Schwarzenegger Calls for Universal Coverage

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Schwarzenegger Calls for Universal Coverage
By LAURA KURTZMAN
AP


SACRAMENTO, Calif. (Jan. 8) - Gov. Arnold Schwarzenegger on Monday proposed to extend health coverage to nearly all of California's 6.5 million uninsured people, promising to spread the cost among businesses, individuals, hospitals, doctors, insurers and government.

The plan contains elements that are likely to provoke opposition from a wide range of powerful interests, including doctors, hospitals and insurers, as well as employers and unions. But it also contains incentives for each of them.

All children, regardless of their immigration status, would be covered through an expansion of the state and federal Healthy Families program.

"I don't think it is a question or a debate if they ought to be covered. ... The federal courts have made that decision - that no one can be turned away," Schwarzenegger said. "The question really isn't to treat them or not to treat them. The question really is how can you treat them in the most cost-effective way."

Under Schwarzenegger's plan, all Californians would be required to have insurance, although the poorest would be subsidized. Businesses with 10 or more employees would have to offer insurance to their workers or pay 4 percent of their payroll into a state fund. Smaller businesses would be exempt.

Also, insurers would no longer be allowed to deny coverage to people because of their medical problems.

Business groups and Republican legislators are likely to object to the extra costs imposed on businesses.

The state would subsidize the estimated 1.2 million poor people who do not currently qualify for state health coverage. They would be able to buy insurance through a state-run pool and would have to make a small contribution toward their premiums.

Schwarzenegger is betting that his plan will save $10 billion a year by cutting health care costs. He says the savings would offset the new fees he is asking doctors and hospitals to pay - 4 percent of revenue for hospitals and 2 percent for doctors.

The state also would increase what it pays doctors and hospitals through Medi-Cal, the state insurance plan for the poor.

The governor was supposed to give his address in person to a panel of health care officials. Instead, he spoke via video link since he is still recuperating from broken leg suffered in a skiing accident.

Article can be found HERE
 
The beggining of the end of healthcare as we know it.

OK FELLOWS GRAB UR ANKLES
 
I predict a huge shortage of doctors and nurses in California
 
wish that everyone that is desperate for national health care coverage could spend a day with me at the VA here in West Palm. They would realize that they should be careful what they wish for. This hospital is supposed to be the cutting edge of VA's and wins all sorts of awards, it is over 1,000,000 square feet. The primary care doc's make the same as the surgeons. Nobody works hard...ever. They have no vascular surgeon -- can't keep one on staff. They have general surgeons, a thoracic guy twice a week, an ortho once a week, and a urologist. Most are part retired. The anesthesiologists there are all foreign looking for visas, they have a hard time finding crna's. A little while ago they couldn't find aneshesiologists or crna's to work there so the OR basically shut down, not allowing anything elective, for three weeks. people died....that didn't have to. a month later during a AAA repair the surgeon freaked because he didn't realize that there wasn't an anesthesiologist in house to back up the crna handling his case in case the sh** hit the fan. it worked out okay but he was pissed. one of like ten things that made him leave BEFORE he got his visa...blew the whole visa thing, that's how bad it was.... I don't even know most of the stuff that he had a problem with. The rest of the hospital, IM, etc. is probably just as messed up but I have only been in surgery and primary care.
 
and according to my attending, BUSH has increased spending at the VA health care system 70%....so it used to be worse!
 
Universal **INSURANCE** is not the same as socialized medicine. Generally speaking, universal insurance programs are good for physicians because it guarantees that health care costs are paid even if that is at a deep discount.
 
Hey Russo

But universal insurance is the slippery slope in the direction of universal healthcare. Its what they want, this is the first step. Hell, i thought the Gvernator was a rep. what happened to no entitlemets for anyone? 😛
 
Bush's 2007 budget calls for a $10 BILLION shortfall in funding for the VA system. I don't know what your attending was smoking...

Do you guys all really think it would be so bad to get paid for EVERY anesthestic you do? Sure it's going to likely be at a discount, but Christ, I get sick of doing charity anesthesia all the time to take care of the handfull of patients that can afford our fees.

These patients without insurance are not going away and will only get much larger in number over the next decade. We live in the wealthiest nation in the world, so it would be immoral to deny them care. So what's going to happen? We'll keep doing charity care and overcharging those with insurance until the insurance carriers quit covering their patients and worsen the problem. We're close to the threshold now, and it's only getting worse.

