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To all "medical coverage is a privilege" folks:

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dirtyhippiegirl has 8 years experience as a BSN, RN and specializes in PDN; Burn; Phone triage.

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You are reading page 4 of To all "medical coverage is a privilege" folks:. If you want to start from the beginning Go to First Page.

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I'm having difficulty following you on the Ryan plan. It seems you're conflating Medicare and Medicaid. I'm not that familiar with the way Ryan's plan deals with Medicaid so... you may be right, I don't know.

With regard to Medicare... something has got to give. No matter who wins this debate, Medicare is not going to be recognizable within a generation, or maybe less. If Ryan loses, and nothing changes... Medicare will fizzle out. There is no way my kids and grandkids are going to have full coverage when they retire. And this is for a simple reason:

WE ARE OUT OF MONEY!

All the economists (actuarialists?) who check the numbers come to the same conclusion. They may quibble about when the program crashes and burns, but they all acknowledge that it will.

Does the Ryan plan change the way we do Medicare? Yes. (Not for people my age, perhaps... but for my kids and their kids.) Is his a good alternative to the death of Medicare? Maybe... maybe not. We could have a robust national debate on the merits of the Ryan plan... except that opponents keep demonizing anyone who proposes a solution. (You've seen the ad where "Ryan" dumps "granny" off the cliff, right?)

Speaking personally... I would like to retire. My husband and I have busted our humps for approaching 40 years, have paid off the house, have no debt, have some savings and yes, we've been blessed much more than we deserve. But I saw the President and Congress strip 500 BILLION dollars out of Medicare to finance the ACA. There's no way we can trust the existing leadership. Between that and the panel of experts who will decide if care is cost-effective... um... the Ryan plan is looking pretty good to me.

But since we can't trust DC, we'll keep working.

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bagladyrn is a RN and specializes in OB.

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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.

Currently in NV also, but I'm starting to see a different picture. I'm seeing more and more pregnant women coming in for delivery (some with serious complications) with no prenatal care as the closest place which will see them with no (significant) upfront payment if uninsured is more than 150 miles away. For the working poor with gas at $4.00/gal and a round trip requiring a day off from their minimum wage job they are in a no-win situation.

Not impressed with NV's solution for healthcare access.

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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I'm having difficulty following you on the Ryan plan. It seems you're conflating Medicare and Medicaid. I'm not that familiar with the way Ryan's plan deals with Medicaid so... you may be right, I don't know.

With regard to Medicare... something has got to give. No matter who wins this debate, Medicare is not going to be recognizable within a generation, or maybe less. If Ryan loses, and nothing changes... Medicare will fizzle out. There is no way my kids and grandkids are going to have full coverage when they retire. And this is for a simple reason:

WE ARE OUT OF MONEY!

All the economists (actuarialists?) who check the numbers come to the same conclusion. They may quibble about when the program crashes and burns, but they all acknowledge that it will.

Does the Ryan plan change the way we do Medicare? Yes. (Not for people my age, perhaps... but for my kids and their kids.) Is his a good alternative to the death of Medicare? Maybe... maybe not. We could have a robust national debate on the merits of the Ryan plan... except that opponents keep demonizing anyone who proposes a solution. (You've seen the ad where "Ryan" dumps "granny" off the cliff, right?)

Speaking personally... I would like to retire. My husband and I have busted our humps for approaching 40 years, have paid off the house, have no debt, have some savings and yes, we've been blessed much more than we deserve. But I saw the President and Congress strip 500 BILLION dollars out of Medicare to finance the ACA. There's no way we can trust the existing leadership. Between that and the panel of experts who will decide if care is cost-effective... um... the Ryan plan is looking pretty good to me.

But since we can't trust DC, we'll keep working.

I completely agree that we are headed for disaster with out current system, which is why need to figure out to make the entire system cheaper, something even Republicans admit the Ryan doesn't attempt to, the Ryan plan only alters the order of collapse, and probably even accelerates it.

