To all "medical coverage is a privilege" folks:

[dirtyhippiegirl]

You're presented with a five year-old who probably has appendicitis. The family is poor, does not have medical insurance, and they only have a small amount of money to cover diagnostics and treatment of their child. (Any veterinarians on this forum?)

Because of the OMG free market stuff, you can remove the child's appendix for a minimum of...$5,000. However, this child's family cannot afford that and are not eligible for that much credit.

...what do you do? What if you're presented with ten such cases over the course of a month?

[Autymn]

I'll jump in on this. Most hospitals will make arrangements with patients to pay off bills. $5000 to remove an appendix? Maybe in Mexico. I had shoulder surgery last year to repair a seperated shoulder and it cost 5 times that, just for the surgery. Labs, PT, pain meds,etc were all extra. Total cost was $48,000. Luckily the injury was a result of a car accident and the other drivers insurance paid (he was at fault).

But what if it was a heart attack, stroke or other type of accident? I worked full time and had insurance (BS/BS). I Paid $300 a month for that privledge. How much would they have covered??

Answer: about $20,000. They would NOT pay for: Ambulance ride or any procedures done in the ambulance, CT scans done in the ER, or Physical therapy. The would have paid a percentage for everything else. I know this because claims were filed with BC/BS before being turned over to the other guys

insurance..."

Wilson - it is rare that some people even inform themselves of exactly what is in their so-called 'full coverage' health insurance. Some of the very same people who actually argue against humane healthcare for others, regardless of the economic vehicle used, will damn straight find themselves or loved ones in the exact position you describe at some time in their lives.

Wrong-minded reasoning often has little experiential basis.

[debkimt]

I had an ob patient on medicaid the other day ask me if it would be safe for her to go on the cruise with her husband next month. She said she needed a quick answer because her husband was about to purchase the tickets. I am a LVN and single parent that struggles to pays for my own insurance and healthcare and I cannot afford to go on a cruise. Or, how about these people that claim they cannot pay their healthcare costs, but smoke 1-2 packs of cigerettes a day? For alot of people, it is really just about what they choose to pay for.

[tewdles, RN]

debkimt...it is clear that you personalized this comment and you are angry.

I went on a cruise when I was dead broke too...my parents paid. I still had to book the tickets though...

[Rob72, ASN, RN]

Anyone familiar with, "fee for service"? I already know the answer. "Universal" coverage is only needed when third-party payors have to pay staff & make profit, and physicians(and RNs) have to pay Gvt. loans.

No historical model validates the concept that individual or long-term societal needs can be effectively be met by an administrative/legislative body. The only extant socialist system greater than 60 years old is China, hardly a prime example of care-delivery.

[nicurn001]

Sigh ! we all get the concept of fee for service and personal responsibility . Surely you get the reality that there will always be those who cannot finance those services , what would you have done to them ? . If you give them care how is it to be financed , so that the providers do not go bankrupt , or do you advocate simply witholding care to all who do not have the finances or access to finances ( usually through insurance )to pay for their care?.

[Rob72, ASN, RN]

Sigh ! we all get the concept of fee for service and personal responsibility . Surely you get the reality that there will always be those who cannot finance those services , what would you have done to them ? . If you give them care how is it to be financed , so that the providers do not go bankrupt , or do you advocate simply witholding care to all who do not have the finances or access to finances ( usually through insurance )to pay for their care?.

I've lived with that reality. One makes choices based on need, not, "desire".

What we are currently financing is not healthcare, but continued self-destructive ideation. Slap a 150% "sin-tax" on televisions and high-calorie/sugar foods, and AV entertainment; we're doing pretty well with tobacco.

I'll be very blunt- take away the data-packages, electronics, and eating out, most of us make a damn good living, and certainly a majority would be able to have savings in addition to the "olde-school", catastrophic event insurance.

I'm sorry, the majority of people in the United States do not shop for the majority of their clothing at Goodwill, most of them cannot prepare a meal that is both nutritious, and capable of feeding them for the next meal as well, most of our children are far too electronically gratified.

