Fix our health system: Be like Switzerland

Fix our health system: Be like Switzerland

I was working in the ER this weekend when one of my nurses asked me a simple question: “How would you fix the health care system?” Obviously, this is a complex problem requiring complex solutions, but in an environment where at any minute a heart attack or a stroke could disrupt a conversation I prepared a sound bite for an answer.

“Do you want the short answer? Or the long one?” I replied. With a smile, she requested the short one. “Be like Switzerland.”

This simple answer, similar to an Anecdote posted here back in May, emphasized some of the features of the Swiss healthcare system that I like. The Swiss base their system on the private delivery of insurance, with privately practicing physicians, with the distinction that basic insurance products must be sold on a not-for-profit basis. This not-for-profit national ethic is something that seems inherently un-American but aligns itself with the goals of health care; I for one think this is a necessary step to achieve universal health care in the United States.

The Swiss system also codifies something which every other European system embodies and the United States appears to abhor, social solidarity. A term I learned from one of my professors in public health school, social solidarity is sorely lacking in America. The Swiss, and the Affordable Care Act (Obamacare), get it right – every individual needs insurance but also shares the responsibility to obtain it. The individual mandate is the keystone buttressing the Swiss system (and Obamacare) from collapse. It ensures for the Swiss a universal risk pool. “Everybody in, nobody out,” a mantra from socially liberal health advocates, can be accomplished with an adequately designed and incentivized individual mandate. What we need in America, at least at the state level, is a universal risk pool.

We already have agreed to supply life-saving health care to our entire society through EMTALA. No matter who you are, no matter how much money you have, if you have a life-threatening condition, every hospital in this country* is required to assess you and stabilize your condition. Where we fail as a nation, is that there is no guarantee of care after that. So we wait until that person’s health starts to spiral out of control again requiring another hospitalization.

Why not ensure that all Americans can actually get the care their need when they need it, not just when they are deathly ill?

With EMTALA, even though that individual does not necessarily pay for that care they receive, our current society finds hidden ways to cross subsidize the costs: taxpayers cover the elderly, disabled, and the poor with Medicaid and Medicare; insured people pay more to cover the uninsured (at a cost of $1,017 per family); and health care providers write off the rest as charity care. The uninsured pay for only about 37 percent of the care they consume out-of-pocket.

Why not have a more rational system? Why not allow the people that know how to administer health insurance and manage provider networks best  (insurance companies) do so? Why not allow government (with its infinitely better mechanisms for collecting and redistributing money) to handle the financing? Why not place the responsibility on the patient to pick a plan that works best for him or her? Why have Medicaid when clinicians can easily distinguish and discriminate between it and private insurance, when low-income Americans could have assistance to purchase “mainstream” health insurance instead? As the Swiss currently do, subsidies would be provided based on income, to ensure affordability.

I think we need to fully embrace two opposing philosophies, the Affordable Care Act’s insurance exchanges and the private (not-for-profit) insurance sector, to heal our broken health care system. We need to consolidate all these different state and federal health programs and streamline them into one financing system while allowing patients to choose their actual insurer. And we must have every one covered with monetary contributions from everyone who can afford it.

That’s how I would start with fixing the health care system.

Cedric Dark is Founder and Executive Editor of Policy Prescriptions.

Image credit: Shutterstock.com

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  • http://twitter.com/kathbee Kathleen Blanchard

    Oh, but people would just complain about surrendering their money to help others. Sad, but I think it’s true.

  • ninguem

    Switzerland has a system of mandated purchase of private insurance, in a tightly regulated insurance system. They have high deductibles.

    But be careful what you wish for, you might get it. Swiss out-of-pocket expenditure for healthcare is actually higher than the USA. It hits the poor most heavily, and they have quite a bit of deferred healthcare because of cost, same as here.

    All that being said, it deserves a look.

    Sort of like HSA’s for the whole country, which would be fine with me.

  • Eric Anderson

    It seems to me that trying to get universal coverage through an insurance-based system is too cumbersome. Insurance is a business relationship. With insurance (health insurance or any other kind) you pay for the coverage you get. Pay little, get little, etc. Couple the business relationship nature of insurance with the intricacies of different state regulations and you have a dizzingly complex situation.

