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.
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.
I also don't have the time to respond to every point but the last one is peculiar. Please do share the part of the constitution where it is stated that the use of federal revenues to provide benefits to all the people is unconstitutional.
Perhaps if you review Marxist and socialist thought, you will find that they are not about the use of wealth as much as about ownership of the means of production. No one is suggesting that kind of shift. All we are asking for, simply, is some way to provide healthcare (especially primary) to all Americans with some consideration of the current partitioning of the national revenue. I mean the government has the right to force me to pay for this morally offensive money pit war in Iraq, why not a mamogram for a poor lady who's been cleaning houses all her life?
I just want to say how nice it is to have such a mature and professional debate that sticks to the issues ... thank you. And that's not sarcasm. Often discussions about these types of divisive issues get contentious and personal.
No one is arguing that the taxes will go up if the government choses to maintain spending consistent in other areas ( such as corporate welfare and defense spending). However your statistic of %50 being exclussively attributed to medical spending is interesting and not consistent with what I have studied. Could you please site some primary sources? Sources which show that healthcare spending alone, not other entitlements or expenditures, are responsible for such a hike.
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.
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.
1. social security is an extremely efficient government agency. see table 1 at http://www.cbpp.org/6-14-05socsec-test.pdf. well under 1% of assets are used for administrative costs. i also question your numbers and percentages about administrative cost vs benefit distribution. medicare roughly has a 5% admin cost vs 15% for most private insurance plans. see cepr.net.
section 8. the congress shall have power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the united states; but all duties, imposts and excises shall be uniform throughout the united states;
the point of single payer advocates is that the current system is both fundamentally immoral and wasteful. i can think of 3 separate single payer models already in use in the us that are both efficient and achieve good patient outcomes. (tricare, va system and the federal employees system.) ultimately the debate is about what kind of social contract do we have. do we really want to live in a society where access to needed health care is by bake sale?
1. social security is an extremely efficient government agency. see table 1 at http://www.cbpp.org/6-14-05socsec-test.pdf. well under 1% of assets are used for administrative costs. i also question your numbers and percentages about administrative cost vs benefit distribution. medicare roughly has a 5% admin cost vs 15% for most private insurance plans. see cepr.net.
section 8. the congress shall have power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the united states; but all duties, imposts and excises shall be uniform throughout the united states;
the point of single payer advocates is that the current system is both fundamentally immoral and wasteful. i can think of 3 separate single payer models already in use in the us that are both efficient and achieve good patient outcomes. (tricare, va system and the federal employees system.) ultimately the debate is about what kind of social contract do we have. do we really want to live in a society where access to needed health care is by bake sale?
Specializes in burn, geriatric, rehab, wound care, ER.
passgasser
as an ex UK nurse I would say that the poor RN wages have more to do with the unions that represent them, than universal health care. They refuse to strike and seem to have a distinct lack of "huevos" when it comes to improving their work environment.
as an ex UK nurse I would say that the poor RN wages have more to do with the unions that represent them, than universal health care. They refuse to strike and seem to have a distinct lack of "huevos" when it comes to improving their work environment.
More later on other points, but did want to address this. I'd be more inclined to accept this argument if there was a strong nurses' union in the US. In many parts of the country, there are no nursing unions whatsoever, and the national organization that purports to represent us all, the ANA, has absolutely no "huevos" either. Yet US nurses clearly outearn their British counterparts.
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.
Insurance companies exist to make profits. They not longer contribute any useful work.
Nice smart people figure out ways to deny "out of network", "Experimental", and other care. "Pre-authorization" and other hoops the person must jump through delay care and har the very people whose money provides the profits.
No insurance company employee provides any healthcare!
They need to be helped to do useful work.
Currently, Medicare incurs only 2% for administrative costs and does not need to advertise or pay commissions. According to Bernstein, private insurance spends considerably more on advertising and management. Administrative costs run as high as 30% because providers and insurers have to employ large staffs to cope with thousands of different plans for billions of billings a year.
OK, first of all, liability issues. Someone here claimed that Liability Insurance for healthcare providers would actually fall under a universal healthcare system, since people would be reluctant to sue the federal government. You might be correct, except that your fundamental premise is incorrect. Look at it this way: If you suffer damages from medical malpractice, do you sue your health care insurance provider? Of course not, you sue the health care provider that caused you harm. Without significant changes in liability laws, that would remain unchanged under any universal healthcare plan. So, my original argument stands. While reimbursement, and therefore salary for healthcare providers would fall, liability insurance would not. There are places, for example some counties in the South, where malpractice insurance has climbed so high for OB doctors, none practice there because they cannot hope to earn enough money just to cover their malpractice premiums. Since income for us will fall under a universal healthcare plan, there will be even more areas where it makes no financial sense for specialty practitioners to go. So, in the name of provision of health care for all, you just reduced the availability of health care to portions of our population.