The Ryan plan on medicaid block grants came up with the topic of shifting healthcare responsibilities to states. Ryan's plan contains proposals for both medicaid and medicare, the main theme for both is to cut beneficiaries without cutting the costs of care, which does nothing more than shift costs to other payers and does nothing to extend the longevity of our health care system as whole. Currently we are on a path where medicare/medicaid will collapse first which will result in the collapse of the rest of the healthcare system shortly thereafter and our economy shortly after that. Ryan's plan just delays the collapse of medicare/medicaid while accelerating the collapse of hospitals, changing that order to Hospitals and private insurers collapsing first, followed by Medicare, followed by medicaid, followed by the rest of our economy. It's also quite possible that Ryan's plan would accelerate the whole process by making huge cuts to preventative care through medicaid cuts, which means that we'll save on the relatively cheap costs of diabetes and hypertension control for instance, only leave medicare to deal with the heavy costs of dealing with uncontrolled diabetes and hypertension (ESRD, strokes, CABG's, etc), in other words the $millions we save today will cost us $billions down the road.

Although some conservatives like to phrase it that way, PPACA doesn't actually strip $500 billion from medicare. It does do away with the "medicare advantage" program, something both democrats and republicans agree on - Medicare advantage was intended to provide cheaper coverage by privatizing it, although as it turned out it costs 14% more to provide the same care under medicare advantage than it does under "regular" medicare. That accounts for $180 billion of the savings to medicare, the remainder of "cuts" are not actually cuts at all, it comes from doing away with waste and fraud, a way of saving medicare dollars that's hard to argue against.

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I'd say bill the family and they can pay it off like they are suppose to over time. Maybe if they are good people and have paid their bills before, they will be given a discount for their situation (this happened to me before).

Healthcare is comprised of services and goods. Isn't it considered unethical to *force* one person or group of people to pay for services used by another person or group of people? If you want a service, shouldn't you have to pay for it yourself?

I've been poor. I've done that. I don't want someone else to have to pay for something I alone am using. If I want my life saved, my thumb stitched, my heart restarted... then I should be the one who pays for it. That's the most logical answer imho.

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nicurn001 specializes in Psych , Peds ,Nicu.

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I guess Naturess using your objections then all insurance is unethical , it is where a number of people paay into a pool and only some use those resources to pay for the services they want.

I feel it is unethical to shift the risk of becoming unhealthy onto me by not insuring yourself against that risk .Now if you are willing to take that risk by carrying this card by all means go ahead .

Individual Freedom Mandate - Truthdig

I would be quite happy to be rid of the individual mandate if you and those who object to it in this healthcare setting either carry this card or relinquish any clainm to any funds other than your own to pay your healthcare bills .

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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I'd say bill the family and they can pay it off like they are suppose to over time. Maybe if they are good people and have paid their bills before, they will be given a discount for their situation (this happened to me before).

Healthcare is comprised of services and goods. Isn't it considered unethical to *force* one person or group of people to pay for services used by another person or group of people? If you want a service, shouldn't you have to pay for it yourself?

I've been poor. I've done that. I don't want someone else to have to pay for something I alone am using. If I want my life saved, my thumb stitched, my heart restarted... then I should be the one who pays for it. That's the most logical answer imho.

The problem isn't unpaid office visit bills, the problem is with bills that the majority of people will never be able to pay off, which is why medical bills are leading cause of bankruptcy. The problem with bankruptcy is that just shifts the cost to those of us that are paying for insurance. The uninsured are often given a discount in the hopes they will actually pay the bill; an uninsured person with a $200,000 hospital bill might be billed $20,000 in the hopes that they might try to pay it instead of just declaring bankruptcy, guess who ends up paying the remainder?

I agree that people should chose what services they want, the problem is the majority of expense in healthcare has to be provided whether or not someone chose to pay for it, so if providing the service is mandatory shouldn't the funding be mandatory? Of should we stop treating acutely ill patients without insurance?

