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.
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.
Specializes in midwifery, gen surgical, community.
Give me my low salary and high patient ratios anytime if it means everyone has access to health care free at the point of distribution.
Let me get this straight, if someone turns up in ER with advanced cancer, but has no health insurance and is not eligible for medicaid its tough luck? What happens, are they just left to suffer?
Give me my low salary and high patient ratios anytime if it means everyone has access to health care free at the point of distribution.
Let me get this straight, if someone turns up in ER with advanced cancer, but has no health insurance and is not eligible for medicaid its tough luck? What happens, are they just left to suffer?
Well, not exactly. This is what happens. If she needs to be admitted, she will be admitted and treated by the hospital. This is the law. If however she is well enough to be discharged from the hospital, her care will be at the mercy of whatever provider has it in his/her heart to provide pro-bono care. There are physicians who do so here, however there are few outpatient labs and radiology centers that do. So she may very well receive decent basic medical supervision at a free clinic or pro-bono doc; but no other major interventions (surgeries, chemo, etc) unless she gets medicaid or she is admitted to the hospital from the ER on a future date. This all leads to care being given in the late, more acute stages of disease. This late care is eventually claimed by the hospitals as a tax rebate so indirectly american taxpayers pay the bill anyway. Many proponents of healthcare for all convingly argue that in the end it may cost the U.S. taxpayer less to pay for interventions in the early stages however this falls on the deaf ears of those americans who feel a moral outrage about paying for healthcare for the undeserving.
Well, not exactly. This is what happens. If she needs to be admitted, she will be admitted and treated by the hospital. This is the law. If however she is well enough to be discharged from the hospital, her care will be at the mercy of whatever provider has it in his/her heart to provide pro-bono care. There are physicians who do so here, however there are few outpatient labs and radiology centers that do. So she may very well receive decent basic medical supervision at a free clinic or pro-bono doc; but no other major interventions (surgeries, chemo, etc) unless she gets medicaid or she is admitted to the hospital from the ER on a future date. This all leads to care being given in the late, more acute stages of disease. This late care is eventually claimed by the hospitals as a tax rebate so indirectly american taxpayers pay the bill anyway. Many proponents of healthcare for all convingly argue that in the end it may cost the U.S. taxpayer less to pay for interventions in the early stages however this falls on the deaf ears of those americans who feel a moral outrage about paying for healthcare for the undeserving.
Bluesky, I cannot thank you enough for so acuratly and eloquently describing the healthcare nightmare that is in place in this country.
I have gone bankrupt, am being supported by my family, still waiting for approval from Social Security Disability, its been over a year now.I am going to a free clinic as I dont qualify for Medicaid in my state, I have inflammatory arthritis bilateral hands and ankles, plus DDD, DJD of spine, DJD knees, Bilateral starting cataracts. I NEED to be seen by a Rhuematologist for treatment, but the clinic cannot pay for this due to cost constraints . What do these anti universal health care people propose to do with us useless, money sucking, lazy, ex workers? I worked in LTC for 27 years as an LPN, ruined my health and am grubbing around for decent medical care, so my hands dont get too crippled before I lose anymore function of them. I was a productive hard working person for many years, put my 4 children through college on my salary alone, my husband left the family when my son was 7 years old. I guess we non productive folks deserve to be thrown away , as we are a burden to the "hard working, deserving" folks. Really, where is our humanity?
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.
First of all the long-term unemployed or underemployed are not counted in the unemployment statistics. Someone could have a very low-paying job or be working very part time and not count as unemployed. So if you're in a low paying job but are then offered a job with slightly more hours or that pays slightly more, you are faced with the choice of working longer hours for fewer benefits, because then you'll lose your medicaid, foodstamps or whatever assistance you're getting. It is unfair to the lower-middle class because they work hard but do not qualify for any government assistance. And if you're on the borderline, you may just decide that you're better off working less and getting more government aid.
