Sunday, October 19, 2008

Let Us Discuss............... Universal Health Care

There is a discussion going on in a Mom's forum I belong to regarding Universal Health Care (UHC). I am being called an asshole and repugnant because I don't believe in UHC. Let's discuss this issue because I honestly want to know why people think it should be a Constitutional Right to have health care.

Here are my points:

I believe we should have universal EMERGENCY coverage for truly emergent situations. I believe we should have coverage for children for preventative care (well child checks, etc) and illness/injury. I do not believe that we should have total coverage for general health care for all adults. I do not believe that this is a RIGHT.

I have seen government run programs (Can anyone say Oregon Health Plan?) that are so completely mismanaged and are more of a hinder to health care than anything else. They have created a healthcare environment that promotes ER visits for non emergent reasons. And even though the patients have to sign a waiver to agree to pay if OHP does not pick up the bill, this doesn't happen. Our ER budget this year showed a tremendous loss of revenue related to this issue (as does every ER in the nation - ER's are pretty much always loss leaders in relation to this). Remember people - we cannot refuse to see anyone no matter what the reason. Now after a medical screening exam we can tell them their situation is non emergent and recommend follow up with a primary physician. Most won't follow up anyway, and we've just wasted 1 to 2 hours of ER flow time because of this. Therefore we have delayed care for someone else who is truly emergent and we have the need for additional staffing to tell people they don't need to be in the ER. And people wonder why medical costs are so high.

Next, I have seen time and time again, people that do NOT follow their physician's recommendations for care of their condition (think diabetes, congestive heart failure, etc.). Should we still help them when they are in a crisis? Absolutely. But we should not pay for their medical visits at a clinic if they are not willing to be cooperative with their medical care. Yes I know there are case by case situations where this may not apply (quacky docs, new therapies, etc), but I'm referring to an in general population.

I do not believe that our current system works, but I also do not believe that UHC is the answer either. Someone told me that Germany has a program where everyone is guaranteed emergency treatment and they have the option to buy into higher level plans if they so desire (does anyone know if this is true?). I think this sounds like a great option. As long as they are NOT government run.

I do believe everyone deserves good medical care - absolutely. I just do not believe that the government should foot the bill.

Let us discuss..................

10 comments:

Sabra said...

The one common thread I have seen amongst proponents of UHC? They have private insurance.

I've been on the government's dime when it comes to health care, both as a child depending on the county and as an adult with TriCare. I know what government-provided health care is like. And I want no part of it, nor do I particularly want it inflicted upon my fellow Americans.

You're absolutely right that it encourages ER visits for nonemergent issues. With TriCare, there was no such thing as an urgent appointment, not at my husband's pay grade. It was a simple matter of: I can go to the Er and be seen in a few hours, or I can call the appointment hotline and be seen in days or weeks, and that's if I could somehow magically produce child care for that time. Guess which happened?

And that's leaving aside the quality of the health care, which was subpar, to say the least.

But I'm expected to believe that if we put the government in charge of everyone's health care, it'll magically get better. That flies in the face of all logic.

Anonymous said...

In Canada the masses are stuck with a sub-standard health care system, and the rich pay to go to the United States, or other countries, for better treatment. Doctors also leave in droves because of the lower salaries and bad working conditions. The system is only universal insofar that the state has universal control either way (through immigration control, if you leave). If the United States sabotages its own health care system by socializing it, the same thing will happen.

1. There isn't a single government agency or division that runs efficiently; do we really want an organization that developed the U.S. Tax Code handling something as complex as health care?
2. "Free" health care isn't really free since we must pay for it with taxes; expenses for health care would have to be paid for with higher taxes or spending cuts in other areas such as defense, education, etc.
3. Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness.
4. Government-controlled health care would lead to a decrease in patient flexibility.
5. Patients aren't likely to curb their drug costs and doctor visits if health care is free; thus, total costs will be several times what they are now.
6. Just because Americans are uninsured doesn't mean they can't receive health care; nonprofits and government-run hospitals provide services to those who don't have insurance, and it is illegal to refuse emergency medical service because of a lack of insurance.
7. Government-mandated procedures will likely reduce doctor flexibility and lead to poor patient care.
8. Healthy people who take care of themselves will have to pay for the burden of those who smoke, are obese, etc.
9. A long, painful transition will have to take place involving lost insurance industry jobs, business closures, and new patient record creation.
10. Loss of private practice options and possible reduced pay may dissuade many would-be doctors from pursuing the profession.
11. Malpractice lawsuit costs, which are already sky-high, could further explode since universal care may expose the government to legal liability, and the possibility to sue someone with deep pockets usually invites more lawsuits.
12. Government is more likely to pass additional restrictions or increase taxes on smoking, fast food, etc., leading to a further loss of personal freedoms.
13. Like social security, any government benefit eventually is taken as a "right" by the public, meaning that it's politically near impossible to remove or curtail it later on when costs get out of control.

Right now the United States really had the BEST healthcare in the world. People travel here for surgery because of this.

Erica said...

I had this conversation with a particularly well-informed security officer in one of the ER's I work in one night. He summed up my thoughts on entitlement to health care for the noncompliant:

"People who don't care about their health, don't deserve healthcare."

Socston said...

right on!

Anonymous said...

In Australia Hospital care is free - ER visits are free, paid for by the general working population TAXES.. its called Medicare, a big bank of dollars every working aussie pays year by year to support any hospital visit by a fellow Australia, rich, poor, compliant and non compliant. The system is not perfect, but we have made it work more or less. We are encouraged to have insurance, but the only benefits is a private hospital (which has a lower nurse to patient ratio, and less equipment) plus the same specialist doctors work in both the private hospital, and public just down the road, so most people see no need to insure, same care if not better, for free.
Wh have Ads on TV to educate people not to go to the Emergency Dept for everyday illnesess the GP can handle. But of course that only deters a certain percentage.
The tax levy on health is on a sliding scale so people on pensions and govt benefits don't pay it, only those working and earning... so we probably have alot to complain about but every one just accepts this is the way in Australia and UK.
Poor people need to be able to access Health but yes, the non compliant, the druggies and the time wasters still fill up beds better needed for the genuine... in our industry we just wear it, we don't always like it, but what can we do?
Most Aussies think the USA system of insurance is bad... but each to his own

Anonymous said...

I'm going to agree with the Australian - because I am Australian. As a pharmacy assistant, going on to study nursing, I'm very aware of how well run the Australian health system is. People complain about having to wait three hours in emergency but at least you're getting to see a doctor, and it's not going to cost you. The most you will ever pay for a medicine (covered by the pharmaceutical benefits scheme, as some aren't and taking the generic brand) is $31.30 for a general patient, $5.00 for a concessional patient and after having 58 scripts dispensed for the year the price of medicine drops to $5.00 for a general patient and free for a concessional patient. So, yeah I'm happy to wait three hours to see a doctor knowing I'm definitely able to see one and knowing I'm going to be able to afford the medicine I need. If people have to pay to see a doctor, that's why they come and clog up emergency.

Anonymous said...

I'm going to agree with the Australian - because I am Australian. As a pharmacy assistant, going on to study nursing, I'm very aware of how well run the Australian health system is. People complain about having to wait three hours in emergency but at least you're getting to see a doctor, and it's not going to cost you. The most you will ever pay for a medicine (covered by the pharmaceutical benefits scheme, as some aren't and taking the generic brand) is $31.30 for a general patient, $5.00 for a concessional patient and after having 58 scripts dispensed for the year the price of medicine drops to $5.00 for a general patient and free for a concessional patient. So, yeah I'm happy to wait three hours to see a doctor knowing I'm definitely able to see one and knowing I'm going to be able to afford the medicine I need. If people have to pay to see a doctor, that's why they come and clog up emergency.

Anonymous said...

Of course the U.S. has to move to universal healthcare because in the end you have to ask yourself what other alternative is there? It seems to me that the people who are suffering the most tend to be lower middle class, the disabled who are forced to wait 24 months before medicare kicks in, the receptionist whose small office cannot afford to offer insurance to their employees, the self-employed who are not making enough money to pay $500+ a month for individual insurance, the caretakers of family and the disabled who have given up their careers and/or full-time jobs in order to take care of loved ones, the shipping and receiving office worker - laid off living on their savings and whose Cobra has run out. These are the kinds of people I run into who do not have health insurance.

A general statement that people don't take care of themselves so no one should have insurance is ridiculous. When did we lose compassion in this country? I have friends all over the world and they cannot believe that we don't take care of our own. No, we don't care of our own. We make excuses as to why it is okay to let millions of people go without health coverage.

It will never be okay to watch your friend suffer through an asthma attack because she can't afford to go to the doctor. She cannot get coverage because she has a preexisting condition that she was born with. She works 60 hours a week taking care of the elderly for a company that cannot afford health insurance for its employees. She will not go to the emergency room because she is still paying off the last ER visit to the tune of $8,000. It was horrifying and inexcusable that she is being made to suffer this way.

I've had the opposite experience as a previous poster. The people that I hear spouting off against universal health coverage have insurance. They are clueless as to what the uninsured are going through. I'd rather wait three weeks to see a doctor than to not be able to see anyone at all.

A very informative view of universal health coverage in other countries was in a Frontline program. You can watch the enire program online. Here is the link: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

My last thought: Don't be so quick to judge. It could be you without insurance next.

Alaina

Canuck said...

The Canadian system is like the Australian system. It's certainly not "sub-par" like Annon #1 posted (why are the ones who bash other systems always anon?). I'm a nurse and I've worked (and been a patient in) both system. And I'd rather be sick in Canada. I'll never lose my house, just because I was unwell.

Helen said...

right on Canuck. I'm a Canadian nurse and I worked in California for 5 years. I had my children there and used the medical system as well- had my children in the hospital there. I was 'lucky' to be covered by an HMO with my husband's employer, so I had no medical bills and medications were a $5 co-pay per prescription...BUT...I only had to look around me to see all of the patients who avoided preventative medical care (children with rotted teeth, pregnant women with no pre-natal care, etc) because they couldn't afford it. It horrified me when a fellow travelling nurse told me one day about her post partum patient who died that day from a raging uterine infection because she had no money to visit a doctor for her symptoms!
This is the sort of thing you would rarely see in Canada. People get the care they need. No, our system isn't perfect, but I'd never live in the US again and the main reason is their health care system. I find it appalling that people aren't given the same levels of care and treatment based on their ability to pay. I feel very fortunate to live in Canada where I know my family members are safe and will be taken care of in case of illness or injury without risk of financial ruin.