Yet again, I'm sorry, we can debate healthcare stats, based on who ran the study, bias, etc., etc.; consumer stats, however, are fairly cut-and-dried. Americans spend their money on physically harmful self-indulgence, and our socio-political model offers no incentive for betterment, nor penalty for abuse. Quite a few States have fought legal battles over the Constitutionality of requiring drug-testing and cessation therapy for public-assistance benefits; the crisis is not over "saving the lost and helpless", but wasting resources for those truly in need on the vulgarly abusive.

One of many, its as bad, if not worse, with Trauma:

https://allnurses.com/burn-nursing/shake-bake-meth-665589.html

[heron, ASN, RN]

I've lived with that reality. One makes choices based on need, not, "desire".

What we are currently financing is not healthcare, but continued self-destructive ideation. Slap a 150% "sin-tax" on televisions and high-calorie/sugar foods, and AV entertainment; we're doing pretty well with tobacco.

I'll be very blunt- take away the data-packages, electronics, and eating out, most of us make a damn good living, and certainly a majority would be able to have savings in addition to the "olde-school", catastrophic event insurance.

I'm sorry, the majority of people in the United States do not shop for the majority of their clothing at Goodwill, most of them cannot prepare a meal that is both nutritious, and capable of feeding them for the next meal as well, most of our children are far too electronically gratified.

Yet again, I'm sorry, we can debate healthcare stats, based on who ran the study, bias, etc., etc.; consumer stats, however, are fairly cut-and-dried. Americans spend their money on physically harmful self-indulgence, and our socio-political model offers no incentive for betterment, nor penalty for abuse. Quite a few States have fought legal battles over the Constitutionality of requiring drug-testing and cessation therapy for public-assistance benefits; the crisis is not over "saving the lost and helpless", but wasting resources for those truly in need on the vulgarly abusive.

Soo ... what penalties for abuse or incentives for betterment would you promulgate and how?

If it's a "sin-tax" how is that different from government interference in personal choices? If it's some as-yet undiscovered incentive program, how is that not government attack on corporate profits? Or government deciding how people shall live their lives? If it's not the government doing these things, who would?

Don't tiptoe around what you're really saying ... to be truly consistent with the current libertarian line of thought, the answer is, "if they can't afford it, let 'em die".

"the crisis is not over "saving the lost and helpless", but wasting resources for those truly in need on the vulgarly abusive." This statement would have us discriminating between the truly "lost and helpless" and the "vulgarly abusive". How does one measure "vulgarity" - basically an esthetic judgement call - in order to determine who is "truly in need".

[bagladyrn, RN]

Heron - you have hit on the one point that has struck me throughout this thread. None of the posters who consider "healthcare a privilege" have laid out exactly what they think should be done, at the hospital door or the ER desk with those patients who do not have the means to pay for necessary services.

Okay - how about it people - what would you advocate for the person who walks in with chest pain, the laboring woman, the unconcious trauma victim dropped on your doorstep by someone who then speeds off if these individuals don't have insurance, credit cards or ready amounts of cash? Are you going to treat them (and who pays for that?) or step over them on your way in?

I'm not asking what these people woulda, shoulda, coulda done prior to the crisis. What are we going to do now?

[rnfostermom, BSN, RN]

Heron - you have hit on the one point that has struck me throughout this thread. None of the posters who consider "healthcare a privilege" have laid out exactly what they think should be done, at the hospital door or the ER desk with those patients who do not have the means to pay for necessary services.

Okay - how about it people - what would you advocate for the person who walks in with chest pain, the laboring woman, the unconcious trauma victim dropped on your doorstep by someone who then speeds off if these individuals don't have insurance, credit cards or ready amounts of cash? Are you going to treat them (and who pays for that?) or step over them on your way in?

I'm not asking what these people woulda, shoulda, coulda done prior to the crisis. What are we going to do now?

