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

[nurseyNJNYC]

hypothetically, how would universal healthcare affect us as nurses? the demand? our salaries? ive had a taste of the whole universal healthcare thing with the movie Sicko coming out and the upcoming election... but i dont know enough to say anything... any ideas?

:cheers:

[Katie82, RN]

wish i had come up with this, but will credits to trudebug from a post on 8-28-05:

the silver rule

i do not do for others that which they can do

for themselves.

sorta sums it up.

great rule - the #1 rule of case management. teach, but don't enable....

[Katie82, RN]

I am quoting from personal experience. I didn't say that UHC in Canada covered everything or that it was perfect and some people do opt to buy health insurance. But we all pay taxes( exemption those completely on SS) so we all pay into the system. So its not someone else paying for me or whom ever.

quote]

I think you are incredibly lucky with the service you have received, but this is not the norm. One of my degrees was obtained online, and there were many Canadian citizens in my classes. UHC was always a topic, and I cannot remember a single Canadian student who defended your system. According to them, the system is overburdened and everyone complains about the wait to see a provider and the rationing od care. I know the American public well enough to know that UHC would not work for the majority of us, we will not tolerate inconvenience. Those who can afford it will continue to buy health coverage, leaving a two-tiered system similar to the status quo. We would simply be enlarging the public pay segment, and the private pays would continue to fight to limit it.

[Katie82, RN]

So all people who make bad choices that affect their health don't deserve healthcare?

Missing the point here. No one is saying people with Diabetes should be denied healthcare. Diabetes is a chronic illness caused by the body's inability to process the glucose / insulin balance. It is not caused by poor choices in many cases, but it is exacerbated by them. I remember the TV commercial that ran several months ago - "Diabetes won't kill you. Failing to control your Diabetes will". I work with non-compliant diabetics, and it would never occur to me to deny them care. But I have to admit that it's mighty frustrating knowing how much of our tax dollars is spent on treating folks who refuse to do something as simple as take their medicine and test their blood. Non-compliant diabetics are not victims, let's not glorify them.....

[Katie82, RN]

It won't matter that I did many good things for others during my productive years, or that I loved and was loved by others; in this brave new world run by the "deserving", I will be just so much trash to be kicked to the curb.

I would never judge you for having Diabetes, even though it is admittedly self-induced. THe whole point of this discussion is, I hope, that you are taking care of your Diabetes now. I have worked with patients who have not only learned to control their glucose with the right combination of meds, but progressed to the point where they control their DM with diet and exercise. That should be the responsibility of everyone with Chronic Disease, but unfortunatly it isn't. I remember the stats a few years ago that declared that 30% of the population is responsible for 70% of US healthcare expenditures because of chronic disease - Diabetes, COPD, and CHF. The numbers may be different now, but I'll bet the principle is the same.

[Katie82, RN]

I get so disheartened to read the many posts by fellow health care providers that do this. These past few days on these forums have been shocking to me, I guess I thought nurses embraced the core values they were taught in nursing school, doctors are no better.

I had an interesting conversation with a doc yesterday. I have a patient whose diabetes is totally out of control because she is non-compliant. She is crying on my shoulder that she wants to see an endocrinologist who can "fix her diabetes", and her PCP refuses to write a referral. The PCP and I were discussing treatment strategies when he told me "I have been her doctor for 20 years and I love her to death, but I have to admit that I feel like she is slapping me in the face when she will not even do something as simple as test her glucose." A specialist is not going to help this lady if she will not help herself by following simple instructions. I call her every day and visit her twice a week to help her monitor her sugar and her diet. She knows I care about her, and I have always treated her with respect. But I have also told her "This diabetes will kill you if you do not control it, but not before it destroys your body one part at a time - you will have pain in your legs before you lose them, you will lose your sight and end up on dialysis, then have a stroke." I don't call this judgemental or lacking compassion, I call it enabling informed choices.

[Katie82, RN]

If diet and exercise were as easy as you seem to think, there would be few diabetics, and certainly no fat people. No one, but no one, would CHOOSE this life.......especially not when healthcare providers are so quick to assume an air of superiority and belittle us for our alleged lack of discipline.

