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ADVANCE Perspective: Nurses

Universal Healthcare Back on the Table

Published December 21, 2007 8:26 PM by Rich Krisher

One of my pet peeves is people referring to universal healthcare coverage as "free," as if it's oxygen in the atmosphere. Someone's always paying for it. It has happened on a few occasions in our magazine. The first time was several years ago in an article about a delegation of nurses who visited Cuba to learn about that country's "free" healthcare system. Perhaps I was the only one who saw irony in that reference.

Another irony is how we spend more on healthcare than any other nation, yet don't enjoy the best outcomes across the board. Costs are spiraling, and it's estimated we'll be spending 20 percent of the gross domestic product on healthcare by 2016, up from about 15 percent today.

We can't stay on this path. Is taxpayer-funded universal healthcare the answer to curb runaway spending? After a long absence from mainstream political discussion, it's back on the table. While anathema among Republican presidential candidates, universal health plans have been proposed by some Democratic contenders.

In the Jan. 1, 2008, issue of Annals of Internal Medicine, the American College of Physicians publishes a position paper  that urges universal healthcare insurance coverage so "all residents have equitable access to appropriate health care without unreasonable financial barriers." The recommendation is based on a study of the healthcare systems in 12 industrialized nations. The group offers pros and cons of a single-payer system, where the government pays all costs, versus a pluralistic system that combines the government and private entities.

I'm leery of putting my healthcare in the hands of politicians, and also skeptical of government's ability to find huge administrative efficiencies and reduce costs, so I'm closer to accepting a pluralistic model if it comes to that. However, rather than covering all healthcare costs for everyone, which inevitably leads to rationing, it makes more sense to create a program that universally covers catastrophic and chronic conditions. Those are the cases universal healthcare advocates often cite when they make their case, and those situations could be addressed without nationalizing healthcare.

While the universal healthcare debate continues, we should explore policy options advanced in "Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending" a report issued Dec. 18 by the Commonwealth Fund Commission on a High Performance Health System. Key among them is the creation of a national public-private center for medical effectiveness and healthcare decision-making, which would evaluate the cost-effectiveness of new treatments and technology. Other recommendations include promoting information technology, reducing tobacco use and obesity, establishing hospital pay-for-performance programs, and paying doctors and hospitals per episode of care instead of for each service. Total savings are estimated at $1.5 trillion over 10 years if all recommendations are enacted.

You're on the front lines of healthcare and are in the best position to know what's wrong and where we should go from here. Whatever your views, make sure they're heard by those seeking your vote.



Regarding the issue of Universal Healthcare, I would like to respond to this comment from Gillian who says she has lived and worked in both the UK and the US....Gillian says "I cannot say which system is the best I think they both come with many problems. Maybe its time for someone to sit down and think of something better for all, take all the good points from both systems and blend them so that everyone gets the best possible health care.  I am not sure I would like to volunteer for that job though."  The idea of a blended system has merit.

Gillian, I concurred with you on this hesitancy to volunteer... until I became familiar with the campaign to Create an Office of the National Nurse... (visit This grassroots movement by working nurses is excellent, with a goal to shift to prevention.  They propose national leadership to guide our US nurse workforce of nearly 3 million to take initiative, demand action and volunteer to help us focus on prevention.   Dollars saved through prevention could be directed to developing a blended system with service for all.

While I do see need for a healthcare system that provides a basic level of care for everyone in America (American or not) I like being able to go to a fancy expensive highly qualified specialist if I want to.  Look at our system of public education (everyone gets to go through high school paid for by taxes - then if you want to go on you will likely be paying  something of your own, and can select the level you want to spend on public or private colleges or trade schools...) Private providers (ie, private colleges, trade schools) still exist and compete for "customers"... so profit is still an option.  But everyone gets a basic education provided.  Society pays for it, and society benefits from it.  

If we had basic levels of care available to everyone, we would likely be able to prevent many costly situations that progress today due to lack of basic care.  Liken it to the airline industry... everyone on board the plane is going to arrive at the destination... but folks in first class who want to pay more, can have a more embellished experience.  

