I keep hearing all this talk about how the emphasis in medicine needs to be on prevention of disease, and not disease management or cures. As a nurse with over 20 years experience in a variety of clinical and business settings, most recently in mental health, I would like to suggest the new paradigm of prevention first is a bit mis-guided and unrealistic.
First, what is prevention? How do you realistically "prevent" obesity, high blood pressure, diabetes, heart disease? There are only 2 ways to affect these chronic diseases: education or dictate. The health community has focused on education for 40 years. Constant repetition on message has slowly changed the numbers of unintended pregnancy, smoking, STDs, and AIDS related illness. There are other examples too, but changing behavior is a slow process. Education alone does not prevent chronic medical problems, at least not quickly.
So the new health reform thinks they can prevent first, limit the expensive care to a few choices at the end of life, and suddenly every one in this country will have excellent universal care that is cost effective, paid for, and even reduce the deficit. Only one problem: you can't dictate behavior.
This is the only way large scale changes could lead to the kind of Utopia one side of the spectrum is envisioning for this county. If you punish behavior that causes chronic disease, it is the only way to effect change rapidly. So, your freedom to choose is taken away, "for your own good" because people left to their own devices will not make smart choices. Outlaw transfats, outlaw tobacco (so why is it still legal if you really want people to quit smoking?) Outlaw sugar, outlaw meat (global warming), remove all snacks except fruit and vegetables from the school vending machines, tax complex carbs to reduce useage, mandate 1 hour of exercise daily for all citizens, fines for BMI over 30, fine smokers. I know - maybe you could just remove food and use compressed supplements with all the recommended nutrition. And those weak humans to do develop diabetes, or high blood pressure, or have too much fat? What do we do with them, after all our "help" controlling their weakness?
Maybe it is time to re-read Brave New World, Farenheit 451, Animal Farm, and Soylent Green. As for me, I prefer the education route, and continue to fund research in to cures. This may be a bit tongue-in-cheek, but this pie in the sky talk about prevention, not cure or treatment of disease seems to ignore the human factor and the gift of free will. I don't want government to take that away from me. Positive reinforcement has always worked better to change behavior than punishment, and yet in this new world of reform, the only way to prevent disease is to punish the behavior that causes it.
Trader Joe's markets are a great source of less expensive fresh fruits and vegetables. I looked at their website for locations of those stores in the northeast, and saw many in New Hampshire, Mass, NJ, etc. They're very "green" and the milk there is inexpensive (relatively, for Organic products). They get oranges from Israel, FLA, CA, Spain, and other countries that cost the least in the country. Their frozen products are the best, and seldom come from countries with lower standards of production. In winter, you don't need a freezer.....
Trader Joe's is inexpensive? I don't think so. I shopped there in Danbury CT. Double my grocery bill. Maine is part of the Northeast. When you are in the Northeast there are no fresh fruits in November. Geography.
They have the same frozen foods as every other supermarket. Green Giant etc.
I heat my house in the winter. I don't keep my food outside. I still need a freezer in the winter. Where do you live?
While all the BC/BS organizations did start out as non-profit cooperatives many decades ago, if you check you will find that many, if not most, of them now been bought out by various for-profit companies and are no different from any other private-for-profit insurance company. And while you may have had a wonderful experience in your jobs working for insurance companies (and I'm not suggesting that I doubt your account), there is plenty of documentation out there of the "dirty tricks" practiced by many of the companies these days to protect the bottom line and boost their profits.
I have worked for Wellpoint, a parent company of Blue Cross/Shield/Anthem, et al, as a case manager. let me tell you, the interest they have in "managing" cases is only to get rid of expensive cases. Also the "preventive" information I had to give patients/members (definitely not clients, they're the employers) was often erroneous. However, I was told not to change a thing on their script.
If you know the cost of clothes and cars, looking at their CEOs belongings, you know where the profit went. They get bonuses bigger that AIG! You see the way to call any company non profit, is to plow the profit into salaries and bonuses of those executives who have been bought - lock, stock, and barrel!
trader joe's is inexpensive? i don't think so. i shopped there in danbury ct. double my grocery bill. maine is part of the northeast. when you are in the northeast there are no fresh fruits in november. geography. that depends on what you get....... there are expensive gourmet items, but also specials that are creatively mentioned in their newsletter, i thought you wanted quality, from green sources. they have king arthur flour (a gourmet item) cheaper than anywhere else.
