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?
If the family has no insurance, then that means they are not working. Maybe they should have thought about birth control before conceiving a child which they can't afford. Why should I feel guilty now for all the folks who are irresponsible - produce kids, don't work, do drugs, illegals? Do you expect me to pay for all of them? If you think that healthcare is a right, then go ahead and pay for all of these people, and we'll see how quickly you'll change your mind.
Most people's health insurance is tied to employment and if they lose their job most will not be able to afford health insurance and many may simply not even qualify for health insurance and companies currently deny anyone with a pre-existing condition.
I wonder what you'd do if that happened to you? Don't be so quick to judge others! It is ridiculous and immoral that we still don't have national healthcare for all. We should have basic national health insurance like medicare for all and then we could purchase any supplemental insurance as is already done with medicare. It would sure be an improvement from today and would cost less than what is spent for healthcare now, the govt doesn't spend millions for CEO's and their fatcats with bonuses, etc!
What about those like me who can't afford it? It would be the choice between taking food from charities or insurance, since it's the same cost as my food budget. I like to reserve the food boxes for those who are truly destitute.
I thought my intent was quite clear when I said "I don't think adults should be forced to pay higher insurance premiums to cover those who choose not to have health care insurance when they can afford it !. It may be easier on their pockets but not mine ". I've highlighted the relevant part ie. if your income is too inadequate to cover everyday living expense , then I support the idea of providing healthcare , but don't expect me to cover this cost if you have disposable income for the latest gadgets and lexus etc..
When I am taking care of a patient, I really don't care who is paying.....however, with the way our department works, it is impossible NOT to know because we do the admissions from the beginning, including "I need to copy your photo ID and insurance card."
However, that being said, when I discharge them to a nice pretty car, help them carry out their Coach bags (even if a knockoff or purchased from the outlet store), note their freshly painted and fancied up nails, can't help but notice the extensive highlights in their hair, that's when I have a moment........Seriously, I have discharged people with no insurance to cars newer than my own.....why can't others understand the unfairness of that?
Easy. The kids get the surgeries and the hospital accepts a payment plan for them after it's done. Sure, $5000 may take a lot of people years to pay off, but it's doable.
This thread has featured one of two basic scenarios depending upon the politics of the poster. One is the family/child/elder who is poor through no fault of their own. The second is the individual (and their dependents) who have refused to delay gratification and are poor because of poor choices.
In a perfect world there would be distinctions made between the first class of people and the second, especially when handing out free services. No one should be cut off, not even the intoxicated indigent found down on a frozen sidewalk. But the poor-through-no-fault-of-their-own group have potential. They have a higher likelihood of being set back on their feet. The others, not so much. A wise social policy would make some distinctions between the two. But the Grand Scheme to Federally Outlaw all Illness and Misery is a ridiculous sham. There is not one perfect solution. But there are thousands of small(er) ones.
The same thing applies to health care. We are not France. We are the most non-homogenous country that has ever existed. I live in NV. We have WAY more space than we do people. Nevada is not Manhattan. Good grief, the economics of health care are more complex than can be possibly imagined in your wildest dreams. Of course there can be a generalized, federal safety net dispersed to States in the form of grants. But let Illinois and Michigan do what works for them. Let the people of Texas and Colorado and New Jersey decide how to serve their poor.
I have no problem with the motives of those who disagree with me on the affordable care act. But I canNOT understand how you can look at the incestuous, out-of-touch bureaucrats in DC and the congress that regularly beclowns itself, and imagine that they can fix our health care on a national level. And if you think this congress is a bunch of clowns, go down the roles of history and find one that is better. (Hint: Start your internet search in a year that precedes the election of Harry Reid to national office.)
Health care reform is not primarily about how to serve the poor. Our safety net for the poor (medicaid) is already administered at the state level. The purpose of health care reform is to make healthcare more effective and efficient for everyone that receives healthcare, not just the poor, in fact very little of it is aimed at the poor.
Sorry to repeat myself, but no one will argue that healthcare delivery is different in rural areas that in urban areas, but the basic principles of treating heart failure don't change from state to state. It's unlikely that 50 individual versions of reform would be more efficient, but at this point we'll take anything other than "let's not do anything", so let's leave it to the states, what would Nevada's version of reform look like?
The basics of treating heart failure may be the same whereever you go (but really, things do differ from area to area), but the logistics of getting that care differs vastly. Distances make a huge difference.
Many people who have chemo or radiation have the distinct advantage of going 10 or 15 minutes down the road for their daily or weekly treatments. My husband benefitted from that 4 years ago.
My dad, OTOH, for his chemo and radiation in the recent months, traveled 130 miles round trip. And that is the closest place to his town. Some people from that town, travel more to get to other centers that are not that close. It is a hardship that must be addressed in ways that people who live in much more populated areas can't imagine.
The basics of treating heart failure may be the same whereever you go (but really, things do differ from area to area), but the logistics of getting that care differs vastly. Distances make a huge difference.
Many people who have chemo or radiation have the distinct advantage of going 10 or 15 minutes down the road for their daily or weekly treatments. My husband benefitted from that 4 years ago.
My dad, OTOH, for his chemo and radiation in the recent months, traveled 130 miles round trip. And that is the closest place to his town. Some people from that town, travel more to get to other centers that are not that close. It is a hardship that must be addressed in ways that people who live in much more populated areas can't imagine.
