Socialized/Universal/Single Payer/Government Funded Health care....why?

HM2VikingRN, RN · Jan 2, 2008

the point is the following:

health coverage has again become a core issue because of the relentless rise in medical costs and its wide ramifications, especially for the fate of the employment-based insurance system. costs are rising far more rapidly than general inflation or real wages: the average total insurance premium for family coverage now runs over $12,000 (just about what a minimum-wage worker makes in an entire year) and is projected to pass $21,000 in 2013. unsurprisingly, employers have shifted costs to workers, the proportion of jobs that come with health benefits has fallen, and the number of uninsured has grown -- according to recent figures, to about 47 million.

being uninsured has also become a more economically perilous condition. in the past, doctors and hospitals charged low-income people lower rates on a sliding scale, but now that insurers negotiate discounts, health-care providers are imposing their highest charges on the uninsured. and as a result of what a recent business week cover story called the "medical debt revolution," providers have begun turning over unpaid bills to aggressive collection companies charging usurious interest rates and taking advantage of the new bankruptcy law that makes it difficult for people overwhelmed with debt to start over.

source: http://prospect.org/cs/articles?article=the_democrats_strategic_challenge accessed today.

health care costs will essentially double in the next five years. health care is like a public utility. it should be regulated and be required to justify any rate increases to a public commission. we have done this for years with electric and gas companies. they stay in business and do just fine within a regulatory environment. (and their employees as a group are well paid....)

HM2VikingRN, RN · Jan 2, 2008

That said, I look to my own sister's experience with wait times in Canada. When she was diagnosed with uterine cancer 10 years ago, there was no wait. Her treatment was immediate. She was also fortunate to be in a large city and could take advantage of an innovative operation that was then being performed by only three surgeons in the world.
Total out-of-pocket cost: Less than $50. Because she opted for a private room.

I have heard a lot of dissatisfaction about the healthcare system in Canada, from Canadians. Most complain about the rationing, the need to wait for diagnostics and procedures. You sister was fortunate (not about the cancer, but the care), but she also had a condition that required immediate attention. Some one with gall bladder disease or back pain might not be so lucky and could find themselves waiting years for care. Would not work in this country, we are too spoiled.

We have greater access problems than other countries:

Are less likely to be able to get a same day appointment:

We have longer waiting times than almost everyone else within our peer group of nations:

Are more likely to skip needed care:

If un/underinsured are less able to manage chronic conditions:

The un/underinsured have poorer control of chronic disease:

Well designed groups are less expensive:

2/5 Americans have serious access problems:

Americare is both cheaper and more efficient:

Health care is not charity. My personal belief is that access to health care is a mutually shared societal obligation to each other.

HM2VikingRN, RN · Jan 2, 2008

I just don't feel responsible for the healthcare of a child whose irresponsible mother needs a Starbucks fix once a day.

The solution is to make health care enrollment seamless and automatic. It is a sad commentary that you feel no obligation to the assuring that children are in good health and have acccess to affordable health care because of the failings of their parents. S-Chip has been widely discussed elsewhere on the boards. The evidence from the world stage shows that the single payer systems and mixed private public systems produce better results at lower costs.

HM2VikingRN, RN · Jan 2, 2008

the va is a high performing system:

[the] vha's complete adoption of electronic health records and performance measures have resulted in high-quality, low-cost health care with high patient satisfaction. a recent rand study found that vha outperforms all other sectors of american health care across the spectrum of 294 measures of quality in disease prevention and treatment. for six straight years, vha has led private-sector health care in the independent american customer satisfaction index.

indeed, the vha's lead in care quality isn't disputed. a new england journal of medicine study from 2003 compared the vha with fee-for-service medicare on 11 measures of quality. the vha came out "significantly better" on every single one. the annals of internal medicine pitted the vha against an array of managed-care systems to see which offered the best treatment for diabetics. the vha triumphed in all seven of the tested metrics. the national committee for quality assurance, meanwhile, ranks health plans on 17 different care metrics, from hypertension treatment to adherence to evidence-based treatments. as phillip longman, the author of best care anywhere, a book chronicling the vha's remarkable transformation, explains: "winning ncqa's seal of approval is the gold standard in the health-care industry. and who do you suppose is the highest ranking health care system? johns hopkins? mayo clinic? massachusetts general? nope. in every single category, the veterans health care system outperforms the highest-rated non-vha hospitals."

