Obamacare: Should I get out while I still can?

mariebailey, MSN, RN · Nov 11, 2012

WF Fqlz

Did your cat run across your keyboard? :lol2:

BlueDevil,DNP, DNP, RN · Nov 11, 2012

AmandaVanGuilder- I am wondering if you are aware that the ACA and the Massachusetts plan of which you are so fond are fundamentally the same? Or is simply the federal implementation of the plan that you oppose? Taxes must go up for many people*, one way or another, mostly through elimination of deductions. That is the long and the short of it, lol.

*above certain income levels, not going to take the time to elaborate on the specifics at this time.

DoGoodThenGo- What you describe has been happening for 20 years and works beautifully, with outstanding results. The fee-for-service model is going to end, and insurance companies are going to have to adjust. They will not like this, as it has been a cash cow for them. But the system cannot sustain it, and the gravy train is over. The transition has already begun, and some of the most successful systems in the country (Mayo, Cleveland Clinic, Kaiser) have already proven the comprehensive care model works, with better outcomes and improved provider and patient satisfaction. They can be profitable as well, but not with the same margins the fee-for-service model used to provide. The only "losers" are the share holders, and what they are losing are a few percentage points. Risk is inherent in investment and they are less entitled (there's that word again ) to that net return than are individuals to basic health care. Therefore, the transition is, IMO, ethical and socially just, not to mention in the best interest of public health.

SC_RNDude · Nov 11, 2012

No, not necessarily. I believe that all Americans should have access to affordble health insurance. In Mass, Romney (while governor of Mass) put together a brilliant plan that allowed for all people to have health insurance. After a year of research, he was able to gain an accurate view of his residents and their needs. By doing so, he was able to provide reform that suited the residents of his state. He developed a plan that would provide for individual residents of the state to purcahse insurance directly and based on their income. The state would provide subsidies according to financial need. The subsidy for the poor was on a sliding scale where the poorest would get a greater percentage of money, and people received less and less of a subsidy as their incomes went up and they were more able to afford it on their own.The monies that would go towards providing these subsidies would come from the funds that were previously designated to pay for people who were receiving a "free ride." What Mr. Romney found through his year long research was that only 20% of the uninsured were truly too poor to buy health insurance. This is a very important point because it had generally been assumed that all the uninsured fell into this category. 40% of the uninsured had the financial means to purchase health insurance but simply refused to do so. The last 40% of the uninsured were people who were able to partially pay for their insurance premiums, but could not afford all of it. As of today recent polls have shown that 84% of Mass residents are in favor of the reform that has gone into place. 99% of the residents of Mass have health insurance, and it has not exceeded it's budget in over 5 years. It still allows Mass residents to choose their plans and therefore retain their freedom and control. I do not endorse a "one size fits all" as Obamacare is and I also do not support a plan that gives the federal government control over such an important issue as my health. I also do not support a plan that will increase tax dollars that I or any other American will have to pay. There is a better way to fix problem and Mr. Romney prooved it. Each state should be responsible for their own. That is the beauty of our unique model as a united nation of states.

Actually, although a less complicated law and run at the state level and therefore much more efficient then Obamacare will be, Romneycare isn't working either. That's why you didn't here much about it from either side leading up to the election.

Sorry, Liberals, RomneyCare Is Still Not Working - Reason.com

SC_RNDude · Nov 11, 2012

Regarding your first statement - NO, that is not what I stated. Nurses advocate for their patients, so I do have a hard time understanding why a nurse or aspiring nurse would be opposed to legislation that would allow more access to primary & preventive services and prevent denial of coverage d/t pre-existing conditions, among other perks. Regarding the quote at the end: nursing is hard work; many of us work long hours under stressful conditions. Burnout potential is high if you like the job/financial security but dislike the nursing aspect of nursing. That is worth considering.

-You have further clarified that you do not think that someone who has a different point of view then yourself on the effectiveness of Obamacare can be a good patient advocate.

-I agree. Someone should consider those aspects of a nursing career when considering going into it. I took you statement a different way (actually two) the first time. Thanks for elaborating.

PMFB-RN, RN · Nov 11, 2012

Actually, although a less complicated law and run at the state level and therefore much more efficient then Obamacare will be, Romneycare isn't working either. That's why you didn't here much about it from either side leading up to the election.
Sorry, Liberals, RomneyCare Is Still Not Working - Reason.com

The problem with your position is that the Patient Protection and Affordable Care Act is a concervative law. Nothing but a shill to big business. It's nothing liberals would want.

