After posting the piece about Nurses traveling to Germany and reading the feedback. I would like to open up a debate on this BB about "Universal Health Care" or "Single Payor Systems"
In doing this I hope to learn more about each side of the issue. I do not want to turn this into a heated horrific debate that ends in belittling one another as some other charged topics have ended, but a genuine debate about the Pros and Cons of proposed "Universal Health Care or Single Payor systems" I believe we can all agree to debate and we can all learn things we might not otherwise have the time to research.
I am going to begin by placing an article that discusses the cons of Universal Health Care with some statistics, and if anyone is willing please come in and try to debate some of the key points this brings up. With stats not hyped up words or hot air. I am truly interested in seeing the different sides of this issue. This effects us all, and in order to make an informed decision we need to see "all" sides of the issue. Thanks in advance for participating.
Michele
I am going to have to post the article in several pieces because the bulletin board only will allow 3000 characters.So see the next posts.
To answer Timothy's earlier question: Yes, I do think Timothy -- and all taxpayers -- should be required to foot the bill for a universal payer system. Just as we require Timothy -- and all other taxpayers -- to foot the bill now for public schools, the roads we drive on, etc.
You've got to do the math: If this system could save $200 billion a year, think about how much money that would free up for the taxpayers.
As for whether universal payer would make the price of a GM automobile go down by $1,000, I suggest that yes, it would: The big 3 are being creamed by foreign competition, and as I noted earlier, that foreign competition -- Toyota -- is building its new plant in Canada to take advantage of its national health care system for workers.
So who loses? If you're hung up on whether universal payer would make the price of a car go down, I say yes, it would. And consider all the taxes we've lost by seeing those Toyota jobs go to Canada. It's a global economy. Our health care system is harming American businesses, and not just automakers.
But beyond the economics, I ask this: Why would a nurse disagree with the notion that the most vulnerable people in our society are entitled to health care? Why should health care be only for the privileged?
Your very first statement expresses WHY this is a communist idea. I should be required? We have a gov't based on a system of ideas. Those ideas, as expressed in our founding documents, are not about stealing from each other by popular vote. There is not a formula in the Constitution for winning the lotto, one vote at a time. Our concept of gov't was intended to be very limited in nature. It was founded on the concept that LEFT ALONE, people can and will determine their best fates. The concept that gov't should TAKE from me and give to someone else provides the very disincentive for many to not try at all. No, it won't seriously affect MY aspirations; no, it affects the very aspirations of those on the margins. In trying to help them, you pigeon-hole them. Take your welfare and stay out of our society. This is why, after 40 yrs and trillions of dollars, we have not made even a minor impact on poverty levels. In trying to 'cure' poverty, we have simply institutionalized it.
I'm a conservative, with conservative ideas because conservatism is about providing the incentives to become a better person and not merely the provision of the mechanisms to subsist in poverty. Conservatism cares about the desires and aspirations of individuals and not about the formulas for keeping them stuck in place.
You claim that the system will 'save' 200 bn dollars. I cry foul. Health care represents about 14% of our economy. Those that advocate providing that care for 7% are either being dishonest, or naive. When you remove incentives, you remove efficiency. To the extent our system is inefficient TODAY, it is because 3rd party payor systems rob the incentive to seek cost effective care as it stands. The solution is eliminating those disincentives, and not a wholesale adopting of them. The costs of this 'plan' will skyrocket unless and until it is rationed far beyond how care is rationed today. The results will be more costs for less care. That is the nature of gov't, or more to the point, the nature of communistic ideas of universal nirvana minus individual incentives.
As far as the Big 3 being in trouble - that has little to do with healthcare and much more to do with being over-invested in SUVs and Trucks in an age of rapidly increasing gas prices. Most Japanese auto makers have major plants operating in the U.S. and they aren't asking ME to fund their mismanagment, primarily because they AREN'T mismanaged. If you remove the incentives of financial penalties for mismanagement and simply transfer those costs to me as a taxpayer, the result will be that, in 10 yrs, the Big 3 will come back to the trough deeper in trouble for not learning the lessons of mismanagement. Why, because by removing the costs of mismanagement, you remove the lessons to be learned.
