How Will Universal Health Care Change Nursing?

CanuckStudent · Jun 26, 2009

It's so popular these days to analogously paint profitable entities as Satan. :smackingf
The logic behind non-for-profit hospitals is to provide charity. In studies, for-profit hospitals provide just as much charity work as non-for-profit hospitals. When you factor in the tax revenue generated/not generated, for-profit hospitals do much more for communities than non-for-profit hospitals. Many restaurants, grocery stores, etc... intentionally locate near hospitals. Are they evil also? NO.

? Did somebody on here refer to for profit hospitals as 'evil'?

I don't recall seeing that. I personally did say that many Americans are brainwashed to think that universal healthcare is 'evil' though.

I don't know anyone who thinks (nor cares to think about) private healthcare as evil. I think it has corruption, just like every other business. Hell, we all know governments have skeletons in their closet, so I suppose this is a moot point. Do most Americans see Big Insurance/for profit hospitals as evil, is this what you are trying to say?

I suppose I've never really thought about that. I just thought that it was accepted as being as American as apple pie. ?

kinesjl · Jun 26, 2009

The Kennedy-Dodd legislation would provide new insurance premium discounts to households with incomes below 500 percent of the federal poverty line. These subsidies would be phased in slowly over a number of years. Total federal costs for the program are expected to be near $1.5 trillion over 10 years, and costs for the bill might go as high as $2 trillion depending on certain legislative specifications.

Even more troubling is the expectation that costs will rise rapidly every year, even beyond the 10-year budget window. The Congressional Budget Office (CBO) has estimated that the annual cost of the insurance subsidy program in an early version of the Kennedy-Dodd bill would rise 6.7 percent per year after it is fully phased in. There is nothing in the legislation that would lead one to expect that pace to slow after the first decade.

Rapid cost growth for a health care entitlement is nothing new, of course. The federal government already runs two other health entitlement programs--Medicare and Medicaid--and they have been growing faster than per capita GDP growth virtually every year since their enactment in 1965. CBO has estimated that between 1975 and 2005, average per capita Medicare spending exceeded average per capita GDP growth by 2.4 percentage points, and Medicaid's "excess cost growth" rate was nearly as high (2.2 percentage points).

The rising costs of these entitlement programs are expected to push the federal government deep into dangerous levels of debt under current law. CBO projects that between 2010 and 2040, federal spending on Medicare and Medicaid alone will rise from 4.4 percent of GDP to 10.2 percent. That jump in spending--5.8 percent of GDP--exceeds the size of Social Security today. As matters stand, the bills emerging in Congress would add yet a third unfinanced health entitlement on top of the two already on the books.

President Obama and his top health care policy advisors have pledged to work on a health care bill that "bends the cost curve" throughout the health sector. But the ideas that the Administration has put forward to date would either do little to slow rising costs or shift costs from public insurance to private premium payers.

First, the Administration has suggested a series of reforms that might be called "efficiency through government engineering." The idea is that the health care system can be made more productive with government-led "investments" in health information technology, comparative effectiveness research, and prevention and wellness efforts.

Some of these concepts may in fact be meritorious. However, as CBO has stated on numerous occasions, absent more financial incentives for consumers or suppliers of medical services, these reforms alone are highly unlikely to produce much by way of savings.

Furthermore, the government has been running the Medicare program for nearly half a century now, and it is clear from that record that the government has little capacity to drive efficiency in health care.

Medicare remains largely a fee-for-service insurance arrangement, which pays any licensed provider of medical services the same rate, regardless of the quality of the services delivered to patients. Repeated efforts to steer patients and services toward a higher-quality, lower-cost network of providers have failed. For instance, a long-running effort to buy durable medical equipment (DME) services for Medicare enrollees through a competitive bidding process was blocked by Congress last year. In its place, Congress passed an across-the-board payment cut for all DME suppliers to meet a budget target.

Recently, in an effort to put more "scoreable" cost-cutting ideas on the table, President Obama proposed to cut Medicare and Medicaid reimbursement rates for various health care providers by an additional $313 billion over 10 years. Those cuts come on top of the $309 billion the President proposed in his 2010 budget submission to Congress, for a total proposed reduction in Medicare and Medicaid of $622 billion over 10 years.

These proposed reductions in Medicare's reimbursement rates, many targeted at hospitals, are emblematic of how the government runs a health insurance plan. After much talk of trying to pay for value instead of quantity, the government is resorting to arbitrary, across-the-board fee cuts--which generally hit all providers, regardless of quality or cost--to meet budgetary goals.

Moreover, these fee cuts are not likely to change the underlying cost structure in health care. In the past, when Medicare has cut reimbursement rates, providers of medical services have raised rates for private insurers to make up the difference. There is every reason to believe President Obama's proposed payment rate cuts would also lead to cost shifting.

The only reliable and lasting way to drive greater efficiency in health care is with cost-conscious consumers in a reformed marketplace. The "Patients' Choice Act" would implement the reforms needed to build just such a marketplace. Americans would get fixed tax credits toward the purchase of insurance. If they used those credits to buy a more expensive plan, they would pay the cost difference. If, on the other hand, they enrolled in less expensive coverage, they would keep all of the savings too.That is the way to provide strong financial incentives to insurers and the suppliers of medical services to reorganize themselves to be more efficient and patient-focused.