There is very little sympathy for physicians out there because we seem to be a lot more interested in making lots of money than advocating for a better system. Everyone agrees that our system is unsustainable and the data shows it is the worst system that exists in the industrialized world based on outcomes, yet we constantly tell our patients that it is the BEST system for them??? They smell a rat and they should.

I want to repay my loans and live a good life for all the risk I take every day, but lying to the country to preserve the status quo is going to get us screwed more than any other strategy. I'm too young to get sh** upon later because my senior partners want to retire early. We need universal coverage (not necessarily national health insurance) to save our financial situation before it implodes.
 
Bush's 2007 budget calls for a $10 BILLION shortfall in funding for the VA system. I don't know what your attending was smoking...

Do you guys all really think it would be so bad to get paid for EVERY anesthestic you do? Sure it's going to likely be at a discount, but Christ, I get sick of doing charity anesthesia all the time to take care of the handfull of patients that can afford our fees.

These patients without insurance are not going away and will only get much larger in number over the next decade. We live in the wealthiest nation in the world, so it would be immoral to deny them care. So what's going to happen? We'll keep doing charity care and overcharging those with insurance until the insurance carriers quit covering their patients and worsen the problem. We're close to the threshold now, and it's only getting worse.

There is very little sympathy for physicians out there because we seem to be a lot more interested in making lots of money than advocating for a better system. Everyone agrees that our system is unsustainable and the data shows it is the worst system that exists in the industrialized world based on outcomes, yet we constantly tell our patients that it is the BEST system for them??? They smell a rat and they should.

I want to repay my loans and live a good life for all the risk I take every day, but lying to the country to preserve the status quo is going to get us screwed more than any other strategy. I'm too young to get sh** upon later because my senior partners want to retire early. We need universal coverage (not necessarily national health insurance) to save our financial situation before it implodes.


Look for more discussion on this issue later this year and in 2008 as the Democrats make "health care" a big issue in the next Presidential Race.
If we get out of Iraq by 2008 health care may become 'the" issue on the domestic agenda.

The question is not "if" we get some sort of "universal" health care policy but when we get it. If the Republicans win in 2008 the universal issue is pretty much dead until 2012. However, if the Democrats win the White House look for an expansion of our "Medicare type" program nationally. Along with this program comes large tax increases and no income limit on the Medicare tax and Social Security tax. Plus, the top income bracket will be raised to Clinton era levels. We could be taking it on all fronts: BOHICA without the lube.😱
 
well

While medical is going to increase, it would make no sense at all to increase it past what you are taking from the us (docs) or it would be a wash.

Star:

Yah i understand what your saying but much of the problem isnt even being addressed. Adding money to give everyone something which ISNT a right only puts a finite bandage on a problem which will only get bigger.

Where are the motion sensing M60's on the border to stop the invasion of illegal mexicans?

Where are the social programs which dont give you just money, but retraining into a job which is in need? Also, where are the rules that say once you hit X months on the program we stop giving you money, too bad for you. Last i checked MacDonalds in hiring everyday yet all these ppl are unemployeed? BS. They dont want to do what it takes when they are given a handout and now we will handout insurance as well. Where is the incentive NOT to be on welfare?

The message that healthcare ISNT a right needs to be sent out and not ina nice way. It needs to say:

- We support and will take care of our elderly
- We will not support and take care of the lazy
- We will not pay for your healthcare while you smoke or eat yourself to death
- We will let you die if you dont have the drive to survive.
- We will go out of our way to help people who help themselves
- We will go out of our way to stop illegal immigration
- We consider the 'migration' of mexicans across the border as an INVASION and will treat it as such

Why are NONE of these primary issues never addressed in a meaningful way? Instead we decide to throw money at taking care of everyone.

Its crazy talk i tell you, crazy talk!
 
The message that healthcare ISNT a right needs to be sent out and not ina nice way. It needs to say:

- We support and will take care of our elderly
- We will not support and take care of the lazy
- We will not pay for your healthcare while you smoke or eat yourself to death
- We will let you die if you dont have the drive to survive.
- We will go out of our way to help people who help themselves
- We will go out of our way to stop illegal immigration
- We consider the 'migration' of mexicans across the border as an INVASION and will treat it as such

Why are NONE of these primary issues never addressed in a meaningful way? Instead we decide to throw money at taking care of everyone.