The same goes with individuals too accustomed to Uncle Sam 'bailing' out their individual mismanagement of their lives. Even at minimum wages, a couple trying hard and making wise decisions (like not having children at 13) can make it in our society. By funding their poor decisions, we deny them the lessons for such failures that can teach better responsibility. Children that see mommy 'making it' on welfare do NOT learn the lessons their parents ought to have learned because they never see the consequences for such mistakes. This is not a 'kindness' you grant to the poorest of our society; it is a prison you impose on them.
As a nurse, I'm NOT for the proposition that our 'most vulnerable' should be denied healthcare. Indeed, anybody can go to any ER and receive treatment, regardless of ability to pay. What I'm against is the formulation of policies that remove the incentives to rise above vulnerability. I'm against telling our most vulnerable that they should take our aid, be greatful, and don't bother trying because Uncle Daddy will take care of you.
Why, you ask, should healthcare only be for the privileged? It's not. Far more people have access to healthcare in this nation than do not. The system we currently have is designed for the masses. Even the masses that cannot pay have avenues to seek care.
The more those on this thread decry that the goal isn't a 'communistic' shift in resources, the more plain it is that this strikes a chord, and for good reason. It reminds me of the push in D.C. years ago to get the homeless access to shopping carts to make their lives easier. Nowhere in that kind of discussion is the concept of actually improving the opportunities available for the homeless. The same is true here. By enabling our most vulnerable to remain vulnerable, you only entrench the very problems that should be solved.
I'm against universal care not just because it will be inefficient, costly and reduce both my own personal availability to such care and hard earned funds. Those are good reasons in and of themselves. I'm also against it because I think that it is cruel and heartless to provide the tools that serve to create a prison of poverty INSTEAD of the tools to rise up and out of it.
What you propose is simply another locked door to the prison. By depriving our most vulnerable of the incentives to reach up and aspire for success, you deprive them of that very ability to attain success. See how wonderful and caring we are, now, take your healthcare and don't bother trying to become something better. You have no need, for after all, Uncle Daddy is here for you.
Zash..., you are articulate and present well designed arguments. However, I'm not clear how taking the 30% paid into health insurance away from the management of insurance and putting it into health care would disadvantage the poor and downtrodden. Our insurance CEO's are among the most expensive executives in the world, yet add nothing to the economy or the health care system. Medicare overhead cost is 3%. If we were all on (a single-payor communist plot to destroy the verisimitude of the Constitional intentions of our Founding Fathers plan) Medicare, the only people that would be disadvantaged would be those in an industry that is an unnecessary drain on our ecenomy. All would have equally affordable healthcare, wich could be suplimented by you if you wanted more or different. There is a disconnect between reality and ideology, but my, your words sparkle in the sun.
Specializes in burn, geriatric, rehab, wound care, ER.
Maybe I am missing something and if so please feel free to point it out. It seems that all I hear about HMOs is how bad they are at providing care and limiting patient choice in favor of getting forms filled out but some people want to create a giant HMO run by the government (the most inefficient beuracracy in history), put them in charge of patient care choices and eliminate any real competition. How does any of this equal better care or more freedom for the consumers?
I too have concerns about HMO's. I opted for a low deductible PPO health care benefit after being a member of an HMO. The HMO was stellar when I was pregnant with gestational diabetes - I had 2 classes with a dietitian, had a nurse practitioner to call if my sugars were too high, biweekly dates with an OB nurse for non-stress tests as well as the regular OB visits. I then had yearly fasting blood sugars/lipid panels to detect the development of any non-gestational diabetes/cardiac risk factors. I was very impressed with the HMO care until I developed back pain:Rx- xray, PT class, Motrin and don't bother me again unless you become paralyzed. I wanted an MRI but I did not meet criteria. I gave up that fight, got into yoga and my pain disappeared. Years later, yoga wasn't cutting it any more and I was in severe pain. So armed with my PPO insurance, I saw an orthopedist, whom I didn't even have to ask for an MRI and got one 3 days later. Bulging lumbar discs were the culprit -as I had suspected all along. Wow, I was impressed- PPO's rock! But you know what - the treatment is still the same - PT, Motrin and yoga. That extra test did not make a difference in my pain (altho at least I didn't need to worry about having a spinal tumor any more).
There is a new doc at my family practice. He has recently left that same HMO. I asked him how it felt to be on the PPO side of things - he said that he felt like he had been let out of jail. I was seeing him for a refill on my cholesterol meds and I asked him if he was current on the AHA guidelines -which of course he was, having worked for the HMO. (I had been less than impressed by my care from the PPO doc who seemed to have a vague idea but didn't seem to be following the guidelines). The ex-HMO doc told me that the organization was great at preventative care but not so good for patients that were actually sick - confirming my beliefs.