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1,982 Posts; 33,621 Profile Views

I'd say bill the family and they can pay it off like they are suppose to over time. Maybe if they are good people and have paid their bills before, they will be given a discount for their situation (this happened to me before).

Healthcare is comprised of services and goods. Isn't it considered unethical to *force* one person or group of people to pay for services used by another person or group of people? If you want a service, shouldn't you have to pay for it yourself?

I've been poor. I've done that. I don't want someone else to have to pay for something I alone am using. If I want my life saved, my thumb stitched, my heart restarted... then I should be the one who pays for it. That's the most logical answer imho.

But then, should only parents pay for their children's education? My grandmother, who died at 101 years old, had not had children or grandchildren in the public school system for YEARS, still paid her property taxes, which included the school tax until the day she died.

Why on earth should my 101 year old grandmother pay for someone elses' child to go to school? Parents can home school their kids and it would not have cost her a dime. Grandma has been poor herself, as she raised her children during the depression.

Is it not just as unethical to force someone else to pay to educate YOUR child? Education is also goods and services, is it not?

If you want your child educated, you should pay for it yourself. THAT is the most logical answer to that. No one else should pay their hard earned money to educate your child.

As usual, JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

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tewdles has 31 years experience as a RN and specializes in PICU, NICU, L&D, Public Health, Hospice.

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I get so tired of the comments that assume that people do not buy health insurance because they want the new truck, or the new ipad, or the Disney vacation, etc, etc, etc.

There seems to be little acknowledgement that health insurance is terribly expensive for those who do not have the benefit of an employer or other group to reduce the cost. TERRIBLY expensive. Add to the costs any rate increase that the insurance company may want to add on for your pre-existing condition (lets say, congenital birth defect - cardiac maybe) and you may just be priced out of the market, especially if you are a low wage earner.

This countries love affair with capitalism and the desire to apply those principles to EVERYTHING is literally costing people their health and their lives. I have no problem with captitalism in it's proper place. I have a problem with people and industry making obscene profit in health care and health care insurance when the pay off is less care to the patient and poorer health outcomes.

Rant off, flame on...

Peace out.

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tntrn has 34 years experience as a ASN, RN and specializes in L & D; Postpartum.

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I continue to marvel at the obscene profits that are perfectly okay (Apple, Nike, Microsoft) and those that aren't (insurance, oil companies.)

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BCgradnurse has 10 years experience as a MSN, RN, NP and specializes in allergy and asthma, urgent care.

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You have a point there. IMHO, I don't think obscene profits are ok for anyone, unless some of that profit is directed towards philanthropy of some sort. How much money does a person or corporation really need? I think it was Eleanor Roosevelt who said "With great wealth comes great obligation". As a wealthy nation, I think we do have an obligation to care for those who cannot do it on their own, and that includes health care. Please note I said "cannot", and not "will not". There's a big difference in my book.

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NayRN has 4 years experience and specializes in med/surg.

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And here's a nice picture of what happens to illegal immigrants in our health care system. Without giving away too much, had a non-citizen come in with a broken bone. Bone was stabilized with an immobilizer, but ortho wouldn't touch patient because of inability to pay/no insurance, no chance of getting medicaid. Patient was discharged with a "sorry for ya," a script for Norco, and a still broken bone. I do understand the financial implications of the whole thing, but as a nurse, it really made me cringe to watch the patient walking out the door.

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1,982 Posts; 33,621 Profile Views

But if they were not in this country illegally, they would go to an Emergency Room in Mexico for treatment. If they could not pay, it would be MEXICO's responsibility to pay for their citizen's healthcare needs. I believe that Mexico is going to a Universal Health care system.

We have AMERICAN CITIZENS, who are doing without healthcare, due to a number of reasons. Citizens and legal residents are our first obligation.

I stop being a worry wart about other peoples self inflicted problems, when I look at what Illegal aliens are costing this country, and its citizens. There are citizens who are doing without, from to the higher taxes caused by illegal immigrants.

They do not deserve free healthcare. Period. Stop the freebies and they will self deport.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

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