they have the same frozen foods as every other supermarket. green giant etc. i never saw green giant at a trader joes! they have their own brands, except for frozen desserts.
i heat my house in the winter. i don't keep my food outside. i still need a freezer in the winter. where do you live?
in canada, where i grew up, we used our "sun porch" for frozen foods. if it got sunny (seldom in winter), we'd take meat and fish to a "locker", a business that just stored frozen foods for people. that was a half hour walk to it, and longer when we had heavy frozen food to carry.
honey, i'm much older than you - we had "ice boxes" instead of refrigerators, and horse drawn carriers for the ice blocks separated with sawdust, that kept them (the ice boxes) cold. the top of the milk, in a rounded glass part, was our ice cream, which we weren't allowed a bit of, without permission. it was worth that treat, to drink the nonfat milk left, after the cream had been consumed.
i live in ca in the summer, and virginia in the winter (i hate their hot, humid summers), having split the ca house i sold, into 2 condos after my daughter in va was diagnosed with ms. my son is in ca.
the insurance companies charge the same for everyone when it's a group policy (employer- or union- provided coverage, for example), but they are free to charge premiums as high as they like for individuals (individuals are really screwed when it comes to shopping for insurance).
i must differ with the statement that premiums are the same for all who are employed at the same company, as friends who owned their own company, told me that blue cross/blue shield charged $1,000/month in 1989 for anyone over 55 years of age. when that person (my friend's husband) turned 65, they were told by bc/bs that medicare wouldn't be allowed as his primary coverage, and his premium went up by $2500/month. he retired, very reluctantly, and they taught their son to run their business, with them as consultants.
as for the high risk people, that comes down to a basic philosophical difference -- again, does one see healthcare coverage as a commodity, like a car or washing machine, where each one of us can buy however fancy a car as we can afford and we don't really care what kind of car other people drive (or if they can afford a car at all), or does one see it as a vital, necessary public service, like police or fire service -- everyone pays taxes so the service is there, and everyone gets whatever service they need when necessary. obviously, there are plenty of posters on this site on either side of that divide.
unfortunately, serious illness can be the beginning of an inglorious end to some peoples' careers. they often learn preventive measures too late to prevent it, and need to make changes in the way they live (i was going to say, lead their lives, but when disease strikes, that's what leads). often anger at their situation is responsible for poor decision making, and then their health declines further, and choice ends.
Specializes in Critical Care, Insurance Case Management.
Having noticed people smoking outside buildings that they'd rather be inside, and hearing the comments they make about restrictions on their smoking, and addiction, I don't see them having high self esteem, except for angry, defensive, disbelieving denial of scientific evidence. So many have told me of parents and grandparents who smokled 2-5 pkg of cigarettes a day, and lived into their 80s and 90s, it seems nothing would kill them.
$35,000 is poverty level, if you live where milk costs $12/week. May I suggest that you put half powdered milk and water with regular milk? After an hour in the refrigerator, it tastes the same as regular milk. Meat is the most expensive element of Americans' diet, yet it consists of a much greater proportion than we require, or that is healthy. It sounds like you live in a city where agricultural products are pricey. Try going out to the countryside and stopping at roadside stands, for fruits and vegetables in season. Learn how to preserve them, and you'll enjoy them all year long.
If you want an addiction to stand as a financial need, it's not. That's like saying "Heroin/cocaine/ meth is so expensive, but I'm addicted to it. There are inexpensive programs to deal with addictions. It takes a willing, health seeking mind to do that.
I was not referring to myself, I make a fine income and actually had a very large vegetable garden and can loads of produce. And I live in the country, with farmers markets everywhere. I was referring to the folks I have worked with as a nurse, who don't make the money, and don't garden, and don't can. Someone else had it right, comparing bags of chips to the cost of milk in NH - smokers are not even in the equation here for financial problems. Not all low income people smoke, especially standing outside your office buildings;) Oh, and the $12 a week is for 2 growing boys who drink a gallon every other day at $2.89. Powdered milk? a typical suggestion from someone who doesn't have to drink the nasty stuff.
You said a mouthful when you said EVERYONE PAYS TAXES so the service is there. So everyone should pay premiums for health care. Or don't you follow logic?
Absolutely not!!
When a person becomes seriously ill, and can no longer work effectively due to that, they pay little to no taxes, need health care programs paid by taxpayers, and generally become entities that make them liabilities, not assets. They haven't enough money to pay for one hospitalization or monthly premium (especially if that is adjusted upward according to increased need for health care).
