"The Healthcare Crisis"

[avery]

I turned on the news this morning and yet another story about the impending doom of the "healthcare crisis." Obviously, the current system has some problems. For example, the millions of illegal immigrants in this country who are using the healthcare system and not only do not pay their bills but also, do not pay any taxes. Then, you have the people who come to the E.R. and abuse the services provided there. Coming to the E.R. because one wants the doctor to write a prescription for Tylenol so Medicaid will pay for it is not a valid reason.

Calling the ambulance because your water broke is another example of inappropriate use of resources.

So what are the answers? As nurses continue to be underpaid, it is unnerving to hear of the impending crisis with no clear resolutions.

My husband and I paid $400 dollars a month for his company supplemented healthcare. Was that affordable? No. Did we think it was necessary to have health insurance? Yes.

I personally feel that there are many people who choose not to be responsible for their own actions and would much rather blame their problems on someone else.

People tend to credit their success to themselves and their failure to others.

Avery

[jojotoo, RN]

Your points are right on target.

[mvanz9999, RN]

But is this really the problem? I seriously doubt that abuse of the ER is the main crisis in healthcare.

I think it's more the overall cost for all Americans, and particularly so for those with chronic illnesses. After all, if you've any chronic illness, most insurers will exclude you. My health coverage is so poor that I cannot use it in the traditional well-sense (yet I would argue my policy is actually better than most). In other words, I depite paying expensive premiums, and high co-pays, it doesn't cover either the basics, or anything until I've paid $1,500 out of pocket, and then only between 50%-85% on additional services. (Is this affordable? Not in my case).

What does this mean? Despite paying high premiums already, I STILL have to pay for wellness visits and basic care. What does this mean? It means, I'm not going to the doctor for a yearly wellness exam, nor paying for relatively expensive blood tests. The end result is that something which could have been caught early (ie, high cholesterol) will not be seen, and will go from something relatively easy to treat (improved diet) to something extremely expensive (bypass surgery). I believe that, in an effort to reduce costs, the lack of willingness to pay for such basic care will cost many, many, many times more, in the long run.

Now, instead of paying $150.00 for a wellness exam, the company will be paying thousands for bypass surgery.

It never ceases to amaze me, the lack of foresight organizations have. Even 5 years ago, I could go to the doctor and get a yearly wellness exam for a co-pay of $20.00. The last time I went (several years ago), I had the office visit ($110.00), the labs ($200.00) and an additional expense for thyroid testing ($500.00). I then received a bill for just over $800.00. All for a wellness exam that would have cost me $20.00 5 years ago. Think I'm going back? No. Not unless I'm taken there because I'm unconsious.

Another issue I've struggled with is the lack of ability to shop for the lowest price service. I have called and called and called and called, and the very best I can possibly get is a very rough estimate. Even that isn't accurate. What other product works like this? You would go to the grocery and pick up a bunch of items without knowing the cost; only to be given a ridiculous fee and told you HAVE to pay it now, since you've already touched the items. There's NOTHING else like healthcare.

Companies should pay much more for basic care services, therefore catching illnesses before they become costly or untreatable. In addition, hospitals should have a price list, just as you would on a menu. Radioactive iodine thyroid testing=$525.00. And that should be the final price. Not "around $500.00". Not "we can't tell you that, because....."

Those are a few of my random thoughts.

[Plagueis]

If "Health Care Crisis" means lack of insurance, then that is a big problem in this country. However, everyone I know who doesn't have health insurance doesn't have it simply because their employer doesn't offer it, or the premiums are too high for them to afford it. They are not unemployed, and many of them work two jobs to support themselves and their families. They are very responsible people who work at low-income jobs. As for the reasons people go to the ER, some people who don't have insurance may realize that the ER will accept them, regardless of their ability to pay, since many doctor's offices want payment upfront. It may seem strange that some people go to the ER for colds and for other "minor" problems, but if a doctor won't see them (and a visit here is around $150), then they may feel that they have no other choice.

[StNeotser, ASN, RN]

I see the OP lays no blame at the door of HMO's nor drug companies. I've even posted profits here, which funnily enough, have risen about 80% for a certain HMO along with the 80% rise in healthcare costs. There is an awful lot of profiteering going on in healthcare. I suppose blaming it all on poor folk does it for some people though.

[tencat]

Put some restricitons on greedy drug companies and HMO's and a lot of healthcare crisis issues would be addressed.

