Could Obamacare cause a shortage in nursing again

allnurses Guide · Sep 7, 2013

death panel care means "rationing". Some people get life saving procedures and others do not. Remember the little girl who was initially denied a life saving lung transplant ? In the future public outcry will have NO bearing on final decisions.

Would you mind citing the part of the PPACA that you base this conclusion on? I assume you are speaking only to those with Medicare, because private insured individuals are not affected by IPAB? I have read it many times and I can fairly confidently say that the PPACA limits the power of MedPAC through the IPAB, which offers an appeal process that MedPAC does not.

This is one of those fear-mongering issues toted by those who oppose the law based on political agenda rather than objective data. I actually appreciate the irony that those individuals calling IPAB a death panel are the same individuals that want to limit the Medicare budget.

Wasn't the "death panel" the winner of Politifact's "Lie of the Year"? But if you say it enough times maybe its true.

Editorial Team / Admin · Sep 7, 2013

death panel care means "rationing". Some people get life saving procedures and others do not. Remember the little girl who was initially denied a life saving lung transplant ? In the future public outcry will have NO bearing on final decisions.

She was not denied a transplant. At her age, she did not qualify for the adult lung list because adult lungs must be modified to fit in a child's body, potentially increasing the risk that the transplant will not work. She was never denied access to a transplant from another child. Additionally, those regulations were created by experts in organ transplantation and had nothing to do with PPACA. And let's be honest- in organ transplants, the demand far exceeds the supply. Not everyone can be saved. Regulations are a must to keep emotion out of the decisions.

Additionally, the adult lungs that she ended up getting did not work out. She ended up needing a second transplant from a child, so those rules she sidestepped didn't really help in the end.

CiscoNurse · Sep 7, 2013

Hey trust me, there will be no rationing of care for the people exempt from this debacle. The following is from Forbes, a publication noted for their ability to print lies : ObamaCare supporters are now waging a high-profile public relations campaign to make medical rationing palatable to the general public.

The latest front is the opinion pages of the New York Times, which recently published two Op-Eds openly advocating medical rationing. The first was by their economics columnist Eduardo Porter, “Rationing Health Care More Fairly” (8/21/2012).

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Porter argued that rationing was “inevitable” and the only question was how best to implement it. He advocated a system like Great Britain’s, which doesn’t pay for medical therapies costing more than $31,000 – $47,000 per year of life gained. Similarly, he praised New Zealand’s approach of not paying for vaccines that cost more than $20,000 per year of life gained.

For Porter, the only question was the precise dollar value the government should set on a year of a patient’s life. Supporters of government-run health care used to argue against market-based approaches because “you couldn’t put a price on human life.” But that’s precisely what Porter wants the government to do.

The second pro-rationing piece was by Obama administration advisor Steve Rattner, “Beyond ObamaCare” (9/16/2012). Rattner stated up front, “We need death panels.”

Rattner advocated restricting medical spending on the elderly, especially on patients in their last year of life, because such spending “consumes more than a quarter of the [Medicare] program’s budget.”

One big problem with Rattner’s approach is that we often can’t know what will be a patient’s final year of life until after they’ve died. It’s easy for a bureaucrat to say in retrospect, “This unnecessary spending didn’t extend the patient’s life.” But the treating physician doesn’t always know whether a patient will live or die from a surgery or procedure. If the surgery succeeds and the patient lives another 5 years, then it was money well spent. But if the patient dies, a bureaucrat can classify it as “wasteful.” Do we really want the government deciding whether or not a doctor is allowed to save your grandmother’s life?

In a recent New England Journal of Medicine (NEJM) article, former Obama administration officials have also advocated a more indirect form of rationing. They’ve proposed a fixed cap on aggregate private medical spending (not just government spending). Such a cap has already been enacted into law in Massachusetts and the authors wish to extend that to the rest of the country. Of course, any cap on private medical spending necessarily means the government must restrict Americans’ right to spend their own money for their own medical care.

