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

Simplepleasures · Feb 19, 2008

sorry again, but the programs you mentioned are all limited to those who already qualify for mediciade due to poverty...uhc is only a change on paper for these folks, as they already have medical care.wrong.hud housing is in no way connected to medicaid or medicaid approval.low income is the only factor, many hud participants are the working poor.

what about the working poor, to "rich" for medicaide, hud, title x, etc..exactly why we need uhc.

if we have a duty to provide healthcare coverage for them (the people without current coverage) what about their other needs? there is no "right" to these items currently. try to be consistent.
yes there is , you sadly are very misinformed. as i pointed out in my previous thread the right to those you questioned already exists. again there is no need for medicaid approval to be eligible for these programs.there are stringent qualifications to be eligible for medicaid, it is not based solely on being poor.

http://dhfs.wisconsin.gov/medicaid/

http://www.hud.gov/offices/pih/programs/hcv/

http://dwd.wisconsin.gov/w2/wisworks.htm

pickledpepperRN · Feb 19, 2008

MediCal, our states Medicaid, was once available to the poor whether employed or unemployed.

Now it is ONLY for children and their legal caregivers.

Single employed poor adults do not qualify.

People are admitted to my hospital whose insurance status is unknown. Crime victims are turfed to County if their wallet was stolen. Or left at an accident scene.

So anyone can be treated as though they are uninsured.

Who was it that said, "When everybody does better, we all do better."?

HM2VikingRN, RN · Feb 19, 2008

as you requested:
2. paying for health care is a duty that we owe each other and to society at large.
quote]
assuming that i agree that this is an obligation, why stop at health care?
do not many of these individuals also lack adequate housing? is that not also a duty? what about secondary education? many smart people cannot afford a college or post-graduate degree? working parents, especially single parents, need high quality child care? is this not, too, a duty we owe each other?
education is one ticket out of poverty. good health is the other. it is a waste of human resources to deny anyone the opportunity to better themselves through education. the things you are bringing up are related to poverty and income issues.if you are truly interested in addressing poverty part of the solution does involve interventions in those areas.
this thread is addressing possible shapes and forms of universal coverage plans. frankly, the questions that you posed are designed to divert the discussion away from the core issue which is "how are we as a nation going to assure affordable access to everyone?"
people with good health, and an education are able to meet their other needs through work. besides this thread is not really about poverty or "charity" it is about the ever increasing burden of health care and cost shifting of health care expenses to families.
uhc is a middle class benefit!

ZASHAGALKA, RN · Feb 19, 2008

Medicare, too, is based on the social-insurance model, and, when Americans with Medicare report themselves to be happier with virtually every aspect of their insurance coverage than people with private insurance (as they do, repeatedly and overwhelmingly), they are referring to the social aspect of their insurance.

No, they are referring to being the first ones into the ponzi scheme. The first ones in make out at the expense of the later ones. Or, according to social security trustees: Later cohorts face difficult choices, each involving tradeoffs with benefits, retiring age, and levels of taxation.

Indeed. Nice to be the first ones into the pyramid scheme.

~faith,

Timothy.

carolinapooh, BSN, RN · Feb 19, 2008

I have patients who would have gone to the ER for gangrene, and perhaps the ulcer, but would ignore the other comorbidities until it kills them. I once had a patient who had every comorbidity known to diabetics, including a bleeding leg wound. He also had AIDS, so I had to try to track him down on the streets of Baltimore to persuade him to go to wound treatment. He should have been high cost, but he wasn't, because he wasn't compliant with care.

OK - I'll be devil's advocate here.

What do you think the cost in "man-hours" - the time you took (bless you for it, as well) to track him down in Baltimore to persuade him to come in for his tx - was?

How much do you make an hour? (Rhetorical - you don't have to answer.) Now since they say time is worth more than money - let's say, thirty percent more - add 30% to that figure. If you make thirty bucks an hour, that's forty bucks. (Again, you don't have to actually answer.)

Now multiply that by the number of patients you see in a year (because I know there are more people than you going out hunting people down - and yes, I plan on being the same way when I'm an NP) and the noncompliant DO run up bills, whether tangible or intangible. The costs are still there.

And besides, if the noncompliant are suddenly forced to be compliant (like a triple bypass or an amputation) - it costs a fortune. If an amputation costs $100K (I'm getting this off the top of my head - my mother's TKR was $37K so I bet amputation is potentially closer to $150K, depending on why you need it) just for the surgery, and rehab is $50K (again, guesstimation; my mother went to inpatient rehab for three weeks following her TKA b/c of her age - 72) - that's as much as $180K. That's not counting the prosthesis (what do they run? Ten grand?) and the required follow-up ortho appointments (again, potentially about $400/visit - and I'm assuming this from my mother's bills).

Insulin is a whole lot cheaper - about $30 a vial. So are glucose monitoring supplies - about $150/month.

