Wisconsin has gutted Medicaid, no mandated ratios!

Nurses Activism

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  • by EponaRN
    Specializes in Psychiatric.

You are reading page 4 of Wisconsin has gutted Medicaid, no mandated ratios!

Specializes in med/surg/tele/neuro/rehab/corrections.
As for corps not paying enough taxes... You could do something in the nature of Texas where there is no state income tax. There is only a sales tax. As for mandated staffing ratios, as one poster stated, only one state has those ratios. I have worked at alot of different facilities, and my current facility asks us to do care on 6-8 patients a nurse. In exchange they offer RRTs for ekgs and breathing treatments, CNAs for VS and help with patient care, Lab techs to draw blood, and other ancillary services. I like that. Some hospitals in california to save costs cut out all of those and had RNs do primary care on 6 patients. According to economics it will all work out. For example if you ask nurses to practice unsafely at too high ratios, nurses will quit, and you will have to hire agency and try to keep them. Eventually the cost of nursing help will be too high for you to afford it and you will either close or get better staffing.:coollook:

In CA Hospitals we have 5 pts on med/surg, RT to do breath treatments and ABG's, Lab techs for blood draws and CNA's for V/S and help with pt care, and the EKG lady does EKG's (I don't know what she is called LOL) plenty of ancilliary staff. Plus the hospital can make a profit and yes we take care of plenty who don't have insurance.

Perhaps there is a rare hospital in CA that doesn't have this and you are welcome to let me know. I just don't know of any.

Specializes in Family Practice, Mental Health.
In CA Hospitals we have 5 pts on med/surg, RT to do breath treatments and ABG's, Lab techs for blood draws and CNA's for V/S and help with pt care, and the EKG lady does EKG's (I don't know what she is called LOL) plenty of ancilliary staff. Plus the hospital can make a profit and yes we take care of plenty who don't have insurance.

Perhaps there is a rare hospital in CA that doesn't have this and you are welcome to let me know. I just don't know of any.

I work in California in the ICU. We have 2:1 ratio, and I agree with this poster.

EponaRN

32 Posts

Specializes in Psychiatric.
"my reason for concern is the mismanagement of the milwaukee county mental health complex under scott walker that went seriously understaffed, cnas were cut leaving rns to have to pick up extra shifts and overtime."

asking for clarification only--what does this statement have to do with walker? he was recently elected, wasn't he? why is he being blamed for a host of things when he was not in charge until recently?

he was the county executive that oversaw the complex and the behavioral health department before becoming governor.

EponaRN

32 Posts

Specializes in Psychiatric.
In CA Hospitals we have 5 pts on med/surg, RT to do breath treatments and ABG's, Lab techs for blood draws and CNA's for V/S and help with pt care, and the EKG lady does EKG's (I don't know what she is called LOL) plenty of ancilliary staff. Plus the hospital can make a profit and yes we take care of plenty who don't have insurance.

Perhaps there is a rare hospital in CA that doesn't have this and you are welcome to let me know. I just don't know of any.

Yes but your system has been in place for how long? This is radical change that is happening in this State not incrementally but immediately once the new budget starts in June. While we can probably get there, there will be a lot of I fear, death and error in the meantime as the scramble begins to figure the system that will work out.

EponaRN

32 Posts

Specializes in Psychiatric.
If you tax corporations they will either leave or simply raise the price of their products and pass on the increase to the consumers, even the poor consumers. If sales drop, they cut positions to compensate. It saddens me when I hear people get angry because they are having to increasingly take financial responsibility for themselves and then see them react to that by wanting to take MORE money that THEY haven't earned from those that HAVE worked and sacrificed to earn it to subsidize a higher standard of living then they themselves produce.

This is especially true since the lower 50%ish don't even pay taxes, meaning every service they get, be it roads, healthcare, national defense, etc. is all ready completely subsidised by "the evil rich".

Now, I'm not against charity, so long as it is voluntary. I don't think all poor people have brought it on themselves. But this idea that you can pass a law and take money from a group that has more money than you just because you want something you can't or won't afford is sad. Lets face it, for the most part we are where we are in life because of the sum total of the choices we have made. Some of those choices to do things or not to do things have life long consequences and lead to a life of financial struggle. I know this because I'm one of them. I'm trying to compensate for that now by trying to educate myself and improve my situation (by becoming a nurse of all things:) but I, as a responsible individual, could and would never "legally steal" from those around me and place upon them, without their consent, the repercussions of my life choices and/or choices of in-action.

