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.
What I don't understand is the argument that a single payer health care system will lead to abuse. Just because I will have health coverage, all the sudden I'm going to go out and start eating KFC and Big Macs, not exercising, and going to the doctor when I cut my finger? I don't think so. I am anal about my health, I don't LIKE fast food, and I don't really care for going to the doctor other than when I absolutely have to, or for preventative checkups that hopefull catch something before it gets too big. I have relatives all over the world, and geez they surely don't go to the doctor when they sneeze just because they can and know it'll be paid for.
Because, if there is no incentive to protect a resource, then there is no disincentive to keep from overusing it.
Ask any ER nurse about medicaid, EMTALA, and abuse of the system. No, not everybody abuses it. But enough do to clog up our EDs across the nation.
Human motivations are all incentive based. You might not like fast food, but if all the food at grocery stores and fast food were free, how many people would live on a 100% mickey d's diet? It doesn't take everybody misuing a commodity or even most for serve damage to result.
Or, look at it another way: if all speed limit laws were repealed, MOST drivers would still be safe. But you can bet that the increase in danger on our roadways would far surpass the percentage of just those that abuse the new rules. They would create a danger for everybody.
I would like to see studies that back these speculative thoughts up.
If Universal Health Care in Europe and Asia is failing, why are we so far down on the list of health of citizens?
Canadians (or Europeans) running over the US for health care is BS and a myth. Show me some info on this supposed fact.
It's not speculative that the waits are longer, or the population is smaller and lives within 2 hours driving distance of a border where privatized care is available to them, or that more Canadians have knee surgery in the US than in Canada, or that socialized systems ration health care.
The reason we are so far down the list is because in general, we don't take care of ourselves. We eat a lot of bad food. We don't exercise as much as we should. We engage in behaviors that impact the health of our newborns.
Someone wanted to see facts. I'll start out with a link to a site with numbers from 1994...and the Canadian system hasn't improved since then. NCPA Brief Analysis 104: Price Controls and Global Budgets: Lessons from Canada. Here's a summary; about 5% of Canadians are on a waiting list for BASIC services...this doesn't include specialists services or things like a CT. 177,000 are waiting for surgery. Remember, the population of this country roughly matches California. Imagine if 177,000 people in California were waiting for surgery. And for proof a failure to improve this system has resulted in the development of the "Wait Times Reduction Fund" by the Canadian government.
33% of Canadian physicians have referred a patient for services out-of-the-country, usually to the US. The premiere of Quebec came to the US for treatment of skin cancer, and paid for it himself.
This is how Canada is able to report lower cost-per-person than the US in health care expenditures; they simply deny or delay the care.
I'd also like to point out that the statistics used to show lower mortality rates among certain countries are not obtained by any consistent standard. The only agency that compiles these Stat's is the WHO, and they do not have researchers on staff. They do not conduct research. They simply ask countries to give them their numbers on infant mortality (etc), and they publish them. What this means is that the country contributing these numbers gets to decide how they are obtained and calculated. For example; the US may attempt resuscitation of any preemie at 24 weeks, and calculate this as an infant death if the child dies, say...3 days later. However, a Scandinavian country may not even attempt resuscitation on anything less than 27 weeks, and might not count any infants who died who were born below 30 weeks. Sort of makes them look like neonatal experts. If they are supposedly engaging some sort of medical expertise that makes them superior at providing neonatal care, then I'd ask how many of you would be willing to go to Cuba, or the Balkans (still rebuilding from years of occupation and civil war), and have your babies, because these places are reporting lower infant mortality rates. It has nothing to do with the health care system and everything to do with the way they punch in the numbers.
Here's more for people looking for evidence; it's a link to a company called "Timely Medical Alternatives." It's a company based in Canada, and run by Canadians all educated in Canada. Timely Medical Alternatives Inc. for Hip replacements. This link is to their "Services" page, and those services include linking patients to private providers in the US and Canada because of wait times. The site includes a link that is actually called "Waitlists," and if you review it you will see that in Ontario alone there are 50,000 people on waitlists for orthopedic and general surgery alone! You will also find that this is with a decrease in wait times, because Canada has begun to ease up on their restrictions on privatized health care.
The titles alone ("Wait Times Reduction Fund," "Timely Medical Alternatives"), are revealing themselves. Here's a quote from the Canadian Medical Association on a policy paper they wrote because the Canadian government was holding back some of the money from this fund, "All too many Canadians simply seek care elsewhere when life or limb is at stake and return to Canada and launch lawsuits at provincial governments and others. This trend can be expected to increase" (in the wake of a recent Canadian court ruling). This was written 8 months ago.
