Tag Archives: Health care

Flu or Ebola?

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The following blog is written by a emergency room doctor who is comparing today’s Ebola epidemic to the Flu epidemic of 1918. It does make sense that since flu season is upon us that we are more than likely to get the flu than Ebola. Flu is contact and airborne, so that quick trip to Walmart could be the time that someone sneezed into their hands and then grabbed hold of that shopping cart. Disgusting isn’t it.

https://shirley-mclain.net/2013/01/12/are-you-sharing/ This link takes you to a previous blog I did a year or so ago on the flu called “Are You Shring”. Take a look at it. It might just save you a lot of misery. Shirley

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I’ve been walking the earth for a half a century, so I’m sure I’ve picked up a bit along the way. I know the Gettysburg Address by heart. I can recite all the presidents. I can taste the difference between Diet Coke and Diet Pepsi, and I’m fairly certain I can tell you the starting lineup from the 1976 Cincinnati Reds. But if you ask me if I’m worried about Ebola, if our hospital is ready or if our nurses and staff are up to the challenge, chances are you will probably hear me say this:

“Hell if I know.”

I have been practicing emergency medicine for more than 20 years and I’ve seen close to 100,000 patients. I’ve written a few books, published some papers, lectured a bunch of times, pissed off about 10,000 soccer moms when I wrote an article telling them their kids weren’t playing the pros. I once even testified in front of a congressional sub-committee on hospital disaster preparedness. I’m still beating myself for at least not stealing a pen, but it was part of my duty as the physician director of mass casualty preparedness for our emergency department.

So you would think if anyone in the emergency department trenches would be versed as to how this Ebola scare will unfold, if it will spread, what to expect, how to diagnose, screen, protect and treat, then I suppose it would be me.

If an investigator for Joint Commissions or some other oversight agency, a member of the press or a committee trying to ensure CDC compliance were to pull me aside to spot check my Ebola acumen, they’d be satisfied with my answers and I’d leave them feeling like they had done due diligence as an administrator.

“Dr. Profeta, do we have enough protective stuff and does everyone know how to use it?”
“Yup.”
“Are the screening plans in place?”
“Yeah, ya betcha.”
“Is the staff versed in transmission and spread of Ebola?”
“Darn tooten.”
“Has everyone read all the CDC and hospital communiqués regarding Ebola?”
“Sure have.”
“Have you practiced the drills in the ER in case we have someone show up with a possible exposure?”
“More times than Lois Lerner has hit her hard drive with a hammer.”

But if they were to ask me if there are any other issues they should be aware of, I’ll just stare with round blank eyes and keep my mouth shut until the right question is asked; the question they will pretend does not exist.

“Dr. Profeta, will they – the staff, you, your partners – show up? “
“That, I don’t know.”

Some years ago when I first started in practice, a very large hospital in our area was having trouble getting patients rapidly admitted from the ER to the floors. This resulted in a tremendous backlog of patients and extreme ER overcrowding. This naturally increased patient wait times and directly impacted the health of those coming to the ER. So, naturally, the hospital system formed a committee and hired consultants. They looked at every single variable: time to laboratory, time to X-ray, nursing changeover, bed request time and on and on and on. Do you know what they found? The roadblock in the movement of patients through this major medical system was housekeeping. Think about that. Housekeepers, traditionally the lowest paid and least-skilled division of employment of the hospital, were responsible for the movement and throughput of patients more than any other factor.

If the rooms on the floor were not cleaned fast enough, then no patients could move from the ER to the floor, and no patients from the waiting room to the ER. ER wait times rose and patient care suffered. Housekeepers handcuffed the entire system, and not because they were lazy. The regulations, protocols and procedures put into place to clean a room are so extensive that rapid room turnover was next to impossible with the current staffing model. That stuck with me. What is the rate-limiting step in a mass casualty scenario or massive patient influx that would handcuff us? Where will all the preparedness collapse? What is the leaking O-ring? What am I afraid will fail?

As I alluded to a bit earlier, I appeared before members of Congress who were investigating Midwest medical centers and regional hospital preparedness for a mass casualty event. The focus was on our readiness should a major earthquake hit the Midwest. The congressmen wanted to know if we had the capacity to mobilize our staff; they asked what assistance we needed. Toward the end of the discussion, they asked each of us what we were most afraid of. The responses were typical answers you would give to a member of Congress if you were seeking money (not having enough resources, not enough congressional or governmental support, not having enough staff or equipment or infrastructure, etc.)

When they got to me, asking what I worried about, I simply said: “The flu.”

Now, flash forward. I wonder if what I really meant to say was “Ebola.”
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When it comes to our ER and our ability to provide the best care during the worst extremes, I have no doubt we can mobilize our hospital to care for hundreds and hundreds of seriously injured patients. We have modeled our Emergency Department response to a mass-casualty incident in much the way Israeli hospitals have structured their programs. (As a side note, Israel is light years ahead of us in terms of all mass casualty – chemical, biological, environmental, mad-made – preparedness.) Specifically, we model our plan after Western Galilee hospital on the border of Israel and Lebanon. This is a large, major, modern-day medical center under constant threat from Hezbollah rockets from Lebanon. They train and drill with a level of involvement, passion and commitment that exceeds anything we can muster.

The staff at my hospital in Indianapolis, however, has bought into it and I truly believe that there is no ER in Indiana, and few in the Midwest, that have a better plan in place. We also gained a better understanding of the type of injuries we would see in each scenario. More specifically, we wanted to know from a pure number standpoint how many patients would have to go to the operating room the minute they hit the door, how many would need to be on ventilators and how many would need emergent life-saving intervention. Fortunately, and not so fortunately, the proliferation of research in this area has provided plenty of hard data well documented in the literature. Ultimately, all things being equal, the data seems to indicate a suicide type bomb loaded with ball bearings or other projectiles placed in a crowded area will result in the largest number of patients requiring immediate, emergent and life-saving intervention. While a disaster like a major earthquake will result in far more fatalities, far less people will require absolute immediate operative or life-saving intervention. All we really need to know is, what type of event, how many patients, and it’s pretty easy to calculate what to expect from an acuity standpoint. In the ER, it isn’t the total number of patients that concerns us, it’s the number we get that will die if not treated in minutes or a few hours. The rest we have no problem letting wait.