One of the co-authors of this NEJM article, Dr. Ezekiel Emanuel, has already laid the intellectual groundwork for overt rationing in a 2009 Lancet article, “Principles For Allocation of Scarce Medical Interventions.” Dr. Emanuel is a former White House health care advisor and the brother of Rahm Emanuel, President Obama’s former chief of staff.

Dr. Emanuel proposes rationing based on a combination of factors including patient age, expected “quality adjusted life years,” and the patient’s “instrumental value” to “society.” Given that the government would be making (and paying for) these rationing decisions, value to “society” will become “value as determined by the government.”

Such rationing completely inverts the relationship between the individual and the state. Rather than the state existing to serve the individual, the individual’s existence is sustained at the discretion of the state. This is the opposite of the American founders’ intention that the government be the people’s servant, not their master.

I’m surprised that ObamaCare advocates are discussing overt medical rationing so quickly. Earlier in 2012, the New England Journal of Medicine still exhorted health policy analysts to avoid the “R-word” because it was such a political hot potato and to instead use euphemisms such as “frugality.” If ObamaCare supporters are confident enough to openly promote rationing, it means they’re preparing to put their plans into action in a second Obama term.

Rationing is inevitable whenever the government controls medical spending. He who pays the piper calls the tune. Under ObamaCare, government control of health spending will quickly expand to affect most Americans, not only the elderly.

Note that we don’t debate how to ration cellphones. That’s because our relatively free market has driven cellphone prices so low that even many of the poorest Americans can afford one.

The free market can also work in health care. Many patients can now purchase “calcium scoring” heart scans, which measure how much calcium is deposited in the coronary arteries. These scans are one of the safest and most reliable ways to measure one’s risk of future heart attack.

Calcium scoring scans do not require a doctor’s order and are not typically covered by insurance. Because patients generally pay out of pocket, motivated consumers shop around. Normal market forces have thus driven down their price dramatically. Several years ago, these scans cost $500; now some centers offer them for under $100. This pattern of rising quality and falling prices can and should be the norm in all of health care.

CiscoNurse · Sep 7, 2013

U r dead on, I hope u r wrong but as someone who follows money, I am afraid U r correct. Hopefully we R both wrong and the collapse of the dollar is only a figment of the imagination.

CiscoNurse · Sep 7, 2013

I see it also. I also see more than 90 million Americans unemployed and %62 of all jobs created R part time now. Who exactly do U see paying for all the additional care of Americans once Obamacare is fully implemented ? The Mexican govt or the Canadians ? Maybe U R one of those people who will work for no pay ? U know , a 60 or 80 % tax rate.

