business of interfering with care, THEN, the gov't could set up a catch all plan to insure that everybody is covered. 4. Universal health care isn't about universal coverage, at all. There are far cheaper -and less intrusive - ways to accomplish that. It's about controlling YOUR health care. It's about the money - why let YOU decide how to spend YOUR money best, when some bureaucrat in Washington knows YOUR health needs better than you do - and has the actuarial tables to prove it! 5. The only reason why a CT scan costs a thousand dollars is because, get this - YOU DON'T ACTUALLY PAY FOR IT. Remove the middle man and it would be far less. In order to have a market for a product, that market MUST be created at a price that will sustain it. Nobody advocates leaving things status quo. I advocate a better system that keeps Washington out of your lives and provides par excellent care to everybody - with no rationing lines. Gov't restricted health care advocates want a fair share in a dismal gov't outcome for all. ~~~~ I advocate that we all have the ability/opportunity to have blackberry cell phones. Gov't restricted advocates argue that, out of fairness to everybody, we must all have black box rotary-dial phones. Would you want to bring back Ma Bell and that black rotary-dial box phone for all? For goodness' sakes, then, WHY ON EARTH would you want to do the same to health care? If you advocate trusting the gov't with your care, then, having put your faith in a bureaucracy for such a personal and important aspect of your life, you cannot then complain that such a bureaucracy ACTS like a - BUREAUCRACY. ~faith, Timothy.
  3. ZASHAGALKA

    Texas girl gets heart transplant, sister waits

    [YOUTUBE] [/YOUTUBE] ~faith, Timothy.
  4. http://www.childrens.com/PatientsFamilies/News/texas-girl-gets-heart-transplant-sister-waits.cfm (Shayde and Emily Smith) "Less than one-in-a-million children are diagnosed with restrictive cardiomyopathy. For two in the same family to be struck with it is rare; for sisters to have it is almost unheard of. When Emily and Shayde Smith's parents were told last March that their daughters share the disease, shock doesn't accurately describe the feelings that followed." Emily Smith went home from the hospital this past Wed, 1/29, s/p Heart Transplant Surgery. ~faith, Timothy.
  5. I've worked for a VA Admin Hospital. I know you work there, now. Nevertheless. Ask a wide range of vets (not just your patients) what they think about the VA. You won't get an overwhelmingly enthusiastic answer. . . Thankfully, most of them have a CHOICE. A gov't mandated option is anti-choice. It's not about providing a better product at a superior price. Its about ensuring that Big Health, Inc., does NOT NEED your choice in selling it's product. (These businesses will not go away; they'll just take over - via superior lobbying.) Except now, you no longer have a choice. Halliburton, in charge of YOUR health care. Take it, or leave it. Gov't rationed health care is about those that would be in charge of the rationing. It has little to do and simply isn't in the best interests of - those that will be rationed from care as a result. (That would be you.) Not everybody is convinced that the VA is the model of care you suggest. I KNOW. I KNOW. President Bush's Administration vastly improved the care over what it was when I worked there, under Clinton. Still. (and WHAT IS THIS with you gaining on me in post counts? I take a little vacation from the computer . . . sheesh!) ~faith, Timothy.
  6. The system is much more equitable NOW when 86% of people have access to some form of insured care (with slightly more when you factor in that some have access to free or reduced cost clinics) and 100% of people have access to emergency care - than it will be when access to both routine AND emergency care is swamped. Imagine what it could be if the gov't got out of the way? I'll tell you what it would be: the absolute best mix of quality for price. Instead, the solution for gov't interference in your health care is - drumroll - MORE gov't interference in your health care. Amazing. So, because a black rotary dial phone from MA Bell is preferable to the risk of the market place, we should all trade in our cell phones and go back to the days of gov't domination over telecommunications. After all, EVERYBODY had a phone back then. If you stayed up really really late, the long distance rates would even go down . . . I don't doubt that the gov't could provide care for all. What I'm SAYING is that that care is a black rotary phone when you could have had a (non-gov't provided) blackberry cell phone. FOR THE SAME PRICE OR CHEAPER. As it stands, ERs are swamped NOW because of EMTALA and the concept that "it's free". Except. Nothing is free. The trade-off is long waits to see an ER doctor. Now. Take THAT concept, and double the number using the system (because, it's FREE!) and then apply it to EVERY aspect of health care. Add to that the fact that the gov't can't pay for the Medicare it is providing NOW - and so, add to that 20-30% routine cuts in funding. (Then add in even more draconian taxation to pay for it all.) THAT is what you will get. 100% of the people not getting access to adequate health care instead of 14% today. At least it will be "fair". A "fair" share in abysmal health care for ALL! Congress cannot repeal the laws of economics. Even if they want to do so. Even if they REALLY REALLY want to do so. Supply must balance demand. When demand is infinite, then supply MUST be infinite (an impossibility), or, rationed. I don't trust the fools in Washington to ration my ability to attain health care better than my ability to provide it for myself, if Washington were to leave me alone. Call me cynical, but faith is Washington is a form of derangement. But, to your main point: He who controls the purse strings, controls and owns the thing. There is no difference. What if we have the slaves do the work, and we'll just be the masters? ~faith, Timothy.
  7. Gov't rationed care is a horrible idea. These guys tanked the economy, social security is on the brink of failure and is only dwarfed by the coming financial wipeout of Medicare. And, we want to trust these people with MORE control over our lives? I think they've proven themselves to be stunning failures without giving them more to ruin. And don't even compare the gov't with Big Health, Inc. They are one and the same. Big Health, Inc. acts the way it does because its lobbiests ensure gov't protection for what they do. Did YOU pick your health care company? Or, did your employer, at the end of a gov't tax break? Hmmmmmmmm. I don't trust a politician more than I can throw them. They are all bought and paid for and I don't have the price for admission. They will make decisions, not in MY best interest, but in the best interest of the highest bidder/donor. A fair share in a dismal, gov't rationed outcome isn't very fair. It's all very nice until it's YOUR family member that dies on the wrong end of a waiting list. Can't be helped, it's not personal, you know. It's just actuarial. That said, Hutchison is leaving the Senate to run for Gov of Texas. AT least, that's what is widely predicted. I'm still mad at her for voting for the Sell-Out. Maybe she'll think twice about voting for the 850BN Great Rip-off. (I heard a rumor that rocker Ted Nugent might run for her seat.) ~faith, Timothy.
  8. ZASHAGALKA