On the other hand I see people really taking Medicare/Medicaid for a ride. A few years ago, as a case manager, I had a 95 year old patient who was blind, demented, and dependent on both dialysis and a ventilator. I'll give you 3 guesses as to her quality of life. Try as we might we could not get her family to change her code status. Full code. But as long as the government was paying for her care the family had no incentive to change their mind. I would have given a week's paycheck to be able to tell them "sorry, the insurance has run out - how would you like to pay for her care: cash, debit or credit ?" I'm not trying to be mean, but you know how money talks, plus I have a big problem with patients being trapped in a body that no longer works with zero quality of life while their families sort out their grieving issues - the phrase "cruel and unusual punishment" comes to mind.
So "antihippie" I see your point - but HMO's are good at preventative care and save themselves a lot of money down the road by preventing and treating chronic conditions appropriately, which in turn translates to a better quality of life for the consumer. We have so much information available on research based clinical practice guidelines that could make a profound difference on our Public Health, and in turn our economy, if only it were implemented in a consistent fashion. We have the information and we have the technology. We just need a good plan to marry the best of the HMO and the best of the PPO, mix it with some incentives, add a dash of personal responsibility and take out the over-inflated CEO salary factor. We just might come up with something bigger and better if we took our heads out of the sand for a moment, overcame our resistance to change and worked together. Do you FEEL me?
Have you seen the malpractice rates doctors have to pay? Have you seen reimbursement rates they receive? I don't think they are incredibly overpaid for their level of training, the hours that they work, and the responsibility they have. Those bills she paid for bypass... think about how complicated the procedure is. The doctor isn't receiving all of that money... it's distributed over a large group with their hands in the pie. :)
I know that the doctor isn't receiving all of it....I know that it's spread over several hands, however, it's still ridiculous.
The issue with the malpractice insurance will take care of itself when legislation is passed limiting people from filing fraudulent suits. There is an ad running right now saying if your child has autism and has had the chicken pox vaccine to call some attorney...THAT IS ILLEGAL!
They don't know what causes autism...and there are MILLIONS of people who have received the Chicken Pox vaccine that are NOT autistic...so why should some drug company have to spend hundreds of thousands of dollars for defending some ambulance chasing attorney who has a personal agenda.
THAT is the problem with healthcare....running ads like that to start with should be against the law.
Believe it or not, doctors make less than lots of insurance company executives and other people who are not doctors. Doctors don't make that much. But I don't believe that anyone, including doctors, should be at the top of the income food chain. I think we all should be there. Why not? You and I and the work we do are just as important as any doctor or person in business.
I've done a ton of loans for doctors, and I have yet to see one that didn't list their income at less than $20,000 per month.
I did one for an ambulance chasing attorney that listed his income at $70,000 PER MONTH. Yup, you read that right.
Your very first statement expresses WHY this is a communist idea. .
I don't agree with a Universal Healthcare System, but it's not a communist idea, anymore than Canada is a communist country, which obviously, it isn't.
Just because an expense is paid for by everyone, doesn't automatically make it a communist idea, regardless of what it is.
Zash..., you are articulate and present well designed arguments. However, I'm not clear how taking the 30% paid into health insurance away from the management of insurance and putting it into health care would disadvantage the poor and downtrodden. Our insurance CEO's are among the most expensive executives in the world, yet add nothing to the economy or the health care system. Medicare overhead cost is 3%. If we were all on (a single-payor communist plot to destroy the verisimitude of the Constitional intentions of our Founding Fathers plan) Medicare, the only people that would be disadvantaged would be those in an industry that is an unnecessary drain on our ecenomy. All would have equally affordable healthcare, wich could be suplimented by you if you wanted more or different. There is a disconnect between reality and ideology, but my, your words sparkle in the sun.
CEO's, in general, are grossly overpaid. Another problem with our economy.
How you can pay 10's of millions of dollars to a CEO who runs a company that is LOSING MONEY is beyond me. If he doesn't cause the company to generate a profit, then why in the hell is he getting a bonus at all?
Actually, you quoted me but I never said anyone was "dying waiting for care in Europe".
