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.
Well. I knew we were in trouble when chellyse66 started this debate on universal health care with an article written by a Libertarian. It is important to realize that Libertarians are a small group whose beliefs are unknown to and not accepted by the vast majority. Your right Cdn_Psych, they are utopian because there has never yet been a libertarian society (though some have come close to some libertarian ideas) Also, libertarian viewpoints are very diverse, which makes it difficult to debate with them. Generally, Libertarians like to restrict the argument to their notions of economics, justice, history, rights, and their misrepresentations of government. Widen the scope, and their questionable assumptions leap into view.
Here are some questions that I have:
1) Are Libertarians serving their own class interest only? Do they really think that charity will provide quality health care to the under served?
2) What are the disadvantages of libertarian policy in regards to health care? What are the safeguards, if it proves inadequate?
3) Are there current, real world examples of libertarian proposed ideas and policies working in regards to health care?
Hi. I think that politics and legal aside, having one's health is a necessity for quality of life. I can agree with comments made by every poster under this topic as they all include valid arguments, but I still feel that being able to obtain or maintain good health is basic just as food, shelter, and water are. We have too many people in the states and too many people world wide that don't have a clue as to what quality of life is about. Most of us posters, I presume do. While some of us write about willingness to support needy children, elderly, and certain disabled people, we must remember that those of us who are in that category of able bodied but abusive toward our health need avenues to improve our health, because the economy essentially rests on our shoulders and so do our needy family members. In the states, this includes many of the working poor.
I feel that while we are diluting the issue of health care with our own personal views, I don't think that anyone can argue that the future looks bleek right now in terms of overall declining health status in many countries and on some continents. This impacts us all economically whether we like it or not. Going to another planet won't change who we are and what we're about. As nurses, we must see to it that as many people as possible are able to maximize their health and be productive in the mainstream for as long as possible. I feel that the issue is not when or why but how will health care reformation take shape and how will a universal health program be executed.
Has anyone read the latest IOM (Institute of Medicine) research on needed changes in the health care system? I plan to soon.
Hi. I think that politics and legal aside, having one's health is a necessity for quality of life. I can agree with comments made by every poster under this topic as they all include valid arguments, but I still feel that being able to obtain or maintain good health is basic just as food, shelter, and water are.
Hello Mijourney,
You are correct. Health is reliant upon many factors.
One of the things which I think is significant is the
relationship between income and health. I doubt anyone
could reasonably deny that the poorer you are, the poorer
your health tends to be.
Good earning potential is improved with improved educational
levels. This suggests that access to education for all
is something that improves economic security.
A third factor influencing health is environmental. In past
centuries in Europe, the destruction of cats allowed for the
proliferation of rats which spread the Plague. Millions died
as a result because of this human-induced environmental
change.
Today, humans are busily releasing massive amounts of toxic
chemicals into our environment. Here in Canada, atmospheric
pollution is leading to rocketing asthma rates. The Ontario
Medical Association has attributed thousands of deaths each
year to smog.
Cosmetic use of pesticides is coming under increasing control
due to concerns about the carcinogenic and other harmful
effects these substances have, especially for children who
are so much more vulnerable. Some municipal governments are
now banning cosmetic pesticides with the rationale that a few
dandelions or other weeds are less objectionable than poisoning
our children (their right to do so having recently been upheld
by our Supreme Court following a challenge by lawn care companies).
Personal decisions we make count too. Do we buy fuel-efficient
cars, or monster SUVs?
Ultimately, many of the things that are determinants of good health
rely on government policies which support the things that lead
to good health - like support for quality public education, universal
access to comprehensive health care, health-oriented programs which
focus resources more on prevention rather than disease (preventing
a problem is better than trying to fix it after it occurs).
It includes nurses insisting that pollution laws be strictly enforced
by providing stiff penalties for polluters. Or that governments
honour their commitments to reducing pollution by fulfilling their
obligations under the Kyoto agreement (which Bush has repudiated).
Or my own country doing the same, instead of playing games with
trying to get pollution credits with "carbon sinks" in order to
justify doing nothing.
In short, it requires that we become politically active to
encourage governments to stop the poisoning of the planet and
the regressive Social Darwinist policies currently in vogue
I am printing all this information and using it for ethics!! Plus to educate myself as I move into learning more for working in health care policy. This is really great. I have to agree that the health care system is broken, and insurance/money alone won't fix that problem. This discussion without addressing ethics and "rights" is why the government can't come up with a solution to date.