what makes this such an explosive story is that the vha is a truly socialized medical system. the unquestioned leader in american health care is a government agency that employs 198,000 federal workers from five different unions, and nonetheless maintains short wait times and high consumer satisfaction. eighty-three percent of vha hospital patients say they are satisfied with their care, 69 percent report being seen within 20 minutes of scheduled appointments, and 93 percent see a specialist within 30 days.

critics will say that the vha is not significantly cheaper than other american health care, but that's misleading. in fact, the vha is also proving far better than the private sector at controlling costs. as longman explains, "veterans enrolled in [the vha] are, as a group, older, sicker, poorer, and more prone to mental illness, homelessness, and substance abuse than the population as a whole. half of all vha enrollees are over age 65. more than a third smoke. one in five veterans has diabetes, compared with one in 14 u.s. residents in general." yet the vha's spending per patient in 2004 was $540 less than the national average, and the average american is healthier and younger (the nation includes children; the vha doesn't).

source: http://prospect.org/cs/articles?article=the_health_of_nations

it serves sicker patients at lower cost.

Katie82, RN · Jan 3, 2008

You are right on the money with this one, MBA nurse. We are much too spoiled for Universal Healthcare. I recently decided to forgo health insurance premiums and use my Tricare benefit. A bit of a shock, and we are capitated to our local military hospital, so things are moving a little slower than I was accustomed to. But I am satisfied with the care I get, and because of my healthcare background, I can advocate for the care I need. You are correct that prevention would save us trillions, but prevention requires a personal committment and we have become not only spoiled, but lazy. We go to the doctor when we need something fixed, and we expect immediate gratification. I am working as a case manager and I am always amazed at the lengths to which I must go to get my patients to perform even the most basic maintenance, like a Pap or PSA or childhood immunizations. Like pulling teeth. I work with a lot of folks with chronic disease, so I am constantly on their case about complying with Standards of Care. What upsets me even more, though, is that I spend entirely too much time reminding docs that these patients need SOCs. Doctors may think insurance companies are trying to run the show, but they shouldn't be forced to chase a doc down to make him order an A1c for a diabetic twice a year. Everyone needs to stop this pissing contest and start working toward wellness.

Katie82, RN · Jan 3, 2008

HM2Viking - good post. I don't think the VHA gets nearly enough credit. My son is a nurse at a VA medical center, and although he complains a lot about personnel issues, he is a loyal cheerleader for the system. Folks seem to think that because the VA delivers such good care, we ought to do the same with Universal HC. Not so.... I believe the VHA is so effective because the powers that be are not paying a lot of attention to them. They have autonomy to shape their own system, and because they have accomplished so much in the past few decades, the meddling politicians are afraid to mess things up. I don't think UHC would enjoy the same status. Medicare is in bad shape because they are not pushing managed care and population management. They are trying to change this, but any change involving the feds is slow in coming. I have a lot of "dual-eligible" patients - those who are on medicare and medicaid. Technically, I don't have to manage them because unless they are medicaid only, but I see them as my neediest patients, so I do. Medicare patients have no one to advocate for them on an individual basis. You can get case management with medicaid, and most insurance payers, but Medicare patients are left to navigate the system alone. I cannot believe that Univ Healthcare would be any different.

Lizzy6 · Jan 3, 2008

Medicare patients have no one to advocate for them on an individual basis. You can get case management with medicaid, and most insurance payers, but Medicare patients are left to navigate the system alone. I cannot believe that Univ Healthcare would be any different.

So true! I case manage the medicaid population.

Freedom42 · Jan 3, 2008

That said, I look to my own sister's experience with wait times in Canada. When she was diagnosed with uterine cancer 10 years ago, there was no wait. Her treatment was immediate. She was also fortunate to be in a large city and could take advantage of an innovative operation that was then being performed by only three surgeons in the world.
Total out-of-pocket cost: Less than $50. Because she opted for a private room.

I have heard a lot of dissatisfaction about the healthcare system in Canada, from Canadians. Most complain about the rationing, the need to wait for diagnostics and procedures. You sister was fortunate (not about the cancer, but the care), but she also had a condition that required immediate attention. Some one with gall bladder disease or back pain might not be so lucky and could find themselves waiting years for care. Would not work in this country, we are too spoiled.

Would not work in this country? I'm missing something. Last May, I began experiencing pain in my right foot. It took me three weeks to get an appointment to see an NP, who told me I had to see an orthopedist. At that point, I was limping. I immediately called the orthopedist's office, told them I was in pain, and was told I could get an appointment in July. Of course, on the morning of that appointment, they called and canceled -- he was overbooked, they said -- and put me off until September.