[printernurse]

What about all the millions of americans who have jobs that pay substandard wages? Many two wage earner families where both husband and wife earn 11 or 12 bucks an hour have no health insurance or substandard insurance with premiums that are unaffordable for them. In Cleveland, the Cleveland Clinic uses private companies to do house keeping, deliver food to patients, work in the kitchen etc. They have no health insurance. Their workers are the tenth highest users of Medicaid in the state. Wal Mart is number one. No surprise there. By the way the Cleveland Clinic is rated as the number one Heart Surgery hospital in the US by U.S.News&WorldReport http://www.usnews.com/usnews/health/best-hospitals/rankings/specihqcard.htm. They have a luxury hotel where most of the oil Sheiks from Saudi Arabia, the United Arab Emirates come to have their health care. They are famous for renting whole floors and bringing hundreds of servants and family with them. Most of the workers in This hotel have no health insurance. What about all the workers at Wal Mart who cannot afford their insurance? And what about all those so called "illegal aliens"? I agree that there is a real problem with immigration in this country. It is said that american workers wont pick crops in this country because the work is too hard and the wages are too low. Who could blame them when even McDonald’s pays more and the work is not nearly as hard or dangerous. Imagine what your apples would cost if workers were paid 11 bucks an hour with health care benefits? (Personally I think that should be the minimum for any job.) How much would your apples cost then? Eight bucks a pound? Maybe that's what they should cost. It is said by some that this country has the best health care in the world. Best for whom? Nurses on med/surg floors at the Cleveland Clinic sometimes have 8 pts. As nurses we know that this is a dangerous ratio, but that it is unfortunately very common. Some people may think that there is no "impending doom in the health care system". I would agree in that the system is already doomed. Health care in this country has been unaffordable for many employers for a long time. Premiums have been high for a long time and keep getting higher. The percentage of the expense that workers have to pay keeps getting higher. Health care costs now count for what I thought I heard was something like 15 percent of GDP. (Someone can correct me if I'm wrong on the exact percentage.) A mind boggling amount of money. It is the biggest reason why real wages have not gone up very much in the last 20 years. Believing that there is no health care crisis in this country is almost as bad as believing that we don't have a problem in Iraq.

[teeituptom, BSN, RN]

And so your point to this is.

What would like to seen done about it.

[SharonH, RN]

You stated that you feel that many people want to blame others for the impending healthcare crisis but then you turn and blame much of the problem on the alleged "millions" of illegal immigrants using the system and not paying and to people abusing the ER. The so called healthcare crisis in this system is complex and you can't just sum it up by pointing the finger at illegal immigrants (who do pay taxes by the way every time they make a purchase) and people you perceive as not deserving of the services of the ER.

[Antikigirl, ASN, RN]

Oh man, you can go to work and come up with several abuses of the system right under your nose! Heck, it is a constant forum at my nursing desk!!!!!

Last nights big issue as the abuse of the medicare system! I had three out of five pts that should have gone home to their facilities (elderly) that day...however...it was a Sunday! Some facilites will not accept pts on weekends, and some MD's don't come in on weekends so they leave it all to the oncall...many of which tend to not wish to take full charge of discharging a pt they do not know (don't blame them), and make them stay till a weekday!!!! Gee, and wonder why we hate mondays huh? EAAKKK!

So basically these people are taking up a room, paying for that room and services (at a very high cost) for 24-48 hours which is not necesarily needed! That leads to upset pts who just want to get home, overworks nurses, drops or passes the buck on responsibility, and costs a fortune on our tax payer dime!!!!!

Just think...three pts yesterday out of my five! How much did that cost on a med surge ortho floor to medicare? Two should have gone home Saturday! Chaaaaaaa ching! What if this pt doesn't qualify for medicare and can't pay? Chaaaaaaaa ching!

Yeah, and people assume it is nursing care that is the crisis!

[Antikigirl, ASN, RN]

(who do pay taxes by the way every time they make a purchase)

Just a reminder that not all states have a sales tax..I live in one of them!

My hospital is located in a rural community that is over 60% immigrants (most of which illegal) there to work as laborers. We are use to treating them and trying very hard to keep things confidential while getting some re-embersment.

We also opened up a free clinics (and part of our hospitals healthcare out reach clinics) for them so they can use those clinics for primary care and really helped cut costs and reduce the use of the ER being their primary source of healthcare. It was funded totally by donations of the local businesses and charity events, and has perminient staff and can involve volunteer MD's and RN's (we try to rotate to help!)...we know it is a probelm...but were proactive and trying to keep these folks healthy and safe in an outpatient type setting instead of just waiting for things to get so bad they had to go to the ER! It is VERY sucessful!!!!!

My hospital is a community hospital payed in full by the community to keep it as a community hospital! Great concept I think...that way we can adjust to our population needs and get total community support to help us gain it! We are non-profit...and that is really cool vs large companies that put their money into things not hospital or community related! Yes, we won't get our annual cost of living increase this year (we just opened up a cancer tx center that is very sucessful for the pts that would have to drive 30 miles to get to one that is over used by pts in four counties!~)...but it beats lay offs and serves our community well!

[JoeyDog]

I agree the cost of health care is a major factor. When my husband and I first got married he worked as a CNA in LTC. The cost to insure both of us (with a crappy plan to boot) meant that my husband would only be earning about $300 a month after we paid the premiums (and he worked full time). Needless to say we did not have health insurance.

I have no solution to the problem though.