Ultimately, though, what I am getting at is that the trauma from a major incident like an earthquake or terrorist attack is very predictable. All you really need to know is the type of event and the numbers and you almost immediately have a pretty good idea of what to expect.

But a real bad flu?

There is no way you can prepare for it. The goal should be to protect your hospital from it.

We have seen influenza pandemics before, the most notable being the Spanish flu of 1918. Researchers estimate between 20 and 100 million peopled died from this strain of flu. What was even more concerning was the number of deaths that occurred in previously healthy people. Each year in the United States, about 30,000-40,000 deaths and 200,0000 hospitalizations can be attributed in part to influenza. Most deaths are in the elderly with pre-existing serious health problems. The Spanish flu of 1918 was different. It killed the healthy, able bodied. It unleashed an incredible degree of viral savagery with an infection rate of nearly 50 percent. It was a biological holocaust.
Field Hospital
Doctors and nurses treat flu patients lying on cots and in outdoor tents at a hospital camp during the influenza epidemic of 1918. (Photo: Hulton Archive/Getty Images)

Thus my biggest fear has always been a strain of flu that is highly contagious with a high mortality rate. The Spanish-flu mortality rate of 1918 was 2 to 5 percent. Ebola has a 20 to 90 percent mortality rate, but it fortunately is not quite as contagious as Influenza. However, I still keep going back to flu and envisioning an epidemic of the Spanish type that will quickly fill all our inpatient beds, every ICU bed, every ventilator, every outpatient bed, every cot, gurney and chair in the ER and in all the waiting rooms. I’m afraid that a flu virus this aggressive will bring five dying flu victims to our ER each day and dozens more with a real possibility of dying.

This would occur on top of a department that is always operating at capacity and drowning in documentation and electronic medical record bureaucracy. After 30 days in our ER, nearly 150 people will have died, providers will be physically and mentally spent and morale will be at below-despair levels. Multiply it by 20 or so other hospitals in the area and now we are talking about 3,000 members of our community dead in only a single month. The obituary pages of the local paper will be thicker than the advertising section the day after Thanksgiving. Expand that number statewide and nationwide and the numbers become so immense they aren’t even real.

Now imagine a realistic scenario in which the flu vaccine only provides immunity to 50 percent of the recipients. That means that half of our ER staff who are seeing all these patients will have little protection, outside of gowns, masks, and gloves, against a virus that is spread primarily though coughing, sneezing and saliva. Simply put, some of us in the trenches in damn near every ER in America will almost certainly die. It could be me, it could be any one of my partners, colleagues and co-workers and it could be one of our children or a spouse who gets infected when one of us comes home thinking the headache and fatigue they are feeling is simply exhaustion from the workload of the day. Can you picture it?

Now imagine that huge numbers of hospital staff – from doctors to housekeepers, from food services to registration, from security and parking to transportation will decide not show up. They will call in sick or simply just say: “No, I’m not coming to work today.” In just a few days, human waste, debris, soiled linens, the sick, the dying and the bodies will pile up. We will be overwhelmed and unable to offer much in the way of assistance because the labor-intensive protocols that allow us to safely care for even one patient are just too exhausting. These procedures are barely repeatable more than once or twice of day, and fraught with so many steps and potential for mistake that it becomes too physically and emotionally taxing for the staff to do … so they simply wont show up.

And I am not sure I will, either.

I love emergency medicine. I love helping people and saving lives and I think I’m pretty good at it, but I am also a person and I have a wife and three children that I love and want to see grow up. I also am keenly aware that not a damn thing I do will have any real impact on the survivability of a patient with either the Spanish flu or Ebola. Fluids, rest and prayer is about all there is to offer. There is an old adage that says a hospital is no place for a sick person. I think whoever first said that had Spanish flu and Ebola in mind.

So we drill and we prepare and we post placards and do screening but no one is asking why in the hell are they coming to us in the first place? Fluids and rest can be provided anywhere: an empty warehouse or a huge tent in the middle of farmland. Why would we not just take the care to them in the form of special traveling Ebola-mobiles that triage and treat the patients at home? Why can we deliver the mail, pickup the garbage and recyclables at damn near every house in America, but we can’t pull up a retrofitted UPS van, drop off a mid-level provider in a hazmat gown, let them do an assessment, draw some blood, drop off cans of rehydrating formula to their doors, clean linen, biohazard bags, gowns and gloves for family members, slap a warning sticker on the front door, tell them you will stop by tomorrow and move on to some other location? I know I sound crass, perhaps like I don’t really have sympathy for these very ill patients. This could not be further from the truth. I’m just kind of angry. I know there is a better way than risking the infrastructure of a medical center for the sake of a few patients that will either do OK at home with simple supportive care or die no matter what care I provide. We’ve had years to prepare for this, we’ve hung all our hopes on a vaccine and not nearly enough thought on containment should a vaccine fail.

Today’s Ebola is tomorrow’s Spanish flu. We’ve had nearly a hundred years to get ready and the best we can come up with is plastic suits, double gloves, respirators, and masks. The battleground of this problem can’t be in the hospital. It is unwinnable in our emergency rooms.

I think I might just call in sick.

Dr. Louis M. Profeta is an emergency physician practicing in Indianapolis. He is the author of the critically acclaimed book, The Patient in Room Nine Says He’s God.

Heathcare Entitlement: Yes or No

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Is Every American Entitled to Healthcare?

That is a question that has caused a great deal of striff in this country from the poorest to the richest person. There is right and wrong to both side so this argument and no matter who wins it they will be a price to pay. As a practicing RN for 32 years I saw the good and the bad in the healthcare system. My personal thoughts are that our system is broken and has been for many years. I also believe that everyone should have basic healthcare especially the old and young. No matter what my feelings I want to present both sides in this blog so you can make up your own mind.

47.9 million people in the United States (15.4% of the US population) did not have health insurance in 2012 according to the US Census Bureau. The United States and Mexico are the only countries of the 34 members of the Organization for Economic Co-operation and Development (OECD) that do not have universal health care.

Proponents of the right to health care say that no one in the richest nation on earth should go without health care. They argue that a right to health care would stop medical bankruptcies, improve public health, reduce overall health care spending, help small businesses, and that health care should be an essential government service.