I also said that I think our socialised system is better than the alternative.
Sorry, wasn't my intention to "quote you". I wasn't really referring to anything you said, so should have posted a separate reply. I seek your forgiveness :)
To answer Timothy's earlier question: Yes, I do think Timothy -- and all taxpayers -- should be required to foot the bill for a universal payer system. Just as we require Timothy -- and all other taxpayers -- to foot the bill now for public schools, the roads we drive on, etc.
You've got to do the math: If this system could save $200 billion a year, think about how much money that would free up for the taxpayers.
As for whether universal payer would make the price of a GM automobile go down by $1,000, I suggest that yes, it would: The big 3 are being creamed by foreign competition, and as I noted earlier, that foreign competition -- Toyota -- is building its new plant in Canada to take advantage of its national health care system for workers.
So who loses? If you're hung up on whether universal payer would make the price of a car go down, I say yes, it would. And consider all the taxes we've lost by seeing those Toyota jobs go to Canada. It's a global economy. Our health care system is harming American businesses, and not just automakers.
But beyond the economics, I ask this: Why would a nurse disagree with the notion that the most vulnerable people in our society are entitled to health care? Why should health care be only for the privileged?
Amen. And what people don't understand about the Canadian model, is that it ISN'T RUN BY THE GOVERNMENT!! People pay into a universal fund, health care is administerd by a PRIVATE business, which gets paid thru this fund by the Government. I am also tired of people claiming that the government is so much more corrupt and inefficient than private corporations. That just isn't so true. I've worked in govt. and private sector. Private sector companies waste money and are inefficient too. Don't tell me that Wall Street punishes such things for private companies, because that isn't true either. Wall Street is run by private companies, and is just a big old Las Vegas for the rich.
There is a lot to read, and I apologize if I repeat something, but the Canadian population roughly matches the state of California, and over 75% of Canadians live within 100 miles of the US border where they can obtain US healthcare.
In spite of the fact that Canada has a remarkably smaller population to provide care for, the waits are atrocious, the choices are extremely limited, and many services simply are not available. There is a reason that the number one hospital for Canadian knee replacements is in Cleveland. There is also a reason that Canada is not trending toward a more socialized system, and are instead opening doors for more privatized provision of health care.
The US is facing the same thing that socialized countries are facing; a dramatic increase in an aging population requiring more services while the younger population is not expanding as quickly to provide the tax base to pay for a socialized system. This will lead to rationing of health care, and a remarkable change in our ethical practices. Currently people shriek with indignance if a service is not fully covered or is denied by their current payor; in a socialized system, there won't even be a code or a provider for these services anymore because no-one will pay for it at all.
Additional endless problems will plague America if we move toward a similar system, which will include the reduction of wages for providers, leading to an exacerbation of the nursing shortage, and it will reduce the incentive for physicians to see as many patients, resulting in longer waits and further distances to travel to see specialists.
More importantly, it will eliminate the incentive for entrepreneurship; a country that restricts private reimbursement for 'new-and-improved' methods does not show much incentive for improving methods of delivery. For example, the implantable Abiocor was developed in Canada...but the inventor had to market the device in the US because it was not approved in Canada...due to cost, not regulation. Be prepared for an age limit to be placed on you for heart transplants (no age limit in the US). Expect the survivable age of preemies to start trending back upwards...no more resuscitation attempts on anyone younger than 29 weeks...but I digress back to rationing of health care.
There is a reason folks come to the US for high quality care, and employment. The only aspect of socialized health care that surpasses the American system is the preventative influence. That said, there is no obstacles for Americans to access any number of preventative programs to improve their health and lives...but we are supposed to be about choice, eh? It's our bodies, we decide what we want to do with them. Well, so they say.
There is a lot to read, and I apologize if I repeat something, but the Canadian population roughly matches the state of California, and over 75% of Canadians live within 100 miles of the US border where they can obtain US healthcare..
You hit the nail on the head with this one...I think that is why it works in Canada extremely well. Canada is one of the few industrialized nations where Universal Healthcare has actually worked, and I, like you, believe it's due to the fact that their population is not only low, but it's very spread out throughout the country, and that is why it works.
The ER's are packed here even when people are having to pay for it...I can't imagine what would happen if they didn't...you would see it be even more packed for no other reason that people don't want to take off work to deal with a paper cut.