I'd like to point out that advocates of a more socialized system tend to also be advocates of embryonic stem cell research. Here's what Canada is spending on SCR: $31 million. That's nothing. Private donors alone have given that much in the US. California alone will spend $3 Billion for SCR. GWB approved $250 million for SCR, $39 million for Embryonic SCR. Stem Cell advocates are mad now...what services will they cut to fund embryonic stem cell research to any functional degree?
The CMA has turned against socialized care, socialized care does not support SCR, so why would we want to turn to a program that will ration care and leave us with no alternatives when the government says "no care for you. You are too old or too sick." Admittedly, costs will decrease if we are all put on waiting lists until we die.
My, my, my, my, my! (Having just read through all the previous postings at one sitting).
Let me provide some clarifications and then raise a couple of new points.
Canadian vs UK healthcare systems: Canada has a one-size fits all system, if you don't like what they have (or how they're doing it) your only choice is to travel out of the country for care. The UK has national health services that are available to all, but if you have your own private health insurance coverage (or you're Lord Big Bucks and can pay out of pocket) you can access private healthcare providers and services. I've had family in both systems, I prefer the UK system. (Although if you have UK elderly relatives, there is systemic rationing of heroic care for older patients, but truly is that a bad thing given the cost versus benefit?)
What is the No. 1 reason individuals in this country file for personal bankruptcy? Medical expenses incurred by uninsured or underinsured people.
I have a diabetic friend who wound up without coverage and had to go in for foot amputation at an HCA facility last year. Two months later the facility filed suit, obtained a judgment, and placed a lien on his house. Being too stubborn to file for bankruptcy (still not able to work, and no private disability insurance either), he lost the house to foreclosure, so the debt load continues to snowball . . .
Heathcare in this country is built on the premise of "cost-shifting." The uninsured patient costs are absorbed by the private healthcare insurers and passed on to consumers (and their employers who provide group coverage), in other words--to all of us. And the bankruptcy, foreclosure, and downward trending economics of the affected patients are also passed on to us all in the form of higher mortgage, credit, and tax costs.
So who's getting rich off this setup? Well, it's not the nurses, and it pretty much isn't the physicians (not unless they start their own insurance companies), nor is it the facility administrators. Who does that leave? What stocks and mutual funds continue to perform well in tough times? Can you say:
And if you think the nation's largest employers have been able to sucessfully leverage their health insurance costs against these financial giants, you are sadly mistaken. Wal-mart (I think you're lucky to get any coverage with them), McDonalds (ditto), UPS, General Motors; even these groups aren't big enough. :smiley_ab
We're all just small potatoes compared to the clout of the actual players. Which is why things get much more interesting when 2 of the big players want to go toe-to-toe over costs, say for example HCA versus UnitedHealthcare. . . . :argue:
Would having some sort of bare-bones universal health coverage be a good thing? I think so because it would help control the costs the big players are sucking out of us on an ever-increasing basis. And I particularly resent having to foot the research and development (R & D) costs for the drug companies when most other countries are able to negotiate much better drug rates than we see in the US. :angryfire
Would that make it a communist or socialist scheme? No, because it doesn't have to be the ONLY option, and goodness knows we are all about having a lot of options in this country. But the size of the group for the indigent and the uninsured in the US is really large, and that's why those big players are working so hard to keep us disinterested in having such a system--it will cut way into their profits.
But in the meanwhile, you can reap some of the benefits accrued by the big players (and offset your ever-increasing insurance and out-of-pocket costs). All you have to do is buy their stock or invest in mutual funds that emphasize those big healthcare companies. If you can't beat them, join them! :cheers:
Specializes in burn, geriatric, rehab, wound care, ER.
Hollyvk -You make a lot of really good points, thanks for your clarifications. I'm afraid I won't be joining you in buying healthcare stocks - I would hate to see my hard earned money going down the toilet when Universal Health Coverage is finally implemented! But I will have that beer..........
Specializes in burn, geriatric, rehab, wound care, ER.
I just quit a job in a LTC facility.......... Many of these 'residents' are being kept alive by very expensive drugs that probably werent around 10 yrs ago - thereby giving them a quality of life (in a unsafe, chronically understaffed and underfunded LTC) of about....nothing. Where do you draw the line when it comes to end of life care??
I have looked after countless SNF residents who have been transferred to the ER for urosepsis/pneumonia - natures way of helping you die, in my opinion. So I do my duty and pump them full of fluids, antibiotics, dopamine even levofed (my "real" priority tho is to keep them as comfortable as possible) and they live to see another "glorious" day back at the SNF/LTC.