The government can and should play an effective oversight role in such a marketplace, much as the Centers for Medicare and Medicaid Services have done with the new Medicare prescription drug benefit. But the government cannot bend the cost curve from Washington without resorting to arbitrary caps and price controls that always lead to a reduction in the willing suppliers of services and waiting lists.

Saúde · Jun 26, 2009

I've never read in our Constitution where it gives our federal government authority over the states on this subject or many, many, many, other subjects. Talking about brainwashed......

Saúde · Jun 26, 2009

America, as originally intended to be, consisted of a bunch of independent and self sufficient states. These states had total sovereignty over their laws, religions, culture, and way of life, unless otherwise specified within the Constitution. For example, New York didn't really care much if Massachusetts had a State established Christian Puritan religion because it was a sovereign state, independent from New York. Who was New York to tell Massachusetts how to run their state? The states were joined together as a country for purposes of protecting the liberties and sovereignty that each enjoyed collectively within their states. This sovereignty has incrementally through the years eroded to the point where today states think they are now cities and the country now thinks it's a state. Many Americans abhor the idea of government funded health care because it flies in the face of Constitutional principles.

Saúde · Jun 26, 2009

(10th Amendment) The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

And again..... Talking about brainwashed.....

CanuckStudent · Jun 26, 2009

America, as originally intended to be, consisted of a bunch of independent and self sufficient states. These states had total sovereignty over their laws, religions, culture, and way of life, unless otherwise specified within the Constitution. For example, New York didn't really care much if Massachusetts had a State established Christian Puritan religion because it was a sovereign state, independent from New York. Who was New York to tell Massachusetts how to run their state? The states were joined together as a country for purposes of protecting the liberties and sovereignty that each enjoyed collectively within their states. This sovereignty has incrementally through the years eroded to the point where today states think they are now cities and the country now thinks it's a state. Many Americans abhor the idea of government funded health care because it flies in the face of Constitutional principles.

Are you worried about states losing their personal independence? In Canada, each province individually controls their healthcare budget. This was already mentioned on this thread. So that isn't necessarily a concern.

I don't want people to lose sight of the big picture. American currency has "In God We Trust" written on it and Presidents are always stating "God Bless America", but the fact is, I believe the US constitution states that church and state must be separate!!!! Yet we don't hear many people protesting because of that. Using religion to bond the masses is a good technique.

Is that what you refer to when you mention "brainwashing"? Do you mean that Americans don't know what is true when it comes to their government, and therefore can't trust them to run healthcare? Perhaps this is valid, I don't know.

Regardless, tax payer funded healthcare as you can see does not *have* to affect the constitution, and what we all need to be focusing on is how to help those who are suffering because they can't get care. That is the main issue.

No one should lose their home because of having to decide between a mortgage and cancer treatment. IMHO.

I'm curious to see what will happen in the coming months in regards to this issue...

Edit: I have to admit that as a Canadian, I know nothing about the US laws or 'constitution'. Zero. And nobody should expect me to. But I still think that a valid option can be found that makes everyone happy.

Saúde · Jun 26, 2009

States are NOT prohibited from establishing a religion, only the Federal Government is. There is NO Federal Constitution prohibition of states establishing a religion as long as the state established religion does not obstruct or restrict the rights of its citizens to practice alternative religions.

Fiona59 · Jun 26, 2009

Could we bring this back to how NURSES would fare under the programme?

Not spout political theory until the cows fall asleep?

Oh, and when my son broke his arm, he was in and out of the ER in under three hours.

Saúde · Jun 26, 2009

Once again... I've never read in our Constitution where it gives our federal government authority over the states on this subject or many, many, many, other subjects.

If individuals are ignorant of our American Constitution then their opinions have no authority and their responses are worthless.

The idea that New York, for example, has a Constitutional right to limit or affect in any way Massachusetts laws, religions, culture, health care, and way of life, unless otherwise specified within the Constitution, should be fiercely opposed and tirelessly exposed on the basis of Constitutional illegitimacy.

jdub3 · Jun 26, 2009

I've never read in our Constitution where it gives our federal government authority over the states on this subject or many, many, many, other subjects. Talking about brainwashed......

Thats pretty much it bottom line. When did we forget the values our country was founded on. Lots of us are missing the real story, Socialism does not belong in America. If you want to be capped off and overworked then yes, go ahead and support this crap that has been laid out by our CNC.

kinesjl · Jun 26, 2009

Are you worried about states losing their personal independence? In Canada, each province individually controls their healthcare budget.

In many ways Canadian health care is less centralized and regulated then the current U.S. system despite Universal coverage.Furthermore, all current U.S. health care reform proposals would only increase this level of centralization, along with all of the problems that come with such a system, which I have already delineated quite thoroughly in several previous posts.

kinesjl · Jun 26, 2009

Could we bring this back to how NURSES would fare under the programme?

That part is rather simple, significant cuts in pay and ample increase in workload.