An RN's thoughts on the health care law - page 4

by RN4MERCY

I've been following the debate about the health care law and it seems like most commenters are totally for it or adamantly against it. I've been watching my family, friends, and patients face bad choices and rationed health ... Read More


  1. 1
    @ That Guy. Best point made! The answer is: It won't help you at all...that is if you work for a living. I have insurance, I work. I want everyone to have insurance..I just don't want to pay for everyone to have it!
    Szasz_is_Right likes this.
  2. 3
    @Ludlow. WHAT????? The government has NO money of their own...you know who pays for that?????? THE WORKING CLASS!!! I don't know if you work for a living, but I do! I have worked in almost every country in the western hemisphere and let me tell you having a Universal health care system is NOT a good idea. I have insurance. I want YOU to have insurance. I just don't want to pay for you to have it!!!!
    CountyRat, Szasz_is_Right, and wildboo like this.
  3. 1
    Quote from withasmilelpn
    It bothers me that some practioners would drop patients if Medicare reimbursements are lower. Thank goodness for those that choose to serve communities. When my husband and I didn't have health insurance for a short (bad) time - my OB GYN made it clear that she would work with me. Another time in our lives, free clinics are what helped us through when we were traveling because of my husband's job. We paid based on what we made. (Had insurance but found out the hard way we weren't covered out of the state we had purchased it in for anything other than Emergency care.) I realize health care is a business, we all need to eat, but it's also caring for people. Even lawyers provide Pro Bono work. I guess most likely it will be the Free Clinics that will end up accepting those medicare patients.
    Here in NYC, there is already a several years old pattern of doctors refusing to take Medicare. I believe that patients will eventually pay cash or go to a clinic. Since I am now on Medicare, I pay attention to this dumping of Medicare pts. Maybe if the administrative headaches were magicslly removed, MDs couldcut their staffs by half.
    lindarn likes this.
  4. 8
    Thank you for taking the time to publish this thoughtful summary and commentary. You raise many important points, but one that stands out in my mind is your apparent distaste for profit. Do you offer your talents and services at no charge, or do you require that those who benefit from them compensate you?

    I work to make a profit (i.e., to make more money than I need to survive) so that I can also save, invest, buy luxury items, and enjoy other pleasures over and above what I need to survive. I do not apologize for this, nor do I ask thers to apologize, whether they are individual employees like myself, or a members of a groups of people joining together to form a corporation.

    Best wishes,

    David Detsch, RN
    Last edit by CountyRat on Jul 5, '12
    Szasz_is_Right, uRNmyway, SC_RNDude, and 5 others like this.
  5. 1
    Those of us who work in private hospitals receive a paycheck from payments to the hospital by Medicare, Medicaid, government workers insurance plans, private insurance and self pay.



    Many of us also volunteer ate free or low cost clinics. If you’ve cared for someone who died as a result of untreated tooth decay you may understand why it is important for dental care to be included.
    Nurses provide pre-screening for hundreds of people a day. Most are working people with no employer insurance or no dental. Before dental work can be done people must have their hypertension and/or diabetes under control.
    Those are the most common medical illnesses treated. A nurse practitioner or physician diagnoses them. Nurses care and teach them. It often takes several hours, but needs to be done that day.
    A volunteer pharmacist dispenses several months of medication. The patient is given a prescription good for a year.
    Then they can come back another day, wait all night outside, and have their teeth worked on.



    Remote Area Medical Volunteer Corps - Oklahoma : Remote Area Medical Oklahoma
    Pikeville, KY Expedition 2012
    Remote Area Medical ends weeklong clinic in Los Angeles | 89.3 KPCC
    lindarn likes this.
  6. 4
    Good points Mr. Detsch.

    There are many of these kinds of threads going on so I don't want to repeat myself by adding links I've already placed with ideas for market-driven solutions.

    I will say THIS RN is firmly against Obamacare. And a recent poll showed that "67% of Americans disapproved of the indivual mandate when it was being labeled a penalty. Now that the Supreme Court has confirmed it as a tax, we can expect the law's popularity to fall even further." I sincerely hope so.

    This is the biggest tax hike in history and will be paid for by middle-class taxpayers. When we are already so deeply in debt (China) . . . I don't think this is the way to solve what many folks on all sides of this issue agree are problems that need solutions.

    I'm in favor of market-driven ideas. Not handing it all over to the government which will increase our tax burden (we are already struggling) and will entail losing many of our liberties.

    I've refused to join the ANA due to it's pro-Obamacare stance. And the fact that they market it as if ALL NURSES are on the same page as the leadership of ANA.

    All nurses are not in favor of more government involvement in healthcare decisions.

    As an aside - the comparison between car insurance and Obamacare has been proven null and void for years and I've posted links before to that truth. I found a new one today from an actual insurance agent that spells it out more thoroughly though.