    Better IMO, if universal coverage is really wanted, is to dispense with the concept of health insurance and have total coverage administered by each state. People pay for it through state taxes.

    Sure, it will be expensive. Sure, some will pay more than others. And, sure, some will abuse their bodies and then expect everyone else to pay for the repairs. But, modifying an insurance-based system is unlikely to work.

  • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

    Agree with much of what you say. As someone has has studied world wide health coverage, lived in Europe for three years, and has provided medical care in both a patient cost free (military) and civilian cost environment, I to have grown to appreciate others.

    In general I like the Swiss and the German systems (although the German ones cover way to much for “base” insurance). What would be best for the USA?

    1. A public run insurance for the elderly (66 and above) and young (18 and under)
    2. A private run insurance market for everyone else with a mandate that all must participate
    3. A base level of coverage in that private insurance market to be run at a NOT FOR PROFIT level with a reasonable deductible (outpatient primary care?)
    4. Options or “tiers” of additional coverage that could be added by the individual or their employer
    5. CLEAR AND EXACT PRICING for all features in the base level coverage (within a region). One can’t comparison shop when even the same providers sell a product to customers at different prices based on their insurance

    Also, coming from a cost containment style medicine in the military I see the inherit value of paying primary care providers on a salary with bonus for productivity basis rather than just fee for service. I would much rather get paid a salary to see 16 patients a day and a bonus for seeing more than be paid according to what part of a physical exam I document in my note. I’m a doctor not a novelist. I should get paid for seeing patients not for what I document about seeing them.

  • Skip Stein

    You know all this is much smoke and mirrors and NO ONE is addressing the REAL problem with ‘healthcare’! It is DISEASE and it’s dramatic increase in recent decades! Most are social ‘diseases’ brought on by the individual’s lifestyle and nutrition (or lack of it). Most diabetes 2, heart disease, cancer and many other ailments are simply due to LACK of proper Nutrition! Fast food, junk food, over-processed ‘food’ and so many other ‘convenient food’ are just lousy when it comes to nutritional content!

    Everyone slathering on sunscreen blocks the vital vitamin D from being created in your body; THAT causes many illnesses, like seasonal flu and what not. Eating processed foods eliminates many/most of the natural nutrients found in Whole Foods so while the stomach is full, there is no nutrition so the body demands more ‘food’ and the crap people eat just further continue to impact (negatively) the health and well being of the advertising driven people who eat this crap.

    Change the lifestyle/nutritional approach an the healthcare problem will fix itself. THEN we can focus on true diseases impacting many. There is enough food to feed our planet BUT it needs to be distributed and not horded. Control by major agribusinesses (Monsanto) and other who control seed patents of GMO plants (and now ‘animals’) restrict the availability of farmers to safe seeds and cross-contamination spreads the patented GMO variety over neighboring fields.. it goes on and on…

    Change the lifestyle of the population and eliminate the need for massive healthcare expense then everyone can benefit and we can focus on those individuals who truly need assistance!

    The problem? NO Profit in Wellness, only in Disease! Follow the money trail (in government and these multinational global corporations) and those who seek CONTROL over Freedom

  • Randy Eccles

    There is no room for those who wish to self insure. Not to mention are not the Blue Cross Blue Shields non-profit. Maybe they vary from state to state and region to region but in this area they are non-profit and some of the most expensive. Sort of like the YMCA, also non-profit but also the most expensive health clubs around. Competition has always brought down pricing and forcing everyone into a one size fits all never works for long. There also always seems to be a LACK of conversation for such insurance plans called Major Medical or Catastrophic. Fairly inexpensive, covers the big things and leaves regular doctor visits to the individual. Simply put most Americans can afford a 120 dr visit once or twice a year. Especially since the average car payment is over 400 bucks per month. Socialized medicine is not the answer.

    • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

      The only requirement to being “non profit” for most insurance companies is that you have a net zero line at the end of the year. Very easily solved by paying your top 50 or so employees multiple millions a year. True not-for-profits link their executive pay to their business ratios.

    • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

      Oh, and ” Competition has always brought down pricing” is simply not true. In fact competition in the medical industry HAS NEVER been shown to bring down pricing. Why? 1) because its a need not a want, more importantly it is often an unplanned need 2) Their is almost no transparency or fairness in pricing. 3) Pricing is largely dictated by the insurers rather than by the providers of services or products.

  • http://www.facebook.com/david.reimer.31 David Reimer

    Insurance is a business … a “risk-reward” business at that. I think running a parallel style to auto insurance for health insurance makes the most sense. Wait … and think about it …

    Mandate that everyone must have proof of insurance, establish the minimum insurance acceptable, “normalize” tiers across carriers for what is and is NOT covered, and allow competition to take over. My auto and home insurance is not the least expensive nor is it the most comprehensive, but I stick with my agent because he is very proactive and service oriented. Under the current and future models, I just can’t see that type of relationship ever happening.

    Keeping with the parallels with auto insurance … I don’t think “basic service” should be covered at all … wellness, check-ups, tune-ups, alignments … same thing. Fees for these services need to be reasonable but paid out of pocket. Health insurance is more complicated, obviously, and more moving parts (LOL) but if you combine auto insurance, the basic warrant, extended warranty … it is really kind of the same.

    It comes down to this … How much do you want to pay up-front so you don’t have to pay much or anything if/when something happens? That’s how health insurance should be … basic benefit is catastrophic (old 80/20 concept) and each benefit level thereafter should be scalable … maybe even based upon family history, advanced diagnostics, regional influences / rates of disease, etc.but that can be a slippery slope as well.

    Ultimately, each person needs to have a level of responsibility for their own health and wellness … eating right, exercising, right choices socially, etc. … and maybe should be rewarded over time. Again, like the auto industry does for “safe drivers” … health insurance providers could do something for “well patients”. Reward my early decisions with reduced deductibles, minimized out of pocket costs, etc. later in life when things naturally deteriorate and break down … makes a LOT of sense since the benefit up until then has been to the profit of the insurance company through reduced payouts due to reduced utilization. Imagine what back-end benefits could be covered if insurance companies didn’t pay out $35 per office visit for runny noses, headaches, check-ups, etc. that should be ours to cover as simply being responsible for ourselves. Now imagine what the savings would be if the hospitals didn’t have to write off visits like these from the ED being used as a “free clinic” … but that’s another discussion for a later time, I’m sure.

    Just my idea … seems to have some basis in common sense, which we direly need in this debate.

    • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

      Some very good concepts

    • dhames

      I do agree that insurance competition is a good thing. I do not agree with required insurance. When I lived in RI [several years past] insurance was not mandatory [it is now] Why? is it because people are less reliable? or insurance companies want more money? Just exactly what is the difference between now and when insurance was an option. I do genealogy and have read of events back in the 1700s-so don’t say that in our modern day we get into more trouble or have more natural disasters, or whatever because it just is not so.

  • http://www.facebook.com/glen.sullivan.509 Glen Sullivan

    I think Skip’s message says everything we all should free with the direction our healthcare system is going. Once everything in the Affordability Care Act is in place and there is no money to sustain it people like Skip will be yelling from the tree tops that the goverment must do something to control these costs. He mentions exactly what may happen, the socialization of all of our food. The goverment will begin to control what can be sold to us the consumer all in the name of better health. Where will it end. I free that some day we will look back to the days before this Act and wonder was it really all that bad.
    As far as Switerland and Germany for that matter thier polpulation size if a small fraction of the US. It is not always as simple as saying just do the same thing. Also, keep in mind that all the citizens in those countries pay extermely high taxes to cover these benefits. How many of you will be ok with the goverment siezing 80% of your income to cover the cost of healthcare.

    • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

      The top tax rate in Germany is 45% at greater than 300K Euro or about $425,000. They also pay a 19% VAT. In the us its 36% at $388,000, and most pay sales tax of about 7-8%. Definitely more, but no where near 80%.