    Black Nurses earn less than whites

    I would stipulate that part of the problem is the lack of diversity in nursing, generally. Since black nurses are woefully under-represented in nursing, generally, it is no great surprise that they are under-represented in salaries, etc. https://allnurses.com/forums/f100/astounding-lack-diversity-nursing-203721.html An Astounding Lack of Diversity in Nursing 13% of the general population is black, but only 4.9% of RNs are black. I would think it a no-brainer that such a lag would be inclusive of a general mindset that is exclusive and that could not BUT translate to salaries, etc. 4.9% of RNs are black. Less than 1% of RNs are non-white males. That's a minority of a minority. I suspect that a key improvement in salaries would result from better REPRESENTATION. And that means a cultural change in nursing and how we recruit future nurses. ~faith, Timothy.
  9. ZASHAGALKA

    Black Nurses earn less than whites

    A point of clarification: The Supreme Cabal ruled in favor of the legislation as written by Congress, as they must without a clear Constitutional issue involved. In fact, SCOTUS didn't 'rule' at all, it merely refused to hear the case. At issue is a loophole in ERISA, the law that creates many of the available Federal rights for employees regarding retirement and insurance. 1. ERISA doesn't really apply in setting salaries for employees, so, is not at direct issue in this discussion. 2. Don't blame the Courts for a failure on the part of Congress. People that are discriminated against under ERISA lost those rights when Congress wrote the law, many years ago. In fact, SCOTUS' refusal to hear the case represents a stare decisis of a 1993 ruling. This has been 'the law of the land' for sometime now. Nothing new. From the link below: "The Bush administration has argued that the appeals courts are misreading the precedents and has asked the high court at least twice to clarify the earlier rulings. So far it has refused. Congress, which could amend ERISA to make clear such suits are allowed, also has taken no action." A chilling example: http://news.postbulletin.com/newsmanager/templates/localnews_story.asp?z=7&a=350671 "Dying of cancer, Thomas Amschwand did everything he was told to make sure his wife would collect on the life insurance policy he had through his employer. . .But Spherion Corp., the temporary staffing company where Amschwand worked, told Amschwand-Bellinger she would not receive any of the $426,000 in benefits she believed she was due. . . "The facts ... scream out for a remedy beyond the simple return of premiums," Judge Fortunato Benavides of the New Orleans-based 5th U.S. Circuit Court of Appeals said in the Amschwand case. "Regrettably, under existing law it is not available." That remedy is your Congressperson. Not really on point to the thread, but this is a chilling story about basic fairness, and worth reading. ~faith, Timothy.
  10. ZASHAGALKA

    Code blue: family at bedside????