AmandaVanGuilder · Nov 11, 2012

BlueDevil DNP: ACA and Romneycare are different in many ways. I am opposed to taxes going up because they don't have to at all. In fact Romney proved that with the implementation of Romneycare. Although it is nice to trust what the mass media tells us about Obamacare and how it is so similar to the very successful program that Mass has in place now, they are lying to you! It's high time we start doing our research instead of just accepting what information we are fed. We must be wise consumers. Here is an outline of the vast differences. RomneyCare VS ObamaCare

RC – Applies to only 8% off MA workers that were not insured.
OC – Applies to 100% of Americans
RC – Bill is 70 pages long
OC – Bill is 2000-3000 pages long (28X greater)
RC – Romney VETOED 8 parts of the Bill before it was passed
OC – Obama VETOED 0 parts of the Bill & has not read the entire bill
RC – Written by Office of Govenor MITT ROMNNEY
OC – Witten by . . . . ?
RC – Funded by existing revenues
OC – Paid for by borrowing money
RC – Did not raise taxes
OC – Raises taxes
RC – Inforced by Massachutes Health (MassHealth)
OC – Inforced by the IRS
RC – Adopted by 67% majority vote in MA (2/3rd)
OC – Forced thru Congress and has no Bi-partisan support (Obama Democrats only) Backroom deals
RC – Leaves 0.02% of children un-insured
OC – Leaves 11% of children un-insured
RC – Doesn’t affect / cut Medicare
OC – Reduces Medicare Benefits
RC – Ruled as Constitutional
OC – Ruled as Unconstitutional twice (so far)
RC – Does not Regualte Health Care Industry – works with Healthcare Providers and Private insurance companies
Oc – Regulates 100% of the Health Care Industry – Forces Healtcare Providers and Private insurance to comply.
RC –
OC – caused the loss of many democratic seats in Novemeber of 2011
RC – Still in effect in MA
OC – Budget concerns, Constitutionality of mandate in question.
RC – Don’t like it – Try another approach
OC – Don’t like it – Tough!
RC – Stayed on Budget Projections
OC – Went over budget by 100% (can Obama add?)

It seems so very obvious to me that we have a real problem on our hands and although it is the law of the land, it is scary!

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d'cm · Nov 11, 2012

Amanda, I see a great future for you in nursing administration, an area of nursing where the ability to promulgate nonsense by citing copious reasons without regard to spin or accuracy is often greatly rewarded.

BlueDevil,DNP, DNP, RN · Nov 11, 2012

Amanda, most of your "facts" are just patently untrue. I won't bother with them individually, it isn't worth the time. Rather, I will point you to the MIT economist and perhaps the foremost expert on health care policy in the country, Jon Gruber, who helped author BOTH of the early proposals that have evolved into what you refer to as Romney care and Obamacare. In his, expert, opinion they are fundamentally the same. Forgive me if I defer to his opinion on this matter rather than yours or the pundits'. FWIW, he wrote both a traditional text book and a comic book. If you care to delve further into the subject, you can choose the format you prefer.

Romneycare, Obamacare, and reform after tomorrow

AmandaVanGuilder · Nov 11, 2012

I am not interested in slinging mud and have no desire to stoop so low. I am allowed an opinion as are you. I am simply putting information out there. I am not asking for anyone to agree with me. I was just giving an answer in response to a previous post. I do not favor Obamacare. I have read multiple documents that outline Obamacare and after doing much research have come to my own conclusion. I do not for see it providing a true solution to our problem. We will see how it does play out in the long run. I will be elated if the program is successful but I am suspicious.

Susie2310 · Nov 11, 2012

Didn't take long post election for the Speaker of the House, John Boehner to issue a statement saying "Obamacare is the law of the land". So like it the thing is done and we all must bear it as best we can.
Not only did Obama win re-election but Democrats held and increased their seats in the Senate in many cases with far more liberal members than before. In short several themes seem to have emerged from the election results including a majority of hte population believes the federal government should be *more* involved affairs such as healthcare.
Physicans as a group in whole according to polls did not support Obama, and now it remains to be seen how they respond to the changed landscape. However two trends that began before the election probably are going to continue; more doctors are going to give up private practice in favour of being "employed" by hospital systems, and physicans who can are going to decline all type and sort of insurance/entitlement programs in favour of cash payment up front. From there patients will have to submitt claims to get their money back.
As it relates to hospitals/healthcare systems the push from the federal government to drive down costs is most certainly going to be felt in one way or another by the nursing service. Hospital/bedside nurses probably looking at yet more paperwork, doing more with less staffing, adjusting to creative and or innovative staffing methods as hospitals seek to fine tune census to nurse ratios.
In many areas of the country there is probably going to be more mergers and or closings of hospitals as the weakest either shut down or absorbed by larger systems. That again continues another trend in healthcare; the larger the system the better able it will be to demand better reimbursement rates from insurance companies and so forth. One foresees hospitals/heathcare systems moving more towards a type of vertical integration system where they are not only providers of healthcare but insurance as well.
Look also for more out sourcing such as what a hospital in Westchester recently pulled off; terminating all employed NAs then contracting out that service to an agency.
Long story short it took generations to build up the private healthcare system in the United States, and many are going to have to be dragged kicking and screaming into any sort of world that even smells of what they associate with "socialised" medicine.

Please could you direct me to the source/s where you found that physicians as a group according to polls did not support Obama. I could not find this information in a google search.