      Also in Germany they exclude “basic living expenses” from taxation. Which amounts to about $12,000 a person. You also deduct about $10,000 per child for the first couple kids. All life & health insurance is fully deductible, as is a portion of mortgage interest and property tax. Property tax is IMMENSELY LOWER in Germany than in the states.

      So an average family of four wouldn’t pay taxes on their first $45,000, then would pay taxes as a higher rate (but not a lot higher) than in the US and still have most of the same deductions as in the US while paying lower property taxes but about twice the sales tax.

      What does that mean?

      The majority of Americans wouldn’t pay much if any higher in overall taxes in Germany.

      Use evidence next time.

  • http://www.facebook.com/Standingstonez Sean Roberts

    While it is a cute short answer it is directly tied to other factors – That Ocare ignores. The Swiss unemployment rate since 1995 has averaged 3.2% and is currently 2.5. The Swiss measure true unemployment, we only measure who is on unemployment. 80% of the population works. The work is hi-tech and educational levels are higher on the whole. The EU system is failing, except Germany which is different. SO we need a solution but far more involved than the Swiss. Also O-care is being shoved at us and was approved with most of the Congress missing… Can we say taxation without representation. Needs work!

    • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

      The senate and the house were in session. One senator and two representatives didnt’ cast votes…. How was congress missing?

  • http://www.facebook.com/phillip.swaim Phillip C Swaim

    You almost had me until you said this “Why not allow government (with its infinitely better mechanisms for
    collecting and redistributing money) to handle the financing?”

    • http://www.facebook.com/phillip.swaim Phillip C Swaim

      Because when you said that, I realized this article must have been written in a style similar to the Onion because I almost laughed myself out of my chair.

  • Michael Zitar

    Did he really just write “Why not allow government (with its infinitely better mechanisms for collecting and redistributing money) to handle the financing?”
    Apparently he thinks we have a budget surplus problem.

    • http://www.facebook.com/people/Daniel-P-Henderson/1242211373 Daniel P Henderson

      The government having better mechanisms for collecting and redistributing money has absolutely nothing to do with its budget issue. The federal government is very good at collecting and redistributing money in the same way that Walmart is very good at moving products around using its very sophisticated supply chain system. Walmart’s revenue stream is totally disconnected from its supply chain system, and the government’s budget imbalance is totally disconnected from its money redistribution system.

      There are great efficiencies to be gained by using a central financial clearing house instead of the current system involving thousands of payees and hundreds of standards for how payments are to be processed. Your comment embodies the real problem that we have in this nation, and it’s the problem that keeps our health care inefficient and expensive–the refusal to accept that our government can be more efficient just because it is not run perfectly. As an MBA, I challenge you to find me any Fortune 500 company that is both efficient and managed perfectly. And even if you could, if our government and a public company both provided the same service in the same way, the for-profit company would have to charge more.

      When we start talking about government in a reasonable way, we will start making progress toward real efficiencies in health care.

  • JK Seattle

    All the US has to do is cut it’s military budget in half once and use
    the other half to pay for the health costs of every one of it’s
    citizens. That pretty much equates to $1 Billion for each citizen that
    can only be used for medical payments. Not all of it will be used so
    there will be plenty leftover. And when it hits a certain low number
    then a federal 3-5%health tax kicks in on all goods and services.
    Simple, easy. And afterall, advancing military tech doesn’t need the
    half it will be missing. The US will do fine with its more advance
    weaponry.

  • http://twitter.com/TCOYWellness Lucy

    Wellness is NOT FOR PROFIT and gravely overlooked. Lifestyle behavior is the culprit. Easy to do, easy not to do…personally I have pursued it all my life because I didn’t want to be sidelined or deal with health issues. Most of it it centers around three things: 1) the food we eat 2) sedentary lifestyles and 3) mindset…”oh this won’t matter much”…habits get created this way.

    HEALTH INSURANCE does NOT give you HEALTH.

    Sadly the pharmaceuticals and food industry have marketed to us so much that we think it’s someone else’s problem to fix. It’s not genetics, that’s less than 9% of diseases.

    Where we spend our time and money shows our priorities. Maybe it’s time to re-think those priorities…for the health of it.