Next, I challenged anyone to name a federal bureaucracy that is efficiently managed. HM2Viking first listed the Social Security Administration. To begin with, the web site to which we were sent was a transcript of testimony before the Senate by a gentleman who was against the privatization of Social Security, so one cannot really consider the source to be at all unbiased. But, even if we take this testimony at face value, consider this. I am in my late 40's, and have been paying in to social security since I was 14. I hope to retire in about 20 years. Every report I have seen suggests that in my retirement planning, I would be foolish to consider any income from social security, since it will likely be bankrupt by then. Just how efficient can the administration of social security be when it is in such dire financial condition?
As to Tricare or the VA, having had experience with both, I'd like to see some reference to indicate that either is well administered. Tricare was born out of a promise made then broken to our soldiers, sailors, airmen and marines. The promise was that in return for service to the country, service members would have free medical and dental care for both themselves and their families during their service. When the military medical services became overburdened, first CHAMPUS, then Tricare were born. Both were based on the model of the insurance industry, and both required co-payments. Hardly the free health care we were promised. As to the VA, it is notorious among veterans for inefficiency, rudeness, excessively long waits, and antiquated facilities and equipment. (Yes, there are facilities that are exceptions, but they are the exception, not the rule.) I've never yet been to a VA Regional Center that didn't have twice the number of administrative personnel over the number of health care providers.
I also want to quickly address the constitutional provision about providing for the "general welfare." This term does not mean welfare as that word is commonly used today. In fact, welfare as it is defined today did not even exist at the time the document was written. What we now call "welfare" was then called "charity." In using the term "general welfare," constitutional authors had in mind the creation of a society with opportunities, unfettered by silly governmental interference, where one could make a living and prosper in accordance with just how hard one was willing to work. They most certainly did not mean that government had a responsibility to act as a safety net for those who did not wish to work as hard. And without a doubt, they did not intend to confer rights on one group of people at the expense of another group. Such a thought was anathema to those who sought to escape a government that would enrich itself on the backs of others.
Oh but people are very well rewarded for not working in this country---they get healthcare that my working earned tax dollars pay for. In order to get healthcare, I would have to stop working, become a criminal, and/or get pregnant.
Oh but people are very well rewarded for not working in this country---they get healthcare that my working earned tax dollars pay for. In order to get healthcare, I would have to stop working, become a criminal, and/or get pregnant.
Fuzzy
About the part on getting pregnant, I recently found stats on how many childbirths are paid for by medicaid....in my state of CO over 28,000 in 2002 - close to 40%. In CA, 66%!!! It really pizzes me off. I had a baby last year, working in a job I hated b/c I (thought) I needed the health insurance which cost me $220 a month, and I paid about $1600 in copays, deductibles, ect. Medicaid recipients pay nothing. I am not rich. My DH was laid off during the time I was pg, we don't own many assets. I probably would have been smarter to try to qualify for medicaid or CHP+ prenatal, and quit my job, sorry to say.
It just seems to me that this is a population that could be working, should be getting their own health insurance, it just calls the whole system into question as to why such a large percentage of pg women qualify for medicaid. I don't know what the answer is - but something needs to be done.
Oh but people are very well rewarded for not working in this country---they get healthcare that my working earned tax dollars pay for. In order to get healthcare, I would have to stop working, become a criminal, and/or get pregnant.
Fuzzy
But, as someone else pointed out in another thread, a national healthcare system would serve only to expand that which admittedly frustrates you.
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bluesky, BSN, RN
864 Posts
I also don't have the time to respond to every point but the last one is peculiar. Please do share the part of the constitution where it is stated that the use of federal revenues to provide benefits to all the people is unconstitutional.
Perhaps if you review Marxist and socialist thought, you will find that they are not about the use of wealth as much as about ownership of the means of production. No one is suggesting that kind of shift. All we are asking for, simply, is some way to provide healthcare (especially primary) to all Americans with some consideration of the current partitioning of the national revenue. I mean the government has the right to force me to pay for this morally offensive money pit war in Iraq, why not a mamogram for a poor lady who's been cleaning houses all her life?
I just want to say how nice it is to have such a mature and professional debate that sticks to the issues ... thank you. And that's not sarcasm. Often discussions about these types of divisive issues get contentious and personal.
No one is arguing that the taxes will go up if the government choses to maintain spending consistent in other areas ( such as corporate welfare and defense spending). However your statistic of %50 being exclussively attributed to medical spending is interesting and not consistent with what I have studied. Could you please site some primary sources? Sources which show that healthcare spending alone, not other entitlements or expenditures, are responsible for such a hike.