#AMAGetOutTheWay: Nurses, Doctors, and Students United

[Melissa Mills]

On Saturday, June 8th nurses, doctors, and medical students stood side-by-side to protest the American Medical Association's (AMA) annual meeting in Chicago. The AMA, which was founded in 1847, is a large, powerful, and wealthy lobbying group. However, it seems that many young physicians and medical students don't agree with the work done by the group. In fact, in 2016, it was reported that the AMA only represented about 25 percent of practicing physicians. This decrease was a significant change from just a few decades ago when nearly 75 percent of all physicians were members.

#AMAGetOutTheWay

If you perform a quick social media search for #AMAGetOutTheWay, you will find support from many healthcare professionals fighting for Medicare for all. Experts believe that adopting a Medicare for all system in the United States would allow us to join the ranks of the rest of the industrialized world where health coverage is universal. They also feel that this would save money and improve health outcomes.

Protesters feel that the AMA isn't fighting for the right initiatives. Adam Gaffney, President for Physicians for a National Health Program and an instructor at the Harvard Medical School, made his feelings known at the rally. "The AMA is not fighting for their patients, they're not fighting for the uninsured, and they're not fighting for the underinsured. We're here today because the AMA is again on the wrong side of history.”

Other groups well-represented at the rally included Students for a National Health Program (SNaHP), National Nurses United, People's Action, and The Center for Popular Democracy. SNaHP published on their website that showing up at the rally showed support by "taking a stand AGAINST corporate greed, misleading advertising, and the profit motive of health care.” National Nurses United is the largest union and professional association for registered nurses and supports Medicare for All.

What is HR 1384?

Medicare for all isn't just a catchy slogan used by Democrats like Bernie Sanders. It's a legislative proposal, HR 1384, that would create a nationwide health insurance program for all U.S residents. A single-payer system such as this would replace the current mixed healthcare system which includes private and public health programs. It also has a provision to allow people to purchase public coverage during a transitional period to this new system.

Who Would Be Covered?

HR 1384 aims to provide coverage to all U.S. residents, documented immigrants, and even undocumented people. The program would prohibit anyone from being excluded because of citizenship status.

How Would it be Funded?

This single-payer system would not require premiums to be paid. However, it would require new federal taxes for both businesses and individuals.

What Would Be Covered?

All medical care would be covered under this system. Those who support HR 1384 proudly boast that it would also cover reproductive health services. This would include maternity and newborn care.

The Power of Unity

Regardless of your opinions about HR 1384, the rally in Chicago is an example of what could happen when healthcare workers come together. It's estimated that there over one million physicians and nearly three million nurses in the U.S. Imagine how workplace problems and care deficiencies could be approached with this type of unity.

Would we be able to solve some of the top problems that plague healthcare? Just think for a minute how discussions about safe staffing, workplace violence, and long working hours might change if these two "strong-in-number" groups stormed the offices of administration and lawmakers across the nation.

Where Do You Stand?

There are so many different conversations that could come from this one event. Do you support a Medicare for all system? And, what do you think about the unity that was displayed at this protest? Oh, and what other issues do you think a unified front could impact?

[ReaganRN]

What MnNurse123 said all day long!!!! If we're (as taxpayers) going to fund medical care for all including undocumented immigrants-then we better find a way to get the Micky-D's and soda industries to pay for it. Because until we figure out the "health disparity" problems among minorities in our country we're going to pay for millions of people to eat, drink, do whatever they want (or don't) at the expense of their health, while expecting a taxpayer-funded program to absorb the "big pharma" costs of their diabetic, blood pressure, etc. etc.. medications. Lack of accountability in individual health care is just as bad among Medicare populations-people who have eaten and drank whatever they enjoyed all their lives, excused themselves from an active lifestyle, and find themselves at 65 needing brand new organs and a back to support the belly they carry. And Medicare pays for this. I'm all for a system that provides health care for all people who are actually accountable for their own health and not dependent on big pharma to slap a bandaid on their poor lifestyle choices. I think this is something that people in other countries living with socialized medicine have come to terms with much better than our society.

[myoglobin, ASN, BSN, MSN]

In the UK you are lucky to get dialysis at 65 let alone transplants. However, access to preventative care is more available, but they pay at least 10% more in income and value added (kind of like sales tax) to fund the system.