    Obamacare vs. Car Insurance

    Obamacare vs. Car Insurance

    "I wrote this article because I got tired of people comparing the "Affordable Care Act" to car insurance. Being an independent agent and selling health insurance, I'm both the policyholder and knowledgeable about the products available. I can tell you, Obamacare has very little in common with car insurance.. . . . ."
    Szasz_is_Right, CountyRat, tntrn, and 1 other like this.
  7. 5
    Hate to break it to you, but "free" clinics still get subsidized by the government, and that's how the staff in those clinics get paid. Very few clinicians can afford to work for free, even if they have altruistic intentions. You can be sure that those clinics won't absorb all of those extra patients either. The ERs will, making busy and crowded departments even worse.
  8. 1
    Quote from Spidey's mom
    Good points Mr. Detsch.

    There are many of these kinds of threads going on so I don't want to repeat myself by adding links I've already placed with ideas for market-driven solutions.

    I will say THIS RN is firmly against Obamacare. And a recent poll showed that "67% of Americans disapproved of the indivual mandate when it was being labeled a penalty. Now that the Supreme Court has confirmed it as a tax, we can expect the law's popularity to fall even further." I sincerely hope so.

    This is the biggest tax hike in history and will be paid for by middle-class taxpayers. When we are already so deeply in debt (China) . . . I don't think this is the way to solve what many folks on all sides of this issue agree are problems that need solutions.

    I'm in favor of market-driven ideas. Not handing it all over to the government which will increase our tax burden (we are already struggling) and will entail losing many of our liberties.

    I've refused to join the ANA due to it's pro-Obamacare stance. And the fact that they market it as if ALL NURSES are on the same page as the leadership of ANA.

    All nurses are not in favor of more government involvement in healthcare decisions.

    As an aside - the comparison between car insurance and Obamacare has been proven null and void for years and I've posted links before to that truth. I found a new one today from an actual insurance agent that spells it out more thoroughly though.


    Obamacare vs. Car Insurance

    Obamacare vs. Car Insurance

    "I wrote this article because I got tired of people comparing the "Affordable Care Act" to car insurance. Being an independent agent and selling health insurance, I'm both the policyholder and knowledgeable about the products available. I can tell you, Obamacare has very little in common with car insurance.. . . . ."
    Oops --- Limbaugh, GOP have it wrong: Health care law is not the largest tax increase ever -- http://www.politifact.com/truth-o-me...ase-us-histor/
    Not_A_Hat_Person likes this.
  9. 1
    Quote from rn4mercy
    i've been following the debate about the health care law and it seems like most commenters are totally for it or adamantly against it. i've been watching my family, friends, and patients face bad choices and rationed health care because of our current health insurance system. what i really want to know is if this law will fix it.

    first, let’s look at some of the key parts of the affordable care act (aca), most of which are phased in by 2014:


    · the best parts of the law are the provisions that people cannot be denied health coverage because of pre-existing conditions, that insurers can not drop you when you get sick, and that eliminate annual and lifetime caps on coverage. what worries me are the loopholes that insurance company lawyers will use to continue to cherry-pick who they cover. for example, the law doesn’t say how much they can charge to cover people with pre-existing conditions.

    · almost everyone (even the insurance companies) agrees that it’s good to let parents keep their children, up to the age of 26, on their health insurance (if they have it).

    · large companies that don’t give their workers health insurance will have to pay $2,000.

    · people who do not have health insurance where they work and choose not to buy it will have to pay a penalty. is the individual mandate a fee, a tax, or a penalty? i don’t really care what we call it. i understand why everyone should be part of the healthcare system. medicare does this, covering everyone 65 and over. the individual mandate is a clumsier way of creating one risk pool, through private insurance companies. i’ve don’t like it because it requires people to give money to profit-making insurance companies.

    · if you are very low income, you may qualify for a government-funded subsidy to buy insurance through a health exchange, or, for the most low income, become eligible for medicaid which is set to expand.

    · it shrinks the medicare donut hole in prescription drug coverage, where there’s coverage to a certain point and then nothing until a higher spending cap is reached. since 2010, 5.2 million seniors and people with disabilities have saved $3.7 billion on prescription drugs. i believe the donut hole should be entirely eliminated.

    · all insurance plans will be required to include preventative care (i.e. mammograms, vaccinations, colonoscopies, physicals) with no co-pay, by 2018.

    · medicare coverage will now include an annual physical and no co-pays for preventative services.

    · before, small businesses paid as much as 18% more than larger businesses for premiums. now, they will get tax credits (up to 50% of the cost of premiums) for offering health insurance to their workers. in 2011, this affected 2 million employees.

    · pharmaceutical, medical device manufacturers and health insurance companies will have their taxes increased. i agree with this. this law gives them millions of new customers. they can help pay.

    · the law increases funding for community health centers, one of the best provisions of all.

