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

KayMichelle · Feb 15, 2008

When you become a nurse, you can actually put into practice all your strongly held beliefs. Just don't DEMAND the crack addict in the ER to get off of drugs, it might be safer to ask nicely. When do you graduate?
Goodness no, I thought we were talking about whether or not to promote universal health care!
As far as the "demand" goes, I was speaking in the context of the rape of virgins in Africa, and yes, I think NGOs surely should demand certain risky practices stop. I promise that if I go to Africa, I will!
In any case, a crack addict in the ER (like the sister I mentioned) isn't going to be concerned about how the healthcare is going to be paid, is he/she?
I would like to have an opinion on universal healthcare, I really don't, which is why I am discussing it here. We are kind of getting off on a tangent talking about noncompliant patients, aren't we?
I already graduated, but I'm older, I'm talking more as a taxpayer than anything else. Honestly, I can't think of anything a government does right so I hate to put our healthcare industry into their hands.

KayMichelle · Feb 15, 2008

Yes, this discussion is truly going no where.

There are two completely different issues getting confused here.

The topic is "universal health care" but people keep referring to 'denying care' The question is whether or not it should be publicly funded care.

It's not much of a valuable discussion.

ZippyGBR, BSN, RN · Feb 15, 2008

tort reform is irreelvant

thebiggest problem US healthcare faces is the fee for service ethos which has led to a lack of clinicla objectivtiy over investigations - becasue there is no need to justify investigations on a price basis the 'standard of care' soon becomes irradiate everyone after taking an armful of bloods ... that might not actually tell you a great deal more than you'd find by good clinical examination ad the minimum amount if investigations to give a good diagnostic picture.

Long Term Care Columnist / Guide · Feb 15, 2008

The issues keep getting confused because they are inextricably linked. Start a discussion about universal health care, and within minutes someone will inevitably object to it because a) someone, somewhere, MIGHT receive a service they are not 100% entitled to, and b) people get sick because they have no self-control, and we shouldn't have to pay for their care.

FWIW, I don't want the feds running health care any more than you do. If universal health care ever happens, it needs to be at the state level and managed by medical and legal professionals, not politicians. But that's a thread for another day.

Simplepleasures · Feb 15, 2008

There are two completely different issues getting confused here.
The topic is "universal health care" but people keep referring to 'denying care' The question is whether or not it should be publicly funded care.

post by KayMichelle

I would actually be for universal healthcare if it only provided those services that are the ones that are not self-induced, due to neglectful health personal choices.

post by Kay Michelle

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.

Wise Words, by jjoy

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

HM2VikingRN, RN · Feb 15, 2008

our problems are nothing like the mess in some countries. some type of tort reform/insurance reform would be a great idea too. that would ease the burden on the hospital staff. it would also help to make the industry more competitive financially as well, i think socialized medicine will wreak havoc on our paychecks, if it comes to pass!
47 million uninsured? that is a big problem.
double digit health care inflation? that is a big problem.
if you are serious about fixing health care the first place to go is administrative costs and profits. i encourage you to read "where is the mango princess." it has an excellent discussion about the difference in quality between the us and canada.
tort costs have an essentially negligible effect on the cost of health care. see the following from epi.

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

HM2VikingRN, RN · Feb 15, 2008

wow.
again, i thought we were discussing the merits of univeral health care.
i didn't think we were discussing the option of denying anyone medical care.
that doesn't actually exist here in the united states. you can go to any emergency care unit at the hospital and it is illegal for them to turn you away.
then, you can just ignore the bill. you can give them a false name and never see a bill.
it could happen, however, if we had universal healthcare.
that is why many are against it. it would "universalize" the system, so that your particular problem could be scrutinized with a history. denial could happen pretty easily.
healthcare reform is probably a better idea. that way, we can continue with no one being denied care. you see, it is possible that no one would know that mary had copd because she smoked for 50 years if that info wasn't centralized by a huge bureaucracy.
i don't think you gave a good example, however, because there isn't much that can treat her breathing problem very well with so much damage. also, if you already have gangrene, insulin isn't going to help very much.
you know, no matter how good a nurse you are, you are not god, and people do get chronic diseases. many times, these people are overmedicated in nursing homes, no matter what you do - those with copd live dismal lives - many on tracheostomies with ventilators.
you should try not to personalize these discussions. we as nurses, need to have a solid viewpoint on these issues that pertain to our profession, we need to discuss them. we might be the ones pushing for a policy that might actually harm our patients in the long run.
when you call people names and say how disgusted you are with them for their opinions, it doesn't exactly foster open discussion. it makes people not want to discuss anything at all. i have mixed feelings about universal health care. yes, i feel sorry for those who are noncompliant, but i've had noncompliant patients myself, and think there should be some kind of predetermined sanctioning against it. it is frustrating for everyone.
i don't "got mine". i haven't had health insurance in many, many years. when i did have it, i paid $350 per month with a $3,000 deductible, of which i never once hit the top. i have a schmuck of a little sister who goes to the emergency room for every possible problem, which is quite often since she is a hypochondriac, and she has never paid a dime.
i know there could be terrible consequences for an open system, at a time when inflation is rampant, prices for gasoline, housing, food is going up at racing levels. i don't think we can afford that as a people.
kay,
i took the time to pull up the following on a better way to care for chronic illness.

