March 22, 2010, 12:08 pm

Between the Lines of Fear and Blame…

What a nice picture, yes?

A lot of people went to bed last night with this version of health care in their heads.

Many folks see government as these strong, protective hands.

It’s a nice thought.

Until those hands start to make fists.


I wonder how long it is going take before you have to wait weeks to see your primary care provider. (Wait, we already know, it could be weeks!).

I wonder how long it is going to take for the government to dictate payment to providers? (Wait, they already do!).

I wonder how long it is going to take for the number of primary care providers (MDs and NPs) to move to more lucrative specialties because they can’t live/pay student loans as a PCP? (Wait, they already are!)

I wonder how long it is going to take for the government to limit which medications are reimbursed and which are not? (Wait, they already do!) Or decide which treatments are covered and which are not? (Wait, they already do!)


We all need health care.  It is wrong that someone with a pre-existing condition cannot find coverage. It is a tragedy to have someone lose everything they have because of catastrophic illness. It is frustrating to be stuck in a job solely because of the health benefits. It’s scary to lose those health benefits if you are laid off.

It is wrong that the majority of health disparities are directly related to poverty.

It is wrong that providers pay tens of thousands in malpractice premiums every year. It is wrong that they are reimbursed a fraction of what it costs to care for patients. It is depressing that they must limit their time with patients because they have to see more and more of them to break even. It’s ridiculous that providers need to hire specialists to navigate the morass of insurance regulations.

Our system has issues, no question.


So, will the new health care legislation make for healthier communities by providing jobs, parks, grocery stores, education opportunities  and health care clinics to poverty-stricken neighborhoods?

Will the new health care legislation provide incentives for students to choose primary care as their specialty? Family/General Medicine, Internal Medicine, Pediatrics, Geriatrics? Takes a lot of money and time to become a physician or advance practice nurse. Will the new health care legislation make it worth the effort?

On the other hand, will the new health care legislation make it easier to find a provider? To actually get in to see a provider in days, not weeks?

You see, being covered is worthless if you can’t find a provider to partner with.

Will the new health care legislation provide incentives for health research? If profits are limited, is there still interest in researching medications, treatments? Or on the other side, if funds are limited will there even be any available for research and development?

Will the new health care legislation provide incentives for keeping ourselves healthy? Exercise? Normal weight? Healthy diet? No smoking? Judicious use of alcohol? What if you’re a sedentary, obese, smoker?

Will the new health care legislation see us as the chief focus of the new system, or as cogs in a wheel that must be regulated and controlled?

Health care is already rationed (yes, it is…think about it). Is there anything in the new health care legislation that keeps it from becoming draconian?


I have absolutely no answers.

There has to be a way to have coverage for all, protection for those with chronic illnesses and protection from the financial fall-out of catastrophic injury/illness.

I have a deep feeling of dread in my gut that this is not the way to go.

I pray we are not starting on a road to government bureaucracy that will end with the IRS looking like a lesson in efficiency.

The federal government can make treaties on my behalf and provide for my defense.

I sure as hell don’t want it dictating my health care.


  • Rachel

    March 22, 2010 at 12:24 pm

    I am hoping it does what it is supposed to do, and that it is a stepping stone to better ways of doing things – including dollars spent on ensuring primary care and investing in poor neighborhoods. Hoping.

    That doesn’t mean I don’t have my reservations. Getting past the individual mandate is going to be hard. Getting people to understand why universal health care is difficult without everyone buying in – is difficult. It would be simple if all parents instilled what my father did. There were no ifs, ands, or buts, I was taking COBRA immediately after college graduation – and he would have known if I didn’t pay or dropped it before finding a job with insurance as he handled his company’s COBRA benefits at the time. He didn’t want to see any of his children be burdened by medical bills like he had been in previous years.

  • Karen Moeller
    Karen Moeller

    March 22, 2010 at 2:56 pm

    I’ll tell you who dictates my family’s healthcare: the one insurance company that we can “choose” via my husband’s employment. And, dictate it they do!

    This health care legislation isn’t perfect. After all, what is?! Still, it’s a huge step in the right direction. There is much more to do, but perhaps we’ll have more stakeholders involved as we go forward.

    Just out of curiosity, when you are eligible for Medicare (I know, it’s in the very, very distant future!), will you accept that or buy your health insurance on the open market? Medicare is the closest this country has to socialized medicine and most seniors wouldn’t think of having anything else. Still, no one is forced to go on Medicare when they become eligible. It’s a choice.

    I love your writing, Kim. Keep it up!

    KarenM in NC

  • Alexandra Lynch
    Alexandra Lynch

    March 24, 2010 at 12:16 am

    This bill means that maybe if I get cancer I won’t shoot myself because there’s no way I can possibly afford treatment.

    It’s not single payer (and I would happily pay a quarter of my income to be able to make this nation a better place, and to get my dislocated midfoot put right) but it is something.

