America, party of 2

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Welp. There will be a new President soon...He has promised to "repeal and replace" Obamacare.

The real question is (as someone who will be out of school and in practice soon) what will happen with our profession? I know with Obamacare, folks were saying NPs will be in high demand. Don't get me wrong, I know NPs will still be in demand, but what do you think it will look like?

I was a cop for a decade in an urban setting. I can attest that violent crime, sans the occasional domestic, occurred exclusively in the ghetto. The complaints always seemed to come from those we arrested the most. It wasn't racism. It was fact. And violent crime will be met with a violent response. Dry up your cry baby river.

I can't tell you how many I've arrested or seen arrested who didn't wind up dead. Your screwy, liberal media reports on those that do - not the other thousand arrested that day that didn't.

"We sleep safe in our beds because rough men stand ready in the night to visit violence on those who would harm us." That's a quote attributed to George Orwell and misquoted to several others.

You know this is a lost cause. I think we have more hope in trying to refute the DNP degree than on this topic. lol

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Since somewhere around 40% of our dollars go to immigrants, legal or otherwise, who have not paid in, I believe a part of the cost savings plan will start there.

Don't mean to go off topic but please quote your sources especially since you invoked legal immigrants as well who are eligible for legal employment. The data shows that undocumented immigrants actually contribute to state and local taxes at an estimated $11.64 billion annually. I don't support illegal immigration either but I strive for facts.

http://www.itep.org/pdf/immigration2016.pdf

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40 % does sound pretty high lol. goodness they would all be millionaires if they got that much

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Specializes in Outpatient Psychiatry.
Don't mean to go off topic but please quote your sources especially since you invoked legal immigrants as well who are eligible for legal employment. The data shows that undocumented immigrants actually contribute to state and local taxes at an estimated $11.64 billion annually. I don't support illegal immigration either but I strive for facts.

http://www.itep.org/pdf/immigration2016.pdf

Ok so 12 billion comes in the front. How much goes out the back feeding, educating, healing them, etc? I'm for facts as well, and we're all missing some. No one asked them to come. That's the rub here. It's simply a war of resources, and illegal immigration represents an enemy threat to our home resources which are finite. We need to exclusively take care of our own people at the expense of illegals.

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Specializes in Pediatric Critical Care.
Very little of substance on any topic was discussed during this horrendous campaign.

Trump had a platform? Other than hate, of course. Because it seems to me that he ran on misogyny, racism, xenophobia and all forms of bullying and hatred.

He actually has a reasonable platform to address many concerns of AMERICANS. But you wouldn't know that if you get your news from any of the media outlets.

Itt was pretty hard to figure out his apparent reasonable platform from watching him at the debates, too. Like Mr.Chicago said, not nearly enough substance in the campaigns this year.

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Specializes in Pediatric Critical Care.
It is good he is a realist. Probably my favorite thing about him. he knows life is hard and stuff sucks, and does not coat it over with icing and fairy tales and misuse of the word "love"

"love" has turned into a word that basically people use when they want to do things they shouldnt do and if you say anything against it by gawd its hate. Sort of like how in some places your kid can have you arrested if you paddle them because its not showing them love according to over-tolerant people. BLM is just as bad as the KKK but heck if your a cop you cant even arrest a minority person without it going all over the news. Another example is i dont see any "white boy" scholarships, they all go to minories but you do see us white people b1tching about it. African americans have the easiest time of anybody getting into medical school since they have played the race card for so long. Unfortunately asians have the hardest, which makes no sense to me. Probably because they dont sit out there and chew for tears like the NAACP does

And no im not racist by saying this. its all on our schools admissions statistics paper and scholarship list.

Obama did nothing but make the racial divide worse by inacting reverse discrimination.

I think that inflammatory language has been a detriment to the political process during this election cycle. It can be hard to have a open, civilized, and productive discussion when both sides are passionate about the things that divide them, but there is language that helps facilitate working together, and language that worsens the divide.

Language that divides would be phrases like "race card", "libtards", "ghetto thug", "republitard", "wingnut", "rethuglican", "idiot".

Also unhelpful: calling someone with differing viewpoints a cry baby or saying that they need to "get over it", making broad negative generalizations about each other, or accusing the other person of having poor reading comprehension for not being in agreement with you.

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Specializes in Float Pool-Med-Surg, Telemetry, IMCU.

PsychGuy: Are you for real? You're a bloody psych nurse and you have no problem with gays being "locked up" or "fined" because you don't agree with our marriage? I hope to God you're never my nurse. Perhaps a profession where you aren't expected to have empathy would be better?