Opponents argue that a right to health care amounts to socialism and that it should be an individual’s responsibility, not the government’s role, to secure health care. They say that government provision of health care would decrease the quality and availability of health care, and would lead to larger government debt and deficits.

Did You Know?

27 million previously uninsured people will gain coverage under Obamacare according to a 2013 White House estimate.

obabmacare4The United States and Mexico are the only countries of the 34 members of the Organization for Economic Co-operation and Development (OECD) that do not have universal health care.

The United States spent $8,508 per person on health care in 2011, over 2.5 times the average spent by member countries of the OECD ($3,322 per person).

The US five-year survival rate for all cancers is 64.6%, over 10% higher than the five-year cancer survival rate in Europe (51.6%),[26] and a 2009 study found that the United States had better cancer screening rates than 10 European countries including France, Germany, Sweden, and Switzerland.

In 2014, the Commonwealth Fund ranked the United States last in overall health care behind (in order) United Kingdom, Switzerland, Sweden, Australia, Germany, Netherlands, New Zealand, Norway, France, and Canada.
Argument For and Against Obama Care

Pro Arguments

Obamacare2The founding documents of the United States provide support for a right to health care. The Declaration of Independence states that all men have “unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness,” which necessarily entails having the health care needed to preserve life and pursue happiness. The purpose of the US Constitution, as stated in the Preamble, is to “promote the general welfare” of the people. According to former Congressman Dennis Kucinich (D-OH), as part of efforts to “promote the general welfare,” health care “is a legitimate function of government.”

Instituting a right to health care could lower the cost of health care in the United States. According to a 2013 study, under a single-payer system, in which all citizens are guaranteed a right to health care, total public and private health care spending could be lowered by $592 billion in 2014 and up to $1.8 trillion over the next decade due to lowered administrative and prescription drug costs. According to the American Medical Association, on average, private health insurance plans spend 11.7% of premiums on administrative costs vs. 6.3% spent by public health programs. According to a study in the American Journal of Public Health, Canada, a country that provides a universal right to health care, spends half as much per capita on health care as the United States. In 2010 the United Kingdom, another country with a right to health care, managed to provide health care to all citizens while spending just 41.5% of what the United States did per capita.

A right to health care could save lives. According to a 2009 study from Harvard researchers, “lack of health insurance is associated with as many as 44,789 deaths per year,” which translates into a 40% increased risk of death among the uninsured. Another study found that more than 13,000 deaths occur each year just in the 55-64 year old age group due to lack of health insurance coverage. In addition, a 2011 Commonwealth Fund study found that due to a lack of timely and effective health care, the United States ranked at the bottom of a list of 16 rich nations in terms of preventable mortality. In Italy, Spain, France, Australia, Israel, and Norway, all countries with a right to health care, people live two to three years longer than people in the United States.

The right to health care is an internationally recognized human right. On Dec. 10, 1948 the United States and 47 other nations signed the United Nations Universal Declaration of Human Rights. The document stated that “everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family, including… medical care.” In 2005 the United States and the other member states of the World Health Organization signed World Health Assembly resolution 58.33, which stated that everyone should have access to health care services and should not suffer financial hardship when obtaining these services. According to a 2008 peer-reviewed study in the Lancet, “[r]ight-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.” The United States and Mexico are the only countries of the 34 members of the Organization for Economic Co-operation and Development (OECD) that do not have universal health care. As of 2013 over half of the world’s countries had a right to health care in their national constitutions.

A right to health care could make medical services affordable for everyone. According to a 2012 study from Consumer Reports, paying for health care is the top financial problem for US households. According to a peer-reviewed study in Health Affairs, between 2003 and 2013, the cost of family health insurance premiums has increased 80% in the United States. According to the Kaiser Family Foundation, 26% of Americans report that they or a family member had trouble paying for medical bills in 2012, and 58% reported that they delayed or did not seek medical care due to cost. According to one estimate of a proposed bill to implement a single-payer health care system in the United States (HR 676), 95% of US households would save money [51] and every individual in the United States would receive guaranteed access to publically financed medical care.

Providing all citizens the right to health care is good for economic productivity. When people have access to health care, they live healthier lives and miss work less, allowing them to contribute more to the economy. A Mar. 2012 study by researchers at the Universities of Colorado and Pennsylvania showed that workers with health insurance miss an average of 4.7 fewer work days than employees without health insurance. [55] According to an Institute of Medicine report, the US economy loses $65-$130 billion annually as a result of diminished worker productivity, due to poor health and premature deaths, among the uninsured. In a Jan. 14, 2014 speech, World Bank President Jim Yong Kim stated that all nations should provide a right to health care “to help foster economic growth.”

A right to health care could improve public health. According to a 2012 study in the Lancet that looked at data from over 100 countries, “evidence suggests that broader health coverage generally leads to better access to necessary care and improved population health, particularly for poor people.” In the United States, people are 33% less likely to have a regular doctor, 25% more likely to have unmet health needs, and over 50% more likely to not obtain needed medicines compared to their Canadian counterparts who have a universal right to healthcare. According to a 2008 peer-reviewed study in the Annals of Internal Medicine, there were 11.4 million uninsured working-age Americans with chronic conditions such as heart disease and diabetes, and their lack of insurance was associated with less access to care, early disability, and even death.

Because the United States is a very wealthy country, it should provide health care for all its citizens. Many European countries with a universal right to health care, such as Germany, France, the United Kingdom, and Italy, have a lower Gross Domestic Product (GDP) per capita than the United States, yet they provide a right to health care for all their citizens. As of 2012, 47.9 million people (15.4% of the US population) did not have health insurance and, according to a June 2013 study, even with the Obamacare reforms as many as 31 million people will still be uninsured in 2016. The United States spent $8,508 per person on health care in 2011, over 2.5 times the average spent by member countries of the OECD ($3,322 per person). With that level of spending, the United States should be able to provide a right to healthcare to everyone.

Providing a right to health care could benefit private businesses. If the United States implemented a universal right to health care, businesses would no longer have to pay for employee health insurance policies. As of 2011, 59.5% of Americans were receiving health insurance through their employer. According to the Council on Foreign Relations, some economists believe the high costs of employee health insurance place US companies at a “competitive disadvantage in the international marketplace.” According to the Business Coalition for Single-Payer Healthcare, a right to healthcare under a single-payer-system could reduce employer labor costs by 10-12%.