RescueNinja123 · Sep 8, 2013

Hey trust me, there will be no rationing of care for the people exempt from this debacle. The following is from Forbes, a publication noted for their ability to print lies : ObamaCare supporters are now waging a high-profile public relations campaign to make medical rationing palatable to the general public.
The latest front is the opinion pages of the New York Times, which recently published two Op-Eds openly advocating medical rationing. The first was by their economics columnist Eduardo Porter, “Rationing Health Care More Fairly” (8/21/2012).
Will Obamacare Play Games With Your Actual Life? Capital Flows Contributor
If You Want Human Progress To Stop, Institute A Maximum Income Capital Flows Contributor
The Federal Government's War On Medical Innovation Capital Flows Contributor
Is President Obama's Prostate Gland More Important Than Yours? Capital Flows Contributor
Porter argued that rationing was “inevitable” and the only question was how best to implement it. He advocated a system like Great Britain’s, which doesn’t pay for medical therapies costing more than $31,000 – $47,000 per year of life gained. Similarly, he praised New Zealand’s approach of not paying for vaccines that cost more than $20,000 per year of life gained.
For Porter, the only question was the precise dollar value the government should set on a year of a patient’s life. Supporters of government-run health care used to argue against market-based approaches because “you couldn’t put a price on human life.” But that’s precisely what Porter wants the government to do.
The second pro-rationing piece was by Obama administration advisor Steve Rattner, “Beyond ObamaCare” (9/16/2012). Rattner stated up front, “We need death panels.”
Rattner advocated restricting medical spending on the elderly, especially on patients in their last year of life, because such spending “consumes more than a quarter of the [Medicare] program’s budget.”
One big problem with Rattner’s approach is that we often can’t know what will be a patient’s final year of life until after they’ve died. It’s easy for a bureaucrat to say in retrospect, “This unnecessary spending didn’t extend the patient’s life.” But the treating physician doesn’t always know whether a patient will live or die from a surgery or procedure. If the surgery succeeds and the patient lives another 5 years, then it was money well spent. But if the patient dies, a bureaucrat can classify it as “wasteful.” Do we really want the government deciding whether or not a doctor is allowed to save your grandmother’s life?
In a recent New England Journal of Medicine (NEJM) article, former Obama administration officials have also advocated a more indirect form of rationing. They’ve proposed a fixed cap on aggregate private medical spending (not just government spending). Such a cap has already been enacted into law in Massachusetts and the authors wish to extend that to the rest of the country. Of course, any cap on private medical spending necessarily means the government must restrict Americans’ right to spend their own money for their own medical care.
One of the co-authors of this NEJM article, Dr. Ezekiel Emanuel, has already laid the intellectual groundwork for overt rationing in a 2009 Lancet article, “Principles For Allocation of Scarce Medical Interventions.” Dr. Emanuel is a former White House health care advisor and the brother of Rahm Emanuel, President Obama’s former chief of staff.
Dr. Emanuel proposes rationing based on a combination of factors including patient age, expected “quality adjusted life years,” and the patient’s “instrumental value” to “society.” Given that the government would be making (and paying for) these rationing decisions, value to “society” will become “value as determined by the government.”
Such rationing completely inverts the relationship between the individual and the state. Rather than the state existing to serve the individual, the individual’s existence is sustained at the discretion of the state. This is the opposite of the American founders’ intention that the government be the people’s servant, not their master.
I’m surprised that ObamaCare advocates are discussing overt medical rationing so quickly. Earlier in 2012, the New England Journal of Medicine still exhorted health policy analysts to avoid the “R-word” because it was such a political hot potato and to instead use euphemisms such as “frugality.” If ObamaCare supporters are confident enough to openly promote rationing, it means they’re preparing to put their plans into action in a second Obama term.
Rationing is inevitable whenever the government controls medical spending. He who pays the piper calls the tune. Under ObamaCare, government control of health spending will quickly expand to affect most Americans, not only the elderly.
Note that we don’t debate how to ration cellphones. That’s because our relatively free market has driven cellphone prices so low that even many of the poorest Americans can afford one.
The free market can also work in health care. Many patients can now purchase “calcium scoring” heart scans, which measure how much calcium is deposited in the coronary arteries. These scans are one of the safest and most reliable ways to measure one’s risk of future heart attack.
Calcium scoring scans do not require a doctor’s order and are not typically covered by insurance. Because patients generally pay out of pocket, motivated consumers shop around. Normal market forces have thus driven down their price dramatically. Several years ago, these scans cost $500; now some centers offer them for under $100. This pattern of rising quality and falling prices can and should be the norm in all of health care.

So are you saying Obamacare is good or bad? I don't quite understand how the free market could work for healthcare, we would have to get rid health insurance companies . I really would prefer if you could explain the cons of Obamacare because rationing seems to work in Britain in New Zealand. I am a nursing student, I always wanted to be in the medical field after volunteering at the hospital I decided on nursing but I am having to rethink my decision whaty should i become a nurse if my degree will be useless?

RescueNinja123 · Sep 8, 2013

I see it also. I also see more than 90 million Americans unemployed and %62 of all jobs created R part time now. Who exactly do U see paying for all the additional care of Americans once Obamacare is fully implemented ? The Mexican govt or the Canadians ? Maybe U R one of those people who will work for no pay ? U know , a 60 or 80 % tax rate.

Which is exactly why I need to know where I stand? I am surprised more nurses don't feel the same.

LadyFree28, BSN, LPN, RN · Sep 8, 2013

Which is exactly why I need to know where I stand? I am surprised more nurses don't feel the same.