[Lane Therrell FNP, MSN, RN, NP]

I'm so impressed by the common sense demonstrated in the replies to this post. Maybe we should send a link to this thread to Washington... As nurses, we need to encourage a more rational approach to healthcare reform among our legislators on BOTH sides of the political aisle. Single-payer is not the answer, AND it's not the only potential solution. But who's out there in the mainstream talking about that? Do we even have any legislators at any level who are interested in solving problems instead of creating them? It's always been worrisome to me that the working nurses and physicians-- the ones who have practical, on-the-ground experience about what works and doesn't-- never seem to be the ones at the table when healthcare legislation is being discussed or re-crafted. Is it too late for healthcare professionals with common sense to give voice? I hope not.

[kbrn2002, ADN, RN]

4 hours ago, MnNurse123 said:

It doesn’t surprise me that it’s the younger people advocating this; to be young is to be idealistic, and to be mature is to be realistic. Socialism doesn’t work, ask people living in countries with socialized medicine whether it has eliminated the problems or just created different ones. I’ll take our imperfect system any day. If we switched the focus to prevention (nutrition, exercise, other lifestyle changes) instead of looking for medication to treat the effects of an unhealthy lifestyle we would take away some of the power from greedy pharma and reduce the overall health care costs, thus driving down insurance costs. Giving tax payer funded health care to illegal aliens is insanity. I’m a nurse AND a taxpayer, and I’m tired of footing the bill for everything under the sun.

Oh yes, and that is another can of worms altogether! The government funded insurance that does exist for low income persons annoys me greatly. At least in the state I am in, and WI is known for not being "a welfare state" after pretty extensive reforms . The insurance that is offered however is amazing.

I pay a pretty large premium with reasonably high deductibles for somewhat crappy coverage plus separate policies for vision and dental that I also have to pay for. A family member recently qualified for state funded insurance and everything is covered at 100% with no out of pocket costs. Zero deductibles or co-pays, expensive meds covered completely without question. Guess who is footing the bill for that? Me and every other tax payer in the state. I can't help but be a little upset and yes, jealous that I can't get that kind of insurance coverage because I work for a living.

[MunoRN, RN]

8 hours ago, MnNurse123 said:

It doesn’t surprise me that it’s the younger people advocating this; to be young is to be idealistic, and to be mature is to be realistic. Socialism doesn’t work, ask people living in countries with socialized medicine whether it has eliminated the problems or just created different ones. I’ll take our imperfect system any day. If we switched the focus to prevention (nutrition, exercise, other lifestyle changes) instead of looking for medication to treat the effects of an unhealthy lifestyle we would take away some of the power from greedy pharma and reduce the overall health care costs, thus driving down insurance costs. Giving tax payer funded health care to illegal aliens is insanity. I’m a nurse AND a taxpayer, and I’m tired of footing the bill for everything under the sun.

I'm not sure your generalization really works as I am neither young nor socialist, I'm fiscally conservative which is why I'm all for reforming our system to universal coverage / single payer.

I'm not sure what the "different" problems you're referring to with "socialized" medicine, but paying far less for superior healthcare is a problem I'd like to have.

One of the biggest costs our current system produces is that it focuses on paying for the result of a lack of prevention and primary care, rather than paying for the much cheaper preventative care instead. We pay about 2/3 of our healthcare spending towards acute care and about 1/3 towards preventing the need for that acute care, countries with better healthcare measures than ours, and yet pay a third to a half of what we do flip that ratio, spending about 2/3 of their spending on preventative and primary care, which is a fraction of the cost of the acute care it prevents. It's not really possible to move towards more of a focus on primary and preventative care without ensuring access to it.

I'm all for not have to "foot the bill for everything under the sun", so what healthcare services should we no longer provide?

[myoglobin, ASN, BSN, MSN]

2 hours ago, MunoRN said:

I'm not sure your generalization really works as I am neither young nor socialist, I'm fiscally conservative which is why I'm all for reforming our system to universal coverage / single payer.

I'm not sure what the "different" problems you're referring to with "socialized" medicine, but paying far less for superior healthcare is a problem I'd like to have.

