Dec 5, 2005

Test 4 & socialized medicine

I'm taking a break from studying and blogging. Tomorrow I have my last unit test. It's over Complications of Postpartum, Pedi Blood disorders, the High risk Newborn, Pedi skin disorders, Infertility/conception, legalities, ethics, and coordinator of care. The last part "Coordinator of Care" is just a fancy term for a module that covers cost effectiveness and prioritizing.

******Warning, tangent ahead********

Prioritizing is very important but cost effectiveness is like, "Duh!" But I'm not saying it's not important to understand as a nurse that medical care is expensive. You don't have to me a Nurse to know that. I'm actually very blessed myself as a student to be covered under the VA's dependent insurance. It's crappy insurance but it is definitely better then nothing, or so it seems. With my current coverage, I pay 20% of costs. There is no limit to who I see as far as my insurer is concerned, however, I live in a non-military city. I have to travel North to a small town about 20-30 minutes to my family practitioner (FP) who is the only clinician in the Big city and surrounding areas who will bill my insurer. If I need to see a specialist, I have to drive to another small town, 45 minutes North. I could pay for the visits anywhere and file the claim myself but you can imagine how expensive that could get. That's why Ari doesn't see her pediatrician anymore for check-ups and sees our FP instead. I do pay out of pocket on her sick visits just because I think pediatricians would be more likely to recognize and diagnose the childhood ailments. It's also because I like her a lot and she's seen Ari since birth.

I've read a lot of debate over socialized medicine and how it works in other countries. I've heard some good stories and bad stories. The advantages of it being every citizen of the country gets the routine health care, the government pays for it. That, oddly enough, helps keep costs down (Go fig) if you look at Canada's example. So, everyone's covered and costs go down,nevermind the taxes, sounds good right?
In places like Greenland where there is socialized medicine most citizens have other insurance coverage as well. Their premiums are low because well, it's optional to have extra coverage. So if you have the extra coverage and the government's coverage then you are doing really good. The poor however just has the basic old socialized coverage. I wonder how that is viewed in their hospitals on who gets surgery first.

I know there are big issues with that and that can be a major disadvantage. In Canada, you have the right to get that replacement cardiac valve surgery. But in Canada, you do not have the right to be first in line, you may 200th in line and you will have to wait until it's your turn. Also, people with money who can pay for their surgeries (ie. Americans) in Canada, can jump in that same line. Why would they go there? Because medical care is cheaper.
I think where we went most wrong in America is when health care became political. Realistically,Congressmen are not going to budget large portions of the govt. money to take care of the 4% of their voters who are poor and underinsured. It's just not going to happen.
The fact is the US may not have a National health insurance but we do have Medicare and Medicaid. Also it is illegal for any hospital or doctor to not treat you in an emergency. If it's not an emergency there are ways for the poor to pay for preventive medicine as well.

Let me use a family member of mine as an example. She has multiple reproductive tract problems. It was discovered after having a baby on Medicaid when they did a Pap test that she had Cervical dysplasia. Cervical dysplasia often leads, if untreated, to cervical cancer and spread to adjoining reproductive organs. Unfortunately, once the baby was born Medicaid no longer covers unless you are really poor and she had no means to pay for the laser procedure to cure the cervical dysplasia. Yet, she still had it done after a couple of months and it was covered by the city. This same relative has been treated for non-emergencies in hospitals and by clinics for years and has never paid more then handful of change for it. Her Quality of health care is actually probably better then mine. Because I'm limited to where I go and I'm covered up to only 80% versus hers (nothing) she can go to any facility and they will find a way to pay for her health care.

On the other hand I have a story I heard from a lady at Ari's gymnastics about a woman who was covered by her insurance at work and was in a car accident. She was at a private hospital here and was in the ICU for weeks. From there she was sent to the acute care unit where she was slowly recovering after a head trauma. Suddenly her insurance coverage was called into question (paperwork error) and hours after administrators notified her of that, her doctor was writing up her discharge despite the fact that she didn't feel right, had a fever, and urine smelled very foul. She died a few days later at home from sepsis caused by a urinary tract infection. (which she probably got from a catheter in the hospital)
Had she not been in a private hospital and in our city's charity hospital she probably would have been all right.

On my unit, at any given time, about 1/4th to 1/3rd of the patients are homeless. I work at the city/county facility and it doesn't matter if you can pay or not. I have to be a first hand witness to the fact that these homeless patients are getting the best we have to offer. They are in rooms right next door to insured patients and they get the same care.

My point is, we don't really need socialized medicine, we need reform. We need it to be illegal for HMO's to put a cap on the coverage on a child with leukemia. We need to make sure that the middle class citizen is not driven into the poorhouse if they get diagnosed with cancer. Our government just needs to create safeguards to cover those holes where people aren't be covered and aren't receiving care. Citizens do need to take responsibility for their health care and use the clinics around the country that use sliding scale and free services if they need them, instead of going to the ER for a sinus infection. My very own MD runs a "rapid care" weekend and night clinic out of her office with flat fees for earaches and strep throats. I know there's always a way.

Some will probably disagree with me on some of this but it's all just my own very humble opinion.....back to studying.

1 Comments:

At 20:39, Anonymous Blue Cross of California said...

Great blog I hope we can work to build a better health care system as we are in a major crisis and health insurance is a major aspect to many.

 

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