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

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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:

Specializes in Maternal - Child Health.

[quote=ingelein;2663539

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?

Perhaps not in so many words, but if continuing to pay for futile health care services to rescue clients who decline to follow treatment regimens that would stabilize their conditions is not "enabling," then what is it?

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Perhaps not in so many words, but if continuing to pay for futile health care services to rescue clients who decline to follow treatment regimens that would stabilize their conditions is not "enabling," then what is it?
Could you post some examples of these futile health care services?
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Specializes in Maternal - Child Health.

1. Inpatient, residential treatment at weight-loss facilities for morbidly obese clients who are documented to have family members bring in food or who order food from late-night delivery services. (As documented on TLC and Discovery Health programs.)

2. Continuing treatment for complications of uncontrolled diabetes (neuropathy, circulatory problems, amputations, vision problems, kidney failure, dialysis) for patients who refuse to check their blood sugars, or attempt weight loss or exercise. (This would include my aunt who refuses to participate in daily care of her diabetes, but calls 911 and rushes to the ER for treatment of unpleasant complications. BTW, she has both a primary physician and an endocrinologist, whose suggestions she ignores.)

3. Repeated emergent treatment for complications of heart disease (multiple angioplasties and/or by-pass operations) for patients who refuse to alter their lifestyles to include exercise, attempted weight loss, reduced fat diet, efforts to stop smoking, etc. (This would include a dearly beloved neighbor who recently passed away from complications of his 4th bypass surgery.)

I could go on, but you get the idea.

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1. inpatient, residential treatment at weight-loss facilities for morbidly obese clients who are documented to have family members bring in food or who order food from late-night delivery services. (as documented on tlc and discovery health programs.)absolutely right! i agree.

2. continuing treatment for complications of uncontrolled diabetes (neuropathy, circulatory problems, amputations, vision problems, kidney failure, dialysis) for patients who refuse to check their blood sugars, or attempt weight loss or exercise. (this would include my aunt who refuses to participate in daily care of her diabetes, but calls 911 and rushes to the er for treatment of unpleasant complications. btw, she has both a primary physician and an endocrinologist, whose suggestions she ignores.)i don't think this would ever happen, to deny them continuing care despite non compliance would bring a slew of law suits when they actually do go blind, or lose a leg, or die from complications of gangrene , the families would say treatment was withheld. bariatric surgery should be allowed, private health insurance has considered it "cosmetic"surgery and routinely denied it.uhc hopefully will see the value in it.

3. repeated emergent treatment for complications of heart disease (multiple angioplasties and/or by-pass operations) for patients who refuse to alter their lifestyles to include exercise, attempted weight loss, reduced fat diet, efforts to stop smoking, etc. (this would include a dearly beloved neighbor who recently passed away from complications of his 4th bypass surgery.)limits on bypass surgery sounds fair.

i could go on, but you get the idea.

i understand and actually agree that it is cost prohibitive to continue some treatments and surgerys. i think that the french have a good model for the care of the chronic conditions, maybe hmviking has this info in his probably massive file.:)

another question, what do you think about medicaid paying for babies of women who choose not to do selective reduction in a multiple baby pregancy causing the babies to be born very prematurly . babies under the weight of 2.6 pounds are eligible for medicaid and ssi, even if they are generally healthy, with only the typical preemie problems.during the time of hospitalization there is no limit on the parents income to be eligible for this entitlement.any idea of how much a preemies hospital costs are? multiply that by the number of the babies.

http://www3.fertilethoughts.com/forums/showthread.php?t=290929

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five core nursing values. (i used this article throughout nursing school as my reference point.)

caring is best demonstrated by a nurse's ability to embody the five core values of professional nursing. core nursing values essential to baccalaureate education include human dignity, integrity, autonomy, altruism, and social justice. the caring professional nurse integrates these values in clinical practice.

http://www.ncbi.nlm.nih.gov/pubmed/15682160

core nursing values:

human dignity,

integrity,

autonomy,

altruism,

social justice.

from my perspective none of these allows us to judge whether a patient should receive or be eligible for health care based on whether the need for care arising from personal choices. if anything we are obligated to provide care.

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Five core Nursing Values. (I used this article throughout nursing school as my reference point.)

http://www.ncbi.nlm.nih.gov/pubmed/15682160

Core nursing values:

human dignity,

integrity,

autonomy,

altruism,

social justice.

From my perspective none of these allows us to judge whether a patient should receive or be eligible for health care based on whether the need for care arising from personal choices. If anything we are obligated to provide care.

Thanks, Viking, I found this interesting article on CARING being taught in nursing school.

http://www.ncbi.nlm.nih.gov/pubmed/2308805?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1

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Specializes in ICU, OR.
I am so SORRY, I will go into my room and shoot myself because you think my I am such a bad guy.