    I understand your point, but there is an order of magnitude difference between routine critical care modalities - no matter how intensive - and a full blown ACLS code. There is a difference. I agree that we can hold a presumption that someone critically ill would want their families to be there. That does not extend to include a presumption that they would want loved ones to watch their deaths, in a most undignified way. THAT would be one presumption too far. The highlighted statement here, though, is directly related to my point. When you give a 'choice' to someone not in a position to MAKE a rational choice, you are, in fact, supplanting your belief system on this vulnerable family member. I agree with you enough to say that I would not likely deter someone determined to be present. I haven't the few times that has been the case. THAT is NOT the same thing as positively advocating that presence. And, make no mistake, for somebody at the most vulnerable moment in their life, even suggesting it is tantamount to advocating it; it is, supplanting YOUR belief system over theirs. When you're paralyzed to make a decision, it is not uncommon to numbly follow the choices offered to you. Add to that the whole norming array of funeral customs and what you end up with is an unavoidable mix of choice and obligation: Am I supposed to witness Momma's code in order to be perceived as grieving normally? ~faith, Timothy.
  11. ZASHAGALKA

    Code blue: family at bedside????

    Which goes back to the fact that this CANNOT be an optional experience. This is the most fundamentally vulnerable moment of a person's life: "Your spouse is currently being resusitated." AT THAT MOMENT, we are going to give them this option and expect that someone, anyone, could make a rational decision? That isn't how things work. We highly ritualize such moments PRECISELY to pre-meditatively deal with circumstances in socially acceptable ways during times when we simply aren't rational enough to make decisions on our own. We do that for a reason. This concept stands that on its head. NO. It's not ethical or advocacy to place someone in that position, at the most vulnerable moment of their lives. The vulnerability of that particular moment, by definition, will take away the option of a rational choice from most. As a result, the choices made, by both them and us, become capricious. Inserting that kind of unpredictability into the most vulnerable moment of a person's life just isn't advocacy. There is a reason why funeral customs are so ritualistic and THAT is to remove such unpredictability. Instead, we foster it and call it advocacy. I disagree. ~faith, Timothy.
  12. ZASHAGALKA

    Code blue: family at bedside????

    I would be much less resistant to the idea, but still opposed. And no, I would not want my family to see me like that. There are better and more time-tested means to achieve closure. ~faith, Timothy.
  13. ZASHAGALKA

    Code blue: family at bedside????

    Of course not, for several reasons. First, surviving a code would, I would think, lead to satisfaction of the outcome in general and so, taint the opinion of family being there under the lens of that satisfaction. NOT surviving a code, if you could survey those that DIED, would, I would think, lead to much LESS satisfaction regarding the outcome. 2nd, surviving a code, by definition, means that this wasn't the VERY LAST thing those family members saw of that patient. That is a different criteria to measure, altogether. 3rd, the issue of dying and death is a different order of dignity than of surviving. It's a measure of apples and oranges. ~faith, Timothy.
  14. ZASHAGALKA

    Code blue: family at bedside????

    There are so few studies on FP and the ones that exist are of such limited scope that it cannot be said that the issue has been studied, at all. This is all emotion driven, on both sides. There is one small study that favorably reported pt's wanting their family there. It's too small a study and misses the point. 85% and higher of codes don't make it. The POINT is how many of those that DIE would have wanted this to be the last thing their family saw of them. I suggest that is difficult to survey. ~faith, Timothy.
  15. ZASHAGALKA

    Code blue: family at bedside????

    We haven't even discussed the Heisenberg Uncertainty Principle: observing an event changes the system of the event. Many point out that FP 'humanizes' a code. By frank admission, a code is being transformed from an all-out attempt to save a life to an observable closure-directed event. You cannot do that without changing the focus, to the extent it shifts to the family, AWAY from the patient. I would want MY code (if I'm not DNR already) to focus ABSOLUTELY, COMPLETELY AND TOTALLY on saving ME. I don't want the doctors and nurses wondering how a potential litigant is observing their actions. I want their complete attention. Sorry if that seems selfish. ~faith, Timothy.
  16. ZASHAGALKA

    Code blue: family at bedside????

    Don't take this the wrong way, but IT REALLY DOESN'T MATTER WHAT YOU WANT! That isn't the purpose of surrogate decision making. It only matters what THEY would want. And this is where we've strayed. THIS is why FP is unethical. Unless you have previous informed consent FROM THE PATIENT, family members shouldn't be allowed into a code. This is simply a decision that cannot be surrogated, by your own admission. It's not what they would want; it's what YOU want. I'm not picking on you. I'm just pointing out the inherent conflict of interest involved here. I'm a PATIENT ADVOCATE first and by priority. ~faith, Timothy.
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