"It's Health Care, Not Health Insurance"

allnurses Guide · Jul 23, 2008

expand successful medicare program to all

...july 30 is the 43rd anniversary of the passage of medicare. medicare began because no one except the government was willing to cover the oldest and sickest of us....

...one wonders, then, why some politicians are opposed to building upon medicare's success....

...as a result, most health care proposals simply add more layers of complexity to our health care system and do not address the need for basic change. there is one bill, however, that stands out: hr 676, the united states national health insurance act. the goal of hr 676 is to provide true universal coverage by improving and building upon the original medicare program introduced 43 years ago....

http://www.journalgazette.net/apps/pbcs.dll/article?aid=/20080721/edit05/807210305

Katie82, RN · Jul 27, 2008

the goal of hr 676 is to provide true universal coverage by improving and building upon the original medicare program introduced 43 years ago....

do you see medicare as being successful? they are losing money hand over fist, projections are they will be out of money in 10 - 15 years. but that's another issue. i have been a nurse for a long time and have cared for underserved populations for at least half of my career.but both my baccalaureate and masters degrees are in health care management, so i see both sides of the fence. i would love to see universal healthcare become more than the pipe dream it is now, but before i believe that someone can deliver on a promise i would need one bit of information -- show me the money!!!!! how are you going to pay for this - actually i know the answer to that. what my real question should be is "how much is this going to cost me?". i haven't heard anyone who promises uhc tell us how they intend to pay for it.

HM2VikingRN, RN · Jul 27, 2008

here is how we would pay for universal care. the pnhp proposal has been available for years.

a universal public system would be financed in the following way: the public funds already funneled to medicare and medicaid would be retained. the difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). the payroll tax would replace all other employer expenses for employees’ health care, which would be eliminated. the income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments. for the vast majority of people, a 2% income tax is less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly if a family member has a serious illness. it is also a fair and sustainable contribution.

at http://www.pnhp.org/facts/singlepayer_faq.php#run_system .

after factoring in cost shifting for the un/underinsured we are paying far too much for administration costs. the simple reality is that we spend something like 16% of our gdp on health care. every other country in the world with uhc spends half that. core inflation in the us is double digit while in the oecd countries it is in the single digits.

ffs medicare is a success. medicare advantage (the "efficient" private sector) is the budget buster. the outrage is that medicare advantage is 12% more expensive than the traditional medicare plan. we need to cut the subsidies out of the medicare advantage market.

allnurses Guide · Jul 27, 2008

HR 676 establishes an American-styled national health insurance program.

The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories.

The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and cost effective health care services regardless of ones employment, income, or health care status.

With over 45-75 million uninsured Americans, and another 50 million who are under insured, it is time to change our inefficient and costly fragmented health care system.

Physicians For A National Health Program reports that under a Medicare For All plan, we could save over $286 billion dollars a year in total health care costs.

We would move away from our present system where annual family premiums have increased upwards to $9,068 this year.

Under HR 676, a family of three making $40,000 per year would spend approximately $1600 per year for health care coverage.

Medicare for All would allow the United States to reduce its almost $2 trillion health care expenditure per year while covering all of the uninsured and everybody else for more than they are getting under their current health care plans.

Under HR 676, the average costs to employers for an employee making $30,000 per year will be reduced to $1,155 per year; less than $100 per month.

Health Care Services Covered!

This program will cover all medically-necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. Medicare will be improved and everybody will get it.

Proposed Funding

Maintaining current federal and state funding of existing health care programs!

A modest payroll tax on all employers and employees of 3.3% each. A 5% health tax on the top 5% of income earners.

A small tax on stock and bond transfers.

Closing corporate tax loop-holes, and repealing the Bush tax cut for the highest 1% of income earners.

http://www.guaranteedhealthcare.org/legislation/hr-676-conyers/united-states-national-health-insurance-act

nursesforchange · Jul 30, 2008

I'm amazed at how divided nurses are on this issue.

nursesforchange · Jul 30, 2008

Do you see Medicare as being successful? They are losing money hand over fist, projections are they will be out of money in 10 - 15 years. But that's another issue. I have been a nurse for a long time and have cared for underserved populations for at least half of my career.But both my Baccalaureate and Masters degrees are in Health Care Management, so I see both sides of the fence. I would love to see Universal Healthcare become more than the pipe dream it is now, but before I believe that someone can deliver on a promise I would need one bit of information -- Show me the money!!!!! How are you going to pay for this - actually I know the answer to that. What my real question should be is "How much is this going to cost me?". I haven't heard anyone who promises UHC tell us how they intend to pay for it.