There's no doubt that healthcare delivery in rural areas is different than in urban areas, but is the delivery of rural healthcare in Texas completely different than rural healthcare in Oklahoma?
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Should the access to rural health care be completely dependent upon your ability to pay? That rural farmer (insert other self employed person) does NOT have the same access to health insurance as does the person working for the factory or hospital or other company with group benefits. So, you add the round trip expenses to the very expensive care (which may or may not be covered by the individual insurance policy) and "boom" you are on the pathway to financial devastation or perhaps the pathway to complete absence of care because you cannot even afford to get to the care AND pay for it too.
You're right of course. The PPACA was something intended for all Americans (except those exempted by HHS... which puzzles me, but oh, well.) At the same time, there is a huge amount of pandering going on. The middle class people who are dubious about it are told they are heartless and bigoted since this legislation is going to provide coverage for the 35 million folks who have none. Read the posts here and you'll see the issues of the poor do get mixed in with the "working poor" as well as the "I want that new pickup therefore can't afford insurance" crowd.
Looking to DC for a solution to something this complex is manifest foolishness. Same can be said about many state capitals. But some States will be innovative and raise the bar for the rest. If we keep talking about the helpless asthmatic child dying in the street for lack of medical care (or "breathalizer" as our splendid leader calls it) we will only be mud-slinging and denigrating each other. Let there be thought and innovation.
You ask what NV's version of reform would look like. Well, first of all, we are the hardest hit state in the union. Big headline in our paper today was celebrating the fact that our unemployment rate is all the way down to 12.9% (Whoo hoo! Break out the bubbly!) Let me tell you about my city. The poor get seen in ER's of course. But there are also clinics supported in part by the county, and in part by the largest hospital in town. There is also a pregnancy center where patients pay on a sliding scale. No baby need be born here without prenatal care. There is also a Blue Cross plan advertised for the uncovered family members of the working poor. It isn't free, but it is more than just catastrophic coverage. Medicaid reimburses the hospitals for folks that can't pay.
We're getting by. It isn't great but I haven't stumbled over dead people in the streets, yet.
Representative Ryan sells the idea of medicaid block grants as a way of allowing states to administer medicaid funds in the way that works best for them, which sounds great as a general idea. This would seem to imply that currently medicaid is rigid and only works in a single demographic, such as urban areas. Although medicaid already has mechanisms to serve the unique needs of various areas such as rural areas; transport outside of the patients community for care can qualify under medicaid, there are special programs to supplement reimbursements in rural areas that don't have the benefit of patient volume to adequately cover costs for things like doctors and CT scanners.
What Rep. Ryan means when he says that block grants would allow states to administer medicaid in a way that works for them is that it would allow states to drastically cut coverage. In Nevada for instance, Ryan's block grant proposal would force 136,000 Nevadans off of medicaid. Mississippi governor Barber loves the idea, even though it would boot 247,000 out of medicaid in Mississippi by 2021. By "do what works best for them" Rep Ryan appears to be referring to drastically increasing the number of poor who lack health care coverage.
This is bad not just in terms of a bleeding heart sympathy for the poor, but because it actually costs us a lot more money. At some point everyone ends up on medicare, either due to old age or disability. Just like private insurers, the goal of states is to keep as much of the costs of care out of their budget as possible, which unfortunately often means suboptimal or even non-existent care for common, relatively easily treatable conditions such as diabetes and hypertension. So we avoid the cost of $50 worth of meds a month and then the patient has a stroke and ends up in a Nursing home for the rest of their lives which puts on the medicare budget, or they need 3x week dialysis, which again moves them into medicare coverage. The problem is that while states save the $50 without having to pay for the exponentially more expensive consequences, wherever the money gets filtered through it all comes from us in one way or another.
That should be the goal, spend a little now to save a lot later, even if that means medicare and those responsible for it (the Federal government) needs to take a more proactive role in making the changes needed so that medicare inherits patients with reasonably well maintained health when they graduate from insurers, medicaid, etc, and enter into medicare, rather than inheriting a neglected and very expensive to care for population.
i for one would like to know what all the healthcare dollars are paying for and why nurses and doctors are being laid off, wethe hospitals in america are so understaffed with nurses, doctors and ancillary employees? $4 million dollar salaries to pay for this crap, while 50 million americans are uninsured, under-insured and cannot access healthcare, have to file bankrupcy, forclosure and the healthcare benefits of working class america are being cut to the bone or removed. but some lout can finance and 'access' his mistress anytime he wants.
and to make matters worse- this story made it across "the pond" to england.
brandy1017, ASN, RN
2,910 Posts
Most people's health insurance is tied to employment and if they lose their job most will not be able to afford health insurance and many may simply not even qualify for health insurance and companies currently deny anyone with a pre-existing condition.
I wonder what you'd do if that happened to you? Don't be so quick to judge others! It is ridiculous and immoral that we still don't have national healthcare for all. We should have basic national health insurance like medicare for all and then we could purchase any supplemental insurance as is already done with medicare. It would sure be an improvement from today and would cost less than what is spent for healthcare now, the govt doesn't spend millions for CEO's and their fatcats with bonuses, etc!