Universal Health Care... what would this mean...

KayMichelle · Feb 11, 2008

The example of how universal healthcare would be beneficial is unsound.

The poster used the example of diabetes, stating that if a person had healthcare he/she would use it before becoming very sick (ie getting renal failure, amputations, etc.) and this would save the system a great deal of money.

Now, I think we all know from personal experience that these folks who do not treat their DMII fail to do so because of lack of discipline, and refusal to accept lifestyle changes, not because they do not have health insurance.

Please, let's not use emotional arguments. Let's live in the real world. These issues are very important to us, especially the quality of care issues, the shortage issues, the salary issues.

KayMichelle · Feb 11, 2008

What an intersting debate. I work in England, but have always been quite interested in the US health system as it always seemed quite elitist. At the beginning of this debate some people were worried about how it would affect their pay and the pt/nursing ratio. Well in the NHS in England, nurses in the private sector don't get paid much more than NHS nurses. However the pt/nurse ratio can be quite high, I often have 15 patients to look after. I don't know what it's like in the US, but I do work on quite an underfunded ward, so it's not usually that high.
At the moment our government is trying to reduce the number of pts that need to be in hospital, so it putting more money into the community rather than hospitals, so people with chronic diseases can be treated and managed better, and therefore in theory need less hospital admissions.
The NHS does have to be careful with resources, for example certain drugs like cancer drugs aren't available to everyone, which has recently caused quite a lot of controversy.
The perfect sysytem would be that everyone could have free health care and there would be no money issues or waiting lists, however that's not going to happen, but I do believe that everyone has a right to good quality free health care.

There is no such thing as "free". Unless of course, you are a volunteer nurse, drugs cost nothing, and there is no need for research and development.

This is the big problem with universal healthcare. It is not "universal". As you say, cancer drugs aren't available to "everyone", so who decides who gets them? The Queen? The Archbishop? Just curious. In America, we really don't accept that kind of authoritarian system. That is why we fought the Revolutionary War, you see!

Another statement that is an oxymoron: "Everyone has a right to good quality free health care..." But, realistically, care that has made you wait is not quality at all.

It is neither free, fair or of high quality.

The true answer is tort reform.

BlueRidgeHomeRN · Feb 11, 2008

what an intersting debate. i work in england, but have always been quite interested in the us health system as it always seemed quite elitist. at the beginning of this debate some people were worried about how it would affect their pay and the pt/nursing ratio. well in the nhs in england, nurses in the private sector don't get paid much more than nhs nurses. however the pt/nurse ratio can be quite high, i often have 15 patients to look after. i don't know what it's like in the us, but i do work on quite an underfunded ward, so it's not usually that high.
at the moment our government is trying to reduce the number of pts that need to be in hospital, so it putting more money into the community rather than hospitals, so people with chronic diseases can be treated and managed better, and therefore in theory need less hospital admissions.
the nhs does have to be careful with resources, for example certain drugs like cancer drugs aren't available to everyone, which has recently caused quite a lot of controversy.
the perfect sysytem would be that everyone could have free health care and there would be no money issues or waiting lists, however that's not going to happen, but i do believe that everyone has a right to good quality free health care.

thanks for the info and observations from the other side of the pond!

ZippyGBR, BSN, RN · Feb 11, 2008

The example of how universal healthcare would be beneficial is unsound.
The poster used the example of diabetes, stating that if a person had healthcare he/she would use it before becoming very sick (ie getting renal failure, amputations, etc.) and this would save the system a great deal of money.

if money is tight are you going to pay the true price for a drug regime including newer agents?

if you are going to be charged for your retinal screening - are you going to go ?

how often are you going to go and get U+Es and HBA1C taken if you are charged for it ?