The question of success is not just how successful is the program, but what would happen if we didn't have it? Is having Medicare a better outcome than the cost of not having it? Showing you the money is complicated because you have to recognize that you are paying for people that are uninsured through rising private insurance premiums and rising costs of care. So those costs need to be contained and part of containing them is through intelligent implementation of coverage for the 47 million uninsured in this country.

Are you willing to pay taxes to support it, and see rising private insurance and health care costs controlled so you will not be at the mercy of the private insurance industry?

It is not a question of who will pay IF we implement expanded coverage, but how we will pay. Whether we implement coverage or not we are going to pay. I'd rather pay and see more Americans with access to quality coverage than see my private premiums and deductibles rise exponentially.

allnurses Guide · Aug 1, 2008

Make original Medicare the foundation for health care reform

As Medicare celebrates its 43rd birthday this week, it's time to take stock of one of the most popular government programs of all time that guarantees all Americans 65 years of age and older universal coverage of comprehensive health care benefits.

At the time of its passage, American seniors were having great difficulty affording health care, especially the costs of hospitalization. They were paying 15 percent of their annual income on health care. Many millions were unable to afford either insurance or their medical bills.

Enactment of Medicare gave them access to a set of benefits defined by law, as an earned right for which they contributed, without regard to their health status or income.

Medicare today covers about 43 million American seniors and the disabled, paying about one-half of their health care expenses.

Amidst an increasingly unaffordable health care market, Medicare recipients have a solid rock of coverage.

The program is administered with an overhead of about 3 percent, less than one-fifth the overhead of competing private programs, while offering defined benefits with free choice of physician and hospital....

...It is time to expand Medicare as a social insurance program for all Americans through a single risk pool of all 300 million of us. This is the most efficient, fair and sustainable way to insure us all against the costs of illness and injury, coupled with the strengths of our private delivery system. Expansion and improvement is the best way to "save" Medicare....

http://seattlepi.nwsource.com/opinion/373083_medicare01.html

lindarn · Aug 2, 2008

expand successful medicare program to all
...july 30 is the 43rd anniversary of the passage of medicare. medicare began because no one except the government was willing to cover the oldest and sickest of us....
...one wonders, then, why some politicians are opposed to building upon medicare's success....
...as a result, most health care proposals simply add more layers of complexity to our health care system and do not address the need for basic change. there is one bill, however, that stands out: hr 676, the united states national health insurance act. the goal of hr 676 is to provide true universal coverage by improving and building upon the original medicare program introduced 43 years ago....
http://www.journalgazette.net/apps/pbcs.dll/article?aid=/20080721/edit05/807210305

i work for a large insurance company. i am a nurse reviewer who approves or denies claims for members. we have to go by each insurance contract that each company has. believe me, the public has no clue what and how much infrastructure goes into the insurance industry. i have no trouble believing that if we cut out the middleman, that there will be more than enough money for universal healthcare! profit has no place in healthcare.

lindarn, rn, bsn, ccrn

spokane, washington

RN4MERCY · Aug 2, 2008

I work for a large insurance company. I am a nurse reviewer who approves or denies claims for members. We have to go by each insurance contract that each company has. Believe me, the public has no clue what and how much infrastructure goes into the insurance industry. I have no trouble believing that if we cut out the middleman, that there WILL BE MORE THAN ENOUGH MONEY FOR UNIVERSAL HEALTHCARE! Profit has no place in healthcare.
Lindarn, RN, BSN, CCRN
Spokane, Washington

Thanks for speaking up about this practice. This is important information and it occurs to me that nurses have to be especially careful about having their "fingerprints" on the process of insurance company denials.

You may remember hearing about a patient in Valencia, CA; a high school student named Nick Columbo, who suffers from Ewing's Sarcoma. His family's insurer, PacifiCare/United Health initially denied CyberKnife treatment, calling it unnecessary and experimental.

During a massive grassroots protest in front of PC/UHC's headquarters in Cypress that was organized by the California Nurses Association, a spokesman for PC/UHC named Tyler Mason, in announcing the company's reversal of their decision to deny approval for the treatment, tried to lay the blame for the initial denial on a nurse.

It was pointed out to him that RNs are not licensed to prescribe or deny medical treatment. The insurers are slick and devious; they will spread lies and attack the credibility of nurses, and sully the public's respect and trust of nurses, as a smoke screen to try to hide their greediness.