:stone

You are absolutely right. One of my biggest challenges working with chronic disease is trying to figure out why folks aren't doing what they should be. I have patients who won't do fingersticks because it causes pain in their fingers. A lot of people can't diet because the family members they rely on to shop for them refuse to buy healthy food. Poverty plays a big role, healthy food is more expensive and if you only get $15 in food stamps, you eat pasta instead of fresh fruits and veggies. I have folks with COPD who don't use their inhalers because no one showed them how to use them. Most people don't wake up in the morning with the intent of damaging their health, there is usually an underlying problem that creates barriers to sucess. I make great progress once I can figure out what they are.

[Simplepleasures]

I had an interesting conversation with a doc yesterday. I have a patient whose diabetes is totally out of control because she is non-compliant. She is crying on my shoulder that she wants to see an endocrinologist who can "fix her diabetes", and her PCP refuses to write a referral. The PCP and I were discussing treatment strategies when he told me "I have been her doctor for 20 years and I love her to death, but I have to admit that I feel like she is slapping me in the face when she will not even do something as simple as test her glucose." A specialist is not going to help this lady if she will not help herself by following simple instructions. I call her every day and visit her twice a week to help her monitor her sugar and her diet. She knows I care about her, and I have always treated her with respect. But I have also told her "This diabetes will kill you if you do not control it, but not before it destroys your body one part at a time - you will have pain in your legs before you lose them, you will lose your sight and end up on dialysis, then have a stroke." I don't call this judgemental or lacking compassion, I call it enabling informed choices.

What you said to your patient was teaching, it was not being judgmental. Respect is the optimal word.

The point I was trying to convey is this; Kindness WITH firmness goes further in teaching, it is NOT enabling to be kind. If a nurse lets her personal bias and prejudices show when trying to teach, it can come across as judgmental, and that will only make the patient want to NOT return for appointments, because they know the nurse or doctor is " going to yell at them" , I have heard this from some of my own patients over the years.

[HM2VikingRN, RN]

thanks to spacenurse for the following quote from alternet.

false. the philosophical basis of america's privatized health care system might best be characterized as medical calvinism. it's fascinating to watch well-educated secularists who recoil at the protestant obsession with personal virtue, prosperity as a cardinal sign of election by god, and total responsibility for one's own salvation turn into fire-eyed, moralizing true believers when it comes to the subject of taking responsibility for one's own health.

they'll insist that health, like salvation, is entirely in our own hands. if you just have the character and self-discipline to stick to an abstemious regime of careful diet, clean living, and frequent sweat offerings to the great treadmill god, you'll never get sick. (like all good theologies, there's even an unspoken promise of immortality: f you do it really really right, they imply, you might even live forever.) the virtuous elect can be discerned by their svelte figures and low cholesterol numbers. from here, it's a short leap to the conviction that those who suffer from chronic conditions are victims of their own weaknesses, and simply getting what they deserve. part of their punishment is being forced to pay for the expensive, heavily marketed pharmaceuticals needed to alleviate these avoidable illnesses. they can't complain. it was their own damned fault; and it's not our responsibility to pay for their sins. in fact, it's recently been suggested that they be shunned, lest they lead the virtuous into sin.

of course, this is bad theology whether you're applying it to the state of one's soul or one's arteries. the fact is that bad genes, bad luck, and the ravages of age eventually take their toll on all of us -- even the most careful of us. the economics of the canadian system reflect this very different philosophy: it's built on the belief that maintaining health is not an individual responsibility, but a collective one. since none of us controls fate, the least we can do is be there for each other as our numbers come up.

http://www.alternet.org/module/printversion/76032

[jjjoy, LPN]

Interesting take on it, huh? We people do have a tendency to self-righteousness, whether it be in regard to taking care of our health, our environment, our financial choices, our moral choices.

Like anything, there's quite a lot gray regarding the personal responsibility, circumstantial conditions, and human foibles that play a role in each of these hot button issues. We certainly don't want to encourage or enable poor choices and behavior, especially when it directly or indirectly affects others in society. But we also don't want go to the other extreme where any deviation from the ideal standards is severely shunned or punished. By defintion, it is impossible to truly achieve our ideals. No one is perfect, life has innumberable variables and we can't control everything nor see the future. Thus, some grace, generosity and humility is also necessary in society.