A right to health care could encourage entrepreneurship. Many people are afraid to start their own businesses for fear of losing the health insurance provided at their existing jobs. The Kauffman-RAND Institute for Entrepreneurship Public Policy estimated that a 33% increase in new US businesses may result from the increased access to health insurance through the Obamacare health insurance exchanges. A 2001 study found that providing universal health care in the United States could increase self-employment by 2 to 3.5 percent.

A right to health care could stop medical bankruptcies. About 62% of all US bankruptcies were related to medical expenses in 2007, and 78% of these bankruptcies were filed by people who already had medical insurance. In 2010, there were 30 million Americans who were contacted by a collection agency about a medical bill. If all US citizens were provided health care under a single-payer system medical bankruptcy would no longer exist, because the government, not private citizens, would pay all medical bills.

A right to health care is a necessary foundation of a just society. The United States already provides free public education, public law enforcement, public road maintenance, and other public services to its citizens to promote a just society that is fair to everyone. Health care should be added to this list. Late US Senator Ted Kennedy (D-MA) wrote that providing a right to health care “goes to the heart of my belief in a just society.” According to Norman Daniels, PhD, Professor of Ethics and Population Health at Harvard University, “healthcare preserves for people the ability to participate in the political, social, and economic life of society. It sustains them as fully participating citizens.”

Con Arguments

The founding documents of the United States do not provide support for a right to health care. Nowhere in the Declaration of Independence does it say there is a right to health care. The purpose of the US Constitution, as stated in the Preamble, is to “promote the general welfare,” not to provide it. The Bill of Rights lists a number of personal freedoms that the government cannot infringe upon, not material goods or services that the government must provide. According to former Congressman Ron Paul (R-TX), “you have a right to your life and you have a right to your liberty and you have a right to keep what you earn in a free country… You do not have the right to services or things.”

A right to health care could increase the US debt and deficit. Spending on Medicare, Medicaid, and the Children’s Health Insurance Program, all government programs that provide a right to health care for certain segments of the population, totaled less than 10% of the federal budget in 1985, but by 2012 these programs took up 21% of the federal budget. According to US House Budget Committee Chairman Paul Ryan (R-WI), government health care programs are “driving the explosive growth in our spending and our debt.” Studies have concluded that the expansion of insurance coverage under Obamacare will increase the federal deficit by $340-$700 billion in the first 10 years, [and could increase the deficit to $1.5 trillion in the second 10 years. Even with these expenditures, the Congressional Budget Office (CBO) estimates Obamacare will leave 30 million people without health insurance. If everyone in the US were covered under a universal right to health care, the increase in the federal deficit could be even larger than under Obamacare.

A right to health care could increase the wait time for medical services. Medicaid is an example of a federally funded single-payer health care system that provides a right to health care for low-income people. According to a 2012 Government Accountability Office (GAO) report, 9.4% of Medicaid beneficiaries had trouble obtaining necessary care due to long wait times, versus 4.2% of people with private health insurance. Countries with a universal right to health care have longer wait times than in the United States. In 2013 the average wait time to see a specialist in Canada was 8.6 weeks, versus 18.5 days in the United States in 2014. In the United States, fewer than 10% of patients wait more than two months to see a specialist versus 41% in Canada, 34% in Norway, 31% in Sweden, and 28% in France – all countries that have some form of a universal right to health care.

Implementing a right to health care could lead the United States towards socialism. Socialism, by definition, entails government control of the distribution of goods and services. Under a single-payer system where everyone has a right to health care, and all health care bills are paid by the government, the government can control the distribution of health care services. According to Ronald Reagan, “one of the traditional methods of imposing statism or socialism on a people has been by way of medicine,” and once socialized medicine is instituted, “behind it will come other federal programs that will invade every area of freedom.” In Aug. 2013, when Senate Majority Leader Harry Reid (D-NV) was asked if Obamacare is a step towards a single-payer universal health care system, he answered “absolutely, yes.” The free market should determine the availability and cost of health care services, not the federal government.

Providing a right to health care could raise taxes. In European countries with a universal right to health care, the cost of coverage is paid through higher taxes. In the United Kingdom and other European countries, payroll taxes average 37% – much higher than the 15.3% payroll taxes paid by the average US worker. According to Paul R. Gregory, PhD, a Research Fellow at the Hoover Institution, financing a universal right to health care in the United States would cause payroll taxes to double.

Providing a right to health care could create a doctor shortage. The Association of American Medical Colleges predicts a shortfall of 63,000 doctors by 2015 due to the influx of new patients under Obamacare. If a right to health care were guaranteed to all, this shortage could be much worse. In the United Kingdom, which has a right to health care, a 2002 study by the British National Health Service found that it was “critically short of doctors and nurses.” As of 2013 the United Kingdom had 2.71 practicing doctors for every 1,000 people – the second lowest level of the 27 European nations.

A right to health care could lead to government rationing of medical services. Countries with universal health care, including Australia, Canada, New Zealand, and the United Kingdom, all ration health care using methods such as controlled distribution, budgeting, price setting, and service restrictions. In the United Kingdom, the National Health Service (NHS) rations health care using a cost-benefit analysis. For example, in 2008 any drug that provided an extra six months of “good-quality” life for £10,000 ($15,150) or less was automatically approved, while one that costs more might not be. In order to expand health coverage to more Americans, Obamacare created an Independent Payment Advisory Board (IPAB) to make cost-benefit analyses to keep Medicare spending from growing too fast. According to Sally Pipes, President of the Pacific Research Institute, the IPAB “is essentially charged with rationing care.” According to a 2009 Wall Street Journal editorial, “once health care is nationalized, or mostly nationalized, medical rationing is inevitable.”

A right to health care could lower the quality and availability of disease screening and treatment. In countries with a universal right to health care certain disease treatment outcomes are worse than the United States. The US 5-year survival rate for all cancers is 64.6%, compared to 51.6% in Europe. The United States also has a higher 5-year survival rate than Canada. Studies have found that US cancer screening rates are higher than those in Canada and 10 European countries with universal health care including France, Germany, Sweden and Switzerland. The United States is estimated to have the highest prostate and breast cancer survival rates in the world. The United States also has high survival rates after a stroke, with an age-adjusted 30-day fatality rate of 3 per 100, lower than the OECD average of 5.2 per 100. In addition, the 30-day survival rate after a heart attack is higher in the United States than the OECD average.