While he hasn't done it perfectly, I am completely behind Walker and his efforts to do what no one else was willing to do, reign in the out of control spending and return personal responsibility to its appropriate owners.

This being said, I do believe in VOLUNTARY charity and know that there are many that truly have legitimate need due to cirmcumstances outside of their control. I'm not heartless. Well, not mostly. I'll do all I can to help my brothers and sisters, but I'll never use the law to steal from them and I will never obligate them to do anything. We are all going to feel the tightening of the belt and we are all going to have take care of each other and help do what we should have all ready been doing, taking care of each other and ourselves rather than delegating that task to those with more money than us.

Your opinions on taxes aside, care to answer my question on patient safety being potentially impacted by cutting an exorbitant amount of Medicaid in rural and urban areas of my State that will have to figure out how to manage with the less money (they already get paid half or so what a treatment is worth, also had to create a hospital "tax" on all hospitals to get extra money for those Medicaid hospitals) which will result in Nursing cuts because that is the biggest expense (it's basic Economics not commenting on the morality of it) and since anything can happen, 12:1 was maybe a high number but what about 8:1 on a Med/Surg floor when you were used to 6, daily, there would be a lot of adjustment and lot of error would there not?

Correction: That would be about 40% that pay no federal income taxes.

This (or some variant) is an often cited statistic that does not convey a true picture of the tax burden in the US and gives the impression that 40% of the population pay no taxes. In order to get the true picture, you must use the total tax burden, which consists not only of federal income tax but also federal payroll taxes (SS and Medicare), state and local income taxes and sales taxes.

Note that everyone pays federal payroll taxes (SS and Medicare) to the tune of about 7.65% - if self-employed, you pay at a rate nearly double that (13.65%). The overwhelming majority of the 40% “paying no federal income taxes” do in fact also pay state and/or local income taxes. And though everyone pays sales taxes, they are by definition regressive, meaning that those with lower incomes pay proportionately more than those with higher incomes.

At the very least then, the “40% that pay no federal income taxes”, pay at least 7.65% of their earnings in taxes for SS and Medicare. It’s highly likely that they also pay some percentage in state and/or local income taxes. And it’s a given that they pay sales taxes.

It’s also true that the rich pay taxes - and in fairness, they actually pay quite a lot. The question that really needs to be addressed is: Do the rich pay their fair share? In 2007, the top 400 taxpayers in the US paid on average $39,000,000 in federal income taxes (I have not been able to find data on the total tax burden for these high earners but SS tax is trivial as a percentage since it only applies to the first $105,000 of earnings, Medicare represents 1.45% and of course state income tax varies – nearly nothing in some states to upwards of 10% in others). For arguments sake, let’s add a whopping 10% to cover these. At the average income level for this group ($215,000,000) then, they might pay as much as $21,500,000 more in taxes.

So the average total tax burden for the top 400 taxpayers (representing about 1.15% of the total income reported in the US) would then be 28% (18% federal income tax plus 10% all other taxes). That compares to perhaps a 10% total for someone earning $25,000 (zero federal income tax, 7.65% payroll tax plus 2.35% all other taxes). Put another way, at the average income level of the top 400 earners ($215 million) the average total tax burden (28%) would mean $60.5 million in total taxes paid. This number dwarfs that paid by someone earning $25,000, who at the 10% rate would pay “only” $2,500.

Here are some other relevant statistics though. In 1995, the income tax rate for the top 400 earners was 30% and their average income was $50,000,000, representing about .49% of total US income. So in 16 years, the average earnings of the top 400 have grown by 430% and their share of the national income has risen by over 300% while their tax rate has decreased by 40%. While it is true that federal income taxes have also declined on low earners over that same period, it is equally true that their income has not increased at anything like 430% (in fact, income growth for the bottom 50% has been more or less stagnant since the Kennedy administration).

So do the rich pay a fair share of the taxes? I honestly don’t know - you can be the judge. Just don’t try to fool folks into thinking that the poor don’t pay any taxes by stating that they pay no federal income taxes.