That's what this heartless, selfish society has created.
Specializes in Critical Care, Insurance Case Management.
He works side by side with those who make less than that, though, and his fight is their fight. He learned humility from experts, in Kenya, Asia, and DC.
You had me pegged for a supporter of Obama, which I am.
I hope that was a joke, it is hard to tell! "Humility'?
Absolutely not!!
When a person becomes seriously ill, and can no longer work effectively due to that, they pay little to no taxes, need health care programs paid by taxpayers, and generally become entities that make them liabilities, not assets. They haven't enough money to pay for one hospitalization or monthly premium (especially if that is adjusted upward according to increased need for health care).
That's what this heartless, selfish society has created.
I am confused - how is this what society created? I thought you guys love Medicaid to help the poor, Medicare to help the elderly, and now universal health care to help everyone. Are you suggesting it is out "heartless, selfish society" that made these poor helpless souls become seriously ill in the first place, to put them in this situation? You mean to say if only government had run their lives right from the beginning, controlling what they ate, what they drank, where they lived, how they decided to work and where, in what environment, then none of this would be happening now! Sorry, it's been tried - Communism. It doesn't work, or hadn't you heard.
Back to the original title of this debate - prevention only works if you dictate everything people do from the beginning. You can't prevent disease by checkups - it only catches problems earlier to put them on the medical track earlier (so you can try to influence the course, but it doesn't prevent anything)
Be careful of statements like that, someone is liable to suggest you move to a country you think is not "heartless and selfish"; which is that by the way? The Neatherlands? Oh wait, they have Amsterdam; Cuba? Iran? Last time I heard, Canadians feel there is room for improvement too.
i agree with some of your reasoning in other posts, Ms Lamaze teacher, but throwing a bomb like that tends to negate other thoughfull postings.
i hope that was a joke, it is hard to tell! "humility'?
it's no joke, bub. in kenya the land's ferocity teaches the people that nature dictates survival. in asia, a political hotbed if ever there was one, you learn to keep your own counsel; and in dc you see many a politician fold up their tent and go home
i am confused - how is this what this society created? i thought you guys love medicaid to help the poor, medicare to help the elderly, and now universal health care to help everyone. there is no public program now!
are you suggesting it is out "heartless, selfish society" that made these poor helpless souls become seriously ill in the first place, no! to put them in this situation? you mean to say if only government had run their lives right from the beginning, controlling what they ate, what they drank, where they lived, how they decided to work and where, in what environment, then none of this would be happening now! no!sorry, it's been tried - communism. it doesn't work, or hadn't you heard. you must see commies behind every bush and around every corner.....probably loved the mccarthy era......
back to the original title of this debate - prevention only works if you dictate everything people do from the beginning. no!!you can't prevent disease by checkups -when they're done early enough, check-ups aren't designed to find disease, but to check their absence, and present opportunities for being healthy, through preventive behaviors! it only catches problems earlier to put them on the medical track earlier (so you can try to influence the course, but it doesn't prevent anything) you musn't have much contact with people who adjusted their diet upon finding that they were pre-diabetic. being a public health nurse, i've known many.
be careful of statements like that, someone is liable to suggest you move to a country you think is not "heartless and selfish"; which is that by the way? the netherlands? oh wait, holland has amsterdam; cuba? too poor iran? i wouldn't wear the black shroud while alive, so i'd be stoned until dead. last time i heard, canadians feel there is room for improvement too.
don't confuse "room for improvement" with bad!
i am from canada, and worked at the public health agency in windsor that fostered their health care programs through the work of 7 doctors there, who thought health was maintained at too high a price, in 1962. no one there thought the welfare of others less fortunate (monitarily) than they were, didn't deserve their support with the health care program! that's a basic difference in attitude. it has no party affiliation.
while my relatives and friends there are concerned about health care costs, they've seen how it is in the us, and pity me for being here (which i wouldn't be, where it not for my grown children and their children, who i like to see). medicare allowed that! but many americans resent its presence.
quality of health there is far greater than it is here, (it just takes a little longer to have elective procedures),but the quality of doctors' waiting room furniture and decor is less. here you have to go to crowded eds with sumptuous furniture at night for medical (not emergency) care, whereas in canada you can go to a mall for it at offices with folding chairs, and no pretty paintings, next to the cost less pharmacy. negotiation for less expensive pharmaceutical products done there has been held with a far stronger base, an entire country's population! yet here we pander to those pashas of iron control over our life saving needs.
i used to get my medications there for $300, a fifth of the price that they were here ($1500/month), until i succumbed due to age discrimination in employment, health care insurance premiums being too high for my employers after i became 55 years of age, so they said "bye"; and ill health due to stressors (don't ask!), and i was able to get medicaid here. talk about humbling experiences!
or would you rather i had died of my illness (gastric ulcer caused hemorrhages that have no bacterial etiology, just stress) and saved you some money? or that i went to a facility where you wouldn't have to see me, but would cost our government far more, than care at home? look up the life expectancy of those housed in those facilities.....