So, what services should be offered? Will research become limited? Can expensive services be obtained through a private pay or black market rather than conventional health care avenues? Who will limit services; the family?physician? government? insurance? This has given me alot to think about yet not much time to research, so any answers you provide will be greatly appreciated. I read most of the posts completely but will find them in their entirety along with the graphs when I have time as well. Keep up the good work!!!!!!!!!!!!!!!!!!!!!!!!
So, you want to talk ethics! The whole managed care system is unethical. The current environment of managed care in the U.S. is in effect a bio-medical experimentation with humans as the subjects, leaving nurses in one big ethical dilemma!
Most of us entered nursing as a humane calling, not as a lucrative business. I have never witnessed such corporate greed and exploitation of nurses--at the expense of quality patient care.
So, you want to talk ethics! The whole managed care system is unethical. The current environment of managed care in the U.S. is in effect a bio-medical experimentation with humans as the subjects, leaving nurses in one big ethical dilemma!
Most of us entered nursing as a humane calling, not as a lucrative business. I have never witnessed such corporate greed and exploitation of nurses--at the expense of quality patient care.
How ethical is that?
How true!
There is a tendency in North America to measure
everything in terms of money without any thought
of what is moral or reasonable. This certainly
prevails in health care and in other factors
which are health determinants.
So we have Bush repudiating the Kyoto agreement
to reduce greenhouse gas emissions because it
allegedly is "bad for the US economy" (translation:
"We think it might reduce profits") and the rest of
the world can suffer with the consequences. The
Canadian government, obsessed with profits from
potentially increased oil exports, is a willing
and eager accomplice in this environmental
degradation.
Health care is also seen only as a profit machine,
not a public service. If a universal, comprehensive
single-payer system is suggested as a solution
to the health care mess, the automatic reply is
that it's "too expensive" (even though it's
actually cheaper) or that "the government shouldn't
tell doctors how to practice medicine" (but it's
somehow okay for an insurance company to do it).
It is morally and ethically repugnant to shamelessly
deny care to patients in order to squeeze out more
The nursing profession, the medical profession, and the entire American health care system are, of course, caught up in the very same processes of disintegration that are affecting all of society and the world. The self-assurance, smugness, and the imperialist arrogance of the medical profession has survived while the prostitution of nursing's talents, potential, and lack of development have gone unnoticed. Despite glaring health problems that are slowly, but surely destroying the lives and spirits of nurses and American citizens, the medical profession still openly argues that we have the best health care system in the world. This is most assuredly a form of hypocrisy that we, as a society, have never analyzed. In many respects, by supporting the maintenance of the American health system as we know it now, we play a lethal game. For the most part, the system itself is rotten to the core and not worth reforming or saving.
Unfortunately, there has been a very concerted effort to spread
disinformation about the Canadian health care system, a process that has been dominated by libertarian elements that wish to keep the government out of health care in the United States. Because knowledge about Canada by most of us is very limited, and because the supporters of universal health care coverage have not been adequately effective in carrying the message of the benefits of the Canadian Medicare program, the average
individual in our country believes that the Canadian health care system is inferior. This misperception is not altogether the fault of health care reform activists. The message of a just, comprehensive health care system is a very complex message to deliver and exceeds the patience and desires of most Americans to study and absorb a subject that for most of them is very boring. On the other hand, the opposition can keep their
message very simple by limiting the facts presented to very isolated problems within the Canadian system, while concentrating on simple rhetoric that lumps health care in with features of government that the public believes to be undesirable.
The media readily report the isolated stories of problems within health care. The horror stories of managed care in this country abound, just as the stories of the deficiencies of the government program in Canada make good copy, or at least news filler. The conclusions that our citizens draw from these reports are that
(1) a patient bill of rights will correct the defects of managed care (2) we do not want a government system like Canada's.
The members of the media reflect the same simplistic viewpoints, and most seem to lack the depth of understanding of the Canadian system that might otherwise influence their reporting stance. This is not laziness on their part but rather reflects the fact that they must make decisions on how to allocate their
time effectively. The "government" health care system of Canada is simply not a priority for them.
Our efforts should be directed to informing the media of the realities of the Canadian health care system. We can never tell them what stories to cover, but we can encourage them to base their coverage on a background of comprehensive knowledge of the Canadian system. An excellent beginning source for them is a 251 page report by the Canadian government on the status of their health care system, released February 2, 2001. It can be downloaded at:
I am wondering if any of you have insight into universal healthcare and its' effects on nurses. Does it affect nurses wages? Is there a wage cap for RN's? etc.