A right to health care could lower doctors’ earnings. The Medicare system in the United States is a single-payer system where government pays for health care bills, and between 1998 and 2009 it reduced physician payments in three different years. In 2009, Medicare payments to health care providers were almost 20% below those paid out by private insurance. In Britain and Canada, where there is a universal right to health care, physicians have incomes 30% lower than US doctors. According to a 2011 study, in comparison to US specialists, the average specialist in Canada earned 30% less, and the average specialist in the United Kingdom earned 50% less. Any lowering of doctor payments in the United States could reduce the number of young people entering the medical profession, leading to a doctor shortage.

A right to health care could cause people to overuse health care resources. When people are provided with universal health care and are not directly responsible for the costs of medical services, they may utilize more health resources than necessary, a phenomenon known as “moral hazard.” According to the Brookings Institution, just before Medicaid went into effect in 1964, people living below the poverty line saw physicians 20% less often than those who were not in poverty. But by 1975, people living in poverty who were placed on Medicaid saw physicians 18% more often than people who were not on Medicaid. A Jan. 2014 study published in Science found that of 10,000 uninsured Portland, Oregon residents who gained access to Medicaid, 40% made more visits to emergency rooms, even though they, like all US residents, already had guaranteed access to emergency treatment under federal law. Since Medicaid provides a right to health care for low-income individuals, expanding this right to the full US population could worsen the problem of overusing health care resources.

The majority of Americans do not believe there should be a right to health care. According to a 2013 Gallup poll, 56% of Americans do not believe that it is the “responsibility of the federal government to make sure all Americans have health care coverage.” In 2012, Gallup found that 54% of Americans opposed the idea of federally-financed universal health coverage.

People should pay for their own health care, not have it given to them by the government. Under a single-payer system, the right to health care is paid for through taxes, and people who work hard and pay those taxes are forced to subsidize health care for those who are not employed. In the United States, people already have a right to purchase health care, but they should never have a right to receive health care free of charge. Health care is a service that should be paid for, not a right.

How to Blow Your Top

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How to Blow Your Top

  Today I’m a nurse and want to do a little teaching.  What did you think when you read my title? Did you think about getting so mad you wanted to blow up?  Well today we are going to chat about when you actually blow your top because you have ignored your blood pressure.

We all have a blood pressure. If we didn’t we wouldn’t be walking around.  If any of you have ever had low blood pressure you know it sometimes makes you feel as if your legs weigh 500 pounds apiece and you can barely drag along. When your blood pressure is high in the first stages, it also makes you barely drag around.  Your head can feel light as if it’s not on your body, or you could have a non-ending headache.  Sometimes they are really bad but most of the time they’re aggravation  to you. I venture to guess that a majority of time these little things are ignored until bigger problems begin.  This seems to happen more with men than woman since they don’t like going to the doctor’s office.

I know a young man now that is in his mid 20′s, smokes, and his blood pressure is consistently above 140 systolic (top number) and 100 for the diastolic (low number).  He has been told many times what is happening to his body but he chooses to ignore it since he doesn’t feel any different. The sad thing is I know this handsome young man is a walking time bomb.

For you who may not know about what the blood pressure actually is, I will explain it the best I can.  The top number of the blood pressure is the Systolic pressure.  What it represents is the amount of pressure that is put against the vessels when the heart pumps it out.  The Diastolic pressure is the amount of pressure that remains in the vessels when the heart is resting  between beats.

Because his pressures are high all the time his vessels throughout his body, but especially in the brain, are under constant pressure which stretches and thins them.  At some point in the future without the hand of God touching him he will rupture a vessel.  All it will take is a pressure higher than normal and he will literally blow his top.  It can happen anywhere in the brain. I’m sure all of you have seen people who have had strokes.  There are those that are so severe that they can no longer walk or speak and most of the time end up with a g-tube into the stomach for feeding. There are others who are paralyzed on one side or blind. All depending where the vessel ruptured. It’s not a pretty picture, but it happens to far to many of us, both male and female.

I know everyone has heard that salt is one of the biggest contributors to hypertension, and so is smoking. Having constant stress in your life is another big factor.  Then there are those that it doesn’t matter what they do and how good their lifestyle is their blood pressure is out of site.  Even children are having problems with their blood pressure and that has to do with the food we are feeding them.

I for one  do not want to be one of those people who have a stroke.  I have all the risk factors, I’m overweight, I eat too much processed food, and the list could go on forever.  Do yourself a favor and go to webmd.com or any other medical program on the web and read about the symptoms of hypertension and how you can control it. Have your blood pressure checked often and if it is above 140 for the top number and higher than 85 for the bottom number, talk to your doctor. It could save you and your family a lot of sorrow.

Let’s talk Obama Care

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Barack Obama at the University of Nevada, Las ...

Image via Wikipedia

This blog is a combination of a couple I posted back in March when the Supreme court was making their decision. I thought it was timely to repost it. I have edited a couple of things.

As a retired RN who has worked in many areas of health care I have seen and experienced our broken health care system.  I have seen and experienced waiting in an emergency room for hours because it is being used like a clinic because lower-income people can’t afford medical care for themselves or their children.

I feel we are being held hostage by the insurance companies who can dictate what our doctors can and can’t do.  Since they have to control their costs and make money, people are denied treatments that can save their life.  I feel every citizen in this country is entitled to medical care and I think the changes that will and have been started by Obama Care is a  good thing.  Why is it wrong for people to help buy insurance in a government-run program?  The citizens of this country have been paying for all of the care given to the poor to start with.  I feel in the long run this can save us money.  I can’t see a problem with them getting supplemented insurance at all. Obama Care will also help decrease the Medicare fraud that is perpetuated by the system in place now.  Wouldn’t that save us a vast amount of money?

I for one applaud the president for taking the initiative to change our health care system.  It is something that should’ve been done long ago.  Politics in this country tries to portray this plan as bad or good.  As I said, it is a new start.  I am not afraid of a new beginning with health care but I know many people are.