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.
http://prospect.org/cs/articles?article=the_health_of_nations
also please see the following:

indeed, the vha's lead in care quality isn't disputed. a new england journal of medicine study from 2003 compared the vha with fee-for-service medicare on 11 measures of quality. the vha came out "significantly better" on every single one. the annals of internal medicine pitted the vha against an array of managed-care systems to see which offered the best treatment for diabetics. the vha triumphed in all seven of the tested metrics. the national committee for quality assurance, meanwhile, ranks health plans on 17 different care metrics, from hypertension treatment to adherence to evidence-based treatments. as phillip longman, the author of best care anywhere, a book chronicling the vha's remarkable transformation, explains: "winning ncqa's seal of approval is the gold standard in the health-care industry. and who do you suppose is the highest ranking health care system? johns hopkins? mayo clinic? massachusetts general? nope. in every single category, the veterans health care system outperforms the highest-rated non-vha hospitals."
what makes this such an explosive story is that the vha is a truly socialized medical system. the unquestioned leader in american health care is a government agency that employs 198,000 federal workers from five different unions, and nonetheless maintains short wait times and high consumer satisfaction. eighty-three percent of vha hospital patients say they are satisfied with their care, 69 percent report being seen within 20 minutes of scheduled appointments, and 93 percent see a specialist within 30 days.
critics will say that the vha is not significantly cheaper than other american health care, but that's misleading. in fact, the vha is also proving far better than the private sector at controlling costs. as longman explains, "veterans enrolled in [the vha] are, as a group, older, sicker, poorer, and more prone to mental illness, homelessness, and substance abuse than the population as a whole. half of all vha enrollees are over age 65. more than a third smoke. one in five veterans has diabetes, compared with one in 14 u.s. residents in general." yet the vha's spending per patient in 2004 was $540 less than the national average, and the average american is healthier and younger (the nation includes children; the vha doesn't).
http://prospect.org/cs/articles?article=the_health_of_nations
rgds...

BlueRidgeHomeRN · Feb 15, 2008

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.
your post just proved my point.
you are a nursing student, perhaps you should familiarize yourself with the core nursing values
quote]
funny, the nursing core values you chose to overlook...
autonomy
stewardship
justice
truth
freedom
integrity
do you think we can stick to uhc and not "denial" of care. there is a big difference. professional nurses who do not see value in handouts, enabling, and "curing the world" are every bit as professional as those who want to save everyone--a futile pursuit.
ps-slamming students is also un-cool......

BlueRidgeHomeRN · Feb 15, 2008

i am sorry - but i agree with this. i am a card-carrying, flag-waving, proud-to-be-an-american, and i wouldn't want to live anywhere else - but i agree completely with the germans on this one.
oh, i see the flames coming...bring them on....

sorry to disappoint, but this is a kudo:bowingpur, not a :angryfire...

my original post was trying to point out just your thoughts--i think its a great idea, too, but if you saw my post about the florida helmet law, you know that many of our fellow americans want to have their cake and eat it too--the freedom to make choices without the responsibility for the consequences (sorta the way the average 13 year old thinks!!).

so--the level 1 trauma center i worked at in orlando had beds full of neurotrauma, unhelmeted cyclists...no assests, no insurance, and ready to spend the rest of their life in a snf on the hospital's dime. and we wonder why tylenol are $10 @? gotta make up the money somewhere....or go bankrupt and serve nobody!!

suanna · Feb 15, 2008

I don't know that it will have much of an impact on out compensation package at all. The health care providers still have to pay a nurse to do the job and the market is the driving force behind our compensation. The job itself may change a bit with everyone having the availability of health insurance we may find younger patients from a lower economic class becoming more often. Despite appearances, there are still some people that worry about how they are going to pay for a hospital stay. These folks may have the oppertunity to get the health care they need. We all may have to brush up on patient care other that geriatrics.

jjjoy, LPN · Feb 15, 2008

Honestly, I can't think of anything a government does right so I hate to put our healthcare industry into their hands.

Not one darn thing?! The fact that we do have many freedoms in a relatively stable society means that despite all of the problems (and I won't deny there are *many* problems) with government that it's not all gone to hell. I'm not for the federal government micro-managing the entire country, but to say it does *nothing* right seems rather over the top.

On a separate note, I'm not sure who used the term "police state" but do be aware that to the general public this terminology is embued with a lot more emotionalism than the way you describe it is used academically. You clarified that you were using it only as indication of a state that can incarcerate those who don't follow it's laws (such as paying taxes). I'm not sure what other kind of state there is out there that is effective. What is more relevant is who makes the laws to be enforced and if those laws are more or less fair and consistent.

Simplepleasures · Feb 15, 2008

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.
your post just proved my point.
you are a nursing student, perhaps you should familiarize yourself with the core nursing values
quote]
funny, the nursing core values you chose to overlook...
autonomy
stewardship
justice
truth
freedom
integrity
do you think we can stick to uhc and not "denial" of care. there is a big difference. professional nurses who do not see value in handouts, enabling, and "curing the world" are every bit as professional as those who want to save everyone--a futile pursuit.
ps-slamming students is also un-cool......
i was not slamming her as being a student, one of our best debaters when he was a student was hm2viking. i was trying to convey the idea that perhaps with experience her way of approaching a patient would change a bit, demanding a patient to do anything will get one nowhere.again, nurses do better when we teach, not preach.
no one has said in this debate that enabling is a correct way with dealing with a non compliant patient, i wonder why it continues to be used as an argument point? this seems to be an attempt to twist what the real purpose of the original comment was. if you can find where i posted it was acceptable to enable, please refresh my memory.
i used the nln website for the core values.those were the only ones listed, i didnt choose to overlook the ones you listed, they were not on the nln site. again, trying to twist my meaning.
http://www.nln.org/aboutnln/corevalues.htm
when quoting things, its helpful to list the source.