Specializes in LTC, assisted living, med-surg, psych.
I don't necessarily think government-run health care is the best idea.......if there's any way a thing can be made impossibly complex, government will find it! But we MUST get the for-profit insurance industry OUT of health care........this is, IMO, the root of all evil where medical services are concerned. Health care stopped being about "caring" when it became a business, and when you've got insurance-company CEOs who've never spent a day in medical school making millions of dollars a year deciding who should and should not receive care, something is very, very wrong.
The United States squanders more money every year on health care bureaucracy than it would cost to provide medical coverage for the 43 million Americans now lacking insurance.
That's the finding of two respected Harvard Medical School researchers, David Himmelstein and Steffie Woolhandler, in a study appearing this week in the International Journal of Health Services.
They determined that of $1.6 trillion in total health care spending last year, at least $399 billion was eaten up by administrative costs such as clerical work in hospitals and processing a vast array of insurance forms.
But if a national health care plan like Canada's were implemented in this country, the researchers found, administrative overhead would be slashed by about $286 billion.
This amount, in turn, would be sufficient to not only provide health coverage for every uninsured American nationwide but also allow millions of underinsured people to improve their quality of care.
Himmelstein, who is also a physician, said in an interview that 10 percent of revenue at his Cambridge practice now goes to an outside billing firm that handles much of his insurance work.
"That amount could be used instead to care for more patients," he observed. "It could be used to hire additional people and fund a huge expansion of care."
Similarly, Himmelstein estimated that at least 15 percent of his time every day is spent dealing with paperwork.
"That's 15 percent of my time that I'd much rather spend on patients or learning more about medicine," he said.
Private health insurers, who would be decimated by taxpayer-funded universal coverage, oppose creation of a Canadian-style system in the United States. Instead, they prefer adjusting the existing system to expand the number of people covered.
But Himmelstein and Woolhandler argue that the existing system is grossly inefficient and needs to be completely overhauled. The findings of their research may be speculative, but they say it points the way toward legitimate cost reductions.
In California, they found, nearly $163 billion was spent last year on health care. Of that total, $45 billion, or about 28 percent, went to administrative costs.
With Canadian-style universal coverage, the researchers concluded, Californians would save almost $34 billion annually on administrative overhead. This would provide more than $5,000 for each of the state's nearly 7 million uninsured.
"As it stands," Himmelstein said, "you could insure all uninsured people for about $1,500 per person. The administrative savings would thus leave plenty of money to upgrade coverage for others."
The Canadian single-payer system is frequently cited as a model for how the United States might go about offering health coverage to all citizens. The Canadian system, begun nationally in 1971, guarantees all citizens access to essential medical services regardless of employment, income or health.
The system is administered regionally but overseen at the federal level. It's not perfect. A 2001 study found that patients requiring elective surgery wait an average of 16 weeks before reaching the operating table. Investment is slow in new technologies and equipment.
On the other hand, Canadian hospitals and physicians spend substantially less time on administrative chores because the single-payer system is relatively streamlined. Hospitals receive lump-sum payments each year from local authorities but have wide discretion as to how their resources are used. Paperwork is minimal.
Would Canada's system work in the United States? Probably not without some tweaking. Experts say a U.S. universal health care system probably would require strong regulatory oversight to ensure cost controls and quality (and such oversight likely would cut into at least some of the projected savings).
Government authorities might also need more say over distribution of medical resources. Just as few communities would want or need two fire stations within a block of each other, regulators would help decide where hospitals are built to avoid wasteful duplication of expensive technologies.
"Health care shares many of the same characteristics of fire departments and police departments," Himmelstein said. "Hospitals should be treated the same way."
Karen Ignagni, president of AAHP-HIAA, the leading trade group for health insurers, challenged the methodology of Himmelstein and Woolhandler's study, and said administrative costs in the report "are wildly inflated."
Many of the expenses included in the study, she said, "actually involve activities that improve the quality of health care. It's not just paper pushing."
U.S. health insurers support extending coverage to all Americans, Ignagni stressed, but are "against a one-size-fits-all approach."
For its part, the drug industry's leading trade group, Pharmaceutical Research and Manufacturers of America, also opposes creation of a single-payer health care system.
Jeff Trewhitt, a spokesman for the association, said private insurance plans offer consumers more choice and "allow pharmaceutical and biotechnology research companies to avoid innovation-stifling, government-mandated price controls."
Harvard researcher Woolhandler responded in an interview that the insurance and drug industries have resisted change for years. "They're extremely happy with how things are now," she said. "For them, it's a life-or- death struggle."