One of the biggest costs our current system produces is that it focuses on paying for the result of a lack of prevention and primary care, rather than paying for the much cheaper preventative care instead. We pay about 2/3 of our healthcare spending towards acute care and about 1/3 towards preventing the need for that acute care, countries with better healthcare measures than ours, and yet pay a third to a half of what we do flip that ratio, spending about 2/3 of their spending on preventative and primary care, which is a fraction of the cost of the acute care it prevents. It's not really possible to move towards more of a focus on primary and preventative care without ensuring access to it.

I'm all for not have to "foot the bill for everything under the sun", so what healthcare services should we no longer provide?

You may in fact be correct, but socialized medicine is a highly contentious issue and when NNU supports it, it undermines the many other issues that unite nurses. It equates a political position ie socialized medicine and essentially de facto support of the Democratic Party excluding the many nurses who are conservative or Republican. Obama care or the Healthcare Reform Act was highly contentious and that was far from socialized medicine. Even if socialized medicine would lead to better outcomes (I’m not sure that it would, but it might depending upon how it was implemented and whether or not different alternative free market reforms were put in place instead), it may not lead to better outcomes for nurses. I’ve known at least five RN’s who moved from the UK or Canada and they all said that they made much more here even before the much higher taxes they paid in their previous homes. Getting overtime hours, NP’s being able to offer fee for service clinics, and higher paying travel positions are greatly reduced under socialized medicine. Our British landlords were stupefied that my SO earned 180k and that I was going back to school to try and do the same since she knew many British nurses barely earning 35000 pounds or about 44000 dollars and these were “band 5,6” nursing leaders. Just on my floor in Florida not one of the higher paying states, I know at least five nurses RN, earning 100k by working one shift of overtime per week (and working nights/weekends).

[MunoRN, RN]

3 hours ago, myoglobin said:

You may in fact be correct, but socialized medicine is a highly contentious issue and when NNU supports it, it undermines the many other issues that unite nurses. It equates a political position ie socialized medicine and essentially de facto support of the Democratic Party excluding the many nurses who are conservative or Republican. Obama care or the Healthcare Reform Act was highly contentious and that was far from socialized medicine. Even if socialized medicine would lead to better outcomes (I’m not sure that it would, but it might depending upon how it was implemented and whether or not different alternative free market reforms were put in place instead), it may not lead to better outcomes for nurses. I’ve known at least five RN’s who moved from the UK or Canada and they all said that they made much more here even before the much higher taxes they paid in their previous homes. Getting overtime hours, NP’s being able to offer fee for service clinics, and higher paying travel positions are greatly reduced under socialized medicine. Our British landlords were stupefied that my SO earned 180k and that I was going back to school to try and do the same since she knew many British nurses barely earning 35000 pounds or about 44000 dollars and these were “band 5,6” nursing leaders. Just on my floor in Florida not one of the higher paying states, I know at least five nurses RN, earning 100k by working one shift of overtime per week (and working nights/weekends).

There's no current proposal to transition to socialized healthcare, there has been a push for reform based on universal coverage, by expanding medicare to those under 65 or to some form of a single-payer system. Socialized healthcare refers to a system where both the coverage and healthcare delivery are government run, such as the VA or the NHS.

The UK doesn't just pay less for healthcare, they arguably pay to little, at about only one-third of what we pay per capita. I haven't heard any proposals to cut our healthcare funding to that extreme degree. What's been proposed is reduce our healthcare spending through reduced overhead costs of insurance administration, more preventative care spending which reduces more expensive acute care spending, and to better control healthcare inflation, all of which already know can be achieved by switching to a single payer system.

The NNU is appropriately advocating for nurses and the nursing profession by lobbying for a core concept of nursing; that health issues should be dealt with proactively instead of reactively, and that the availability of healthcare should be equitable, that's not a democrat or republican nurse thing, it's just a nurse thing.

[myoglobin, ASN, BSN, MSN]

46 minutes ago, MunoRN said:

There's no current proposal to transition to socialized healthcare, there has been a push for reform based on universal coverage, by expanding medicare to those under 65 or to some form of a single-payer system. Socialized healthcare refers to a system where both the coverage and healthcare delivery are government run, such as the VA or the NHS.

The UK doesn't just pay less for healthcare, they arguably pay to little, at about only one-third of what we pay per capita. I haven't heard any proposals to cut our healthcare funding to that extreme degree. What's been proposed is reduce our healthcare spending through reduced overhead costs of insurance administration, more preventative care spending which reduces more expensive acute care spending, and to better control healthcare inflation, all of which already know can be achieved by switching to a single payer system.