Its crazy talk i tell you, crazy talk!


This will definitely win over the population... 🙁
 
"Where are the motion sensing M60's on the border to stop the invasion of illegal mexicans?"

...are you fuc*ing for real, or do you just have a very bad sense of humor?
 
Ive said it before, and this wont be the last time- we already have universal health care, this is dealing with universal reimbrusement. for the people who are actually committed to providing care to those who need it, not just those who can afford it, some reimbursement is better than none a significant part of the time.

the people whining are the ones who take the "100% privately insured patients!!!" jobs and sorry, but all I can do is chuckle. if it comes down to paying 2% of revenues for all physicians and larger reimbursements for now-universal medicaid, i cant feel sorry for you.

and yes, my apostrophe key is broken 🙁
 
Hey Russo

But universal insurance is the slippery slope in the direction of universal healthcare. Its what they want, this is the first step. Hell, i thought the Gvernator was a rep. what happened to no entitlemets for anyone? 😛

Not necessarily. Universal insurance can be provided in the marketplace by multiple sellers---in fact, competition for health care insurance would help drive down prices. Our society also needs to accept that not everyone gets "Lexus" health care. The overwhelming majority of othewise young, relatively healthy uninsured can be adequately covered with low-cost catastrophic plus PPO/HMO high deductible ambulatory care and preventive medicine insurance.
 
Star

It might not win over the population but often the things that need to be done are not popular. Unfortunate but true.

Dirk:

Yes Im serious. What else is it but an invasion? Recently they even attacked a border in Arizona (it was on the news) with weapons driving back the National Guard there.

The country needs to spend more time and money taking care of the problems RIGHT HERE than abroad.
 
I don't understand why physicians should subsidize insurance for others. Why not pro atheletes too? Why not plaintiff's attorneys? Why not Fortune 500 CEOs? Seems a bit discriminatory to me.
 
i get so pissed when i see crap like this..... a politician who promises some sort of medical reform but passes the buck off to the physicians to take it up the pooper. this is absolutely friggin ridiculous.

imagine being on call for emergencies and some indigent/illegal/heck maybe even a small business owner comes into the ER for let's say, acute appendicitis and need surgery immediately. i get to come in, work for free at, oh 2am, assume every bit of liability, face getting sued even though everything goes perfectly smooth and then just tear up the bill because there is absolutely no way we're getting paid for that. the hospital will collect some small, nominal fee from the county for indigent/no pay health care but the MD's will see ZERO. yeah, i'm honored to be where i am but this get's old after a while and more frustrating as i see companies(insurance) and the gov't dipping their hands into the kitty just becuase it's another way to make money

i know this is a somehwat rambling post with prob zero sense but i get pretty worked up about it. washington is another issue in it's entirety and i'd rather not get started on it...
 
oh geez - i didn't realize what forum i was on when i posted this... i thought i was on a car forum so pardon some of the layman's thought process - thought i was talking/preaching to a different audience 😉
 
Not necessarily. Universal insurance can be provided in the marketplace by multiple sellers---in fact, competition for health care insurance would help drive down prices. Our society also needs to accept that not everyone gets "Lexus" health care. The overwhelming majority of othewise young, relatively healthy uninsured can be adequately covered with low-cost catastrophic plus PPO/HMO high deductible ambulatory care and preventive medicine insurance.

Sounds good to me...problem is i think most americans think they are entitled to lexus health care.
 
wish that everyone that is desperate for national health care coverage could spend a day with me at the VA here in West Palm. They would realize that they should be careful what they wish for. This hospital is supposed to be the cutting edge of VA's and wins all sorts of awards, it is over 1,000,000 square feet. The primary care doc's make the same as the surgeons. Nobody works hard...ever. They have no vascular surgeon -- can't keep one on staff. They have general surgeons, a thoracic guy twice a week, an ortho once a week, and a urologist. Most are part retired. The anesthesiologists there are all foreign looking for visas, they have a hard time finding crna's. A little while ago they couldn't find aneshesiologists or crna's to work there so the OR basically shut down, not allowing anything elective, for three weeks. people died....that didn't have to. a month later during a AAA repair the surgeon freaked because he didn't realize that there wasn't an anesthesiologist in house to back up the crna handling his case in case the sh** hit the fan. it worked out okay but he was pissed. one of like ten things that made him leave BEFORE he got his visa...blew the whole visa thing, that's how bad it was.... I don't even know most of the stuff that he had a problem with. The rest of the hospital, IM, etc. is probably just as messed up but I have only been in surgery and primary care.


wasnt there a study like 2 years ago that stated that the VA provided the best care anywhere... it made all the national papers.. True story..
 
wasnt there a study like 2 years ago that stated that the VA provided the best care anywhere... it made all the national papers.. True story..

