Uninsured=financial ruin

Nurses Activism

Published

admittedly this is anecdotal but the story still speaks to a larger issue. having affordable access to health care is an essential part of the social contract. being uninsured and lacking access to health care puts patients at risk for early death and is one of the single greatest causes of personal bankruptcy in the us. both of these eventualities are quite likely to play out in this woman's life.

from daily kos: http://www.dailykos.com/storyonly/2007/1/14/1438/61856

(emphasis added)

a woman came to the emergency room with advanced cancer. against the advice of several doctors, she decided to delay treatment until she was sure she had been accepted by medicaid.

...

i must tell you from my vantage point, we have evolved into a society where there are tiers of citizenship.

one tier for those who are barely hanging on.

another tier for those who have slipped through the thoroughly destroyed safety net.

and a tier, for very fortunate people like me. people who can afford to patch together a life and pay for healthcare when the insurance company refuses to honor the social contract.

what you're going to read is about honoring the social contract.

a woman, let's call her inez, came to the emergency room last week. she was complaining of various symptoms (which i'll spare you) but they weren't good.

turned out she had advanced cervical cancer. naturally, it was recommended that she begin treatment immediately. chemo, radiation, surgery. she was an uninsured amercan. perhaps had she been insured, she would not have waited until her symptoms became acute to seek treatment. but she did wait, fearing financial ruin--not for herself, but for her family.

she was frightened, proud and tentative. finally, as she spoke, all the pieces of the puzzle began to fall into place. she was uninsured. she had applied or was in the process of applying for medicaid but was still not approved.

her doctor told me she said over and over, "i can't leave my family with a mountain of bills."

i am worried about inez because he said she was resolute. she absolutely would not think of beginning treatment until her medicaid application was approved. that begs the question, will it be approved? and what will happen to her if it isn't approved. i. don't. know.

most tragic, she was certain that her country would come through for her. again, her doctor related to me what she said. "how can they not accept me?" "i am sick, but i am an american citizen."

i'll tell you why they may not accept you, inez. because in the united states of america, health care is only a right if you are rich, powerful or an elected official.

Who wants to eliminate Medicare?

These are not primary care providers, or hospital employes providing care. It is all waste. None of these people do anything useful for our tax money.

$135.47 million for William McGuire, UnitedHealth Group CEO. (He resigned amid

a scandal over the timing of stock-option grants.)

$57.49 million for John Rowe of Aetna.

$42.13 million for Edward Hanway of Cigna.

$5.71 million for Michael McCallister of Humana.

http://www.nonprofithealthcare.org/documentView.asp?docID=628

The USA spends twice as much per person for healthcare as any other industrisalized country.

http://www.pnhp.org/facts/single_payer_resources.php

Why not pay the people who provide patient care rather than those who build big insurance company buildings where no health care takes place? People who work hard to figure out ways to deny the care people already paid for.

Yes I have my story too.

The uninsured aren't the only ones who have to worry about financial ruin. So do the insured, sadly. From Health Affairs:

"In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9-2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick."

That's the truth. My mother was diagnosed with cancer a couple of years ago and it's been eye-opening to see what her insurance company considers "not medically necessary." She has a good company-provided policy from a reputable insurance company and has still racked up thousands of dollars in uncovered medical expenses. And I've lost count of the times my mother has had to switch to what her doctor considers a less-effective medication because his original prescription is not on the insurer's Preferred list.

Who said anything about eliminating medicare?

But your second post was more telling. You listed the salaries of CEO's in four major health insurance companies. Are those salaries exorbitant? Perhaps, but they are what the market will bear. More to the point though, is this: If you were to add up all the salaries of all the CEO's of all the health insurance companies, hospitals, and managed care companies, you would have a sum that would end up being a very small drop in the very large bucket of health care dollars spent in the US. So the point is ultimately moot.

Moreover, you may feel that you (and all other nurses) are worth more than what they are being paid. I'd agree with you. However, so long as your solution to the problem is to cut CEO salaries, you are spinning your wheels. Organization and cohesion are the answers to that problem, things nurses are historically very bad at.

All of which is very interesting. It is also irrelevant to the topic under discussion, which is whether we need universal health care. My contention is that we do not, and in fact a government run universal health care plan would be disasterous.

Let me reask the questions I posed earlier:

Are you willing to continue doing what you do now for 20 to 50% less than what you currently earn?

Are you willing to see your taxes rise to take 50% of your earnings before you ever see a dime?

If the answer to these two questions is yes, what lifestyle changes are you willing to make to make this happen? Are you willing to give up home ownership? How about giving up the newer car you may have?

Are you willing to see the federal government grow yet again to encompass the needs of such a program?

Are you willing to give up yet another bit of your privacy to the federal government in order to see such a program enacted?

Are you willing to see more and more healthcare rationing? Are you willing to tell the family "Sorry, I know you love grandma, but federal regulations say that at 75, she is simply too old to warrant ICU care?"

Who said anything about eliminating medicare?