Thank you, Linda, for having the courage to speak up! :up:

lindarn · Aug 2, 2008

Thanks for speaking up about this practice. This is important information and it occurs to me that nurses have to be especially careful about having their "fingerprints" on the process of insurance company denials.
You may remember hearing about a patient in Valencia, CA; a high school student named Nick Columbo, who suffers from Ewing's Sarcoma. His family's insurer, PacifiCare/United Health initially denied CyberKnife treatment, calling it unnecessary and experimental.
During a massive grassroots protest in front of PC/UHC's headquarters in Cypress that was organized by the California Nurses Association, a spokesman for PC/UHC named Tyler Mason, in announcing the company's reversal of their decision to deny approval for the treatment, tried to lay the blame for the initial denial on a nurse.
It was pointed out to him that RNs are not licensed to prescribe or deny medical treatment. The insurers are slick and devious; they will spread lies and attack the credibility of nurses, and sully the public's respect and trust of nurses, as a smoke screen to try to hide their greediness.
Thank you, Linda, for having the courage to speak up!

The nurses don't actually deny the claims. We review the policy, and then send it to the physician reviewers with a recommendation to deny. The actual denial is the physician's responsibility. His ID number and name goes on the denial. If I recommend denial, it is still their decision to deny. He can approve the claim even if a nurse recommends denial. I can't speak for Pacificare, and how they run their company. But ultimately we have to go by policy. If I approve something that is against the policy I will get in hot water.

Lindarn, RN, BSN, CCRN

Spokane, Washington

RN4MERCY · Aug 3, 2008

The nurses don't actually deny the claims. We review the policy, and then send it to the physician reviewers with a recommendation to deny. The actual denial is the physician's responsibility. His ID number and name goes on the denial. If I recommend denial, it is still their decision to deny. He can approve the claim even if a nurse recommends denial. I can't speak for Pacificare, and how they run their company. But ultimately we have to go by policy. If I approve something that is against the policy I will get in hot water.
Lindarn, RN, BSN, CCRN
Spokane, Washington

A single-payer, national health care plan, HR 676 would be the ultimate, transparent solution in terms of equitably securing an accessible health care delivery system for people based on medical need. It would be publicly accountable; a responsible public health policy, as opposed to a proprietary, bureaucratic for-profit private wealth policy.

How do you deal with the myriad of ethical dilemmas that must confront you on a daily basis at work? If I understand you correctly, your recommendation to deny is based on whether or not the request for medical treatment is a "covered" commodity according to the policy that the patient, (or their employer), has purchased from your company. The patient's own physician, based on his or her assessment and judgement, has recommended a treatment plan that will restore a patient to optimum wellness. As an RN, you are educated and are able to make a determination that the requested treatment would be therapeutic and it would be in the best interest of that patient to receive that care.

Your job, on behalf of your employer, (not the patient), then, is to determine if the policy that the patient, (or their employer), purchased, actually stipulates the disease, injury, illness, or treatment of it thereof is eligible according to the company policy? And, that your recommendation is subject to review, by a physician who is also an employee of the insurance company. He or she sits at a desk, and never hears, sees, or feels the patient to make a direct assessment. But then again, I guess, they don't have to, because they're not accountable for the patient's well-being. Their job is to recommend what's best for the insurance company, based on company policy, not what's in the best interest of the patient.

It's unconscionable and almost unimaginable that good and well-meaning people have to worry about balancing "making a living" and "getting in to hot water" when they find themselves working for a company that profits by denying care to people based on policy. Dr. Linda Peeno used to be a claims reviewer for Humana and I was so moved by her testimony and her appearance in the movie, SiCKO.

The point being that most of us who think we have insurance that will provide for our health care if we need it, and prevent us from financial ruin in the event of illness or injury may be sadly and tragically deceived. In fact the evidence is overwhelming that we are; nearly 80% of people who are bankrupted by illness had insurance at the onset. Having insurance is not the same as being able to get needed care!

It's a shame that we live in the wealthiest nation in the world in terms of material goods, but we're morally bankrupt among all the other industrialized nations of the world because we don't have a national health plan that provides medically necessary care for our most precious resource, the people who live here. It's a shame that 101,000 people die of PREVENTABLE illness in this country every year; not the "best healthcare in the world" at all!

We the people, are finally getting mad enough to organize against this injustice, and in support of HR 676. You lend a credible and important voice in the fight to achieve a universal, guaranteed national health care plan in this country.

http://www.guaranteedhealthcare.org