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.
Specializes in ICU, Paeds ICU, Correctional, Education.
from someone who lives and nurses in a country with universal health care it has it's problems but generally works well. it certainly does not discriminate based on the capacity to pay. i think there is an obligation to humanity to look after its own which ethically determines that everyone should have the right to have the suffering caused by illness addressed.
if we are talking about ethics then not only should this right be upheld but the private health insurers, medical appliance and drug companies should stop generating massive profits for themselves out of the suffering and fear of dying common to all of us. this of course adds to the massive economic burden of health care. universal healthcare can help to regulate this such as by the use of generic medications and the evaluation processes for effectiveness and cost of medical appliances, not to mention their appropriate applications.
i would imagine that the wealth generated from private health belongs in the hands of the most powerful. those that don't have access to private health are the most vulnerable and those with the weakest voices.
we are nurses...our patients are not commodities nor, are we expediture.
from someone who lives and nurses in a country with universal health care it has it's problems but generally works well. it certainly does not discriminate based on the capacity to pay. i think there is an obligation to humanity to look after its own which ethically determines that everyone should have the right to have the suffering caused by illness addressed.
if we are talking about ethics then not only should this right be upheld but the private health insurers, medical appliance and drug companies should stop generating massive profits for themselves out of the suffering and fear of dying common to all of us. this of course adds to the massive economic burden of health care. universal healthcare can help to regulate this such as by the use of generic medications and the evaluation processes for effectiveness and cost of medical appliances, not to mention their appropriate applications.
i would imagine that the wealth generated from private health belongs in the hands of the most powerful. those that don't have access to private health are the most vulnerable and those with the weakest voices.
we are nurses...our patients are not commodities nor, are we expediture.
i agree that we should look out for those of us that cannot look out for themselves.
i disagree that extends to those that won't look out after themselves.
health care is not a right; it's a personal responsibility.
health care isn't a commodity; it's a service. if it's also a right, then others are entitled to the labor of those that provide health care. there is a definition of being entitled to the labor of others: slavery.
there are some fundamental issues of morality at play with such concepts. rights do not occur absent responsibility. to say somebody has the 'right' to health care, regardless of their responsibility to secure it, is utterly meaningless.
I think that in the end we need to build and implement systems that make it easy for people to be responsible.
As to the tax question every credible proposal that I have read speaks to the idea of replacing premiums with either a payroll tax OR allowing employers and individuals the option to purchase health care insurance directly from Medicare, or FEBP. IF private insurers want to stay in the game they will have achieve dramatic administrative cost reductions. 1 dollar should buy at least 95 cents of health care instead of our current 70 cents. We simply cannot afford double digit administrative costs or health care inflation.
The OECD average is about 9% GDP for health care. We spend 16% GDP. A substantial driver of the difference is administrative inefficiency and duplication along with incomprehensible and inconsistent benefit plans.
I think that in the end we need to build and implemetn systems that make it easy for people to be responsible.
I agree. But this is what is at the heart of most of the disagreement here on these UHC threads.Some will say it should not be made easy, some will continue to expect all in society to be able to conduct themselves in the way in which they would. The sad fact is that it just wont happen. In the meantime it IS costing ALL of us pretty pennies to have the irresponsible use the ER has a primary care service. Health care access with parameters to avoid abuse and fees based on income is the only realistic way the health care situation can see improvement.
In the meantime it IS costing ALL of us pretty pennies to have the irresponsible use the ER has a primary care service.
The simple solution, of course, is to repeal EMTALA.
I don't really advocate the repeal of EMTALA. I DO however, advocate co-pays to use the ED, refundable if admitted.
I personally pay $125 co-pay for such use. Sounds reasonable.
Allow EDs the ability to aggressively go after non-payers. For example, in the case of those on welfare, benefit reduction to reimburse hospitals if co-pay isn't paid at the time of service. For others, streamlined pathway to garnish wages.
publicado - published: 11/10/2007gainesville (debbie gilbert / the times).- what part of the word "emergency" do you not understand?
and a growing number of hospitals are now giving such patients an ultimatum: if you come to the er with a nonemergency, don't expect to get treated unless you pay up front.
here's how it works: patients who come into the er are evaluated by a physician. if their condition is a true emergency, federal law requires that they be treated, or at least stabilized so they can be transferred to another facility, regardless of their ability to pay.
"if the patient does not have an emergency, we recommend that they see a primary care doctor, and we give them a list of options in the community, including free or reduced-fee clinics," said duffy. "if they insist on being treated in the er, we will certainly do so, but they must pay either their insurance co-pay or a $150 deposit."
true emergencies include chest pain, trauma, severe bleeding, respiratory distress, stroke symptoms and other conditions that clearly require immediate attention.
"we are not turning anyone away," duffy said. "all emergencies will be treated, and physicians will always err on the side of caution."