Well, not exactly. This is what happens. If she needs to be admitted, she will be admitted and treated by the hospital. This is the law. If however she is well enough to be discharged from the hospital, her care will be at the mercy of whatever provider has it in his/her heart to provide pro-bono care. There are physicians who do so here, however there are few outpatient labs and radiology centers that do. So she may very well receive decent basic medical supervision at a free clinic or pro-bono doc; but no other major interventions (surgeries, chemo, etc) unless she gets medicaid or she is admitted to the hospital from the ER on a future date. This all leads to care being given in the late, more acute stages of disease. This late care is eventually claimed by the hospitals as a tax rebate so indirectly american taxpayers pay the bill anyway. Many proponents of healthcare for all convingly argue that in the end it may cost the U.S. taxpayer less to pay for interventions in the early stages however this falls on the deaf ears of those americans who feel a moral outrage about paying for healthcare for the undeserving.
First of all the long-term unemployed or underemployed are not counted in the unemployment statistics. Someone could have a very low-paying job or be working very part time and not count as unemployed. So if you're in a low paying job but are then offered a job with slightly more hours or that pays slightly more, you are faced with the choice of working longer hours for fewer benefits, because then you'll lose your medicaid, foodstamps or whatever assistance you're getting. It is unfair to the lower-middle class because they work hard but do not qualify for any government assistance. And if you're on the borderline, you may just decide that you're better off working less and getting more government aid.
I do understand your point, honestly. Not true of the jobless rate. I do feel that it applies more to the uninsured working class than the lower middle class- but that's semantics. All differences set aside, this discussion is about health benefits specifically and not entitlements in general. Even by the standard of your own argument, the inequities you are condemning would be resolved by a healthcare system that covered everyone, including the hardworking uninsured. The only other option within the framework of the way you present the paradigm, would be to provide healthcare to only those who are working. Well clearly the most infirm cannot work so you are left with vagueries such as... well were they working before they became infirm or not... were they receiving other entitlements... I mean you see where this is going... straight to a series of moral judgments which would be difficult (not to mention not so humanitarian) to legislate. What about a mother of 3 who, having been a law abiding, devoted christian housewife, was left by her husband... no benefits, and gets cancer. She may not have the time, energy or childcare resources to train for a job. Would you just leave her without any support? Why is it such a crime to care about the less-than-morally perfect members of our society? I mean we do it at the bedside, don't we?
I think that you are so quick to frame this as a right-wing vs. left-wing debate that you are jumping on me as if I am morally condemning the uninsured rather than perceiving in me that perhaps we have some common goals. This is the problem with politics in the US and why we are having such a hard time resolving the healthcare issue. We'd rather harp on those heartless Republicans or immoral Democrats or idiotic Bushes or corrupt Clintons. Maybe if we weren't so polarized all the time we could sit down and really discuss the good, bad and ugly about our healthcare system, really listen to the pros and cons of each argument and come out with a resolution. But we'd rather sling mud so we get stuck in that same mud and never make progress.
Walk into any ED and be treated for any complaint, whether you have resources (or intention) to pay or not.
We already have universal healthcare. It's just being delivered in the least efficient way you could possibly conceive. Think the hospitals are losing money? Think the insurance companies are losing money? Maybe marginally, but the bulk of the costs are simply being transferred to those who are self-pay or insurance premium payers.
Guarantee payment for basic primary care and the tax/insurance premium payer will save a LOT of money.
While I'm writing this in triage, a 20-year-old self-pay (aka: "no pay") frequent flier has just come in via EMS for a runny nose. Know who's paying for his ambulance transport and ED care? I AM.
Most of this response will be directed at the comments made by Bluesky, though I will also include what others have written. Forgive the length of this post.
You claim that most of my points are based on imagination. Not so. They are based on the examples of what has happened elsewhere (i.e. nursing salaries in Britian) and on the history of how the federal government (mis)manages every federal program. I do not make "extensive use of the European and Canadian systems as bases for what would be." I did point out that in every country where some kind of government supported universal health care program has been established, taxes have had to be raised to 50% and higher. Now, if you think our government can enact a federally mandated and supported health care program, costing multi-billions of dollars a year without raising our taxes, please enlighten me. We are already deficit spending. I also drew the comparison between nursing salaries in nations with universal health care and our nation. Again, if you can show me how our government can shoulder this burden without reducing health care workers salaries, I'm all ears. As to government management of the system, considering things like the welfare system (60% of every dollar received goes to maintaining the bureaucracy, while only 40% goes towards actual welfare payments), I think it safe to assume that a federal healthcare bureaucracy would do no better. I still challenge you to show me one federal bureaucracy that is efficiently run, that could be used as a model for a healthcare bureaucracy.