Let me guess, you're a pissed off white male with a whopping sense of entitlement who thinks women and minorities have gotten too uppity. Reading your posts makes me want to vomit. I'd expect your level of discourse in the comments section on yahoo news but I'm pretty disheartened to see it on a message board of fellow professionals.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

"Ok so 12 billion comes in the front. How much goes out the back feeding, educating, healing them, etc? I'm for facts as well, and we're all missing some. No one asked them to come. That's the rub here. It's simply a war of resources, and illegal immigration represents an enemy threat to our home resources which are finite. We need to exclusively take care of our own people at the expense of illegals"

Hey, you're preaching to the choir here. I came to this country legally and worked my way through the long process of citizenship on my own merit. That said, I have close family members who continue to be denied entry to this country for no apparent reason but have not resorted to sailing the large expanse of the Pacific Ocean on leaky boats to sneak in. My point is, if you're going to quote a figure, you better have proof. I am against illegal immigration for other reasons - many illegal immigrants are prone to exploitation and abuse that goes unresolved for the years they've stayed illegally because of the language barrier and the fact that they are undocumented.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Thanks to everyone who actually answered my questions.

I agree that president can't change state regulations. Is he able to appoint a healthcare "Czar" who will initiate changes in Medicare/Medicaid rules, since these are federal entities?

CMS, the federal agency that oversees Medicare, Medicaid, and CHIP does have an administrator that is a presidential appointee.

Medicare is a federal program for Americans 65 and above or those who have special circumstances. Many elderly Republicans depend on Medicare for healthcare so I have no reason to believe that the new administration will make drastic changes.

Medicaid programs and rules are set by the individual states. For instance, some states actually pay NP's the same rate as physicians for those insured under their state-run Medicaid program.

If Medicare, for example, would mandate that NPs can only work under the supervision of MDs to be able to get reimbursement, than it is only a matter of time when the rest of major insurers will follow the suit, regardless of what state scope of practice is. Can it possibly happen?

Medicare defers to state practice acts in terms of how APRN's could become providers and whether supervision by a physician is required or not.

Also if Medicare decides to change the reimbursement to NPs from 85% to 60% as a cost cutting matter, without affecting reimbursement to MDs, the rest of the major insurers might also follow the suit. Can this happen?

Hypothetically, yes. I think such decision would not come from a partisan motivation.

Is it true that conservative states have the most restrictions on NP practice, which is reflected in reimbursements to NPs in those states being much lower that the rest of the country?

If you consider Arizona and Alaska as conservative, then no since they have independent practice there. California's political climate to me, seem fraught with regulations (which Republicans hate) and leans toward a liberal agenda but yet our NP practice here is quite restrictive.

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Specializes in Outpatient Psychiatry.
PsychGuy: Are you for real? You're a bloody psych nurse and you have no problem with gays being "locked up" or "fined" because you don't agree with our marriage? I hope to God you're never my nurse. Perhaps a profession where you aren't expected to have empathy would be better?

Let me guess, you're a pissed off white male with a whopping sense of entitlement who thinks women and minorities have gotten too uppity. Reading your posts makes me want to vomit. I'd expect your level of discourse in the comments section on yahoo news but I'm pretty disheartened to see it on a message board of fellow professionals.

j

No, I'm a psychiatric nurse practitioner making the mentally ill well for the betterment of themselves and society.

I am indeed angry. I'm angry because our Republic has been neglected. Reason has gone out the window. Instead of globalizing and concerning ourselves with special interests, let's look at our internal state and general interests.

I'm very white and male and not in the least bit ashamed as out modern pundits would make us. I also pray to God in the name of Jesus. And believe it or not, I think the world is round.

And why do I have to support gay marriage to effectively ameliorate psyhopathology?

Vomit away.

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Specializes in Outpatient Psychiatry.
I think that inflammatory language has been a detriment to the political process during this election cycle. It can be hard to have a open, civilized, and productive discussion when both sides are passionate about the things that divide them, but there is language that helps facilitate working together, and language that worsens the divide.

Language that divides would be phrases like "race card", "libtards", "ghetto thug", "republitard", "wingnut", "rethuglican", "idiot".

Also unhelpful: calling someone with differing viewpoints a cry baby or saying that they need to "get over it", making broad negative generalizations about each other, or accusing the other person of having poor reading comprehension for not being in agreement with you.

I'm in favor of ending televised debates for this very reason. No one cites sources or supports their arguments and never have in the debates. They merely incite emotions of those incapable of researching the issues on their own. That's why we elect the President not by popular vote but by electors.

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CMS, the federal agency that oversees Medicare, Medicaid, and CHIP does have an administrator that is a presidential appointee.

Medicare is a federal program for Americans 65 and above or those who have special circumstances. Many elderly Republicans depend on Medicare for healthcare so I have no reason to believe that the new administration will make drastic changes.

Actually, Paul Ryan is already talking again about privatizing Medicare. That would certainly be a "drastic change."

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