MunoRN, RN · Nov 11, 2012

BlueDevil DNP: ACA and Romneycare are different in many ways. I am opposed to taxes going up because they don't have to at all. In fact Romney proved that with the implementation of Romneycare. Although it is nice to trust what the mass media tells us about Obamacare and how it is so similar to the very successful program that Mass has in place now, they are lying to you! It's high time we start doing our research instead of just accepting what information we are fed. We must be wise consumers. Here is an outline of the vast differences. RomneyCare VS ObamaCare

I appreciate the thought you've put into this, and breaking these issues down is a good idea, although many of your statements are incorrect. First it's important to note that Romneycare and Obamacare have many key similarities, but are not exactly the same; they have two very different scopes. I should also clarify that I don't like Obamacare either, it's essentially a Republican bill, most of what Republicans are complaining about could have been fixed if we had gone with the more progressive proposal of single payer, non-profit/government option, and best practice requirements.

I included my responses within your list (bracketed, bolded and italicized), I don't know if this makes it any easier to read or not.

RC - Applies to only 8% off MA workers that were not insured. [Regulations to plans affect 100% of plans, affecting 100% of residents] OC - Applies to 100% of Americans
RC - Bill is 70 pages long [229 pages long actually]
OC - Bill is 2000-3000 pages long (28X greater) [995 pages long,
RC - Romney VETOED 8 parts of the Bill before it was passed [All of his vetoes were overriden]
OC - Obama VETOED 0 parts of the Bill & has not read the entire bill [The bill included 160 Republican amendments, many of which I'm sure Obama would have liked to have seen gone, but he was trying to make a bipartisan gesture (which got him nowhere).]
RC - Written by Office of Govenor MITT ROMNNEY [The Governor's office made a proposal to the Legislature who then wrote the bill that was passed.]
OC - Witten by . . . . ? [Written by the Senate Finance Committee - 3 Democrats and 3 Republicans]
RC - Funded by existing revenues [Funded by both individual and employer mandates]
OC - Paid for by borrowing money [Also funded with mandates, No additional money is borrowed due to ACA, actually it decreases the deficit by $212 Billion between 2012 and 2021]
RC - Did not raise taxes [Tax/penalty ranges from $228 to $1,212 per year]
OC - Raises taxes [Tax/penalty ranges from $97 this year to $695 when fully phased in]
RC - Inforced by Massachutes Health (MassHealth) [Tax/Penalty enforced by the Mass Dept of Revenue]
OC - Inforced by the IRS [Health Provisions of the Act enforced by the Dept of Health and Human Services]
RC - Adopted by 67% majority vote in MA (2/3rd)
OC - Forced thru Congress and has no Bi-partisan support (Obama Democrats only) Backroom deals [Written by a bipartisan committee, included 160 Republican amendments, written during 31 Bipartisan meetings between June and September of 2009]
RC - Leaves 0.02% of children un-insured [the Mass uninsured rate was 4.1% in 2012, Romney's initial proposal didn't include additional measure to insure children, that was added by the legislature.]
OC - Leaves 11% of children un-insured [leaves 7% uninsured by 2022, the Romney/Ryan proposal to change healthcare reform would triple that.]
RC - Doesn't affect / cut Medicare [it's a state law, legally it can't alter medicare]
OC - Reduces Medicare Benefits [specifically states it cannot reduce Medicare benefits]
RC - Ruled as Constitutional
OC - Ruled as Unconstitutional twice (so far) [Ruled constitutional by the Supreme Court]
RC - Does not Regualte Health Care Industry - works with Healthcare Providers and Private insurance companies [Romneycare actually operates under some of the most complex regulations on health care plans in the country]
Oc - Regulates 100% of the Health Care Industry - Forces Healtcare Providers and Private insurance to comply. [includes similar regulations for plans, leaves state specific regulations in place]
RC -
OC - caused the loss of many democratic seats in Novemeber of 2011 [Democrats usually aren't happy when their representatives pass a law that is tailored primarily to Republicans]
RC - Still in effect in MA
OC - Budget concerns, Constitutionality of mandate in question. [The CBO's current projection is that Obamacare will REDUCE the deficit by $210 billion. The supreme court has already ruled on the mandate, which was a core principle of Republican healthcare policy]
RC - Don't like it - Try another approach
OC - Don't like it - Tough! [The mechanism for changing both Romneycare and Obamacare is the same]
RC - Stayed on Budget Projections [Romneycare is on track to exceed it's $1.8 billion budget by $150 million this year year]
OC - Went over budget by 100% (can Obama add?) [i assume you're referring to the claim that the CBO reported an increase in cost from $940 billion to $1.76 Trillion, which is not actually what the CBO report said. This reflected only a portion of the equation (costs), missing that as costs go up so do savings, the CBO actually said that the gross costs of the insurance provisions have gone up 9%, but there are also been increases in savings, resulting in a NET cost DECREASE of 0.64% from previous projections.]

Mindful, RN · Nov 11, 2012

Romney lost !