Maby.....

Enjoy your SHREEKING

I for one agree with your previous analysis. I have seen so many people with the attitude that whether not they choose to sit and drink or drug all day, they DESERVE to be taken care of by those of us who work hard and pay taxes and follow all the rules. I do not mind giving assistance if I so choose, but forced charity is just robbery. Small gov't and making people take responsibility for poor choices that they have consciously made (not misfortunes bestowed upon them by means beyond their control) is, in my opinion, the only way. If you give a man a fish, you feed them for a day. If you teach a man to fish, you feed him for a lifetime!

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Specializes in Maternal - Child Health.

Another question, what do you think about Medicaid paying for babies of women who choose not to do selective reduction in a multiple baby pregancy causing the babies to be born very prematurly . Babies under the weight of 2.6 pounds are eligible for Medicaid and SSI, even if they are generally healthy, with only the typical preemie problems.During the time of hospitalization there is no limit on the parents income to be eligible for this entitlement.Any idea of how much a preemies hospital costs are? Multiply that by the number of the babies.

http://www3.fertilethoughts.com/forums/showthread.php?t=290929

I don't think that selective reduction is really an issue with multiple pregnancies among Medicaid recipients. To the best of my knowledge, Medicaid does not cover infertility treatments, which are the cause of 99.99% of high-order multiples. When women conceive high-order multiples, they do so courtesy of private insurance or private payment. Now, if you are asking whether the fertility "industry" should be regulated to prevent the occurance of high-order multiple pregnancies, I think that is a worthy topic to discuss. The issue of selective reduction can be eliminated altogether by judicious use of technology and cancellation of treatment cycles when a woman's ovaries are hyper-stimulated.

I agree that the care of high-order multiple pregnancies conceived via mis-managed infertility treatments and and the care of the resulting premature infants is astronomically expensive. I don't believe that infertility treatments are an appropriate use of public funds, given that infertility is not a life-threatening medical disorder. But nor do I believe that a moral society can "mandate" a patient to terminate a pregnancy under any circumstances.

As for Medicaid and SSI payments for hospitalized preemies regardless of their parents' financial situations and insurance status - I think that is a perfect example of what politicians do with taxpayers' money - taking it whether it is needed or not, and spending it whether it is neded or not. It is a perfect example of why I think our government is not fit to manage our healthcare. There is no means testing or efficiency in the system.

FYI When my youngest daughter was born prematurely, I convinced her pediatrician to send her home with me, even though she didn't meet the criteria for discharge. I am a NICU nurse and wanted to care for her at home, away from the threat of RSV and rotavirus. I did not know about the Medicaid and SSI subsidy, and that would not have influenced my decision, but I am an example of someone who most definitely did not need the subsidy, and would have received it anyway, at the taxpayers' expense.

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As for Medicaid and SSI payments for hospitalized preemies regardless of their parents' financial situations and insurance status - I think that is a perfect example of what politicians do with taxpayers' money - taking it whether it is needed or not, and spending it whether it is neded or not. It is a perfect example of why I think our government is not fit to manage our healthcare. There is no means testing or efficiency in the system.

I did not know about the Medicaid and SSI subsidy, and that would not have influenced my decision, but I am an example of someone who most definitely did not need the subsidy, and would have received it anyway, at the taxpayers' expense.

Curious, what is your opinion about people who would take this entitlement ( it is NOT automatic, one must apply for it) whether or not they needed it ? Would this be ethical, would it be paramount to robbing Peter to pay Paul , especially if Paul did not need the entitelment? Would UHC be more palatable if there were to be built into it parameters for such conundrums, as the above scenario as well as non compliant patients, near suicides and the aftermath, drug addicts,overuse of surgeries, obesity,alcoholism, etc. ?
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Specializes in Maternal - Child Health.

"Would UHC be more palatable if there were to be built into it parameters for such conundrums, as the above scenario as well as non compliant patients, near suicides and the aftermath, drug addicts,overuse of surgeries, obesity,alcoholism, etc. ? " from ingelein above

In all honesty, government-mandated, taxpayer funded healthcare won't be palatable to me in any form. It is just a factor of my personal philosophy that we ought not be using tax money to care for anyone, in any way, that is capable of caring for him/herself. I am not opposed to providing assistance to those who are truly disabled by age, illness, injury, and psychiatric conditions, or providing temporary assistance to those who experience hard times. But in my opinion, mandating all Americans to participate in a healthcare program that many neither need or want will be worse that what we have now. I agree that reform is needed. But I believe that reform needs to take the form of increased personal responsibility (encouraged by tax breaks, rebates, and grants to fund healthcare savings) and by getting third party payors out of routine and preventive healthcare.