    • Dorothygreen

      Health insurance is a necessity whether it comes in the form of premiums to a non for-profit company or to state or federal government in the form of taxes and everyone needs to have it from cradle to grave. That is the way it is in every advanced country except the US. That is what the ACA is attempting to accomplish. Variations of insurance models are always on table. Universal coverage should never be. Even developing countries know this is a necessity to assure folks don’t go bankrupt, are left out in the cold, die needlessly or simply do not have access to medical care.

      After studying many different models of universal health insurance (through reading), I believe as the author does that Switzerland is the best for the US. Of course it does not give you health – who says this?

      A poor diet is now the major RISK factor for the PREVENTABLE DISEASES that result in huge health care costs. Lack of activity certainly in a RISK FACTor. This is a public health issue and the US will not be able to reduce health care costs without reforming our eating culture. See previous remark.

      It is not that wellness is “gravely” overlooked it, there is a ground swell of efforts all around the country. It is is that there are so many speed bumps and out right obstacles including the Corp money you speak of that it will be a harder battle than it was to get tobacco smoking from 60% to about 20% and hence the ultimate deaths and disablity from this addictive habit to a single digit number.

  • Dorothygreen

    Good post. Additional points.

    For-profit insurance for basic care is outlawed in Switzerland. There is a standardized rate. Swiss insurance companies (there are about 1000 but not cross canton) CAN be for-profit for supplemental insurance – private hospital rooms, choice of physicians, alternative care, brand name drugs etc. This makes for the competition. Supplemental costs are per service. For a private room the cost is about $100/per person/month.

    The government sets the base rules; keeps the insurance companies from cheating the customers, the docs and hospitals from cheating the insurance companies and customers, mandates insurance and subsidies the poor. They are not involved in the administration.

    The difficulties in the US getting to this system are:

    No mandate for non-profit basic care. Insurance companies have the power to raise premiums when THEY see fit and within their allotted 15% administration costs can pay CEOs what they choose.

    No standardization in our budding health information.

    Failure to see we could have an insurance system for health care with government oversight but only administration of Medicare and VA.

    The biggest difference between Switzerland and the US is our eating culture. For example, Switzerland’s smoking rate is just a few % points above ours but our obesity rate is 4X theirs. A country’s obesity rate is the
    best indicator of RISK for chronic preventable diseases. Obesity and poor nutrition caused by the pervasiveness of cheap, highly palatable products with layers of processed sugars, fats and added sodium. Chronic
    preventable diseases eat up about 2/3 of our health care dollars. They are the big business, the profit in health care. It is not the kids with leukemia, the periodic million dollar cancer or heart transplant. CPD are the drivers of unnecessary diagnosis and treatment, fraud, over crowded ERs, extra expensive drugs and surgeries. Waste alone has a $750 B price tag (IOM).

    Addiction is part of the human condition. Prohibition doesn’t work but much can be done to curb the use of addictive substances. The US did it with
    tobacco smoking when we had higher rates than any other country. Corporations who advertize the latest and greatest “addictive” cereal with a name like “Krave” or an ad for potato chips “bet you can’t eat just one” etc is like saying “I double dog dare anyone to mess with us. It’s shameful. Opponents to a “soda tax” (which is too little) use AGMs – attention getting mechanisms – such as sin, junk, fat tax or Nanny state labels. It’s time to think outside the box and develop a new tax- call it RISK (not income tax- maybe like an excise tax) on potentiallyh addictive legal substances. So Congress won’t consider a consumption tax and Mr. Norquist has the GOP locked into his “no new INCOME taxes pledge” RISK could be applied to not only processed sugar, fats and salt but marijuana, tobacco, alcohol – all to be put into a health fund, not the general fund. Congress could sign a pledge for this for the health of the NATION. Think of the revenue at $.003 per gram sugar and fat and 100 mg sodium. At least $100 Billion a year – public education, to help subsidize the Food Revolution so sorely needed to sustain our economy. And jobs for farmers! Real farmers! Real Food!

    Happy New Year.