"it's an issue that every hospital in georgia is grappling with," he said. "a lot of it is linked to the uninsured population, which is growing so fast."
"we have people who are habitual users of the er," she said. "but treating patients who are inappropriate just encourages them to come back next time."
"the regulations only say we have to triage and evaluate," she said.
"but since patients incur most of their expenses during the evaluation, most hospitals just end up treating them."
the cost of treating the uninsured has forced some hospitals nationwide to close their emergency departments. yet there is still a reluctance at many hospitals to redirect patients who are inappropriate for the er.
that reluctance is driven in part by fear of lawsuits. there's always a chance that a doctor may send a patient home, only to have that person turn out to have a real emergency. but bowers said more hospitals are now willing to take that chance.
"liability concerns are one of the reasons the systems has evolved as it has," she said. "but everything in medicine has some risk of liability. you have to balance that against the risk of using your resources on non-emergent care and not having it for those patients who have true emergencies."
make urgent care clinics accessable 24-7, put them next door to the ers.
Whilst universal health care seems wonderful, [further] socialization of our medical system will diminish the care received. Think about this for a moment... If our society were to adopt a universal health care system - a system that would be run by the government - we, as nurses, will lose any autonomy we have. We will become a government regulated group - not the self governing body we currently are.
I agree it would be wonderful if every US citizen were able to have health insurance, but I will never stand for government provided health care. We are a capitalistic society - not socialistic. The more we allow our government to control us, the more they will seek to control.
The simple solution, of course, is to repeal EMTALA.
I don't really advocate the repeal of EMTALA. I DO however, advocate co-pays to use the ED, refundable if admitted.
I personally pay $125 co-pay for such use. Sounds reasonable.
Allow EDs the ability to aggressively go after non-payers. For example, in the case of those on welfare, benefit reduction to reimburse hospitals if co-pay isn't paid at the time of service. For others, streamlined pathway to garnish wages.
~faith,
Timothy.
And if they cannot afford the co-pay? Wait- that is the problem now. Can anyone believe that someone on welfare can afford 125$? Well, cat food is cheap, and some may even be nutritious.
And if they cannot afford the co-pay? Wait- that is the problem now. Can anyone believe that someone on welfare can afford 125$? Well, cat food is cheap, and some may even be nutritious.
The idea is to discourage folks from using the ER for non-emergencies. At least $125 is re-payable for someone on limited means, and they'd be encouraged to access a clinic (hopefully next door with long hours) for $25 (for example). I know even $25 can be discouraging enough for some to avoid seeing a doctor, but it's a very reasonable amount that could be borrowed from a friend or paid to the facility in $5 installments.
For those with a verified need and a precarious health situation that necessitates frequent ER visits or MD visits, perhaps such user fees could be waived.
I understand your concerns, but there wouldn't be much of a dent made with co-pays from the poor. If 5$ or 25$ would take care of a clinic visit, it would be utilized already. Administrative costs could exceed the actual cost of the co-pay.
I understand your concerns, but there wouldn't be much of a dent made with co-pays from the poor. If 5$ or 25$ would take care of a clinic visit, it would be utilized already. Administrative costs could exceed the actual cost of the co-pay.
The problem is a whole lot bigger.
Such co-pays aren't about making a dent in the actual costs; they are simply there to discourage overuse. I acknowledge that in many places $25 won't cover a clinic visit. To provide service at such a low cost would necessitate subsidization. Unnecessary and unpaid for ER visits are costing lots of money already so the idea is to find a way to minimize unnecessary ER use by not only adding a minimum payment for non-urgent use but also by offering an affordable alternative. It is a problem that currently many clinic visits can end up costing anywhere from $80 to several hundred dollars and so it's "less risky" financially for those with little savings and few assets to go to the ER where the bill generated is in the thousands but it's (apparently) possible to avoid paying anything. I agree that reasonable alternatives must in place in order to reduce the current overuse of ERs for non-urgent care.
CO2emission
100 Posts
from someone who lives and nurses in a country with universal health care it has it's problems but generally works well. it certainly does not discriminate based on the capacity to pay. i think there is an obligation to humanity to look after its own which ethically determines that everyone should have the right to have the suffering caused by illness addressed.
if we are talking about ethics then not only should this right be upheld but the private health insurers, medical appliance and drug companies should stop generating massive profits for themselves out of the suffering and fear of dying common to all of us. this of course adds to the massive economic burden of health care. universal healthcare can help to regulate this such as by the use of generic medications and the evaluation processes for effectiveness and cost of medical appliances, not to mention their appropriate applications.
i would imagine that the wealth generated from private health belongs in the hands of the most powerful. those that don't have access to private health are the most vulnerable and those with the weakest voices.
we are nurses...our patients are not commodities nor, are we expediture.