There should be no room for profit in healthcare.
We are taking care of each other. We should make a good living. It should be that simple.

YES. If people had access to healthcare we wouldn’t be overcrowded on a continuous basis. The little old lady with HTN wouldn’t be in crisis because she couldn’t afford to fill all her medicines. If there were alternatives for the patients whose pain clinic, drug treatment center, homeless center etc etc closed for economic reasons- they wouldn’t be adding to our wait times of 6-18 hrs or more. We see the Pts that are to supposed to ‘follow-up with PMD or specialist’ in our ER routinely as there just are few specialists/PMD’s who can afford yet another Medicaid/ Medicare or Insurance-poor patient. Or maybe their PMD just doesn’t have an extra minute for yet another Pt. Frequently they can’t FIND a PMD and many of the same reasons apply
I won’t even touch on the millions of dollars that are spent on the abuse of the system. (And the sense of entitlement some of our most obnoxious and abusive Pts have shown)

Thank you for this chance to speak,
ER RN for decades.
We are still there because we still care.

V.B.
New York

In fact, there is an example of such an approach currently and it is called Medicare. Expanding the role of Medicare to cover the health of all Americans would be a step in the right direction. Of course, the cost of such an expansion of Medicare would be enormous, but would be more than offset by the cost reductions realized through the elimination of inefficiencies in the for profit system. It might be argued that this is anathema to the capitalist objectives of our free market system. The fallacy there is that the healthcare of our people is not and should never become a profit driven commodity. (Besides, a single payer system doesn’t mean there cannot be a separately existing for profit health insurance industry for those willing to pay more for added services). The same holds true for our national defense, where there is a single payer system, the defense department. If we value our nation’s health as we do our nation’s defense, it makes sense that there should be a single payer here as well. Another argument that may be made is that such systems have been tried elsewhere like Canada and the U.K. with mediocre outcomes. It would be the job of any administration to bring together the right team to create a system that works for the majority of the people and that learns from the experiences of others. It would be necessary to provide sound, physician and patient (not trial lawyer) sensitive tort reform as we have seen in states like California and Texas as well as liability reform based on the prevention and acknowledgement of medical errors as has been proposed by both Barack Obama and Hillary Clinton (http://content.nejm.org/cgi/content/full/354/21/2205).

No system will satisfy everyone. The mark of a good system would be to provide basic quality healthcare to the most number of people in an efficient and cost conscious manner.

But that’s off the point of your original comment. I agree with you that Obama does not go far enough toward universal coverage and I absolutely agree that medical insurance needs to be permanantly divorced from the workplace.

However, I think the primary care physician shortage is a symptom, not a problem in it’s own right. Paying internists more would help reduce the shortage. But it would not solve the core problem.

The real problem is our insurance structure, which Obama does not address. (I’m voting for him anyway since McCain’s ideas on the subject are simply ludicrous).

The first and foremost thing that needs to be done, is to eliminate “pre-existing conditions” all together. Everybody, sick or well, deserves to be covered. Denying coverage due to pre-existing conditions is cruel, and it’s morally and ethically wrong, finances aside.

Eliminating pre-existing conditions will force the issue; the rest will follow. The current for-profit insurance structure could not survive without it’s actuarially based business model.

What would then follow is likely a centralized universal insurance plan which will be so much more efficient than paying 25-35% overhead to insurance companies, that it will cover everyone, and maybe even have a little left over to boost primary care.

Anybody in Washington got the guts to do it?

No one wants to go into primary care because it is not a challenging occupation. It is a job for nurses. That’s what PCP’s in Canada (and other nationalized and partly-nationlized systems like the U.S.) are: glorified nurses.You don’t need an IQ of 120 and 10 years of training to take vital signs, evaluate primary complaints, prescribe outpatient solutions and triage complex or sick patients to better-armed sources.

You, sir, are a dinosaur who made bad choices and you resent it — don’t blame the political party platforms for that.

Why are you blaming the government because students don’t WANT to go into primary care? Did you anywhere list WHY they don’t? I’ll tell you:

It’s a dumbed down job that refuses to shed its doctor-glory rep from 30 years ago.

Truth is, now students want to go into other specialties because that’s what smart people like: more complex problems with more complex technology and better pay.

Sorry.

Next patient.

Stop waiting on a politician or political party to save you. Save yourselves.

P.S. The feds can do little about tort reform that affects you (putting aside that it really doesn’t help you anyway). It’s a state law issue.

Thanks

* Paperwork and demands of dealing with the chronically sick are the reasons no one should go into the education field, either. Paperwork is everywhere; I work under the wonderful NCLB, and the paperwork can be crazy at times. I have never found a job, when dealing with human lives, that is without paperwork. And, there are quite a few classrooms equivalent of a ped. psych ward!

Let’s see, in the next decade, our bright kids, will be work at less stress occupations – Starbucks – and our dumb students cannot rise to any expectations – education, nursing or medicine. Our country is in the dumps!

Once health insurance is divorced from employers, only a select few will be able to afford unsubsidized coverage. That means you can cherry-pick from the healthier and younger members of the dwindling upper- and upper-middle classes, who will be the only ones able to afford your services.

You already have the right to deny access to Medicaid and Medicare recipients, which you should do as soon as economically feasible. Not only will you free yourselves from obscenely low reimbursement rates, but from the onerous paperwork and regulations, as well. This will allow you more time for better paying patients, more time with family, and perhaps a vacation here and there.

Also, you’ll no longer need to worry about the dearth of medical students interested in primary care. You see, once McCain’s brilliant plan is in place, there will already be a sufficient number of you for the patients who can afford primary care.

And what of the middle- and lower-class masses? Well, screw them. If they can’t earn enough to afford decent healthcare, they deserve to rot anyway.

Heaven forbid someone should propose or endorse a plan that benefits both doctors and regular citizens. That just wouldn’t be American.

And we definitely need tort reform.