Now, I think we all know from personal experience that these folks who do not treat their DMII fail to do so because of lack of discipline, and refusal to accept lifestyle changes, not because they do not have health insurance.

blame the 'victim' why don't you

case management in the USA is about maximising profit, case management in the Uk is about optimising resource use...

jjjoy, LPN · Feb 11, 2008

Now, I think we all know from personal experience that these folks who do not treat their DMII fail to do so because of lack of discipline

If that's truly the case, how is it helpful when health care is more expensive to access? A national plan should include case management (as most health insurance companies do in order to reduce costs) which can follow up with patients, educating them and encouraging them to do the right thing. It's true that a number of people won't change their ways. But it's even less likely they'll change their ways if they fear how much it will cost to seek care. It can be quite intimidating to speculate on health care costs and I don't think we can expect people to be rational 100% of the time. Insurance with questionable cover will cost several hundreds of dollars a month, more with pre-existing conditions. A primary care doctor's visit might cost $75 out of pocket, tests could run in the hundreds, medications can run in the hundreds every month, and a hospitalization could mean complete financial ruin. Putting one's head in the sand and simply not renewing that expensive prescription or always putting off scheduling an appointment for that sore on one's foot are actually pretty normal human responses, albeit not benefitial for their physical health.

ZippyGBR, BSN, RN · Feb 11, 2008

This is the big problem with universal healthcare. It is not "universal". As you say, cancer drugs aren't available to "everyone", so who decides who gets them? The Queen? The Archbishop? Just curious. In America, we really don't accept that kind of authoritarian system. That is why we fought the Revolutionary War, you see!
.

Lets see,

NICE http://www.nice.org.uk/

clinicians,

PCT management when money is short...

the issues are over cancer drugs which don't have NICE approval or have nice approval only for their licenced indication although there is limited evidence for their use outisde their licence

there is the issue if at what point does 'life prolonging' palliative treatment actually provide a meaningful return...

pickledpepperRN · Feb 11, 2008

Regarding your assignment of up to 15 patients I'm curious about the type of patients and your system.

I work in critical care. We are blessed with fine nurses who came to us for a two year adventure and stayed. One told us that she had never started an IV in England. A doctor was available at all times.

Night nurses could wake up this doctor to start and IV or help when one or more patients got worse. There was a lot of overlap in medicine and nurse ine with regard to this doctors duties.

He would take vital signs and do many treatments that only nurses do here except for the very rare attending.

HM2VikingRN, RN · Feb 11, 2008

the example of how universal healthcare would be beneficial is unsound.
the poster used the example of diabetes, stating that if a person had healthcare he/she would use it before becoming very sick (ie getting renal failure, amputations, etc.) and this would save the system a great deal of money.
now, i think we all know from personal experience that these folks who do not treat their dmii fail to do so because of lack of discipline, and refusal to accept lifestyle changes, not because they do not have health insurance.
please, let's not use emotional arguments. let's live in the real world. these issues are very important to us, especially the quality of care issues, the shortage issues, the salary issues.

the french have addressed the problems of chronic illness in a rather unique way:

problem is, studies show that individuals are pretty bad at distinguishing necessary care from unnecessary care, and so they tend to cut down on mundane-but-important things like hypertension medicine, which leads to far costlier complications. moreover, many health problems don't lend themselves to bargain shopping. it's a little tricky to try to negotiate prices from an ambulance gurney.
a wiser approach is to seek to separate cost-effective care from unproven treatments, and align the financial incentives to encourage the former and discourage the latter. the french have addressed this by creating what amounts to a tiered system for treatment reimbursement. as jonathan cohn explains in his new book, sick:
in order to prevent cost sharing from penalizing people with serious medical problems -- the way health savings accounts threaten to do -- the [french] government limits every individual's out-of-pocket expenses.
in addition, the government has identified thirty chronic conditions, such as diabetes and hypertension, for which there is usually no cost sharing, in order to make sure people don't skimp on preventive care that might head off future complications.
the french do the same for pharmaceuticals, which are grouped into one of three classes and reimbursed at 35 percent, 65 percent, or 100 percent of cost, depending on whether data show their use to be cost effective. it's a wise straddle of a tricky problem, and one that other nations would do well to emulate

evidence based practice is part of the solution to getting better quality care.