Your opinions on taxes aside, care to answer my question on patient safety being potentially impacted by cutting an exorbitant amount of Medicaid in rural and urban areas of my State that will have to figure out how to manage with the less money (they already get paid half or so what a treatment is worth, also had to create a hospital "tax" on all hospitals to get extra money for those Medicaid hospitals) which will result in Nursing cuts because that is the biggest expense (it's basic Economics not commenting on the morality of it) and since anything can happen, 12:1 was maybe a high number but what about 8:1 on a Med/Surg floor when you were used to 6, daily, there would be a lot of adjustment and lot of error would there not?

When the Medicaid cuts are made by all the states (and they will be) the administrators/owners will still make the same or more money. The cuts are to the patient's care and needs (food, clean linen, activities, etc.) and staff. The owners/administrators will pass the cuts along to everyone else. Just like any other corporation! If the LTC facility is publically traded, the shareholders will still want their money. It's all about M-O-N-E-Y!!! If you think the owners/shareholders/administrators are truly worried about cuts to staff and patient care issues....I have some waterfront property to see you in Kansas....just sayin'.:uhoh3:

EponaRN

32 Posts

Specializes in Psychiatric.

Not sure I gave the impression I cared about the administration making money, I thought I was talking about patient safety and the real possibility of it being threatened by too much too soon cuts to funding. You kind of just made the point I've been making all thread.

Your opinions on taxes aside, care to answer my question on patient safety being potentially impacted by cutting an exorbitant amount of Medicaid in rural and urban areas of my State that will have to figure out how to manage with the less money (they already get paid half or so what a treatment is worth, also had to create a hospital "tax" on all hospitals to get extra money for those Medicaid hospitals) which will result in Nursing cuts because that is the biggest expense (it's basic Economics not commenting on the morality of it) and since anything can happen, 12:1 was maybe a high number but what about 8:1 on a Med/Surg floor when you were used to 6, daily, there would be a lot of adjustment and lot of error would there not?

Holy run-on sentence Batman.........:)

Ya, sorry, I got a little (o.k., a lot) off topic there. But as often happens in a thread with over 60 replies, the topic throughout the thread tends to wander and change. So while it did not directly answer your initial post, it did fit more into the context of the previous posts to it. Especailly since multiple posts had a very anit-Walker, anti-what-he's-doing slant to them. I apologise if that bothers you........

The 40 percent is correct for households with zero or negative tax, but as you mention drops to about 14% if you also includ payroll taxes. While social security, medicare, and unemployment are called taxes, they really aren't in the truest sense because they will "supposedly" get them back later. They are more of an insurance/investment with a return than a tax. They will draw their social security upon retirement, and use medicare as their health declines in future years, and should they get laid off or loose their job they can then draw unemployment. So they do pay them, yes, however they will get much of them back. Hopefully. I do have my doubts. But you are correct. That was good info you supplied to, thank you for that!

EponaRN

32 Posts

Specializes in Psychiatric.

I am not trying to take an "anti-Walker" stance or tax stance on anything. I am talking about the real threat of cutting large swaths of funding to hospital systems that get MOST if not all of their funding from the very source getting cut and what that will do to patient safety, even if in the short term. You do not have to be for or against Walker to see the potential, possibly unintended effect, of patient harm and/or death.

caregiver1977

494 Posts

I love it when we balance budgets on the health and backs of the low and middle class tax payors...being very careful not to over burden our wealthy residents or businesses.

...or when it is balanced on the backs of the truly working poor. I think people often forget that many people who are on Medicaid and similar programs are not just sitting around on their butts waiting for every handout that comes by. Many of the people on these programs are working poor who are employed at low paying jobs with no insurance or insurance that is not worth the high price charged. I once worked a job that had rather stinky health insurance (that they probably got cheap) and the management ENCOURAGED employees to get Medicaid instead.

Oh, I know your not. But some of the reply posts did, mentioning wanting to recall the Gov. and such. It was posts in the thread i was referring to, not you directly. Sorry, sometimes what I type isn't what i was thinking and I'm not as clear as i should be on things:)

There is no denying that scaling back funding will have effects that, if not handled correctly, could indeed cause harm to people in the medical feild, both patients and staff alike. Hopefully institutions will recognize their limits and work within them rather than try to over-burden staff, and hopefully staff will recognize their limits and stand up to the institutions if they try and institute the over-burdening to dangerous levels..........

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