  • http://www.facebook.com/profile.php?id=100001096736059 Valery Yalouskikh

    Just some facts: In developed countries, excluding America, doctors with no speciality earn about twice the income of the average worker. America’s specialist doctors earn ten times America’s average wage. American Health care system is ranked #37 in the world. 45 thousand people die every year in the U.S. because of a lack of health insurance.

    • Sneaky Booger

      Perhaps the socioeconomic policy can explain some of that. What other country asks, “Send me your tired, your weak, your weary”?
      Have you tried to immigrate to Switzerland lately?
      America truly is a melting pot. Switzerland not so much?

  • Nexusfast123

    Generally the notion a of ‘social contract’ is not championed by the media and any notion of a ‘collective’ approach to health in any form is demonised by lobby groups.

    The point about health is that for an individual is it hard to deal with serious health challenges. It is somewhat patronising and amazingly selfish to tell people to ‘suck it up’ and look after themselves. In countries with ‘universal’ health care systems bankruptcy, for instance, is not heard of as an outcome of an illness whereas in the US, I believe, it is one of the most common factors that contributes to small business failure.

    I grew up and have lived in 4 countries with national health systems. The points I would note are. A national or public approach to insurance minimises cost as monies are not pointlessly syphoned off in terms of ‘profit’ (this is effectively a ‘private tax’ and cost to society that can be avoided). It is impossible to have a ‘free market’ (whatever that means). No market operates in accordance to the simplistic notions of supply and demand optimisation and other ‘structures’ are required to facilitate health care. All markets are regulated and controlled to some degree. A seminal paper written in 1963 entitled ‘Uncertainty and the Welfare Economics of Medical Care’, by Kenneth.J.Arrow pointed to the inability of a ‘free market’ solution for health to operate effectively.

    A national approach to health delivery means national strategies to health standards, care and prevention can be applied. In the US you get the impression that the system wants more people to be ill as it generates more insurance ‘opportunities’. Other factors are that a national system of payment for treatments is administratively more efficient and nationally delivered drug procurement strategies can drive down drug costs across society as a whole.

    I will never be a fan of the ‘I’m alright screw you’ view of society. I have no interest in the preposterous notion of liberty and the idea that an individual can do what they like, are always sufficiently informed so they can make ‘optimal’ decisions and all this has no impact on others. The extreme outcome of this is anarchy but generally the outcome is one that is detrimental to society as a whole in terms of costs that everyone carries.

    Nothing will change in the US as the lobby groups will continue to influence health policy in their favour no matter the underlying public sentiment. There are also too many brain washed people that are selfish and think any form public service provision are ‘stealing’ their incomes.

    Personally I am happy to live in a ‘commie’, ‘socialised’, ‘marxist’ country that has universal health provision. When I worked in Boston these where some of the terms that some people used to describe health in Australia where I currently live.

    • ninguem

      Nothing wrong with what the Australians do, they have a system of public facilities, and they have private facilities for those dissatisfied with the public system.
      It would be fine with me if we create something similar in the USA. It’s two-tiered, what you do is make sure the bottom tier is something you’d feel comfortable to receive yourself.
      When public systems are contemplated in the USA, there is a knee-jerk revulsion to two-tiered systems, when in fact they are inevitable.

  • ninguem

    My posts aren’t going through for some reason. I’ll strip off the links.

    The Swiss control cost by significant cost-sharing. Out-of-pocket spending for healthcare in Switzerland is actually higher than the USA.

    As a result, a significant number of Swiss are reported to forego healthcare services for financial reasons. In particular, the Swiss poor. About 3% of the upper income group forgoes healthcare, and up to 30% of the lower-income groups report they forego healthcare services because of cost.

    Physicians for a National Health Plan has an article in opposition to the Swiss system as a model for the USA.

    Now all that being said, I am not necessarily opposed to consideration of a Swiss model for the USA. Just be careful what you wish for. One thing speaking strongly in its favor is the last article linked.

    If PNHP opposes it, they must be doing something right.

    I’ll put the links in the next post.

  • ninguem

    Sorry for the multiple posts…………

  • ninguem

    “Cherry-picked” means “I don’t agree”.
    You wanted data, I gave you data.
    You don’t like it, that’s your problem.

