The complaints about a lack of adequate health care for a growing number of our nation's citizens continue to resonate that old liberal refrain: "Too little, too late, for too many." We blithely refer to those who complain about the status quo of our health care system as whiners and naysayers-people with many complaints and few solutions. We ask: "What do these people have to complain about?" Nationally, we pride ourselves in believing that our country has the most complete and effective health care delivery system the world has ever known. No other country can save lives to the extent we can. However, we cannot be proud of statistics showing that 77% of the uninsured come from working families and that children comprise 12% of that number.
The World Health Organization has said that America spends more than any other country on health care but ranks low in overall quality. Yet among the Organization of Economic Cooperation and Development nations, there are only two nations holding membership that do not offer universal health insurance coverage for their citizens: the United States and South Africa. In America today there is an expectancy about new and innovative ways of presenting coverage options, and we staunchly support the diversity and independence of our health delivery system(s) and the providers associated with them.
The problem with that rationale today is that we are in a recession. Once plentiful jobs have begun to disaapear. Many organizations simply do not offer the number of moderate-wage jobs with benefits that once were so plentiful. Instead, some are shifting to contract and part-time labor and do not provide health benefits as part of the employment agreement. Moreover, the numerous small firms that provide no health insurance is a major national problem.
Hence, we no longer can rely on the "go to work" cliche as a means of justifying our failure to respond to the current crisis in health care.
For those of us with health coverage, one of the most exciting aspects of our system of care is that one never quite knows exactly what will be paid for and how much will be paid. We wait expectantly for our Explanation of Benefits (EOB) to arrive from our insurance carrier to find out just how much will come out of our pocket. When we see the EOB, we note that the provider billed at its standard (retail) rate and the payer then discounted that rate to a more reasonable level based on its reimbursement contract with that provider. We then have a nominal deductible to pay and we thank our lucky stars for our coverage and good fortune.
Think for a moment what that envelope-opening scenario must be like for an uninsured person who must figure out some way to pay the retail rate. Uninsured individuals describe the feeling as gut-wrenching, laced with a sense of utter helplessness, and worse.
To resolve the problem of the uninsured, our elected officials must stop trying to satisfy their political responsibilities with band-aid solutions and begin addressing the need for a health care subsidy-a tax-that will be earmarked for the uninsured. Those of us who are covered by health insurance are simply going to have to shed our unyielding posture of no new taxes, and accept the fact that it is an absolute necessity to address this serious and growing problem. We also should thank and praise, rather than vilify, those politicians showing the courage to enact this needed and long overdue measure. Finally, all recipients and providers of health care must recognize the limits inherent in our system, despite its greatness, and accept the fact that some rationing will be essential in realizing a greater good for all.
If the current problem continues to spread unabated, it has the potential of severely damaging, perhaps permanently, the economic infrastructure and growth potential of our entire country. Protecting the health of the uninsured not only reflects a great moral value but also makes good business sense. Simply stated, healthy workers are more productive than sick ones.
This issue of The Health Care Manager (HCM 22:2) offers the following articles for consideration:
* "The Interrelationship of Organizational Characteristics of Magnet Hospitals, Nursing Leadership, and Nursing Job Satisfaction," which addresses the question of whether magnet hospitals remain able to provide reasonable levels of job satisfaction among nurses during a prolonged period of nursing shortage.
* "Hospital Restructuring, Workload, and Nursing Staff Satisfactions and Work Experiences," which reports on a study examining changes in patient-nurse ratios resulting from hospital restructuring and how these changed circumstances affect nurse functioning and other operating characteristics.
* "Decertification Elections in Health Care: Some Recent Evidence," which addresses the three-year history of hospital union decertification elections and comments on win and loss rates for unions in hospitals.
* Case in Health Care Management: "She's Having a Rough Time," which asks the reader to consider the problems presented by an employee who is chronically unavailable because of health reasons and appears to be afforded extra consideration because of personal relationships.
* "The Movement for Diversity in Health Care Management," which reviews the problems inherent in attempting to achieve workforce diversity through quotas and regulations and calls for adoption of an ethical and moral basis for embracing diversity as essential to the future of health care management.
* "Length of Stay at an All Time Low," which addresses the critical question of whether the constant pressure to reduce the length of hospital stays adversely affects the quality of service.
* "Ideal and Perceived Satisfaction of Patient Care Providers," which reports on a study that compared ideal job satisfaction and perceived job satisfaction levels of patient care providers in several specialized area of patient care.
* "Clinical Supervision: A Working Model for Substance Abuse Acute Care Settings," which outlines a particularly successful model of clinical supervision applied in this setting.
* "Sexuality, Sexual Harassment, and Sexual Humor: Guidelines for the Workplace in Health Care," which suggests that managers must set appropriate standards for workplace humor and take positive steps to avoid legal problems as well as damage to interpersonal relationships.
* "A Study of the Skills and Roles of Senior-Level Health Care Managers," which reports on an effort to determine senior health care managers' perceptions of the roles and associated skills that are most important in managing in today's health care environment.
* "Relocating Rheumatology Patients to a New Infusion Center at Duke: A Case Study," which reports on the relocation of rheumatology patients at Duke University Medical Center to a new infusion center located in a physician-based treatment setting.
* "Document Security: A Funny Thing Happened on the Way to the Shredder," which addresses everyday document security concerns from the perspective of the health care department manager and offers some suggestions for protecting both employee privacy and patient confidentiality.