I must differ with the statement that premiums are the same for all who are employed at the same company, as friends who owned their own company, told me that Blue Cross/Blue Shield charged $1,000/month in 1989 for anyone over 55 years of age. When that person (my friend's husband) turned 65, they were told by BC/BS that Medicare wouldn't be allowed as his primary coverage, and his premium went up by $2500/month. He retired, very reluctantly, and they taught their son to run their business, with them as consultants.
I apologize for not being clear and specific enough. I was referring to large, corporate employers. Small businesses are almost as bad off, when it comes to shopping for health insurance, as individuals.
I apologize for not being clear and specific enough. I was referring to large, corporate employers. Small businesses are almost as bad off, when it comes to shopping for health insurance, as individuals.
Large facilities have similar costs for older employees. I lost 8 good positions after I was 55, at a Public Health Department's clinic; a hospital's patient education department; a large "foundation"; and the last one was Blue cross/Wellpoint. That was like being in the den of tye enemy! They made me fill out the health insurance questionnaire that has a space for your birth date, and I didn't fill that in (I'd told them that I already had health insurance from another source). It was sent back to my supervisor who asked that I fill it in (nicely, she thought I'd forgotten); and then I was called by 6 different individuals from different departments there, asking what my birth date was (somewhat illegal). I was told to go to another building several miles away from the one in which I worked, where the security department is (couldn't they have sent it by interdepartmental mail?), to write my birth date under each picture of me (I don't look/act my age of 70) that they had taken. The next day I was told I "wasn't a fit", and was asked to write a letter of termination (???). I wrote a letter saying what had happened, and was escorted out with all the stuff I'd brought for my use and comfort in the tiny cubicle to which I'd been assigned. So I gave up on paid work.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
I was not referring to myself, I make a fine income and actually had a very large vegetable garden and can loads of produce. And I live in the country, with farmers markets everywhere. I was referring to the folks I have worked with as a nurse, who don't make the money, and don't garden, and don't can. Someone else had it right, comparing bags of chips to the cost of milk in NH - smokers are not even in the equation here for financial problems. Not all low income people smoke, especially standing outside your office buildings;) Oh, and the $12 a week is for 2 growing boys who drink a gallon every other day at $2.89. Powdered milk? a typical suggestion from someone who doesn't have to drink the nasty stuff.
My blended family was working poor while I was a teenager. With the "marriage" of 2 families money was pretty tight. The fact that we had 4 teenagers, 3 of them atheletes living in a household of 7 total made groceries a challenge, even back in the day...working poor is working poor. Anyway, my mom used powdered milk to "stetch" the good stuff. Honestly, as a hungry thirsty kid who liked milk...if it was good and cold it didn't matter.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
I have noticed something in these threads which gives me pause...
We banter about our personal responsibility for premiums, and planning, and even for preventative care. The elephant in the room is that much of the human health concern cannot be planned for, and is largely unpreventable (when you rule out vaccine preventable disease and famine). Most cancers...only a few have known causes...we speculate a lot. AV malformations or disorders. Congenital cardiac defects...etc. You get my point. There are scores of people in all walks of life who will never be able to adequately prepare for the financial strain that life will throw their way...they have no control over it. Throw in mid-level things that are still expensive (with high deduct/copay policies) like broken bones, appendectomies, blown knees, etc; and the working poor family is destitute.
I am ready for us to radically change the way we view healthcare in America. I wish our politicians were not the ones writing the laws regarding such change.
Onekidneynurse
475 Posts
Trader Joe's is inexpensive? I don't think so. I shopped there in Danbury CT. Double my grocery bill. Maine is part of the Northeast. When you are in the Northeast there are no fresh fruits in November. Geography.
They have the same frozen foods as every other supermarket. Green Giant etc.
I heat my house in the winter. I don't keep my food outside. I still need a freezer in the winter. Where do you live?