As dysfunctional as the VA is, I think that you get pretty good care if you're willing to wait...

But the VA represents the problems with a universal PAYOR; not universal INSURANCE. Kaiser is sort of the civilian version of the VA.

Universal INSURANCE is good for doctors; universal PAYOR is bad.
 
wasnt there a study like 2 years ago that stated that the VA provided the best care anywhere... it made all the national papers.. True story..

really? i can't believe it at all. either that or my VA is messed up. but they don't have a vascular surgeon...have not had one since mid-october...they have been looking but with no luck. i have a patient that had his enormous hemangioma embolized. it is slowly necrosing from the inside out. he is ruining his life getting addicted to pain meds because we don't have vascular to cut it off and the gen surg's won't touch it.
believe me, when the OR was shut down to all but emergencies, people died. one patient sticks in my mind... waiting for his BKA, that became an AKA, that became sepsis and...
no way is this the best care anywhere.
 
wasnt there a study like 2 years ago that stated that the VA provided the best care anywhere... it made all the national papers.. True story..

Don't remember that, but I do remember that around that time, the VA in Dallas was ranked as the absolute worst hospital in the U.S. Dead freakin last.
 
The media is starting to lay the groundwork as well with CNN firing off stats on how health care spending increased 4% from last year to this year (inflation adjusted) with the rise being blamed on hospital costs, pharmaceuticals, and doctors' fees. Would love to see them quantify those costs as the first two likely contributed to 85+% of that increase.
 
Why should Dr's be the only ones paying this excess 2%?!?! What about the other high income earners in the state of cali? What about the middle class? I'm sick of being a target for every little cut b/c I worked hard and decided to pursue a career that will earn me a good salary. Cremsickle was right, we need to figure out a way to provide healthcare to those who DESEVE it.

[Starting rant] If I see another gorked out NH patient getting a full work up I'm gonna puke. I can't stand changing the dressings of an IVDA whose now got huge ulcers b/c of his prior drug use when he claims "I havn't done any drugs since 78" and the tox screen comes out positive for opioids. I hate manageing bp and cholesterol meds on the 150kg person who swears, I've been on a diet but I just can't seem to keep my choleterol or weight down. These are the types of issues that make me want to run away from medicine forever [End rant]
 

the papers can say all they want, but i have to agree with amyl. i did some time my intern year at a va hospital which also had all kind of awards to its name. i wouldnt let my dog get care there with some of the stuff i saw. the VA system is a classic example of "it doesnt matter what you do or say, but what you document". it was just sad seeing all the folks that got hurt, literally, in that hospital. and to make things worse, from stories i heard while working there, they really were getting better care there than they would at some other va hospitals.
 
to be fair, the va system does have some big pluses.
1. computerized order entry that has built in warning mechanisms to help prevent medical errors
2. computerized notes, so that you can easily read up on past medical history and easily read consult notes
3. computerized medication list that is up to date, assuming the pt gets all their meds through the VA. this can also give you an idea of how compliant they have been.
4. you really cant sue the VA, so more money towards pt care rather than lost to keeping legal defense on staff and lawsuit payouts
5. in the primary care setting, the computer system will actually remind you of needed rountine health maintenance checks based on their problem list, age, and when these checks were last performed (i.e colonoscopies, eye exams, flu shots , etc.)
 
The VA generally does provide excellent care if you look at the data. They do a good but not great job in the OR environment, but the real strength the VA has (and most national health care systems has) is in primary care and preventive care. The VA was really the only place I've worked where the vast majority of patients arrived in the OR with a full and reasonably complete workup. They also were optimized as best as can be (sick as ****, but optimized) compared to most other places.

They certainly have their problems (try to get a hold of someone at 5pm on a friday!) but compared to the horrible preventive care that the majority of americans receive, they look pretty good.

Overall the VA gets a pretty bad rap as the care there was horrible in the 70s and 80s but has improved markedly since then.
 
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