The only people that seem to benefit from these drastic measures are the care facilities, the insurance companies, the drug companies and everyone who makes a living caring for them. I continue to wonder how the priorities in health care have become so skewed. Shouldn't we be focussing our efforts on helping people live well rather than preventing them from dying well?
Heck I would be happy with affordable and available medical care. Right now I have neither. I don't have any health insurance. Why? I cannot afford it. I have pre-existing conditions where even the psuedowonderful state policy that is supposed to be available to all is over $600/month. I know that sounds like a pittance to some people but I only take home about $1800/month. I'm not a nurse but a CVT (I work with animals).
I can tell you how much "elective gall bladder surgery" costs because I'm paying the entire $16,000 out of pocket. I also pay for all my prescription medications ($150/mo) for my pre-existing conditions out of pocket so I can stay well enough to work and be a tax payer instead of a tax taker. I didn't get any help with this bill because:
I make too much money in a single person household (approx. $25,000/yr);
I'm too young to collect on social securty or medicare;
I'm too honest to deadbeat the fine hospital, doctors, nurses, and staff
who took care of the problem by not paying the bill;
I'm an American citizen instead of an illegal alien;
I don't have 10 kids so I'm not eligible for medicaid or welfare; and
I choose to work for a living.
Recently (Nov 9th), one of our state senators was diagnosed with acute myloid leukemia. Mr. Craig Thomas is at the National Naval Medical Center in Maryland. I know that part on my taxes are paying for his treatment because he has a wonderful insurance policy. He only needs to worry about getting better not how he is going to have to pay for the treatment. He also is receiving the best treatment that our tax dollars can buy. I have nothing against Mr. Thomas, in fact I like him. I even like him well enough to have voted for him every time he has run for the senate. I hope that he has a speedy recovery. Last year, Mike Enzi's (Wyoming's other senator) wife was diagnosed with cancer. She is also receiving the best treatment that our tax dollars can buy. I also wish Mike Enzi and his wife the best.
My point is if I were to happen to "catch" cancer, have a heart attack, get hit by a car, or have any other health crisis where I could not work, I would have to die. I certainly would have a hard time finding good treatment. I certainly wouldn't be able to just get better without worrying how I was going to pay for the medical care that I would receive.
Don't worry I can and do live without the cable TV, eating out, cell phone, computer games, high speed internet, home computer, going to the movies, driving and new or nearly new car, owning my own home, paying the premium user charges for allnurses or any other website, or really having any other "neccessities" like these. I try to live within my means and budget. Yes I'm only two months from being homeless like many Americans. One major medical problem away from not being able to work ----- homeless.
Heck I would be happy with affordable and available medical care. . .
I can tell you how much "elective gall bladder surgery" costs because I'm paying the entire $16,000 out of pocket.
The key terms there are 'elective' and 'available'. Under a national healthcare system, that would mean that you would still have your gall bladder.
And your appt to see someone about getting it out: 4 months from now.
Scheduling the surgery itself? 18 months.
It'll be cheaper, to be sure. That is, if you can get it. Because everbody knows that elective surgeries are mere luxuries. Buck up, those precious surgery spots are needed for someone else.
In fact, it's simply EVIL of you to presume that your gall bladder is more important than the open heart surgery Mr. Jones had to wait 9 months to get scheduled for . . .
I can't complain. I have good insurance. The patient's might have some...but alot of times have none. I'm not sure the Canada plan is right for us. We have too many people that milk the system. I think that is you are given a diagnosis, if you decide to be complient, the system will pay. If you decide not to comply....then pay the bill...and quit coming to the hospital.
Money is doing to much of the talking and effectively silencing the voice of everyday people. I'm talking about the huge campaign contributions from HMOs and Insurers to politicians who vote against public interest legislation, out of fear of offending their large corporate donors. Huge healthcare corporations realize their ability to make a profit depends on controlling the political system. It works for them, not the rest of us! The corrupting and corrosive influence of big money in politics is the reason we don't have universal health care. Campaign finance reform is another subject and as Bill Moyers said...it's the reform that will make all the other reforms possible!
I just wanted to recommend a website, Physicians for a National Health Plan, PNHP. If you ever get a chance to attend one of their training seminars, go for it! There are some links that provide factual information that will clear up most of the common myths about Single Payer. As nurses we see the fallout from our broken healthcare system every day. It's imperative that we act responsibly as educated patient advocates...for social, political and economic justice in the exclusive interest of our patients.