[carolinapooh, BSN, RN]

Personal responsibility and common sense are interesting concepts. When a modern day snake oil salesman tells desperate people that taking a "colon cleanser", with cascara, will cure them of virtually any health problem: are they lacking personal responsibility by not buying the product or lacking common sense when they do? We can improve this with better patient education, if they had access.

If they saw the snake oil guy I think you're referencing - they've GOT access: they have a television (and probably cable or satellite; at the very least, they have bunny ears). Why am I not seeing health-related adverts on the boob tube with some redeeming educational value instead of some nauseating GSK ad for VALTREX that's been on eight times in the last two hours? Why can't GSK fork out the bucks for THAT?

(On another note, we're the only developed nation on the planet that allows DRUG ADVERTS on television, so that should tell you something.)

Sorry to drag up an old post, but this one really got me....back to the debate....

[KayMichelle]

So all people who make bad choices that affect their health don't deserve healthcare?What about the people who drive recklessly and get in an auto accident and sustain a brain injury, what about the women who remain in abusive marriages ? What about athletes, skiers, ice skaters, bicyclers, rollerskaters, runners, they all are at risk for sustaining injuries.What about secretaries and carpal tunnel, nurses and back problems,etc, etc. We all live lives in the real world, not a bubble of safe moral living. People are human, they still deserve health care. Also Diabetes 2 is not 100% attributable to bad diet or lifestyle.

People will continue to make mistakes, some will not be compliant with cares or meds, some DID bring in their illnesses by poor choice, but again , are we as Americans ready to DENY these people health care?

How absurd, of course I don't think these people "don't deserve healthcare". I just don't think that the government should use their police powers to force Peter to pay for Paul's bad choices.

You are jumping from conclusion to conclusion. No one has ever advocated that we "DENY" anyone healthcare. Just that we don't become enablers by financing the fix to bad choices.

The type of healthcare that should be "free" (or rather on the public dole) should be only those that are not precipiated by poor choices.

[Simplepleasures]

How absurd, of course I don't think these people "don't deserve healthcare". I just don't think that the government should use their police powers to force Peter to pay for Paul's bad choices.

You are jumping from conclusion to conclusion. No one has ever advocated that we "DENY" anyone healthcare. Just that we don't become enablers by financing the fix to bad choices.

The type of healthcare that should be "free" (or rather on the public dole) should be only those that are not precipiated by poor choices.

Your post just proved my point.

You are a nursing student, perhaps you should familiarize yourself with the Core Nursing Values

http://www.nln.org/aboutnln/corevalues.htm

Core Values

The National League for Nursing implements its mission guided by four dynamic and integrated core values that permeate the organization and are reflected in its work:

• CARING: promoting health, healing, and hope in response to the human condition
  
• INTEGRITY: respecting the dignity and moral wholeness of every person without conditions or limitation;
  
• DIVERSITY: affirming the uniqueness of and differences among persons, ideas, values, and ethnicities
  
• EXCELLENCE: creating and implementing transformative strategies with daring ingenuity

• Mission and Goals

CARING: A culture of caring, as a fundamental part of the nursing profession, characterizes our concern and consideration for the whole person, our commitment to the common good, and our outreach to those who are vulnerable. All organizational activities are managed in a participative and person-centered way, demonstrating an ability to understand the needs of others and a commitment to act always in the best interests of all stakeholders.

INTEGRITY: A culture of integrity is evident when organizational principles of open communication, ethical decision-making, and humility are encouraged, expected, and demonstrated consistently. Not only is doing the right thing simply how we do business, but our actions reveal our commitment to truth telling and to how we always see ourselves from the perspective of others in a larger community.

DIVERSITY: A culture of diversity embraces acceptance and respect. We understand that each individual is unique and recognize individual differences, which can be along the dimensions of race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious beliefs, political beliefs, or other ideologies. A culture of diversity is about understanding ourselves and each other and moving beyond simple tolerance to embracing and celebrating the richness of each individual. While diversity can be about individual differences, it also encompasses institutional and system-wide behavior patterns.

EXCELLENCE: A culture of excellence reflects a commitment to continuous growth, improvement, and understanding. It is a culture where transformation is embraced, and the status quo and mediocrity are not tolerated.