I am attaching a Bill Moyer’s video talking about medical lobbyist in Washington. It explains why so much propaganda is spread about anything affecting medicine or drugs.

http://youtu.be/GsIcS7egnyw

I have stated before on this blog that I think the healthcare program is a good thing for the people of this country.  With the insurance company‘s running the doctors and hospitals a lot of people are not getting the care they should be getting. We are already paying out the wazoo for the uninsured to receive care  with the high costs of medical care and deaths that could have been prevented.  If the mandatory insurance makes people get insurance who would otherwise just think they can use the ER as an Emergency Room with no thought to how they are tying up the system or the cost to all of us.  I think it is a good thing to make everyone responsible for something that might help reshape our medical and insurance system. It is something everyone uses at one time or another.

I do not think only the rich should be entitled to medical procedures which can save and improve lives.  As an RN I am not in favor of prolonging life just because it can be.  A life needs quality, not just quantity. I think this will give a good start to equal access.

I know how I want this election to go, but I also know it’s in God’s hands.  As an American and a Christian I will live with the final outcome. Either way it will be tough on all of us.

That’s my two-cents once again on healthcare.  Let me know what you think and why you feel the way you do. I look forward to hearing from you.  A healthy discussion is always good.

Per Request, a Re-posting

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United States Supreme Court building in Washin...

United States Supreme Court building in Washington D.C., USA. Front facade. (Photo credit: Wikipedia)

I was asked to re-post my first blog concerning Obama Care and the status of our healthcare system in this country. Today I’m re-posting from January of this year.  Please stop by and leave your comments.  We need to get more dialogs going about this issue. If you are a Christian, as I am, lets pray that the right answer comes from the Supreme Court for this country and all the people, not just a few.   Blessings to all.

Let’s Talk Obama Care

As a retired RN who has worked in many areas of health care I have seen and experienced our broken health care system.  I have seen and experienced waiting in an emergency roomfor hours because it is being used like a clinic because lower-income people can’t afford medical care for themselves or their children.

I feel we are being held hostage by the insurance companieswho can dictate what our doctors can and can’t do.  Since they have to control their costs and make money, people are denied treatments that can save their life.  I feel every citizen in this country is entitled to medical care and I think the changes that will and have been started by Obama Careis a  good thing.  Why is it wrong for people to help buy insurance in a government-run program?  The citizens of this country have been paying for all of the care given to the poor to start with.  I feel in the long run this can save us money.  I can’t see a problem with them getting supplemented insurance at all. Obama Care will also help decrease the Medicare fraud that is perpetuated by the system in place now.  Wouldn’t that save us a vast amount of money?

I for one applaud the president for taking the initiative to change our health care system.  It is something that should’ve been done long ago.  Politics in this country tries to portray this plan as bad or good.  As I said, it is a new start.  I am not afraid of a new beginning with health care but I know many people are.

I am attaching a Bill Moyer’s video talking about medical lobbyist in Washington. It explains why so much propaganda is spread about anything affecting medicine or drugs.

http://youtu.be/GsIcS7egnyw

It’s My Opinion on Obama Care, Again.

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Barack Obama at the University of Nevada, Las ...

Barack Obama at the University of Nevada, Las Vegas Presidential Health Care Forum, March 2007. (Photo credit: Wikipedia)

Today I am writing the blog giving my opinion about the politics around what the Supreme Court is going to be deciding in June. Obama care as it has come to be called is now before the biggest court in the land and has the task of determining if the Healthcare mandate is constitutional.

Even in the highest court in the land politics continues to overpower.  You hear what the Republicans want their five appointed judges to do and how much the program is in trouble. As an American I would like the judges to rule on what is fair and right for the people of this country.  I do know what ever way each judge votes, someone else will be unhappy. It is a fact of life you can’t make everyone happy.

I have stated before on this blog that I think the healthcare program is a good thing for the people of this country.  With the insurance company‘s running the doctors and hospitals a lot of people are not getting the care they should be getting. We are already paying out the wazoo for the uninsured to receive care  with the high costs of medical care and deaths that could have been prevented.  If the mandatory insurance makes people get insurance who would otherwise just think they can use the ER as an Emergency Room with no thought to how they are tying up the system or the cost to all of us.  I think it is a good thing to make everyone responsible for something that might help reshape our medical and insurance system. It is something everyone uses at one time or another.

I do not think only the rich should be entitled to medical procedures which can save and improve lives.  As an RN I am not in favor of prolonging life just because it can be.  A life needs quality, not just quantity. I think this will give a good start to equal access.

I know how I want this debate to go, but I also know it’s in God’s hands.  As an American and a Christian I will live with the final outcome. Either way it will be tough on all of us.

That’s my two-cents once again on healthcare.  Let me know what you think and why you feel the way you do. I look forward to hearing from you.  A healthy discussion is always good.

Let’s talk Obama Care

Standard
Barack Obama at the University of Nevada, Las ...

Image via Wikipedia

As a retired RN who has worked in many areas of health care I have seen and experienced our broken health care system.  I have seen and experienced waiting in an emergency room for hours because it is being used like a clinic because lower-income people can’t afford medical care for themselves or their children.

I feel we are being held hostage by the insurance companies who can dictate what our doctors can and can’t do.  Since they have to control their costs and make money, people are denied treatments that can save their life.  I feel every citizen in this country is entitled to medical care and I think the changes that will and have been started by Obama Care is a  good thing.  Why is it wrong for people to help buy insurance in a government-run program?  The citizens of this country have been paying for all of the care given to the poor to start with.  I feel in the long run this can save us money.  I can’t see a problem with them getting supplemented insurance at all. Obama Care will also help decrease the Medicare fraud that is perpetuated by the system in place now.  Wouldn’t that save us a vast amount of money?

I for one applaud the president for taking the initiative to change our health care system.  It is something that should’ve been done long ago.  Politics in this country tries to portray this plan as bad or good.  As I said, it is a new start.  I am not afraid of a new beginning with health care but I know many people are.

I am attaching a Bill Moyer’s video talking about medical lobbyist in Washington. It explains why so much propaganda is spread about anything affecting medicine or drugs.

http://youtu.be/GsIcS7egnyw

Long Term Care (reprint)

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This is a reposting of a previous blog  that I felt was worth reposting.  If you have loved ones in long term care or possibly will have in the future, there might be some helpful information for you.

