Here is my husbands 2 cents. He thinks we need to take the doctors out of the control of the ins companies. have the ins companies give catastrophic coverage only.  Consumers then are able to shop for doctors and the medical groups which are another beurocracy goes away. Doctors can then reduce fees for service because they are getting paid cash from consumers, anytime you open up competition for services the cost of that service goes down. We have too many people managing healthcare in between the patient and the doctor. By causing doctors to lower there fees you enable people who cannot afford ins premiums to at least get in to see a doc for a smaller fee. You would get catastropic coverage and a certain number of vouchers for regular office visits a year plus illness visits, depending on how much you paid your ins co. you could take these vouchers to ANY doctor and this would cause costs to drop. You could negotiate your services with your doctor yourself you could even get more visits, the goal here is to put the patients in the position of being able to shop for doctors like it used to be long ago. Doctors charge so much because the ins companies cap the rates they pay, so the doctors pass the loss to the next cash pay patient.

I would rather see the control of healthcare in the hands of the patient.........NOT the insurance companies.  They are the reason that the doctors have to charge so much, since their contractual reimbursement does not even come close to what is billed (which is obviously inflated due to the reimbursement rate)  HMO's were the beginning of the healthcare crisis.........and control of who you could see and when you could see a specialist was taken out of hands of the physician............give me the old FFS anytime.  I think patients need to be informed, do research on their docs (and i realize some are restricte to certain plans depending on their coverage)

I also agree with your statement on the illegals........as someone who was a hospital administrator in California for years.......it has destroyed the bottom line and we all are paying the price.

I have no problem with the population as a population means there will always be work for nurses....my problem is the maltreatment of nurses by ther some bosses and the poor working conditions and the need to recognize how much goes into nursing......it is both a mental and physical task

I am also concerned with the impact the job of the nurse has on her family and her or  his health.......I have met so many nurses that have gone throw divorces and it conerns me that nursing does not promote the nurse to have time to care for herself or her family.... how do we fix these problems

How do we protect the health of the nurse from contact deseases and reduce the spread of nososcomal desesaes these are some questions that should be address also see my blog on ethics and nursing.

I want to see control of healthcare back in the hands of patients. Then patients can confer with their physicians about what is the right course of treatment. Keep insurance companies out of the equation, being respectful of them, of course.  We pay premiums that are negotiated for services; so insurance companies have NO business trying to influence decisions.

I am on the healthcare advisory board for John McCain/Sarah Palin and on their healthcare coalition. If you're for the ticket, I invite  you to join us and share your ideas. We have been banging about policy with physicians  ( a bit boring I might add!), but now nurses will be 'breaking off to form their own  group, to brainstorm ideas amonst themselves. If you're a McCain supporter, e-mail rachel escue at: rachel4vols@yahoo.com or me: anowlin@mac.com  Rachel is the head of the nurses for McCain coalition. If you hurry, there's a call on Monday 7 PM EST

But, even if not for McCain/Palin, I'd urge you to get involved in this political election. Too much is being taken away from nursing to make it safe these days. The  American Red Cross removed it's only nurse from advisory board, with the explanation that if they need nursing advice, they can always ask for it. That shouln't be the case. Nurses should be in advisory capacity with EVERY  major healthcare organization.

Annie

I am a McCain/Palin supporter but am VERY concerned with McCain's plan to provide amnesty to all illegal immigrants.  I work in a clinic that is 100% Medicaid.  I must see 4-5 patients per hour to cover the no call no shows that occur between 25-30% of every day.  Most of the clients are either illegal immigrants or people who are moving here from Puerto Rico.  They don't speak the language, have never been part of the work force and never intend to be.  The high no show rate in my opinion, is because they don't value the services they are getting.  They seem to feel entitled to it.  They state they move here because there are better resources and there is too much poverty in PR. I don't know about that as I have never been there.

I work in the mental health field and the current trend that is being quoted is "mental illness disability is the new welfare."  I see many patients that have true mental illness but just as many who are malingering.

Now, I have no problem with people wanting to live in the states however, I DO strongly object to the waste I see.  Most of the folks are exactly as described below, wearing expensive jewelry (gold chains with huge letters spelling out their names, multiple diamond rings, all members of the family have cell phones with blue tooth-which each professional has a sign on the door requesting they turn off their cell phones during the appointments as we are scheduled so tightly we cannot afford to have them taking personal calls during our 15 minute appointment times- and on occasion, some of the patients get offended!

The patients have free medicaid, free medication, subsidized housing ( one patient told me she pays $49.00 per month for a 4 bedroom apartment and pays no utilities because she is under the income guidelines to have to pay.  She has 6 children with 6 different men and none provide child support to her), most clients also receive food stamps.  They are also all living with spouses/partners who are also collecting social security disability for "mental illness".  Thier children are also collecting SSDI for a diagnosis of ADHD!!  Some women then slide a paper across my desk asking me to certify for the welfare department that they cannot look for work or volunteer 20 hours per week because they are "needed in the home to care for the disabled child" who is in school 6 hours per day.  I refuse of course.  Unfortunately, there are professionals in the clinic that actually provide bogus diagnosis and symptoms so these forms can be filled out and of course, the MD signs them without reading them.