The NNU is appropriately advocating for nurses and the nursing profession by lobbying for a core concept of nursing; that health issues should be dealt with proactively instead of reactively, and that the availability of healthcare should be equitable, that's not a democrat or republican nurse thing, it's just a nurse thing.

It is one thing to advocate for preventative healthcare, but when it comes in the guise of single payer the issue becomes political. Many nurses who advocate for free market, non single player reforms also believe strongly in preventative healthcare. Also many nurses who believe in single payer do not believe that those who come here contrary to the laws of our country should be supported by the taxes of those who have. By making such a political issue a central theme it appears as if NNU is endorsing the future Democratic candidate thereby alienating the 40% plus of nurses who support Republicans, but would be inclined to support issues like California ratio laws, and expanded nursing unions.

[Lane Therrell FNP, MSN, RN, NP]

16 hours ago, MunoRN said:

There's no current proposal to transition to socialized healthcare, there has been a push for reform based on universal coverage, by expanding medicare to those under 65 or to some form of a single-payer system. Socialized healthcare refers to a system where both the coverage and healthcare delivery are government run, such as the VA or the NHS.

This nuance is lost on most people, including our legislators, unfortunately. For many (and I would argue most), single payer = universal coverage = wholly government run = socialized medicine, which is why they oppose it (or advocate for it, as the case might be). Maybe it's all a vast misunderstanding, but the future of healthcare delivery is getting based on it...

Meanwhile, speaking as a consumer, I want LESS government involvement in my life, not more. Just look at the shambles our government is in right now (and has been for a long long time). I REALLY REALLY REALLY don't want these people-- who are incapable of speaking rationally, disagreeing amicably, and working together to solve real problems-- having much to do with my personal healthcare decisions over time. And as a healthcare professional, I do not wish to become a government employee (which is what would happen under a full-on socialized model as you define it).

Be all that as it may, I wholeheartedly agree that preventive care must be emphasized, incentivized, encouraged, and promoted more. Preventive care is the key to cost containment and reduction in any model.

[BeenThere2012, ASN, RN]

On 6/13/2019 at 7:25 PM, myoglobin said:

That’s why I hate NNU endorsing single payer so strongly. Some of us are progressives/ socialists, who may be more inclined to back Sanders or say Biden, while others are conservative, or libertarians who supported Trump. However, we are all nurses and there are many issues like ratio laws where our consensus is probably at least 80% in support. However, Medicare for all is probably more like a 60/40 issue (split close to overall voting trends) and is quite divisive. I can think of at least five good reasons to support such a policy, and five why it would be a poor choice.

Yes, because it entirely depends on how it is run etc...Just like Obama care. It started as one thing, and by the time it got re-worded and negotiated to death in other to get everyone on board in order to pass it, it only vaguely resembled the original idea.

So, assuming it could be set up well and then administered well, I’d be for it, but one never knows the actual eventual outcome!

[GrumpyRN, NP]

On 6/15/2019 at 6:52 PM, myoglobin said:

In the UK you are lucky to get dialysis at 65 let alone transplants.

Can you supply a reference or any sort of evidence for that claim?

[myoglobin, ASN, BSN, MSN]

I don't have a specific reference for the dialysis, but here are several relating to life threatening waits for vital care: https://www.forbes.com/sites/sallypipes/2019/04/01/britains-version-of-medicare-for-all-is-collapsing/#6b84b08336b8 . Here is one relating to inability to obtain transplants because a hospital beds are not available (despite an organ being available) https://www.bbc.com/news/health-47668136 . Here is another relating to the rising costs and wait times involved with the UK's system https://www.heritage.org/health-care-reform/report/london-calling-dont-commit-nationalized-health-care . Of course I could just as easily list ten articles that support socialized or single payer healthcare. However, the point is that this is a highly contentious issue and nursing and the NNU should equate being "a good nurse" as being a supporter of single payer or socialized healthcare. There are too many other issues such as expanding unions, expanding non for profit hospitals, expanding nursing ratio laws, and limiting (or eliminating H1B or special work visas for nurses) where support if far wider and less contentious (among nurses).