The US currently spends more on healthcare than any of the western countries with nationalized healthcare.  Yet we rank miserably compared to them in health outcomes.  Selectively we have excellent providers for those that can afford them... but we have many who have no access to providers...Is this what we want?  Nurses are trusted by the public... I think if more nurses would become spokespersons for healthcare reform we may be able to create an ideal "blended" system.  To start, we can work hard to get the Chief Nurse of the US Public Health Service designated as a symbolic National Nurse.  That position can begin a cultural shift to prevention in our society, and will serve as a role model and impetus to recruitment to combat the nursing shortage.  Nurses can unite across our individual specialized practice areas... we can all agree prevention is key to reducing healthcare costs.  We can get involved with MRCs in our communities to promote prevention. Then with cost savings due to prevention, we can design a system that provides basic care to all.  We can all be involved in voluteer efforts to bring change... now is the time... "change" is being politically driven...Join the National Nurse movement... get on board.  Susan Sullivan PHN

Susan, Public Health - Staff Developer, County Health Dept January 21, 2008 5:43 PM
Santa Ana CA

Being born and raised in the UK, a country with "free healthcare" it interests me to see some of the differences people expect and think that having a "free system" will make.

Most of my family still live there including my elderly parents who have the benefit now of never having to worry about a medical bill or prescription charge ever again. During their working years they payed healthcare taxes which covered their healthcare costs, almost similar amounts to what I pay for healthcare insurance now.

When people are not working for whatever reasons then the goverment covered the costs. Sounds a little like medicare and medicaid to me.

The difference I have seen the most being an RN in both countries is that private insurance gives me a choice. I discussed with my surgeon a suitable time for me to have my gallbladder out. In England it would be at the time of an available bed, not giving either my Surgeon or myself options.

My Father has some pretty significant health issues and in the USA would be given the option as to wether he would like to risk his life for vascular bypass surgery, where in the UK the decision was taken out of his hands and made by his "medical team" who daily decide the care appropriate for chronically ill or elderly patients with minimal imput from the patient or family.

On the positive side for "universal free healthcare" though is that Physicians in the UK are paid more for the amount of preventative care they give their patients. If every patient gets the needed annual tests related to their age and risk factors, and all the pediatric patients get their immunizations and well baby checks then the practise can earn a significant amount of goverment money.

The other benefit I see is that after working in Emergency Nursing for over 20 years, 7 of them being in the UK, I never encounted a patient in the UK who ever asked me about the cost to be seen. I never spoke to a parent who worried about paying for tylenol or an antibiotic for a sick child. I will never see my parents having to decide if this month they fill prescriptions or pay for heat in their house.

I cannot say which system is the best I think they both come with many problems. Maybe its time for someone to sit down and think of something better for all, take all the good points from both systems and blend them so that everyone gets the best possible health care.  I am not sure I would like to volunteer for that job though.      

Gillian , Emergency Room - Clinical Nurse Supervisor, Baystate Medical Center January 2, 2008 8:36 PM
Springfield MA

Your suggestion to fund only catastrophic and chronic illnesses is not going to fit the needs of the many.  In Florida the fastest growing job area is in the service industry.  These are low paying (usually $10 or less per hour), often do not offer health insurance or if offered, it is so expensive that it is not at option.

These are the uninsured in Florida, the working poor.  Their health needs are not met because routine health care is so expensive.  So they are not preventing HTN, heart disease, diabetes or any of the other myriad ailments that can be prevented or lessened with routine care.  They don't go to a doctor for illnesses, they go to the ER because that is the only place that will see them without up front cash.  Then they don't fill scripts because of the cost.  As a result, short term treatable problems later become chronic or acute.  I know of many working poor who whould be more than willing and able to pay a small premium monthly to obtain routine care,  and trust me, they would much prefer not to sit in some ER for 12 hours just to get antibiotics for a simple UTI, strep or just Some effective cough syrup for the flu. Neither of my adult children currently have health insurance, nor do their children.  (They both earn too much to qualify for medicaid for the children, but not enough to qualify for the Healthy Kids program here in florida.)  One is a painter, the other an administrative assistant.  These are not minimum wage jobs, but what would once have been middle class jobs.  Now, with the cost of living, they are considered borderline poverty level.  The only solution is a government funded healthcare system, does not even need to be entirely "free" to receive service but it must be affordable to ALL.

I often wonder if any of our legislators would survive long if they only made ten bucks an hour.  Maybe they should have to for at least 6 month before than can even run for office.  Oh well, thats a story for another day..(Oh, by the way, I at 59 years of age, do not currently have health insurance, I could not afford it this year-I really have to do something about my unreasonable need to eat and have a roof over my head).............:)

Helen, OR - RN, HOSPITAL December 30, 2007 2:10 PM

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