HM2VikingRN, RN · Feb 11, 2008

Tort reform has minimal to no effect on health care costs. See:

No evidence of significant effects on health care costs
The cost of medical malpractice claims and litigation is so small a part of national health care expenditures as to be insignificant—even as calculated by Towers Perrin, which indicates its tort cost estimates (Chimerine and Eisenbrey 2005). According to Towers Perrin, medical malpractice tort costs, broadly defined to include the costs of insurance industry overhead (including profits) and claims handling, as well as all claims paid without litigation, totaled $28.7 billion in 2004, only 1.5% of the nation’s $1.9 trillion bill for health expenditures. The Congressional Budget Office (CBO) concludes that “even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 to 0.5 percent” (CBO 2004, 6). To put the insignificance of this into context, health care inflation in 2004 would have been 7.8% instead of 8.2%.
If, as Towers Perrin has claimed, damages awarded to plaintiffs are 46% of total tort costs (Tillinghast-Towers Perrin 2003, 17), and non-economic damages are about half of all damages awarded to plaintiffs, then fully eliminating noneconomic damages in medical malpractice (and the attorney fees associated with them) would have a negligible effect on U.S. health expenditures, reducing them by 0.5% or less.5 It follows logically that legislative changes like those recently debated in Congress that would cap such damages at $250,000 would have an even smaller effect.

http://www.epi.org/content.cfm/bp174

A much bigger target is administrative simplification. (As well as defining a minimum set of benefits so we have consistent health coverage between insurances. Many "bare bones" health policies are penny wise but pound foolish.

Katie82, RN · Feb 12, 2008

The NHS does have to be careful with resources, for example certain drugs like cancer drugs aren't available to everyone, which has recently caused quite a lot of controversy.
The perfect sysytem would be that everyone could have free health care and there would be no money issues or waiting lists, however that's not going to happen, but I do believe that everyone has a right to good quality free health care.

You have just listed two issues that will prevent Universal Coverage from working in the US. THe first is the need to be politically correct in the face of an impossible situation. I have case managed cancer patients who have cancer in a site that promises a poor prognosis with mets to a couple of other bad areas. The possibilities of recovery are two - slim and none. Yet we spend tens of thousands(even hundreds) of dollars on chemo and radiation for a patient who has no hope for recovery because we want him (or more likely the family) to feel as if someone is doing something. I know this is a difficult decision to make, but the bottom line is should we really spend $100k to prolong the inevitable for 6 months? This is the kind of issues we face with Univ HC.

The second point you tried to make is that everyone has a right to good quality free health care. THis is an oxymoron in terms of what we can afford to provide given the budget we would have.

Katie82, RN · Feb 12, 2008

Please, let's not use emotional arguments. Let's live in the real world. These issues are very important to us, especially the quality of care issues, the shortage issues, the salary issues.

You said a mouthful here...I case manage diabetics on Medicaid and I can tell you that most of my patients are diabetic because of poor lifestyle choices, and will end up with every comorbidity in the book because they refuse to take care of themselves. You can give a patient free supplies and medications, but you can't believe how many people I have with an A1c of 12.0 who refuse to test their levels daily, much less adhere to a sliding scale. We pay a lot of money for laziness and ignorance, universal healthcare is not going to solve that one.....

Katie82, RN · Feb 12, 2008

blame the 'victim' why don't you
case management in the USA is about maximising profit, case management in the Uk is about optimising resource use...

These people are usually not victims, but creators of their own situations. As to your analysis of case management - what is the difference between maximizing profits and optimizing resource use. Both result in savings. The only difference is that in your system (and my employer's), the money you save is non-profit, while we are still part of the free enterprise system.