That wasn't in Canada. That was in the US of A, where I have what most people would consider Cadillac health insurance. Yeah, I'm spoiled. And I know lots of other folks who wait weeks and months to see providers. Guess they're spoiled, too.

If my condition were life-threatening, I'm sure I would have received faster service. But there were other people whose conditions were worse than mine or who had been waiting longer. They had to go first. That's part of living in society. You have to consider other people.

HM2VikingRN, RN · Jan 7, 2008

So the government will bungle health care the way they bungle everything? Uhh, we trust them with running the military, the post office, roads, public education, FAA, FDA... My personal observation is that deregulation of government agencies and services has led to more problems and corruption and higher costs.
Yes there is always some waste and inefficiency, but I resent my health care dollars going for lobbying and advertising.
MBANurse--thank you for your military service. And I am happy that you do not suffer form a chronic disability that prevents you from working, that your family hasn't been stricken by illness that has caused you to declare bankruptcy or that you employer hasn't cancelled your insurance or made the premiums so high that you must choose between paying the rent or insurance premiums. I would guess that you have never had to have bake sales to raise money for medical care. That is a common occurance in my community of hard working people (farmers, fishermen, loggers, Walmart employees) who can't pay for medical insurance.

Here is a very powerful argument in support of single payer based on the efficiency of the SS system:

All of you have heard politicians and pendants refer to Social Security as a problem. Far from being a problem Social Security is a model for the rest of the government. Everyone knows that Social Security's benefits are sent reliably, accurately and on time every month to millions of retirees, widows, widowers, children and disabled Americans. But did you know that after Hurricane Katrina when President Bush famously told Brownie that he was doing a heck of a job, Social Security really was doing a heck of a job. Its representatives were at the Houston Astrodome and other evacuation centers insuring that those people who no longer had homes or access to their bank accounts nevertheless received those benefits on time and even in cash when necessary.

Did you know also that Social Security was the first insurer on the scene after the terrible events of September 11th? Virtually every worker who perished that day was covered. The families of every worker [were] covered by Social Security. In the chaotic aftermath of that tragic day millions of Americans reached into their pockets and generously contributed to the Red Cross and other charitable organizations. But the most immediate, sustained and generous support came from Social Security. The very first benefit checks were sent out just three weeks later on October 3rd, 2001. Today virtually all working Americans continue to contribute to those 9-11 families every payday.

The money that is withheld from your paycheck is put into the Social Security's Old Age and Survivors Trust Fund out of which those 9-11 families receive benefits still today. Social Security is a model in other ways as well. Politicians talk about family values. Well Social Security is all about protecting America's families. Its dependent benefits make it the nation's largest children's program. Another example of Social Security's model behavior; everyone has heard about fraud, waste and abuse in the government. In contrast, Social Security operates smoothly and efficiently,

returning in benefits more than ninety-nine cents of every dollar collected, spectacularly greater efficiency than you will find in any private sector retirement plan or any private insurance.

Source: http://www.sharedprosperity.org/av/071120/transcript-retirement-security.pdf

Katie82, RN · Jan 17, 2008

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For someone who has MBA in their moniker, you do seem to come from a mostly emotional place when this topic is discussed.

I also have a MBA in Healthcare Management, and one thing I learned early on is that this Universal Healthcare that people are praying for is going to cost us more than we can afford. Every time I listen to these politicians promise us a solution to the healthcare problem, I keep waiting for at least one of them to tell us how they propose to pay for it..... I guess I get a little emotional too, the naivete and gullibility of a large portion of the American public brings tears to my eyes.....

pickledpepperRN · Jan 17, 2008

I don't think any presidential candidate has a workable solution.

I also think we must have a healthcare system for Americans.

We do not have one now.

Katie82, RN · Jan 27, 2008

It is the insurance shell game: You think you know what to expect and you are totally wrong. Surprise!

Source: http://www.nytimes.com/2007/12/29/business/yourmoney/29instincts.html?ref=health accessed 12/30/2007.

You may be looking at the wrong bad guy here... Your employer purchased this plan for you. An insurance company does not dictate a plan, they put a plan together based on what your employer wants you to have. I know these plans cost money, but is your employer not willing to pay for better coverage because they are spending money somewhere else? I worked for a company that paid two or three bonuses a year. The tas witholding was 50% and they raised my income enough to bump me up to a higher bracket, so were these bonuses doing me any good? I would have preferred to have that money put into the insurance pot so my premiums were lower. But what do I know?