  • Shannon Poling

    That is the dumbest thing I’ve ever heard! In Switzerland, you could wait up to a year to be seen for something as critical as a broken arm!
    Doctors won’t want to be doctors if they can’t make money doing it.
    Check your facts!

  • LatterlifeMidwife

    The title caught my interest but this opening line lost it: “I was working in the ER this weekend when one of my nurses asked me a simple question.” your nurses, huh? Could have sworn she was a health care professional who worked for the hospital. Nevermind, I’ll just keep enjoying working for, and benefiting from, my NHS. And hoping my friends and family in the USA will one day have an even better NHS than I have!

    • http://twitter.com/Chernie Chernie

      Couldn’t agree more. Nurses are not property. Unfortunately this attitude seems SOOO prevalent in the healthcare system. The system could be improved a lot if input from bedside, direct care nurses were listened to. (example: National Nurses United).

  • Roger

    Why not have people take responsibility for their own health,? Much of the diseases that are merely managed are completely preventable. Something is seriously being overlooked with regard to healthcare. We do not have a healthcare problem, we have a people problem. Get them off their fat buns and have them exercise. Take away the Cheetos, Twinkies and beer and cigarettes first, Have them exercise and lose weight.Then you may see an improvement, and be able to use resources in a more reasonable manner.

  • Roger

    And, oh yeah- we need to take the name of a certain president out of the description of healthcare in this new era in America. The name “obamacare” is rather offensive.

  • Ileene Sheeley

    Really the comment that rapstars take limos to get food stamps is so racist. Shame on you

  • 7citizen7

    Trouble with Obamacare, way too many people are exempted!! All of Congress, the WH, muslims, just to name a few!!!

  • 7citizen7

    Under this system, who pays for the “insurance” for the illegals? They will not.

    • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

      Actually they do, but only in emergent or ER settings (just like the US). They don’t get preventive care or routine care coverage. Incidentally it is the legal Americans and the under-insured Americans that cost the system much more than the smaller number or illegals (not that they aren’t a drain on the system finances however)

      • 7citizen7

        Beau—just how many business offices in hospitals have you worked in??? Having been in the hospital accounting/business offices off and on from 1961 until 2007, I know what I am talking about. The illegals go to the county hospitals for free clinics and/or emergency rooms. Their bills are “written off”. In other words, they are charity cases because they cannot pay. Therefore, the bill is presented to the county, state and federal government and is paid for by your taxes and mine. Under Obamacare, it will be the same. They will not have the money to pay so they will be exempt!!! Learn your facts before you start telling others that do know them.

  • Jakob Gunge

    I agree with Neene the rapper comment is questionable but as an image for what is wrong in the moral fabric of society I get your point. Every once in a while delegations travel from France to study the Scandinavian model and come back and say: “We need to do like that too.” Except there are really only few Scandinavians in France, so it will not work.

    The succesful systems of the world in social responsibility, health care, education, pensions, maternity leave and any other kind of mutualisation of risk and reward are succesful when very few people abuse it and greed doesn’t take over. Be it providers of insurance or care who overcharge, or patients who junk-food themselves to oblivion and expect doctors to provide an easy fix to match their lack of education or sense of responsibility.

  • dhames

    I usually enjoy your writings but I have to disagree with this one. I do not relish supporting others when I can barely support myself-and it is getting worse as more commodities [such as electric and car ins.] take more to cover those who do not pay.
    I do agree to let the states make their own health plans-rather than federal-and as long as those plans will be good in all states. And I do agree to be able to choose your own provider.
    Never would I say that the federal government is good at redistributing what it collects-that entity is very poor in accountability and financial skill.
    I do think it is unconstitutional to ‘require’ health insurance, although it may possibly be ‘responsible’. My insurance would be at least 2400 a yr plus the standard 700 that all workers must pay in taxes; plus deductions that have to be paid before insurance pays;
    but my medical bills amount to about 400 a year. So where is the fairness in that? I would rather save, as I have always been doing, and pay cash, as the deductible requires anyway.