But your second post was more telling. You listed the salaries of CEO's in four major health insurance companies. Are those salaries exorbitant? Perhaps, but they are what the market will bear. More to the point though, is this: If you were to add up all the salaries of all the CEO's of all the health insurance companies, hospitals, and managed care companies, you would have a sum that would end up being a very small drop in the very large bucket of health care dollars spent in the US. So the point is ultimately moot.

Moreover, you may feel that you (and all other nurses) are worth more than what they are being paid. I'd agree with you. However, so long as your solution to the problem is to cut CEO salaries, you are spinning your wheels. Organization and cohesion are the answers to that problem, things nurses are historically very bad at.

All of which is very interesting. It is also irrelevant to the topic under discussion, which is whether we need universal health care. My contention is that we do not, and in fact a government run universal health care plan would be disasterous.

Let me reask the questions I posed earlier:

Are you willing to continue doing what you do now for 20 to 50% less than what you currently earn?

Are you willing to see your taxes rise to take 50% of your earnings before you ever see a dime?

If the answer to these two questions is yes, what lifestyle changes are you willing to make to make this happen? Are you willing to give up home ownership? How about giving up the newer car you may have?

Are you willing to see the federal government grow yet again to encompass the needs of such a program?

Are you willing to give up yet another bit of your privacy to the federal government in order to see such a program enacted?

Are you willing to see more and more healthcare rationing? Are you willing to tell the family "Sorry, I know you love grandma, but federal regulations say that at 75, she is simply too old to warrant ICU care?"

Your arguments are erroneous and you sound like a serious fear mongerer.Do you work for a drug or insurance company?
Your arguments are erroneous and you sound like a serious fear mongerer.Do you work for a drug or insurance company?

Neither. Also a very poor debating tactic. You claim my arguments are erroneous, yet fail to demonstrate a single error. So, since you can't debate the points, you attack the one who made the points.

Specializes in Critical Care, ER.
How do you explain Medicaid then?

Don't confuse the issue. The problem is not that only rich people can afford health care. The problem is that we punish the hardworking low-wage earner while rewarding those who contribute the least. So if you are unemployed, you are eligible for Medicaid (which provides reasonably decent coverage if you can get it) but if you have a job, working hard and barely scraping by, you are eligible for nothing. That's the injustice.

Divided and conquered. Both deserve medical care. I just don't believe that in a society where our thrifty president can find $ 1 trillion for the war in Iraq, he can't find enough to cover medical bills for both the working uninsured and the non-working uninsured. To pit them against each other, the 2 most disposessed groups in our society, by blaming one for the suffering of the other... well that takes talent.

Arguments (or lack thereof) before notwithstanding, consider what would possibly be the worst effects of creating a national healthcare program.

Think of the federally administered programs now in existence. Now, try to come up with just one that has not become a bloated bureaucratic behemoth. Try to come up with one that does not spend more in administering itself than it spends in actual aid of whatever kind. You can't, because no such program exists.

Now, try to think of one program that is rapidly responsive to the people it serves. Again, there is no such animal. Why not? Because programs administered by the federal government are truly accountable to no one. "You want what we have? You'll have to wait for it." At least insurance companies are accountable to two different populations. First, to their customers, in that if they are not responsive, the customers go elsewhere. Loss of business makes them have to answer to their second population, the investors. Who does the federal government respond to? The voters? Show me one federally funded program that has been changed significantly because of an election.

Some in this thread have already posted about how difficult it is currently to get healthcare they are qualified for from the government. You want to turn all of healthcare into that nightmare?

Finally, consider the bureaucratic red tape you would face from such a program. Again, name for me one federally administered program that does not involve reams of paperwork, all of which is rejected if just one "t" is not crossed.

Make all the claims you want about a federally funded healthcare program. However, the federal government has proven time and again that it simply cannot administer any social program efficiently or effectively. You may look to the future with hope, but historically I see only despair.

Specializes in Critical Care, ER.
One other issue: If you think I painted a bleak picture for nursing, consider the situation for physicians and nurse practitioners. We too will see a reduction in salary. On top of that, folks like John Edwards, who have made their fortune through malpractice law, are not about to allow that system to change. Therefore, while salaries will go down, malpractice premiums will continue unchanged.

There are already places in this nation where the malpractice premiums for certain specialties are higher than what the provider can possibly earn in a year. That's only going to get worse.

Add it all up, and I can easily forsee an exodus of health care workers to other professions. That will make our current (mythical) healthcare crisis look like gentle summer breeze next to a Kansas tornado.

Quite an imaginative defense of the status quo. Your predictions are based on so many intangible, unproven assumptions that's it's difficult to assess where to begin.

To begin with, the extensive use of the European and Canadian systems as bases for what would be. Canada. No wealth, no comparable resources, GDP much lower. No comparison. Western European democracies. All small homogenous ageing societies whose population, while taking less income home, report much higher on quality of life and satisfaction surveys than the U.S. In other words, your average german nurse may earn less than the average U.S. nurse, but she gets a month vacation every year, the knowledge that her mother will be taken care of after being a faithful nanny to the prime minister's family for 30 yrs. When was the last time you worked with a western european nurse who is just soooo happy to be here making so much more money in the U.S. Um, never. She must be happy where she is.