If we want to know where waste in health care dollars go, this is one area that should be looked at. Of course, this is only one nurse's opinion.  How can I forward this to McCain/Palin? any ideas?  Would love to hear anyone else's feedback on this topic.

Unfortunately there is no "simple easy fix" for our health care crisis. The insurance companies are greatly to blame. But we are to blame for giving them carte blanche for so many years.

I work in the ED and feel like we have become the primary care for uninsured peoples. It can be frustrating because it clogs up the ED for the truly emergent folks, but it also insures work for us!

I am not in favor of government run, subsidized health care. You think we have no choice now, just wait till the government has to pay for it! HA!

 I too like the idea of National health care.  Canada has it and you rarely hear of problems in their system .  Physicians don't get greedy and are not rich like those in this country.  Everyone is covered, not like here in the land of money ,where the illegals and the rich appear to be the ones that can get and afford healthcare.  I don't believe that McCain/Palin are the answer either.  My opinion and my opinion only, is that the McCain/Palin ticket will only excaserbate the problem especially if McCain were to grant immunity.

Well, I'm certainly happy my maternal great grandparents arrived in the late 1800's on Ellis Island, otherwise I wouldn't be here with the general attitude towards immigrants displayed here.

AbusyRN2go says ...

 Here is my 2 cents, first we need to close our boarders, the illegal population is crippling our country.  We need to change the anchor baby law. Thousands arrive here to deliver babies for citizenship, this needs to stop now. This would reduce those from coming here.  I have more ideas but want to let others be heard.

I do think there is a problem with the number of illegal immigrants seeking medical care in this country, but I doubt its a huge issue in this country.  You're in CA, so your perspective is probably slightly skewed.  The patients that are not paying for services where I'm at in Missouri have not been illegal immigrants.  Heck, they aren't even immigrants.  They are citizens.  Think about Wisconsin, Vermont, Montana, Iowa, etc... the illegal immigrant population, while present, probably represent a very small portion of the healthcare seekers.  And, if I think about it (though I have no data), I wouldn't be seeking healthcare unless death was approaching if I was an illegal immigrant.

Its easy to scapegoat illegal immigrants, but I try very hard to remain objective, especially unless I have cold hard data.

 I realize that there are pro's and con's about universal healthcare... and I certainly don't know too much about it, but what about something similar to help everyone...being a bedside nurse, I know that the treatment and options are absolutely different when a patient with insurance comes to the hospital, I think the hospital should have certain commodities, but we are giving in to too many commodities and sometimes I think we forget about some things that are more necessary... Some hospital beds reminds me of a five star hotel rather than a place where you go to get better and go home.

I have two points to share on this topic.

1)  I totally agree about the illegals and the "anchor" babies.  Why should a woman be granted citizenship just because she has a kid here in the US?  Our delivery rooms are full of women having babies that WE pay for because they are illegals receiving Medicaid.  I'm disabled and I can't get Medicaid.  Guess I don't speak enough Spanish!

2)  My daughter is an organ procurement specialist (in other words she assists in the harvest of donor organs, transports them to wherever they are needed and assists with the transplant).  She tells me that, occasionally, someone gets "bumped up" on the waiting list for organs because they have multiple health insurance plans.  Not fair but the doctors are the ones responsible for some of it.

Personally I think illegal aliens are the least of our problems.  My idea is to let them in, give them green cards and make them pay taxes. 

I really agree with sherrynurse here. I DON'T like the thought of a national or socialized plan. We only need the government to butt it's head into that which we can't manage ourselves. Keep it out of our healthcare. With government run healthcare, there will be more rationing like there is in Canada and that I can't abide.

I'll use Sherrynurse's husband as an example. He had an MI 12 years ago, and I'm sure that requires periodic angios or stress tests to determine that everything's okay. Well, if the government allows 1 cath per year  and he has a bout with angina after that, something's gotta give. I was speaking to a physician who used to practice in Canada; it was with regularity that she needed to send her patients to the US for care; not necessarily because there's better quality care, but because they can't always GET care in Canada.

Check this out and then tell me you really want a single payer system. I don't rely on YouTube for my news, but this substantiates what I've read:

www.youtube.com/watch

There is no way that I'll go for a single payor system. I really believe that McCain's plan of competition, safe importation of medications and other facets he speaks of on his web-site will drive down prices, making insurance more portable and covering patients with pre-existing conditions.