I hear you, and my reply would be that we treat these people. I work in a 'safety net' hospital that cares for anyone who comes through the doors regardless of ability to pay. In 7 years of working there, I have never once heard that a patient cannot have a test, or a procedure, or a medication because of the cost or they don't have insurance, or anything along those lines. I like that. I think this is how it should be for everyone. I'm absolutely willing to pay higher taxes for this. Obviously, implementing some kind of universal health care would not be problem free. There is a lot of waste, huge numbers of really irresponsible people who wreck their health and, accordingly, difficult choices to be made about allocation of resources. Also, programs that have worked in smaller countries (as discussed in the movie Sicko) would be much harder to implement on a USA-sized scale. Still, it is what I believe in, and I continue to hope it can be possible one day.

[nicurn001]

In my contributions to this thread I keep coming back to two points and as highlighted by the last few responses they have not been answered by those who view healthcare as a priveledge :-

a) what are you going to do for people who CANNOT pay for their care due to unavoidable circumstance , NOT poor lifestyle choices .

b)How are you going to get those who CHOOSE not to buy health care insurance or have inadequate financial resources to self insure , to pay their bills .( this is the group the individual mandate is aimed at , it is an attempt to ensure personal / individual responsibility is met ) .

It would be interesting to see how those who view healthcare as a priveledge would address these issues , rather than see them ***** footing around the reality that appears they would prefer people to die rather than give them healthcare they cannot pay for .

[Rob72, ASN, RN]

"the crisis is not over "saving the lost and helpless", but wasting resources for those truly in need on the vulgarly abusive." This statement would have us discriminating between the truly "lost and helpless" and the "vulgarly abusive". How does one measure "vulgarity" - basically an esthetic judgement call - in order to determine who is "truly in need".

1) I am no Libertarian.

2) Rationality requires judgement; it is not terribly difficult.

3) "Vulgar"- per Merriam-Webster:

b : undeveloped, or unregenerate : gross c : ostentatious or excessive in expenditure or display : pretentious

In context, if one is not currently, or has not previously, contributed to the "social welfare", one cannot expect to withdraw from said welfare indefinitely, whether the paradigm is Humanism, theological, Fascist/Communist, whatever.

If one has means to purchase illicit recreationals, one may pay for healthcare, food, clothing and shelter. If one has funds for combo cable/dish/Netflix, cigs, and delivery pizza, but cannot make payments on an angio, that has nothing to do with "need".

If someone is able to demonstrate, using Erickson's, how providing care for every bit of dumbassery(see linked discussion on the impact of meth-kAbooms on burn units) contributes to the development of members of society in a positive manner, by all means. My personal assessment, after 20 years, is that we have a HUGE segment of society locked in early-middle adolescence, lacking in cause-effect relational modelling and in calculating cost in interpersonal acts.

I am unclear as to where aesthetics fit into the discussion. Choices have consequences. Americans have not experienced consequences, on a national scale, in 60 years.

[Rob72, ASN, RN]

a) what are you going to do for people who CANNOT pay for their care due to unavoidable circumstance , NOT poor lifestyle choices .

b)How are you going to get those who CHOOSE not to buy health care insurance or have inadequate financial resources to self insure , to pay their bills .( this is the group the individual mandate is aimed at , it is an attempt to ensure personal / individual responsibility is met ) .

It would be interesting to see how those who view healthcare as a priveledge would address these issues , rather than see them ***** footing around the reality that appears they would prefer people to die rather than give them healthcare they cannot pay for .

a) This was what charity/community hospitals did, before there were requirement to accept 3rd party payors or all "indigent" emergents. Again, no huge mystery, its a very clear historical record.

b) What is the over-powering NEED to force people to buy insurance or have "adequate resources"? How does forcing myself, self-sufficient, middle-class, to support those who choose self-destructive behavior improve the situation? Will the children of the enabled be better decision-makers for it, or will they see the entitlement benefit, and promulgate and procreate? Again, history is extremely clear- enabling models do not work.