Yet in the face of such politically powerful opposition, most experts agree it's unlikely nationwide universal coverage will be adopted in the United States anytime soon. Then again, Canada began its system more than half a century ago on a province-by-province basis.
Cdn_Psych
34 Posts
kday,
>Cdn-
>
>First, in response to your example of being
>grateful that the government does not allow
>drunk driving, etc., I must say that you seem
>to have Libertarianism confused with Anarchy.
>Libertarians believe in law enforcement and a
>judicial system. Anarchy and Libertarianism
>are not interchangeable.
Okay, let's suppose your assertion
that libertarians are not just a bunch of
right wing anarchists is correct.
I note that, once again, you have not explained
how libertarians will pay for these services
(legislators, cops, courts & prisons)
without resorting to taxation.
Secondly, please explain why it is acceptable for
government to provide a public criminal justice
system (as per your statements) but somehow
morally objectionable for government to
provide a public health care system or
a public education system? Surely all
three services (from your viewpoint) must be
tainted by the fact they would need to be
paid for with "stolen" money (i.e. taxes).
>Second, yes, I do believe things like
>water-quality testing could be successfully
>privatized. Your one example of privatization
>failing is not enough to convince me that
>it should not be attempted again.
Perhaps you might ask the British how happy
they are with Thatcher's privatization of
water. Or Californians how happy they are
with the privatization of electricity (but
be patient - they might have to wait for
the power to come back on before they can
tell you).
I know how privatization has worked out here
and its not very attractive - costs have gone
up and quality has gone down.
>I cannot privately contract
>to have my water tested because of the æred tapeÆ
>imposed in my state, however, if it were an
>option, I would definitely be willing to do so.
Come to Ontario. I trust you will enjoy
paying five times as much as it used to cost
when the government labs did it.
>Just because something has failed before doesnÆt
>mean it should never be tried again.
Nor does it mean that it should be repeated.
How many times would you need to bang your head
against the wall before concluding that it won't
make your headache better? After all, as you have
pointed out, just because it has failed before
doesnÆt mean you shouldn't try it again. Right?
Bang! Ouch! - Bang! Ouch! - Bang! Ouch! - Bang! Ouch!
If you ever get tired of that approach, kday, I'll be
pleased to send you some Tylenol to try - (no charge!).
>Democracy was once such a thing.
Yes. I understand that a lot of Americans believe
that the Supreme Court stole the election. I take
it you're one of them.
>Third, what is so wrong with eliminating
>government schools? Private and charter schools
>overwhelmingly out-perform their government
>counterparts, and contrary to popular belief,
>not all charter schools and private schools are
>expensive and æout of reachÆ to the poor.
>Many offer scholarships. An even better option
>is home schooling. Home schooled children
>repeatedly beat the pants off their government
>schooled counterparts in things like SAT testing
>and college grades. Government schools are expensive
>and inept. Throwing more money at them has proven
>to be ineffective at best.
Perhaps. Maybe that is true, I suspect it isn't.
I do know that an educated (and healthy) population
is more attractive as a workforce than one in which
illiteracy and ignorance is rife. I do know that
businesses need to consider infrastructure in making
decisions and that a location with good roads and a
healthy, educated workforce is considered a plus.
If low taxes and virtually nonexistent public services
were the path to prosperity, then Haiti would be the
richest country in the world.
One of the things I find so ironic about free
enterprise business types who are always singing the
virtues of the market, is that they are always the
first ones looking for a handout. What they really
want is socialism for the rich and free enterprise
for the poor.
And people continually fall for it, worrying about
the pittance spent on welfare for the poor, while
ignoring the billions handed out in corporate welfare.
>Fourth, yes I have read Solzhenitsyn. When I was 15.
>Nice try at psuedo-intellectualism. Solzhenitsyn was
>an existentialist.
You say you have read Solzhenitsyn. Forgive me for
saying so, but I find that exceedingly difficult to
believe. If you had read Solzhenitsyn's works, you
would not be labouring under the misconception that
he is an existentialist.
Here's a free clue...
Aleksandr Solzhenitsyn is one of the greatest literary
figures Russia has ever produced, on the level of a
Tolstoy or a Pushkin. He spent decades as a prisoner
in Soviet concentration camps and is a man whose fierce
dedication to truth could not be silenced or broken.
His works have been translated into English for those
of us who do not read Russian. They include such
important works as "The Gulag Archipelago" and
"The Cancer Ward", among others, which provide
a graphic description of daily life in the camps.