Which brings me to my second point. Your use of net income as the ultimate measurand of quality of life. Is it, really? I mean really?

Thirdly, the malpractice issue. Well, the government is much harder to sue than private hospitals_ just ask anyone who works for NIH or Navy Med. With government resources behind clinicians, litigation will decline.

And, John Edwards may be an ambulance chaser, but at least he's not a incompetent chicken hawk war monger. Let's just take our pot shots in the open, shall we?

Fourthly, the brain drain argument. All the medical professionals will run to other well paying careers such as business. Hmmmm. Well then if all professionals were motivated by personal wealth alone, how come the fields of physics, biology, litterature and education are populated by professionals who chose to earn a modest salary? Maybe it's just you who doesn't want to give up a portion of your salary.

Simply, the justifiable crux of your argument is quite simple. You represent the opinion of a group of Americans who believe that sharing their own wealth in a systematic, organized way to alleviate the suffering of others is neither necessary nor American. When I say others, I mean all others, not just the righteous people who suffer_ all people who suffer. There is nothing wrong about your opinion- in fact clearly a majority of americans agree with you. Just not me.

I'll trade my BMW for universal healthcare anyday.

Specializes in Pediatric Pulmonology and Allergy.
Divided and conquered. Both deserve medical care. I just don't believe that in a society where our thrifty president can find $ 1 trillion for the war in Iraq, he can't find enough to cover medical bills for both the working uninsured and the non-working uninsured. To pit them against each other, the 2 most disposessed groups in our society, by blaming one for the suffering of the other... well that takes talent.

You're missing the point. The point is that in this country you are penalized for working and rewarded for not working. As long as the system is in place that you lose benefits by getting a job and earning wages, people with low income have less incentive to work hard and get better jobs because that means they'll lose the government cushion and will have to work harder for less. It has nothing to do with "pitting one group against another." The member of one group could easily fall into the next group tomorrow.

Specializes in Critical Care, ER.
You're missing the point. The point is that in this country you are penalized for working and rewarded for not working. As long as the system is in place that you lose benefits by getting a job and earning wages, people with low income have less incentive to work hard and get better jobs because that means they'll lose the government cushion and will have to work harder for less. It has nothing to do with "pitting one group against another." The member of one group could easily fall into the next group tomorrow.

Not really. Adults don't just get benefits when they don't work either they have to pay COBRA which is exhorbitant or apply for medicaid which they will only receive if they are sick. Sick people deserve to be covered, whether they are working or not. And the working poor will receive medicaid. Now the fact that the government makes the ceiling income for benefits so low that no farm animal could live on is merely further proof of the lack of empathy in the government, not any type of unfairness. The benefits themselves are so meager that very few chose to try to live off them. Last I checked the jobless and unemployment rate in this country were pretty low... so if being a subsidized poor person was just soooo profitable, then how come there are so few of them? The republicans are quite effective at fomenting class warfare with this 'look at the lazy poor who just sit around and live off entitlements' argument while simultaneously taking credit for the low unemployment rate. In essence, blame the most disempowered %10 of society for all its ills since of course they can't defend themselves anyway... and then all the anxiety the american people are feeling over their own financial troubles and personal security can easily be chaneled onto the weakest instead of questioning the priorities and fiscal responsibility of the government itself. Brilliant. Heartless, but brilliant.

Specializes in Critical Care, ER.
Arguments (or lack thereof) before notwithstanding, consider what would possibly be the worst effects of creating a national healthcare program.

Think of the federally administered programs now in existence. Now, try to come up with just one that has not become a bloated bureaucratic behemoth. Try to come up with one that does not spend more in administering itself than it spends in actual aid of whatever kind. You can't, because no such program exists.

Now, try to think of one program that is rapidly responsive to the people it serves. Again, there is no such animal. Why not? Because programs administered by the federal government are truly accountable to no one. "You want what we have? You'll have to wait for it." At least insurance companies are accountable to two different populations. First, to their customers, in that if they are not responsive, the customers go elsewhere. Loss of business makes them have to answer to their second population, the investors. Who does the federal government respond to? The voters? Show me one federally funded program that has been changed significantly because of an election.

Some in this thread have already posted about how difficult it is currently to get healthcare they are qualified for from the government. You want to turn all of healthcare into that nightmare?

Finally, consider the bureaucratic red tape you would face from such a program. Again, name for me one federally administered program that does not involve reams of paperwork, all of which is rejected if just one "t" is not crossed.

Make all the claims you want about a federally funded healthcare program. However, the federal government has proven time and again that it simply cannot administer any social program efficiently or effectively. You may look to the future with hope, but historically I see only despair.

Well, if you can come up with an alternative to a government mandated or administered system that provides the necessary service_ Healthcare for all American citizens, I'll vote for you. :)

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