By extension, it stands to reason that a monolithic health care bureaucracy would lead to the same kinds of red tape and frustration that every other federal program has. You need look no further than the posts of those who relate personal anecdotes of their frustration with the current system. In one case, a poster has been fighting the system for over a year and still does not have the federal assistance required. And you want to foist this system on ALL of us?
Is net income a measure of quality of life? For some people it is, and for some people it isn't. But I do think it's safe to state that for everyone, net income is certainly a contributor to the overall quality of life. Therefore, an across the board reduction of net income would certainly have an impact on everyone's quality of life, don't you think? Especially in light of the fact that for the majority of us, what we are doing now is working, bringing me to a major point of my argument:
Those who support the idea of a "universal healthcare program" point to the fact that 15% of the people in this nation do not have health care coverage. In citing that statistic, there are a couple of things they don't want you to notice. First, the statistic talks about those without health care coverage. That in no way equates to not having any healthcare whatsoever. More importantly, though, those who cite the statistic do not want you to do the simple math. If 15% are without healthcare coverage of any type, that means a whopping 85% of our nation has health care coverage of some kind or another. Name for me if you can any other system that to one degree or another meets the needs of 85% of our population, particularly one we consider to be a failure.
I'm running out of time, but wanted to get to one quote of yours:
"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."
You are correct. The "sharing of wealth" that you talk of is not "American." Neither is it constitutional. It is socialism, pure and simple. Socialism, on the scale of which you speak, is demonstrably harmful to the economy, and more to the point, it flies in the face of the principles of the US Constitution. If YOU want to trade YOUR BMW to help others, you are free to do so, and I laud you for it. However, neither you nor government has the right to force all of us to do so. The constitution forbids it.
One other point. I tend to think more in concrete terms, rather than the abstract. So, I do not view "redistribution of wealth" in the abstract of "leveling the playing field." I see it in the concrete "we are going to take money from you to give to others who don't make as much as you."
I am a CRNA, and I earn quite a good living. I refuse to feel guilty for that, neither will I apologize for it. I worked VERY hard to get where I am, with the intent of being able to provide a certain life for both myself and my family. I take a dim view of those would tell me that my hard work means nothing, and that I should give up a significant portion of what I earn for "others."
I often give of both my talent and my money. In so doing, I decide where that donation will go, where it will do the most good. I'll be damned if the government is going to force me to do so.
Walk into any ED and be treated for any complaint, whether you have resources (or intention) to pay or not.
We already have universal healthcare. It's just being delivered in the least efficient way you could possibly conceive. Think the hospitals are losing money? Think the insurance companies are losing money? Maybe marginally, but the bulk of the costs are simply being transferred to those who are self-pay or insurance premium payers.
Guarantee payment for basic primary care and the tax/insurance premium payer will save a LOT of money.
While I'm writing this in triage, a 20-year-old self-pay (aka: "no pay") frequent flier has just come in via EMS for a runny nose. Know who's paying for his ambulance transport and ED care? I AM.
I hope that you aren't putting all of us uninsured, self pay people in this category. I, for one pay my bills as long as I am working and able. Since I'm considered self pay, I could easily become no pay, however I was not raised like that. I know several people who declared bankruptcy because the medical bills were so out of sight that they could never pay for them in their own or their childern's lifetime. These poor souls didn't have a runny nose either. There will be deadbeats and all of us pay for them-unfortunately. I know part of my exhorbant hospital bill (which I pay on religously) goes to pay for those deadbeat bills and yes the stuff that insurance won't cover for their own clients. This is why the hospital charges $54 for a bag of LRS that the vet hospital buys for $3 and sells for $9. When I saw that, I asked if I could bring my own next time.
cheshirecat
246 Posts
Give me my low salary and high patient ratios anytime if it means everyone has access to health care free at the point of distribution.
Let me get this straight, if someone turns up in ER with advanced cancer, but has no health insurance and is not eligible for medicaid its tough luck? What happens, are they just left to suffer?