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ZASHAGALKA, RN
3,322 Posts
Your very first statement expresses WHY this is a communist idea. I should be required? We have a gov't based on a system of ideas. Those ideas, as expressed in our founding documents, are not about stealing from each other by popular vote. There is not a formula in the Constitution for winning the lotto, one vote at a time. Our concept of gov't was intended to be very limited in nature. It was founded on the concept that LEFT ALONE, people can and will determine their best fates. The concept that gov't should TAKE from me and give to someone else provides the very disincentive for many to not try at all. No, it won't seriously affect MY aspirations; no, it affects the very aspirations of those on the margins. In trying to help them, you pigeon-hole them. Take your welfare and stay out of our society. This is why, after 40 yrs and trillions of dollars, we have not made even a minor impact on poverty levels. In trying to 'cure' poverty, we have simply institutionalized it.
I'm a conservative, with conservative ideas because conservatism is about providing the incentives to become a better person and not merely the provision of the mechanisms to subsist in poverty. Conservatism cares about the desires and aspirations of individuals and not about the formulas for keeping them stuck in place.
You claim that the system will 'save' 200 bn dollars. I cry foul. Health care represents about 14% of our economy. Those that advocate providing that care for 7% are either being dishonest, or naive. When you remove incentives, you remove efficiency. To the extent our system is inefficient TODAY, it is because 3rd party payor systems rob the incentive to seek cost effective care as it stands. The solution is eliminating those disincentives, and not a wholesale adopting of them. The costs of this 'plan' will skyrocket unless and until it is rationed far beyond how care is rationed today. The results will be more costs for less care. That is the nature of gov't, or more to the point, the nature of communistic ideas of universal nirvana minus individual incentives.
As far as the Big 3 being in trouble - that has little to do with healthcare and much more to do with being over-invested in SUVs and Trucks in an age of rapidly increasing gas prices. Most Japanese auto makers have major plants operating in the U.S. and they aren't asking ME to fund their mismanagment, primarily because they AREN'T mismanaged. If you remove the incentives of financial penalties for mismanagement and simply transfer those costs to me as a taxpayer, the result will be that, in 10 yrs, the Big 3 will come back to the trough deeper in trouble for not learning the lessons of mismanagement. Why, because by removing the costs of mismanagement, you remove the lessons to be learned.
The same goes with individuals too accustomed to Uncle Sam 'bailing' out their individual mismanagement of their lives. Even at minimum wages, a couple trying hard and making wise decisions (like not having children at 13) can make it in our society. By funding their poor decisions, we deny them the lessons for such failures that can teach better responsibility. Children that see mommy 'making it' on welfare do NOT learn the lessons their parents ought to have learned because they never see the consequences for such mistakes. This is not a 'kindness' you grant to the poorest of our society; it is a prison you impose on them.
As a nurse, I'm NOT for the proposition that our 'most vulnerable' should be denied healthcare. Indeed, anybody can go to any ER and receive treatment, regardless of ability to pay. What I'm against is the formulation of policies that remove the incentives to rise above vulnerability. I'm against telling our most vulnerable that they should take our aid, be greatful, and don't bother trying because Uncle Daddy will take care of you.
Why, you ask, should healthcare only be for the privileged? It's not. Far more people have access to healthcare in this nation than do not. The system we currently have is designed for the masses. Even the masses that cannot pay have avenues to seek care.
The more those on this thread decry that the goal isn't a 'communistic' shift in resources, the more plain it is that this strikes a chord, and for good reason. It reminds me of the push in D.C. years ago to get the homeless access to shopping carts to make their lives easier. Nowhere in that kind of discussion is the concept of actually improving the opportunities available for the homeless. The same is true here. By enabling our most vulnerable to remain vulnerable, you only entrench the very problems that should be solved.
I'm against universal care not just because it will be inefficient, costly and reduce both my own personal availability to such care and hard earned funds. Those are good reasons in and of themselves. I'm also against it because I think that it is cruel and heartless to provide the tools that serve to create a prison of poverty INSTEAD of the tools to rise up and out of it.
What you propose is simply another locked door to the prison. By depriving our most vulnerable of the incentives to reach up and aspire for success, you deprive them of that very ability to attain success. See how wonderful and caring we are, now, take your healthcare and don't bother trying to become something better. You have no need, for after all, Uncle Daddy is here for you.
~faith,
Timothy.