Single-Payer National Health Insurance
PNHP Resources Webpage quote:
"Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 46 million completely uninsured and millions more inadequately covered.
The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans' health dollars.
Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.
Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.
Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.
A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled though negotiated fees, global budgeting and bulk purchasing."
The links below will lead you to more specific information on the details of single-payer:
Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business.
That says it all.
Of course, that depends on your definition of 'modest'. As some have posted here, my money isn't really mine. I should be 'required' to pay for everybody else's cradle to grave 'Uncle Daddy'. If eveybody would just understand that those that work for the incentives they now have would just keep working at the same pace without such incentives, then those that don't work wouldn't ever have to work again. And the skies would be sunnier, bluer, and brighter.
The thing about 'new' taxes is that they are hardly 'modest' and rarely static. This non-incentive based system would implode under misuse, mismanagement, increased taxes and rationing of care.
When you design a communistic system, you get communistic results. Didn't we already win this war? No, wait. . . There's still Cuba that we can model our gov't after.
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.
Sorry but our educational/work requirements do not even come close to the pressures most (not all but most) MDs face. And they are not personally paid all that well.
Prior to the enactment (and enforcement) of the 80 hour rule, MDs worked routinely over 100 hours per week, for lower wages than ours for years and years before starting their own practice. 24 hour straight shifts were regular, 36 hours note unheard of. And those 100 hours (and the current 80 hours) do not include prep time.
My MD's practice contains 9 MDs, a registered dietitician, two NPs, several social workers and encompasses 4 separate locations. In the central location alone, they have LPNs/MAs/RNs of at 8-10, office manager, social worker, phelobotomists/lab techs, a few rad techs, several office workers/receptionists. There is an untold number of people to handle the complicated insurance mess and multiple medicare/medicaid forms. He is head of the local medical board and each MD does rounds in the local nursing homes, and most work in the more distant offices in rotations. They have to handle THOUSANDS of phone calls for advice, emergencies drug refills, info that all have life threatening complications.
His practice supports many more people than himself, all fulltimers getting benefits and professional wages. This despite the fact that the Bill for 100-150 dollars routinely gets prorated by insurance down to less than 50 for my yearly physical/gyn workup. Not to mention the repeated paperwork/aggravation to get even that pittance.
And yet when I have a problem on the road (as a traveler), I call him and get a personal phone call back. And I don't get billed for it.
Yes, nurses are underpaid in many places and yes, we do not get adequate credit. But do not think that we have put in NEARLY the time or the stress that MDs have, nor begrudge the good ones what they get paid. They have earned it.
Specializes in Med-Surg/Cardiac/Surgical Stepdown.
Timothy I can agree with quite a few of your arguments about the government creating a "prison" of welfare dependency, humankind's inherent "what's in it for me?" mentality, and intrusion of the government into our lives. I wish to god our gov't was smaller and more effective with managing our nation. Unfortunately, people like me are trapped in an entirely different "prison." My prison is created by the self-interests of more powerful people: my boss, who offers ZERO benefits to his workers, the fuel companies that charge $2 a gallon for gasoline, the healthcare conglomerates and insurance companies whose priorities lay with funding their management's insane salaries and investors' dividends. As long as these people hold such massive amounts of influence over the government, nothing will happen to improve the situations of the millions of people in this country who are being rationed out of traditional healthcare and have no choice but to abuse the ER, or file for bankruptcy due to huge medical bills. As long as they continue to receive huge corporate handouts, elected officials could give a damn about what the voters actualy need and want from their government, which means there will continue to be a huge number of uninsured. I'm getting long-winded here but what I'm tyring to get at is that at some point some force has to come along and kick the powerful peoples' self-interest in the teeth to restore some sense of balance to the equation. If it takes a national healthcare system that will put insurance companies out of business and chip away at the huge corporations' profit-margins, then so be it.
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ZASHAGALKA, RN
3,322 Posts
Because, if there is no incentive to protect a resource, then there is no disincentive to keep from overusing it.
Ask any ER nurse about medicaid, EMTALA, and abuse of the system. No, not everybody abuses it. But enough do to clog up our EDs across the nation.
Human motivations are all incentive based. You might not like fast food, but if all the food at grocery stores and fast food were free, how many people would live on a 100% mickey d's diet? It doesn't take everybody misuing a commodity or even most for serve damage to result.
Or, look at it another way: if all speed limit laws were repealed, MOST drivers would still be safe. But you can bet that the increase in danger on our roadways would far surpass the percentage of just those that abuse the new rules. They would create a danger for everybody.
~faith,
Timothy.