He was finally released from the Soviet Union after
Brezhnev died. As I recall, the former head of the
KGB (Yuri Andropov) was the Soviet leader who made
the cunning decision to exile Solzhenitsyn to the
West, realizing that Westerners would never
understand him and so he would not pose a threat
to the Soviet government.
Kierkegaard and Camus are existentialist philosophers
and I believe you may possibly have heard their names
when you were 15.
Nice try, kday, but no cigar. Perhaps there is some
pseudo-intellectualism in our attempt at discourse
here. But you have misidentified the source, as
demonstrated by your profound (mis)understanding of
Solhenitsyn as an "existentialist".
Do tell, are you a product of the government-funded
education system you hold in such contempt?
Or a poster child for the charter schools?
>Existentialism has absolutely
>nothing to do with Libertarianism. On that note,
>Communism and Libertarianism are not interchangeable
>either, as you have implied with your æred fascismÆ
>example.
I made no such implication. I was (as you will discover
if you read what I wrote again - please, carefully
this time) pointing out that that critics of the *SOVIET*
system referred to the *SOVIET* system as "Red Fascism"
when attempting to describe it to others. In plain English,
that Communism and Fascism are totalitarian twins.
The only difference between them is the rhetoric.
The practice is the same.
This is the second time you have grossly misrepresented
what I have written. I am beginning to suspect that you
are suffering from a severe reading comprehension deficiency.
>Communists support the re-distribution
>of wealth an assets amongst itsÆ citizens in the name of
>æequality.Æ In essence, the Democratic/Leftist philosophy
>is much closer to Communism. Libertarianism and
>Communism are very different.
Libertarianism is another Utopia. Every attempt I know
of to institute Utopia on Earth has only resulted in
profound human suffering. I have no reason to believe
that your Utopia will be any different.
>The example of locking up the poor souls who steal
>bread to æfeed their familiesÆ is a nice, touching story,
>however, not realistic in this country. People in this
>country do not steal to feed their families.
>They steal tobuy rims for their cars, beepers, drugs,
>cell phones, and Tommy Hilfiger clothes.
And some people steal from the ill by denying them care.
But those people will never have to worry about going
to jail. They are respected pillars of society.
>Even if they
>DID steal to feed their families, theft is theft.
>Period. Lock æem up.
Ah, in the magnificent even-handed justice of the
libertarian world, we may rest satisfied in the
knowledge that both the rich and the poor will be
equally forbidden to sleep under bridges or to steal
food when hungry.
Lock 'em both up!
>Finally, yes, I agree, human beings ARE interdependent.
>It is this that drives the Libertarian philosophy to
>some extent. People would not cease to be benevolent
>if the government did not mandate it. Church
>groups, sororities, fraternities, and private benevolent
>foundations do a wonderful job of assisting the poor
>and downtrodden in this country WITHOUT government
>funding or interference. To say that people would
>allow others to æstarve in the streetsÆ and not assist
>their fellow man in need if the government was not
>there to step in shows an enormous lack of faith.
So I would never see hunger and deprivation if I
travelled to Appalachia, nor on a reservation in Canada?
Was private charity sufficient to relieve misery during
the Great Depression? And any day now I can expect the
problem of homelessness to be solved by private charity?
You tell me that you think it's right to throw people
who steal food for their hungry children in jail.
And in the next breath you ask me to believe that
private charity and compassion (such as yours, perhaps?)
will be sufficient to solve the problem.
And sooner or later, will private charity result in
the USA having infant mortality rates that don't trail
the rest of the developed world?
>Unfortunately, I believe this debate has reached an
>impasse. Your arguments fall on deaf ears, as
>do mine. It is like pitting a pro-life activist
>against a pro-choice activist. Both are passionate
>about their philosophies and hold them near and dear.
>No amount of arguing or barb-throwing will change their
>minds. It is with this in mind that I have to say at
>this point we will simply have to agree to disagree.
Good tactics, kday. If you're losing the debate, try
cutting your losses by posturing as "reasonable"
and declaring a draw.
We do have one fundamental difference. You consider
taxes to be "theft". I consider taxes the price of
living in a civilized society. Perhaps someday if
you are sick or injured and you have no health
insurance and no income because you've lost your
job, you may have a change of heart and a somewhat
more compassionate attitude toward others. I can
only express the hope you will never find yourself
in that situation, especially in a society which has
adopted the libertarian ideology you espouse.
Hell, I'll bet North Carolina doesn't even have an
ice floe for them to abandon you on.
>It's been....interesting.
And hopefully you've learned something.