My writing this piece is a purging for years of frustration.  I am an RN, and I have been for over thirty one years.  I grew up in Long Term Care (LTC) and my children were raised in the environment also.

My family built and ran LTC facilities.  I have worked at every job in a facility from laundry to cook, NA, CNA, and Director of Nurses.  Later in my career I was also a LTC surveyor in two different states.  So you can see this particular topic is near, and dear to me.

My LTC background started at a time when you had individual run homes.  You did not have the large corporations coming in and buying several in a state or across the country. You still had good homes and bad ones.  Trying to make the all mighty dollar would drive a lot of issues.

The LTC facility I was first involved with was Regency House Nursing Center.  It was owned by my uncle and my mother was the administrator.  As I grew up, as I mentioned before, I did every job in the facility at one time or another.  I knew how things were suppose to be done.  Over time I became the Director of Nurses.  It should go without saying the administration and myself had a very direct line of communication.

The first rule in that home was, you had to give good care.  All of the patients were like family members.  Even the poor souls who no longer were themselves.  You had all the personalities from the very aggressive to the very meek.  It was a family, and I lived with that family for ten years.  I watched people I cared about leave this world and new ones would come in to take their place.  It was a cycle of life.

We had annual state surveys that nursing always did well at.  They might find a medication not being initialed, but the patient care was excellent.  The building always received the same deficiency every year, but there was a waiver to cover that particular issue.  Everything ran smoothly, and the patients were happy.

The food was good and fresh for three meals a day.  The menu was catered to the farming community the patients came from.  Diet guide lines were followed for the most part, but the bottom line was the patients were happy with the food.  You also must know, there is always someone who doesn’t like something.  The fact that the food can’t be seasoned properly with salt caused a lot of unhappiness to be voiced.

Then of course you always have the hard to please family members.  You know the one’s that every member of the staff cringed when they came through the door.   Absolutely, nothing you did, or tried to do made them happy.  It didn’t matter if you had seventy other people who required care.  If Mom or dad wanted something right now, then right now they should have it.  Life in a facility did not and does not work that way.   Luckily those family members were few and far between.

Since that time, let’s say from the mid 1980’s, multiple cooperation’s have bought up the LTC facilities and have also built many more.  I feel the majority of Administrative staff in today’s homes want good quality care.  The problem as I see it, is the cooperation’s bottom line has to be money.  So everything is maintained at the bare bones level and if you talk to them about staffing the words will come out such as “we have more staff for the amount of patients we have, than what is mandated.”

Staffing a facility is a constant changing nightmare, for a number of reasons.  Once again you are dealing with all different types of people and their personalities.  I believe the majority of the personnel in any facility want what is best for the patients they care for.   This goes from the maintenance person, to the nurses and CNA’s that are working directly with the patient.

Facility staff are overworked and underpaid for what they do.  That is how the system is set up and will continue to be until something changes.   I’ve got ahead of myself. I was talking about staffing.  Some states do not require a particular number of staff to take care of the patients.  Some states require a minimum.

Back in time when I was working in LTC, Oklahoma required one to seven direct care staff to provide care to the residents on day shift.  This number counted the LPN giving the medications and providing treatments.  It also counted the activity director as providing direct care.  I always felt this was very deceptive.  The CNA’s on the floor where the ones who were bathing, feeding, dressing, walking, cleaning changing, taking to the bathroom and just doing whatever the person could not do for themselves.  The number of CNA’s decreased with each shift.  If you had four people on day shift providing care on one wing, that would go down to two on a wing and then for night shift it could go down even further.

For some reason, the thinking is there is not as much to do on the evening and night shifts.  That  is not entirely true.  You still have to do the care, feed the patient, problem solve, ect.  I think you can see my point.

The facilities have people who call in sick, without thinking of the problems it will cause.  You also have people who are so dedicated or need the money so badly, they come to work when they should have stayed home.  That in itself can cause problems.  Rampant virus illness is not pleasant for anyone, and it can go through a nursing facility quickly.  Care should be taken, family or staff if you are sick, stay home.

It is not easy finding staff to work when someone calls in.  Usually some overworked CNA, who needs more money will volunteer.  It is not uncommon for the caregivers to work more because of the low wages they receive.  When someone is tired, they can’t give their best, even though everything in them says they are.

States that do not have mandatory staffing use the premise that a facility must provide enough staff to care for the patients.  This is well and good, sort of.  You can have five on the floor caring for ten patients.  You would think all the care would be done, and everything would be wonderful.  It could be, only two of those people are really working.  They bust their behinds getting all the work done while the other three take smoke breaks outside, hide, look busy doing something else, but not really accomplishing anything.  So there is the dilemma.

Unfortunately, I have been in facilities that consistently ran short of staff to provide care to the patients.  During the three days of survey, they would bring in staff from sister facilities to really make it look good.  The survey team knew what was going on but nothing could be done about it.  We would hear statements from patients such as “I am really glad you’re here, we have so much more staff today than we usually do.  Another might say, my call light is sure being answered quickly today.”  I always felt the difference I made in patient lives were the three days I was there doing a survey.  I think it is a very sad thing not to be able to completely trust the care that is given to some of our geriatric population.

The general public has no idea how many restrictions are really placed on surveyors that go into a facility.  We all started the job thinking we were really going to make a difference in people’s lives.  Those money hungry cooperation’s that provide poor care, because they are trying to get more of those sacred dollars are going to be shut down.

Nope, that is not the reality.  The federal government has a very large book of regulations for LTC and what you can and can’t do.  It is almost impossible to shut a home down.  It can be done, but it takes a great deal of time, effort and money that states do not have.

Then you have to consider the patients in these homes.  Where are they going to go?  In some areas they may be moved fifty miles away before a facility can be found that will accept them.  If they have family that visits them, what happens if they don’t have the transportation or resources to get to where the patient is located.  Families can’t take care of mom and dad like they use to because of being scattered across the country, or everyone is working trying to survive.  So where does that leave the patients?

The survey process itself is unannounced.  The facilities do not know exactly when the survey team will show up.  What they do know is, a three month time frame it could happen in.  The tension can be felt in a home when it is getting close to survey time.  It has happened that a survey team will check into a motel and the facility will know the survey team is in town.