I don't feel the same because I have a preexisting condition, and the ACA has helped me be eligible for healthcare again...I can get off of Medicare and many other can as well...a lot of us had no other choice but o choose Medicare and SSDI because of major medical problems. I was kicked off of "free market" insurance (which I enjoyed) because of my lifetime limits, and my issues exceeded what they were willing to cover. I was unable to work as a nurse and could not return to work, because of lack of access to healthcare to cover my healthcare needs.

You cannot convince me "the market" :sarcastic: has given me better healthcare; in fact "the market" threw me under the bus while the government allowed me to be able to get back to where I needed to be.

I've seen what lack of healthcare can do to my patients; if anything, anything else can be a start; we can get involved and tweak the system for the better; I saw this when the ACA was being prepared and planned; I know the people who created these proposals; one of them being my nursing instructor in my BSN program. There are students in graduate studies that are proposing changes in my state on many healthcare topics that are helping our profession; I am fortunate to have seen the side of EBP and public policy.

I encourage people to find nurses who are proposing public policy; get involved and understand the process; know what the ACA is about..anyone can paraphrase and interpret what "it is" to fit an argument; what does it REALLY say, unfiltered??? Find out on your OWN, and then ASK questions.

We don't know what's going to happen; but there are positives in this plan that are helping Americans everyday, including THIS nurse.

RescueNinja123 · Sep 8, 2013

I don't feel the same because I have a preexisting condition, and the ACA has helped me be eligible for healthcare again...I can get off of Medicare and many other can as well...a lot of us had no other choice but o choose Medicare and SSDI because of major medical problems. I was kicked off of "free market" insurance (which I enjoyed) because of my lifetime limits, and my issues exceeded what they were willing to cover. I was unable to work as a nurse and could not return to work, because of lack of access to healthcare to cover my healthcare needs.
You cannot convince me "the market" has given me better healthcare; in fact "the market" threw me under the bus while the government allowed me to be able to get back to where I needed to be.
I've seen what lack of healthcare can do to my patients; if anything, anything else can be a start; we can get involved and tweak the system for the better; I saw this when the ACA was being prepared and planned; I know the people who created these proposals; one of them being my nursing instructor in my BSN program. There are students in graduate studies that are proposing changes in my state on many healthcare topics that are helping our profession; I am fortunate to have seen the side of EBP and public policy.
I encourage people to find nurses who are proposing public policy; get involved and understand the process; know what the ACA is about..anyone can paraphrase and interpret what "it is" to fit an argument; what does it REALLY say, unfiltered??? Find out on your OWN, and then ASK questions.
We don't know what's going to happen; but there are positives in this plan that are helping Americans everyday, including THIS nurse.

What state are you in?

LadyFree28, BSN, LPN, RN · Sep 8, 2013

What state are you in?

In PA.

I've taken care of people in major medical crises that have come to my area for care and rehabilitation...I've seen it with my local patents as well the struggles prior to the ACA implemented...there are working people-yes nurses-who cannot afford insurance or do not have the best insurances that have public health centers, and are overstocked with people. They can't see everyone in 8 hours, do not have weekend hours, and there is already a delay of care. I did not see this in my childhood...there was a time where people were able to chose their provider and have a reasonable co-pay or payment plan, etc. "The market" has driven healthcare to run like a business when they are not in the "business" to help people, that's what we do...I have the opportunity, as well as anyone else, to provide solutions. This model is not working...to the point that some organizations are using scare tactics to cut back on supplies, and staffing. The outcomes measure for nurses has been around since 2006, ensuring reimbursement for chronic individuals cannot be covered by hospitals; these acts have been in place before the ACA has been enacted. Healthcare orgs have not been using nurses for what we are worth in our competency and education; the outcomes model is shifting towards us; it's about time! It will be better than adding housekeeping to our list (see Vanderbilt Medical Center). CMS is headed by a NURSE. It about TIME that nursing is heavily involved in policies and having a part of the process, by using the nursing process, EBP. :yes:

I will wait, and act accordingly when the rest of the ACA is enacted, as of now, I am very pleased with the direction it is going for the many people I care for; for the problems when they come, I will become involved with the solutions. :yes:

damrcngrl95 · Sep 8, 2013

I don't feel the same because I have a preexisting condition, and the ACA has helped me be eligible for healthcare again...I can get off of Medicare and many other can as well...a lot of us had no other choice but o choose Medicare and SSDI because of major medical problems. I was kicked off of "free market" insurance (which I enjoyed) because of my lifetime limits, and my issues exceeded what they were willing to cover. I was unable to work as a nurse and could not return to work, because of lack of access to healthcare to cover my healthcare needs.
You cannot convince me "the market" has given me better healthcare; in fact "the market" threw me under the bus while the government allowed me to be able to get back to where I needed to be.
I've seen what lack of healthcare can do to my patients; if anything, anything else can be a start; we can get involved and tweak the system for the better; I saw this when the ACA was being prepared and planned; I know the people who created these proposals; one of them being my nursing instructor in my BSN program. There are students in graduate studies that are proposing changes in my state on many healthcare topics that are helping our profession; I am fortunate to have seen the side of EBP and public policy.
I encourage people to find nurses who are proposing public policy; get involved and understand the process; know what the ACA is about..anyone can paraphrase and interpret what "it is" to fit an argument; what does it REALLY say, unfiltered??? Find out on your OWN, and then ASK questions.
We don't know what's going to happen; but there are positives in this plan that are helping Americans everyday, including THIS nurse.

This is how I feel about the ACA. I have a hearty laugh at people who want to point fingers at the government trying to kill people off through death panels. Well, the old laws for health insurance sure let that happen and the laws were so corporate sided it wasn't even funny. If you were seen as a drain on the insurance company then your coverage was rationed or you were barred from even getting insurance at all. I do see the ACA as a starting point that we can work forward with and have a healthier country. It's not going to be perfect, but it's a start.

One of my rotation hospitals told me that 2/3 of the people in their hospital will not have insurance and won't be able to pay. So that means that 1/3 of the people are going to pay for everyone. At least come October the ratios of being able to pay will start to change. Can we all agree that something needed to be done with our current health care system? I have faced the fact that either way, as a health insurance holder or tax paying citizen, I am going to pay some portion of an uninsured person's hospital bill. Otherwise we need to start telling people that no matter how close to death they are no insurance/money means no care. I don't think our forefathers founded this country on that either.

I have read and tried to educate myself on the ACA, and what I can see is that it is very close to Romneycare. The difference is that Romneycare didn't have to stand up against the threat of not funding it or one part of its congress acting like children and doing everything possible to make sure it failed. If the ACA fails then the majority of the fault will rest on the backs of our congress who have tried so hard to make sure this doesn't get the funding or support needed.

LadyFree28, BSN, LPN, RN · Sep 8, 2013

This is how I feel about the ACA. I have a hearty laugh at people who want to point fingers at the government trying to kill people off through death panels. Well, the old laws for health insurance sure let that happen and the laws were so corporate sided it wasn't even funny. If you were seen as a drain on the insurance company then your coverage was rationed or you were barred from even getting insurance at all. I do see the ACA as a starting point that we can work forward with and have a healthier country. It's not going to be perfect, but it's a start.
One of my rotation hospitals told me that 2/3 of the people in their hospital will not have insurance and won't be able to pay. So that means that 1/3 of the people are going to pay for everyone. At least come October the ratios of being able to pay will start to change. Can we all agree that something needed to be done with our current health care system? I have faced the fact that either way, as a health insurance holder or tax paying citizen, I am going to pay some portion of an uninsured person's hospital bill. Otherwise we need to start telling people that no matter how close to death they are no insurance/money means no care. I don't think our forefathers founded this country on that either.
I have read and tried to educate myself on the ACA, and what I can see is that it is very close to Romneycare. The difference is that Romneycare didn't have to stand up against the threat of not funding it or one part of its congress acting like children and doing everything possible to make sure it failed. If the ACA fails then the majority of the fault will rest on the backs of our congress who have tried so hard to make sure this doesn't get the funding or support needed.

Exactly :yes: