There are many problems in our healthcare system. HMO's denying treatments, saying they're experimental, now they're trying to deny CT scans and other valuable tests, even more vehemently than before. Lack of insurances availability or high deductibles. Health care administrators who have no clue what is going on, only that it costs. Lack of policing physicians and then people are shocked their physician is amoral and has put them at risk. The usage of Emergency rooms as clinics, rather than having urgent care centers open 24 hours, so those who need emergency care, wait hours for treatment. The poor, who have no insurance or means to pay for health care.
Physcians who have abused insurance companies and it's now resulted in HMO's. The list is endless.

Does anyone have any potential solutions, things they've thought about. Like cdnurse: any thoughts about HOW mental health care can be improved? It is terrible to send these individuals to jail instead of some kind of rehab; but what kind of realistic changes in mental health care could you suggest?

This is another good one: "rather than having urgent care centers open 24 hours," The Urgent Care Center near me closes at 6 or 7 PM. Not long ago, I saw a special on TV (60 minutes or some show) and a gal was interviewed. She chose NOT to have insurance (she was able to afford it-she said). However, when she needed medical care, she'd go to the ER.

Then, when she received the bills, she just "didn't pay them." Sort of like flaunting the law.

I have an ear, and I can pass on anyone's info and it will be heard.

Annie

As far as problems. Wow! The first thing that comes to mind is a hospital stay that I had for 13 days. The bill was $18000, I paid my out of pocket max of $3000, the insurance company paid a part and the hospital wrote off the rest.

However, if I'd been uninsured, the WHOLE $18000 would have been my responsibility to pay. The person with the LEAST ability to pay has the most to pay. How right is that!

There's a book, "Saving Lives and Saving Money" by Newt Gingrich which lays some good groundwork and is an easy and good read. An example, the EMR. We think NOTHING of swiping our credit card (with all the info it can give) to pay for gas; but accesing medical record with a card, password? Some way we should be able to get EMR for all.

Some healthcare systems can afford the EMR; other's can't. There are medication and medical errors; many of the problems of our health care system are 'blamed' on errors. NONSENSE! Health Care practitioners shouldn't be blamed. They can work on safety issues, which we are. But, health care practitioners are NOT the problem.

I believe that the problems stem from greed for a profit, often by insurance companies. But, I feel that if we change and let the government dictate how we manage our health care, the government will get greedy as well.

I think that there are free market solutions which will make a big difference. However, ALL Americans need to roll up their sleeves in coming up with the solutions, to advocate for their patients, their families, themselves. Health care workers are in a unique position because they see the problem in a unique way.

Laypeople see that care is denied with increasing premiums and increasing medication costs. Nurses and other healthcare professionals see that they have less staffing, and then less time for adequate discharge teaching, etc.

Right now, I'm watching "Sicko." What do others think about what I've said and the movie?

Annie

I'm (yet again) in full agreement with dmazment's last post. Unfortunately I have no suggestion fo a solution to this ever constant problem. It's diffiulcult to find one party of people who are not going to get overly greedy, or power hungry. We need to find some sort of checks and balances system.

EmilyB said:

dmazment said:

There are many problems in our healthcare system. HMO's denying treatments, saying they're experimental, now they're trying to deny CT scans and other valuable tests, even more vehemently than before. Lack of insurances availability or high deductibles. Health care administrators who have no clue what is going on, only that it costs. Lack of policing physicians and then people are shocked their physician is amoral and has put them at risk. The usage of Emergency rooms as clinics, rather than having urgent care centers open 24 hours, so those who need emergency care, wait hours for treatment. The poor, who have no insurance or means to pay for health care.
Physcians who have abused insurance companies and it's now resulted in HMO's. The list is endless.

OMG amen sister!! I see this every day...How blaten of these physicians...It angers me to NO end...!!! We are so filled at times we have to revret patients over to another hospital...One that is half as good as ours and the patients get sublevel care there and in the end, when we finally have room, by the time they get back to us...things are such a disaster!! Yes the list is endless and I could write on and one..about neglect by physicans for their patients/ physicans taking their names off of peoples cases,because they do not have the best insurances...it is sad, it is WRONG and the oath, that physicans take seems to be just words and not meaningful anymore!!
Emma

+++++

"physicans taking their names off of peoples cases,because they do not have the best insurances"

I'd like to pass on information, but I need some clarification here. Does this happen in the ER? Offices? Clinics? I know one thing for sure is that I can bring up Urgent Care facility hours, mental health issues, the disconnect between health care administrators and staff/patients. Quite frankly, I don't think the disconnect is because they don't have "a clue" as to what's going on. I think they KNOW what's happening, but like pharmaceutical industries, insurance companies, lobbies; they are run like a business with the bottom line; MONEY.

They need to be run like a business; but a business that REALIZES, really realizes that it's commodity is PEOPLE: who have needs 24/7; NOT paper which can sit idly by from 5PM until 9AM.. That commodity might be their mother, their father, their best friend. But that hasn't sunk in. And it won't until something hits close to home.

dmazement, HOW do your propose that HMO's STOP denying treatments? Having nurses or health care professionals on review boards? Personally, I think that there should be nurses and doctors on decision making-teams, who are NOT given bonuses for the numbers of denials they generate.

Did you see the Congressional testimony of Linda Pena, MD? As a medical reviewer, her job was to determine which cases could be covered; but she was given incentives for DENYING coverage; the more the number of denials, the greater her bonuses.That's business; but that can't be the business of HEALTH CARE.

Just an example, the CEO of Humana received total compensation (salary, bonuses, stock options, etc) of
$3.3 MILLION in 2006. Sure, CEO's make tough decisions, but what could be THAT tough? What about the decisions that you make, on the spot, life and death decisions.

But, from what I understand, the stockholders and board of directors might see a CEO as so valuable in running their company, that they increase their pay and will do ANYTHING to keep him/her.

dmazment said:

I've got one better for you. The CEO of kaiser permanente in northern california receives............almost ten million dollars annually with salary, stock options, bonuses.

Having nurses or health care professionals on review boards? Personally, I think that there should be nurses and doctors on decision making-teams, who are NOT given bonuses for the numbers of denials they generate.
Yep, this is what I believe must and should happen. They should be independent thinkers, who can think outside the box to solve problems.

Another thing, the original HMO, which is Kaiser Permanente and regardless of the exorbitant amount the CEO makes, is probably the best role model for HMO's in this country. The founder, Henry Kaiser's concept although it has been morphed with different CEO's basically was all receive the best care available. Physicians are employees, not independent contractors. They have rules and regulations they have to abide by. They are considered part of the team, where as still physicians, in private practice believe they are captains of their particular ship. This concept has promoted, for the most part, an excellent working relationship between nurses, physicians and all ancillary staff members

History is replete with independent thinkers who think outside of the box; in ancient times, they were stoned to death or burned at the steak! We're too civilized for those things, but we will let humans suffer needlessly because some insurance company or CEO wants to make a buck. What a shame.

I'll definitely pass on the info about nurses and physicians sitting on decision-making boards as a potential solution. The health care problem in this country is multi-faceted, and as such, has MANY solutions.

Right now, at this time, agency nurses are used because there are no nurses to hire for staffing. Agency nurses are not expensive when you think of the alternatives. Law suits, closing floors, patients not getting good care. Waste, oh yes there is huge waste in the healthcare system. There are administrators who aren't needed at large salaries. Hospitals WASTE huge amounts of money by bringing in experts on staffing and they ultimately have no clue what's going on. Hospitals also use large amounts of money to keep unions out. Large amounts of money are wasted for advertising, using TV ads etc. The best advertisement for any hospital or clinic, if they are happy, contented and proud of their places employment are.........those who work there and patients who go there.

The exorbitant amounts wasted in OR's because the rooms are opened, everything is rushed.........ONE case cancelled which can't be converted to another procedure can be over $10,000. Articles opened because the surgeon insists and then not used and can not be re-sterilized. This is just a very short list of what I think is wasted in hospitals.

Yes I think committees of nurses and physicians could make a big difference, but it has to be a balanced consortium and the nurses who are on this committee must be able to stand up for what they think is right and not bend to the wants and views of others.

I am ashamed to say I left out something I feel is very important. There is a nursing shortage, lack of RN's. The trend started in the late 70's to go towards primary care nursing, rather than team nursing has left out LPN's/LVN's. teamrn you have said you can pass along information, then please ask why LPN's/LVN's are not being utilitized in most hospitals anymore? Why not go back to team nursing? Why not utilitize some of the most valuable healthcare workers available, the LPN's and CNA's in hospital settings?

My mentor's name was Mildred Stewart LPN. I loved, respected and listened to this woman. She was wonderful and I am forever going to attribute much of my knowledge, confidence and practical experiences to this very special woman.

I know that this is not a popular position to take... especially with Republicans...but I am perplexed as to why our nation is not really looking at a single payer system for healthcare. Why can't we Extend Medicare -like coverage to everyone...? Or why won't we EVEN CONSIDER HAVING a nationalized system like so many other developed nations have...? the problems can be no greater than we currently face... We realize societies have to provide education, fire and police protection to citizens...I think healthcare is also a basic necessity of civilized societies. We do not expect police or firefighters to make a profit... Why should we build huge profit into healthcare?? We provide basic education to all, and then those that want a "superior" education can seek a private education... why not a similar model for healthcare...? Basic coverage and services for all...elitist services for those who want to pay additionally... When I look at the advantages of government provided healthcare such as
coverage is constant, and not tied to employment,
freedom to change jobs and/or retire at any age,
no masses of uninsured clogging ERs,
services include coverage for mental health, dental and vision,
During emergencies,governmental healthcare employee systems are in place to respond to emergencies -like presented by SARS in Toronto---
No bankruptcies and enormous credit card debt due to medical care costs,
No ignoring symptoms...like women ignoring lumps in their breasts ...for fear of cost of care...etc)
Why not really compare options?. I think the hysteria over "nationalized" or "socialized" medicine is perpetuated by the insurance companies, the healthcare industries, and the pharmaceutical companies... Let's talk to people in Denmark... they are the "happiest people on earth." (per a recent '60 Minutes' segment) .. Danes have wonderful healthcare, childcare and eldercare all provided by their government... sure they pay higher taxes... but it goes for programs that benefit society, not WAR!!
Even many MDs are now in favor of national plans....Look at the information posted on "Physicians for a National Health Program" iIt is really fairly compelling... (look at how costs for healthcare administration have soared!!) Yet only Dennis Kucinich had a plan that came anywhere near proposing a single payer system...Why ?
Corporate Profits???? Greed??? Vested interests?? Do we really know? or care? Nurses are in a position to see many sides of this issue...and this nurse of 40+ years would like to see some objective analysis of all the data... We value evidence based decisions.... why not in healthcare?
For what we spend on healthcare...Our citizens deserve better. Susan Sullivan RN RHN MSN

I. think the fact that Dennis Kucinich was the only presidential candidate for a single payer system was VERY telling.

2. Consider the national plans proposed by Senator Obama. I've spoken to someone in Canada where there is a national plan. Diagnosis of epilepsy. He had a burst of seizures, so an MRI was done to explain them. Sounds ok, right? Then several weeks later, he had more uncontrolled seizures; the MRI and neurologist visit weren't to be had for a few months, this time.

I'd also direct you to something I found on You Tube (I don't always give much credence to stuff on You Tube and hardly my sole source of information!) http://youtube.com/watch?v=X_Rf42zNl9U -a short course in brain surgery.

My take on this is, we'd be trading the insurance of all Americans for the rationing of health care for individuals with chronic illnesses: I'm one with many chronic illnesses, so I take a personal interest in health care. I don't want to see people without coverage; however, when I need my CT or MRI-stat- I need to know that it is going to happen-stat.

3. As for Senator Clinton's plan, I could find that a bit more palatable. However, I'm not for a big government remotely becoming involved in my healthcare. It should be between my physician and me.

Granted, the way the system is now, we've got insurance companies dictating our care and Medicare (the government) breathing down backs of Medicare patients.

Sure, the Danes LOVE their care. I always wonder what the size of theses countries has to do with the success of successful national insurance plans. In Canada, there are 35,000,000 people versus 310,000,000 here. That's just shy of 9 times smaller than us in populations. BIG difference. Most other countries with successful national or universal plans are MUCH smaller than we are. Do they manage because they don't choke on paperwork?

I don't know how you feel about your taxes, but mine are plenty high; the tax rates in some of these countries is much higher. Gasoline $3.50 a gallon? NADA. There's are taxes on everything which pays for healthcare and other goods and services. Citizens of many of these countries are taxed up the wazoo for the privilege of having their health care paid for UP FRONT.

We all have ideas about problems and the resolution of these problems and I feel nurses are in a unique position to see some of the ills facing our system. We could benefit by strengthening healthcare IT, utilizing EMRs to the maximum, mandating that ALL physicians make use of e-prescribing. It is sinful that in this day and age, only 2-3% make use of such simple technology.

Yep, I'm a Republican and I really don't see how anyone could want SOMEONE ELSE meddling in their affairs. A BIG government (liberal Democrat) will do just that. I think a SMALL (Republican) government can work out free market solutions if we ALL drop our political agendas at the door and determine how to best solve our healthcare problems of incredible corporate greed. Could we cap CEO salaries? Insurance CEO salaries? Create an oversight body to make sure that drug prices are negotiatied and the public isn't GOUGED.

Susu has pointed out some good problems. Now, I think if we butt heads, we might be able to come up with SOLUTIONS to those problems. If we really value evidence-based practice, lets have nurses sitting on boards with REAL decision-making abilities, not just token boards with NO TEETH.

Newt Gingrich has written a book (one of many!) entitled "Saving Lives, Saving Money." A good and easy read, he identifies several problems and potential solutions. Let's debate this and figure out what are good approaches.

Annie

You know, I watched Sicko also.  It made me so mad.  When I read the posts by many of you you mentioned the ER's being used as an urgent care.  My mother broke her leg and was in extreme pain sitting in the ER waiting room while kids with colds are seen first.  Please!!!  She had to wait 4 hours to be seen.  There was a waiting room full of kids with minor problems that could be easily handled in an urgent care.

In December of 2006 my mother was sent home early due to her insurance stoped paying.  She died the next day.  Not to mention she was mis-diagnosed as was my dad back in 1984.  This is the reason I am becoming a nurse in the first place.  Maybe I can make a difference.

I don't have an answer either.  Sometimes I feel helpless. 

A major issue i feel is charges and reimbursement.Medicare is going to be making devastating changes on in hospital reimbursement. Not only medicare but all insurance and medicaid.The population that doesnt have insurance nor a job only worsens the  problem, as it raises costs for others.Charges for medical care is out of this world.Are the charges appropriate?Are some of the tests/ hospital stays neccessary?I see some Dr's that keep people forever, run what seems liks unneccessary tests, then others that get the job done and get them discharged.Now pt's can object if they feel they are being discharged too soon, and have a couple more days for it to be evaluated.I see alot of "frequent flyers" for pain issues,etoh/drug detox etc.I  think the basics have to be re evaluated and start from the bottom up.If things continue the way they are and going to change, the medical care in this country is going to spiral downward until it cannot be saved.