"Curious, what is your opinion about people who would take this entitlement ( it is NOT automatic, one must apply for it) whether or not they needed it ? Would this be ethical, would it be paramount to robbing Peter to pay Paul , especially if Paul did not need the entitelment?" from ingelein above

I don't like the idea that this entitlement (and many others) exists in the first place, but I don't fault those who accept it regardless of their financial or insurance status. Anyone who pays taxes is paying for the program, and as such has a right to accept the benefits for which they qualify. It is politicians who set the limits on who qualifies for any given entitlement, and it is politicians who ought to be held responsible if benefits are being paid to individuals who are not in need. I'm sure we've all read stories about well-to-do retirees who have tried to "opt out" of SS and/or Medicare, only to be told that they don't have the choice. The better option is to leave money in the hands of taxpayers in the first place, and not redistribute it, especially to people who are not in need

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"would uhc be more palatable if there were to be built into it parameters for such conundrums, as the above scenario as well as non compliant patients, near suicides and the aftermath, drug addicts,overuse of surgeries, obesity,alcoholism, etc. ? " from ingelein above

in all honesty, government-mandated, taxpayer funded healthcare won't be palatable to me in any form. it is just a factor of my personal philosophy that we ought not be using tax money to care for anyone, in any way, that is capable of caring for him/herself.i agree that our screening process for those applying for ssi or ssdi is in need of reform, the system that is in place now, allows some folks who are not truly disabled to be approved while those with more severe disabilities are denied. i am not opposed to providing assistance to those who are truly disabled by age, illness, injury, and psychiatric conditions, or providing temporary assistance to those who experience hard times.i think most states have a built in timetable for assistance , they are dropped if they have not accomplished getting a job , or training of some sort within the prescribed time limit. but in my opinion, mandating all americans to participate in a healthcare program that many neither need or want will be worse that what we have now. i really do wish that for those who do not want to participate , there was a opt out option, but in reality , it wont be possible, as there needs to be a large pool to make the costs affordable for all. i agree that reform is needed. but i believe that reform needs to take the form of increased personal responsibility (encouraged by tax breaks, rebates, and grants to fund healthcare savings) and by getting third party payors out of routine and preventive healthcare.i would go further and say that we need massive legislative reforms, how would you get third party payors out of routine care, would routine care be out of pocket? wal mart is setting up walk in clinics i hear, which may be cost efficient for less affluent folks, but do we want walmart as our health care provider?

"curious, what is your opinion about people who would take this entitlement ( it is not automatic, one must apply for it) whether or not they needed it ? would this be ethical, would it be paramount to robbing peter to pay paul , especially if paul did not need the entitelment?" from ingelein above

i don't like the idea that this entitlement (and many others) exists in the first place, but i don't fault those who accept it regardless of their financial or insurance status. anyone who pays taxes is paying for the program, and as such has a right to accept the benefits for which they qualify. it is politicians who set the limits on who qualifies for any given entitlement, and it is politicians who ought to be held responsible if benefits are being paid to individuals who are not in need. i'm sure we've all read stories about well-to-do retirees who have tried to "opt out" of ss and/or medicare, only to be told that they don't have the choice. the better option is to leave money in the hands of taxpayers in the first place, and not redistribute it, especially to people who are not in need

i think we need to change the income cap for some of these entitlements. it doesnt make sense for the very wealthy to be recieving ss , medicare they may be wise to keep , as health care costs spiral upward yearly.
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Specializes in Med Surg, Tele, PH, CM.

There are many syndromes that will be made worse by making healthcare "free". The state should not become an enabler. If someone is noncompliant in their therapy, how can you justify forcing another citizen to pay for it?

I think a monetary fine at least should be levied for noncompliance if we had universal healthcare. Other wise, it is like someone refusing to work, but still getting a paycheck.

It could be a true nightmare.

You feel that treating chronic disease is "enabling". I say not treating Diabetes or COPD is punishment, and would be certainly classified as Cruel and Unusual by the ACLU (who I generally do not support). Twenty-five years of nursing have taught me that there a lot of people out there with less than optimum coping skills. I cannot "blame" someone who has DM for having diabetes or emphysema, and I certainly cannot advocate withholding treatment. By the way, I have had a lot of COPD patients who never smoked, and even more skinny diabetics, so not every chronic disease is self-inflicted. Non-compliance drives me crazy. I believe in tough love for these folks - it works. But before it can be effective, you have to establish a relationship of trust, and that takes time. I'm sorry to say I have dropped folks from Case Management because I lacked the patience to establish that relationship, but my case load sometimes reaches critical mass. These folks are only part of the problem. What do we do with the young mother who refuses to fill and administer her child's asthma maintenance meds? One of my 3 yr old patients died recently from an asthma attach because the mom was non-compliant. Here is someone who should be punished......

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