Annie

 I want to answer "Rustys" questions about emergency rooms and non insured illegal aliens that end up at the hospitals and who pays, the answer You and me, the hospital looses the money when an illegal ends up in the hospital and cannot pay, a patient I know of who is illegal been in a coma several years the hosp has been paying for the hospi has tried to send him back to mexico at its own cost but now family that lives here is trying to sue the hospital to prevent this illegal alien from being shipped to a hospital in mexico. I know of another patient in Texas with similar situation it is NOT just CA, although it is really bad here. The hospt looses money and they turn around and have to raise costs that us folks that DO live here legally have to pay for services, wake up the illegal alliens are crippling our economy at the tune of billions of dollars which was the last article I read on this topic, I will find and post it again for all to read, these ARE hard facts. I do not pretend to have the answers the point here is to stimulate discussion and maybe WE the nursing population with all of our firing brain cells can help find a solution, let us be part of the solution.

 " Nurses are the largest and most respected subculture in health care and we have the power to change. How do we do it? I'm not sure."

We can talk about this topic and other subjects on websites, blogs, and groups. I see the catharsis in comments and feelings on many nursing sites and blogs. This cathartic effect tends to serve as the action many nurses take to essentially get the anger, frustration, disappointent, etc., off their chests by venting.  Then, going back to work and enduring the same old conditions until a new job comes up (new job same BS), or the ability to go part-time, or PRN, or retirement, or the ability to leave the nursing profession altogether.

Until nurses actively support and engage in activities, organizations, individual and collective actions to advocate for nurses and nursing, to advocate for patients, to demand better pay and working conditions, nothing will be changed or accomplished ... other than limitless posts, venting, (some call it whining) and distractions from what really matters ... you, patients and your practice. 

We have to promote a single payer form of health insurance that is an extended form of Medicare. The business/competitive/capitalistic system we have in place is pathetic and inhumane. Particularly, since we are  one of the richest countries in the world. If we can spend 10 billion of our tax dollars on Iraq each month, then we can afford to insure every American. If we can pass a law to bail out people who are being foreclosed on their homes (some McMansions) then we as a humane & humanistic society can provide healthcare insurance to all. The United States has a third-world infant mortality rate. Actually, some parts of the third-world may be doing better!  The weight of the uninsured, the underinsured, and those without are and will become the burdens of our children and their children! 

The arguments against not having a single payer system pale in comparison to people losing their homes, their life savings, becoming homeless and on the streets, and actually dying because insurance companies deny coverage, or will not pay, or the premiums are too high, or they simply will not cover individuals. 

With an extended form of Medicare, the single payer system, everyone would be included with no one left out. Many private insurance companies and some hospitals in adopting a business model of healthcare delivery and services, have commodified disease and thus have made the patient (and the patients families)  proxies in our present healthcare system. As nurses, we are part of this collusion upon patients, the public and each other because the public trusts us. As stated in 'nurses are the most trusted healthcare professionals.'  Yet, this publict trust and integrity is being exploited by hospitals and private insurance companies The public trusts us and right now, I do not know if they really should. We act impotent. We do too much talking and not enough action. 

Nurses need to unionize! Doctors have a union, although they do not use the language/word union. For doctors it is the American Medical Association. The AMA,  among it's many strengths, is it's political clout with lobbying connections  The AMA does in fact serve the holistic interests of it's membership the medical profession. If you think doctors do not negotiate or argue about their pay, healthcare coverage, hours, etc, ... think again.

Every medical student /doctor within and upon exiting medical school is encouraged to join and support the AMA. As a matter of fact, most medical students/doctors consider joining the AMA as a rite of passage within their profession. The same drive and enthusiasm to membership within a professional nursing union should be evident in every nursing school. Yet, name one union that you heard of upon graduation ... or even now? Most nurses are groomed and institutionalized to believe that unions are bad and unprofessional (anytime a nurse hears the term unprofessional, it is usually from management in an attempt to control behavior). Nurses hear much of that propaganda from hospitals and those within hospital administration, nursing management, and other nurses that are institutionalized within the hospital system!

Actors have a union. Actor's Equity, the union serves the holistic interests (pay, health insurance, collective bargaining, etc.) of actors. 

Nurses need a professional collective bargaining, nurse advocacy, ratio mandate/mandating progressive union that is Nurses Only. We should not be aligned with service workers (janitors, custodians, food service, with the SEIU, etc.) as we do not work within those industries. Can you imagine the AMA or Actor's Equity being part of any other union that does not serve their distinct and unique needs?  We require our own professional organization that champions, promotes, negotiates for and educates our membership and the public.

The National Nurses Organizing Committee (NNOC) answers that need and collective call. Please, go to the site. Read and empower yourselves about this union, the single payer system, and how you and others can work to change the system ... not just for you, but for the betterment of  those who will come after you.

The website is http://calnurses.org

Adrienne Zurub

http://adriennezurub.typepad.com