    · for the first time, the law taxes health benefits, and the main target is the comprehensive, best plans. in 2018, those plans (more than $10,200/single; $27,500/family) will be taxed. the insurance company has to pay, but they’re going to pass the cost along to anyone lucky enough to have a good plan. i think this will push more people into plans that cover fewer health needs and have large out-of-pocket costs.

    · in 2013, if you make more than $200,00 (individual) or $250,000 (family), you will pay a medicare tax on investment income (before medicare tax was only on wages).

    · the medicare tax rate goes up to 3.8%, from 2.9%.

    although the advocates for the law say that it will bring down health care costs. i believe that some of these benefits are over-stated and ignore some remaining very large problems.

    what the law doesn’t or maybe won’t do:

    · despite the all the claims about cost controls for individuals and families, most of them are weak. insurance companies, drug companies, and hospitals will still largely be able to charge what they want. although there are limitations on rate increases, this is not enough protection, 9% increases for several years is just as untenable (although it is better than the current, unfettered, increases).

    · i expect that people will continue going bankrupt because of high medical bills or choosing to skip or delay doctor visits or needed treatment.

    · insurance companies will still be able to deny care recommended by a doctor using the same excuses (“experimental,” “not medically justified,” etc) as now.

    · i read that the non-partisan congressional budget office said that up to 27 million people will still have no health coverage. since the supreme court decision allows individual states to opt out of the medicaid expansion for low income people without a federal penalty, that number will probably grow.

    · some people are worried that employers will drop existing coverage because the exchanges will now be a more affordable option. i’m not too worried since before this law, employers could drop or reduce coverage any day they wanted (and many did). there’s nothing in aca which makes it more attractive to drop coverage, in fact they might have to pay a penalty for dropping coverage.

    · the law promotes it systems in healthcare, many of which are wasteful and have been used by some employers to erode rn clinical judgment.

    · there are similar misguided incentives for “wellness” programs that penalize people who have diabetes, high blood pressure, or other medical conditions often beyond their control.

    · the windfall for insurance companies, big pharmaceutical firms (who were exempted from strong cost controls to win their support for the law), further strengthen a healthcare system already too focused on profits rather than patient need.

    for me, the bottom line is the aca law didn’t go far enough. insurance companies are going to be a little more restricted more than they were in the past. it will help some people but doesn’t cover all americans.

    polls show that a majority of americans would rather that medicare cover everyone. we would still have to work to improve it, but it would be easier and more cost-effective. it would eliminate the higher administrative costs (aca limits insurance companies to 15%, even assuming they don’t find ways around that, medicare’s is 3%) and the corporate profits – billions of dollars removed from the health care system and not spent on health care.
    thank you for this analysis.
    this is a good discussion.
    what do you think of these assertions? -- four reasons why the court's decision to uphold obamacare is good news for the economy | thinkprogress
    the congressional budget office estimated that obamacare will reduce the federal deficit over the next decade. repealing the law would increase the deficit by $230 billion over the next 10 years. $210 billion
    many young americans have insurance thanks to obamacare. http://money.cnn.com/2012/06/19/pf/h...ults/index.htm
    health reform will help create about 4 million jobs over the next decade, according to a 2010 center for american progress report, by reducing the cost of health care and making it cheaper for businesses to hire. the law will create between 250,000 and 400,000 jobs a year. according to the study, the law will help create more than 200,000 manufacturing and 900,000 in the service sector by 2016. -- read the full report here
    it will be cheaper for employers to provide health care. these costs are often passed on to customers. one study estimates that each car sold by general motors contains $1,200.00 in health costs. http://www.usnews.com/opinion/blogs/...the-us-economy
    small businesses already receive tax credits contained in the law to help insure their employees. -- http://www.irs.gov/newsroom/article/...223666,00.html
    article “[color=#333333]obamacare: it’s cheaper!” -- http://www.thedailybeast.com/newsweek/2012/07/05/obamacare-it-s[color=#333333]-cheaper.html
    lindarn likes this.
  10. 2
    "That Guy" has the same reaction that many doctors have to coverage for everyone. It's commonly known as the "I've got mine" approach to the needs of others.
    The way this remarkable act (remarkable for having passed both houses, despite strenuous opposition) works to lower medical costs, is that those who will be covered, will no longer use the ED as their neighborhood doctors' office, arriving in more advanced states of their illnesses. That costs us taxpayers more, and provides fewer other programs (like transportation) that could benefit us. Prevention programs also will keep almost everyone well enough to work, longer than the current programs.
    Since doctors charge so much for their services, utilization of nurses for patient education and nurse practitioners for preliminary care will increase, and that means more time will be spent with patients by professionals who have expertise to educate them more thoroughly and effectively. Doctors traditionally speak to patients with terminology that is difficult for them to understand, and in a dispassionate manner that forbids emotional reactions (no time for that).
    Consequently, remuneration for nurses will likely increase, as well as job opportunities.
    Last edit by lamazeteacher on Jul 8, '12
    Not_A_Hat_Person and lindarn like this.


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