  • Jamie Davis, the Podmedic
    Jamie Davis, the Podmedic

    March 24, 2010 at 4:25 am


    As a health care professional, I am dismayed by the way that all of the special interests on both political sides of this legislation watered down the parts of this legislation that might have made a difference.

    As for government involvement in health care, what makes an insurance company a better gatekeeper for health care? At least there is some accountability from my elected officials. Not much, I’ll agree, but some.

    A private insurance company is accountable to only one person – their share holders. They remain focused on one goal – find ways to hold on to more of the premium dollars they are paid. People forget that they are not the customers of the insurance for which they pay. Their employers are the customer and the employers are constantly trying to reduce costs spent on health benefits.

    So who do you trust with overseeing your health care: the company who only makes a dollar by finding new ways to not pay for the care you need or the elected officials who at least rely on your vote to stay in their jobs?

    Neither is a perfect choice but I am more comfortable with the one over whom I have some control.

    My two cents – thanks for starting the discussion!

  • […] friend, Kim over at the Emergiblog wrote this post on her response as a nurse to the recent healthcare reform legislation.  While she and I don’t always see eye to eye politically, I still think she voices some […]

  • Willie

    March 24, 2010 at 10:49 am

    This nurse says: To have the opportunity to be and stay healthy is a right. It should not be predicated on ability to pay (got $/insurance -> get healthcare; don’t got $/insurance -> tough). The right to good/optimal health is a right that has needed to be asserted… now we are on our way.

    My expectation is that people, and the system, will eventually focus on optimal health, remaining healthy, and prevention efforts. And one day, somewhere in the distant future, prevention focused health care drive the costs do far down that for-profit industries and government will have much, much less interest and control… I know this to be true for the distant future : )

  • mmmhhhmm

    March 24, 2010 at 2:32 pm

    Try to read the thing before you complain about it… And yes, it is on the internet. the main point of this bill is that no one can be refused coverage based upon pre-existing conditions. Of course, that just means that they will be paying higher premiums. There is nothing in there about rationing. Aside from the horror stories heard about the NHS, one has to realise that there are many many benefits to such a system. And look at Sweden, France, Denmark, Germany and Norway for examples of how universal healthcare DOES actually work, and quite well at that. Before you start complaining, look at the facts and not the horror stories that the republicans are spewing. And remember that all of Europe is laughing at you. The headline on a french online newspaper the day after the legislation was passed? “The United States Arrive in the 20th Century.”

  • Margaret

    March 26, 2010 at 1:14 pm

    Most of the people who are against this bill are in a situation that allows them to have insurance through one group or another. It’s those who fall outside of the norm that this bill will hopefully cover.

  • missbhavens

    March 28, 2010 at 12:00 pm

    The bill is flawed in many ways, no doubt. But I do believe that it’s a first step in the right direction. I think it will take years–many!– for our healthcare system to actually straighten up and fly right. Change has to come from all sides: insurance companies, Medicare, Medicaid, Doctors, drug companies, hospitals AND patients! Preventative care has to jump into the forefront of how we approach medicine. I believe someday it will.

    No, I don’t really trust the government to “run” healthcare, but that’s not what this bill does. And I REALLY don’t trust insurance companies.

    So here we go. It’s going to be bumpy!

  • rn4life

    March 30, 2010 at 11:20 pm

    I believe we have to start somewhere and make adjustments. This thing called health care needs to be fixed, it is critical. Being a super power has it privileges as well as responsibilities and we should as a nation be taking the health care needs of the people who needs it most into consideration. I agree that we need balance, but for too long the insurance companies and their cronies on Capitol Hill have had their way with health care and have cause misery and agony to many people. So is there a clear fix, not yet, but someone has to do it, and I feel that because the fix is coming from who is in power at this time, then it is not acceptable. Let us not throw out the baby with the bathwater. Everyone agrees that something needs to be done, feeble attempts have been made over the years, but the ones with the gold always ends up winning. Let’s do something, will produce the same results. Nothing!

  • William

    April 7, 2010 at 7:11 am

    When did “The right to good/optimal health” become become a “right” that gives you the moral authority to use government to forcibly confiscate my labor and efforts to provide you this “right”? I read The Constitution (federal) and my State Constitution (Florida) and did not see it mentioned. Please provide your sources.


  • Sylvia Foley, senior editor, AJN
    Sylvia Foley, senior editor, AJN

    April 13, 2010 at 6:13 am

    I’m glad the health care reform bill finally passed; yes, it’s flawed, but so is the current greed-based system.

    As for sources: The idea that adequate health care is a human right doesn’t sound far-fetched to me. I’d say it’s pretty basic. But if you need sources, look at the Universal Declaration of Human Rights, adopted by the United Nations in 1948:

    Article 25.

    * (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
    * (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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