Surveyor’s are not suppose to talk about their schedules.  It could mean their job if it is proven they let a facility know when their survey is going to take place.  If a town has several facilities, you could go into a home to do a complaint and every facility in town will know you are there.

As soon as a team walks into a building, fresh drinking water starts being put out, and call lights put within reach of the patient.  You can see the activity of preparing for surveyor’s beginning.  If it wasn’t so sad it would be comical.

The numerous complaints called into a state office is usually held until survey time unless there has been harm or potential harm to the patient.  One or more surveyors will go to a facility and pick a number of residents including the one the complaint was about.  Trying to prove a complaint can be very difficult.  Let’s say mom told you they are not changing her at night and she is laying in a wet bed all night long.   First thought  you have is, how dare they do that to my mother.

You go to the Director of Nurses and you tell her the staff is not changing your mother at night.  She then tells you it will be taken care of.  She instructs her staff in checking and changing the patient’s every two hours.  It is well documented in the patient record.  You go back in a few days and mom tells you the very same thing.  This time you are livid, and you will take care of it, so you call the state and complain.  Unless the patient has a bedsore, the state will probably hold that complaint until the next survey and then look into it.

So now you are frustrated because you think the state doesn’t care and is just blowing it off.  Finally the survey happens and someone from the state calls you and tells you that your complaint is unsubstantiated.  You just can’t understand this at all because you know they are not changing mom at night.

Let me explain a little to you about what has to be looked at, and what has to be there in order to prove your allegation.

  1.  Mom’s initial and subsequent evaluations has your mom coded as incontinent.
  2. Does your mom have any skin break down.  Has she had previous breakdown and if so did it heal properly.
  3. Has your mom had any urinary tract infections.  Females tend to develop UTI’s more frequently if not changed.
  4. What is your mothers mental status.  If the evaluation the facility has completed, has her sometimes confused, then that can be one of the factors that will cause a complaint to be unsubstantiated.
  5. What documentation does the facility show on her record.  They have shown the patient is checked every two hours and dried when necessary.  The argument can be, it is not our fault we go in to change her and she is not wet, and then after we have gone she wets on herself.

Unless you can prove beyond doubt that care was not provided.  You can’t substantiate the complaint.

On the other hand let’s say mom developed a really deep bed sore from lack of care.  The facility can be given a deficiency.  They would be required to fix the problem for the person named in the complaint, and anyone else who could be affected.  They would have to devise a plan to make sure it doesn’t happen again and who will be monitoring do make sure it doesn’t happen again.  This is all put on a form on sent to the state and the federal government.  Usually within thirty to sixty days someone will go back in and make sure the plan was put into place and everything is done appropriately.  If it is not corrected then fines can be put in place by the government.

If it is never corrected to the satisfaction of the state, then the facility can go into the process of being shut down.  Sometimes, facilities will sell and the name will change and all of the previous problems will be wiped clean.  The new facility will have an opportunity to go through the whole process from start to finish.  If they took care of it, then all is well.

 

The Nursing Home Association has a very powerful lobby in Washington DC.  They keep a lot of rules and regulations from passing they feel could harm the industry.  As you can probably surmise, the care of our geriatric population is very complicated.  It is overrun with many problems and it’s a constant struggle.

I don’t want anyone to misunderstand my feelings here.  I know there are some very good facilities in this country that take excellent care of their residents.  They have loving caring staff that does what it takes to provide the needed care.  I also know they are facilities I would not let take care of my dog, much less one of my loved ones.

I am fortunate in that I have a family of nurses and care givers and my parents or one of my immediate family will not go to a nursing facility.  I know everyone does not have that choice.

Be planning ahead, and if you have to find a facility then look at it very seriously.  The years previous survey has to be posted for public view, that is law.  Look at the survey, go at different times of the day and observe what they are being served at meal time.  If you enter the facility at 9:00 in the morning what does it smell like.  You are always going to have some odor on the hall just because of someone being changed at any given time.  It should not remain in the air consistently.  How clean is the facility kept?  Are people sitting around in wheelchairs parked in front of the nurses’ station?  What type of activities do they have going on.  Are they appropriate for the mental and physical abilities of the patients.

This is only the tip of the iceberg, and I hope and I have give you some information you can use, as well as educate you a bit.  We have some major problems to overcome, when it comes to the care of our geriatric age group.  It takes a very special person to go into long term care and stay.  We have to do our best and keep striving to make things better for those who can no longer care for themselves.

 

 

 

Let’s talk Healthcare….

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First of all, let me tell you I am not political.  I don’t want to fight over whether I am republican or democrat, or independent.  I will say, at least someone is trying to fix a very broken system, and I applaud that effort.  I am an RN and have been so, for almost 32 years now.  I have watched healthcare in this country go down the drain because of the climbing prices and cuts in staffing.  We have gone from a hospital system being run by doctors, nurses, ect. to hospitals run by the insurance companies.

As a nurse, who was supposed to be caring for the patents, I got to empty trash and mop floors because there was no staff.  I watched as the paperwork became the most important thing, instead of the people.  You have to have the paper work in and done just right so the insurance companies can pay.  You have to have the paperwork completed just right so Medicaid or Medicare can pay.  It is always more and more for less and less.  You would have so many patients you couldn’t take care of them well, because you didn’t have time.  There have been cuts in nursing, even though there is a shortage of nurses.  Patient care suffers.  Anyone in my family who goes to the hospital, has someone with them 24/7 in order to be sure care is provided as it should be.

I listen to people screaming about Obama Health care Reform.  As I said in the beginning, Hooray for him.  At least he is trying to do something to help the poor and middle class citizens of this country, who can’t afford health care insurance.  This issue is very complicated and affects every person in this country.  It doesn’t matter if your rich or poor.  You will be touched.

I can see good things when a person can take themselves or a child to the doctor and get what they need.  A mother or father being told their child is going to die because the Insurance company will not approve a surgery.  The insurance company dropping someone who has cancer because they have spent too much all ready.  My son calls me a socialist because I want everyone to be able to get the healthcare they need.  Not just the people who have money or the good insurance.

I am proud of the doctors and nurses of our country who work so hard to care for the people but can’t do what needs to be done because of the control of money. They work and do what can be done, not for the hospital or the insurance company but for the people.  They push for reform.

Let me know your thoughts on healthcare.  It is an interesting topic.