You're right in saying the noncompliant aren't the ones running up the big bills - not now. The effect is delayed. Right now the bills for the noncompliants from ten years ago are the ones we're paying with higher taxes and higher premiums. We haven't even begun to touch the bills for TODAY's noncompliants.

Again - just being a devil's advocate. :smokin:

Jolie, BSN · Feb 19, 2008

Frankly, the questions that you posed are designed to divert the discussion away from the core issue which is "How are we as a nation going to assure affordable access to everyone?"
It is not irrelevant to ask how it is that we as a nation are able to provide food and shelter for our needy citizens without mandating participation of every citizen, regardless of need, simply to "share the cost", as is proposed with healthcare.
It is also interesting that existing food and housing programs demand financial participation of the recipient, something that seems to be lacking from healthcare proposals.

Simplepleasures · Feb 19, 2008

Frankly, the questions that you posed are designed to divert the discussion away from the core issue which is "How are we as a nation going to assure affordable access to everyone?"
It is not irrelevant to ask how it is that we as a nation are able to provide food and shelter for our needy citizens without mandating participation of every citizen, regardless of need, simply to "share the cost", as is proposed with healthcare.
It is also interesting that existing food and housing programs demand financial participation of the recipient, something that seems to be lacking from healthcare proposals.
HUD housing is a federal program that is funded by our tax dollars, therfore it IS already being mandated. Food assistance, also funded by our tax dollars does not require the participant to contribute any monies out of pocket.
http://dhfs.wisconsin.gov/foodshare/

carolinapooh, BSN, RN · Feb 19, 2008

Education is one ticket out of poverty. Good health is the other. It is a waste of human resources to deny anyone the opportunity to better themselves through education. The things you are bringing up are related to poverty and income issues.If you are truly interested in addressing poverty part of the solution does involve interventions in those areas.
This thread is addressing possible shapes and forms of universal coverage plans. Frankly, the questions that you posed are designed to divert the discussion away from the core issue which is "How are we as a nation going to assure affordable access to everyone?"
People with good health, and an education are able to meet their other needs through work. Besides this thread is not really about poverty or "charity" it is about the ever increasing burden of health care and cost shifting of health care expenses to families.
UHC is a middle class benefit!
Maps like that seem a bit...well, they actually border on misleading to me - because if you look at the biggest spenders, they are first-world, developed countries with high populations and fat bank accounts. (I see the US, Canada, Japan, Scandinavia, Great Britain, western Europe, New Zealand, and Australia.)
(Yes, for all of our problems, I would rather be among America's poorest of the poor than, say, Calcutta's, and I doubt anyone else would feel any different. Even our poorest poor are among the world's wealthiest people - which is what makes life in the US even more ironic and even more screwed up when you start thinking about it.)
Of course the spending in those countries would be higher - the infrastructure and the money exists to do it! Yes, China and India outstrip us in population - but they have neither the money nor the infrastructure to support, say, a Duke Medical Center or a Stanford University Medical Center or a Sentara Norfolk General Hospital. We do, as does the rest of the so-called First World, and therefore we spend it.
Why are our outcomes worse? I believe access to care isn't the only reason - there's a portion of it that rests on the shoulders of the owners of these bodies we work every day to fix. I'm not perfect - I need to be better, and am making my own conscious effort to sort myself out before it's too late for me. Another problem is insurance companies with WAAAYYY too much power - these 24-hour post-birth discharges and 48-hour post-Caesarian discharges iand "drive-through" mastectomies and the other ridiculous mandated (under!)stays have GOT to stop.
There is a huge lot of it that falls on inability to access care - yes - and that needs to be addressed. But UHC - or the lack of it - really isn't the whole problem, nor do I feel it's the only problem or even the biggest problem. Dealing with the permeating sense of entitlement that I see every day - on the news, on the floor, in public - and making people believe that this is the only shot and only body you really get, and that popping a pill is not the answer (thanks Glaxo! Thanks Astra-Zeneca!), and that doctors really AREN'T gods - now if we started there, I believe a great many other things would follow.
Again - universal PRIMARY coverage, yes. Help when you need it - because there are many Americans teetering on the edge of financial ruin just because crap happens, not because they made bad decisions - YES. But cleaning up everyone else's mess? Uh-uh.

HM2VikingRN, RN · Feb 20, 2008

As I said somewhere else today. Do we want to race to the top or race to the bottom. Our peers in the EU spend less per capita for better outcomes.

BlueRidgeHomeRN · Feb 20, 2008

again - universal primary coverage, yes. help when you need it - because there are many americans teetering on the edge of financial ruin just because crap happens, not because they made bad decisions - yes. but cleaning up everyone else's mess? uh-uh.
terrific post, and with that i'm going to leave this thread, at least for awhile.
seems the topic has gotten lost for the most part, and histionic naming and blaming of others with differing opinions is giving me a ha. somebody pm me when we get back on topic.

Home Health Columnist / Guide · Feb 21, 2008

Closing for a time out rest...