Health Care: The Ticking Time Bomb

VickyRN, MSN, DNP, RN · Jul 14, 2009

Do you realize that Medicare is "government run insurance"? Last I heard, it works fine and patients are very satisfied with it!

Last I heard, Medicare is not working fine. In fact, it is in serious jeopardy. It is due to become insolvent (aka "broke") sometime in the near future. Latest projections are the vicinity of 2017-2019. The government is becoming more and more desperate in its cost-cutting attempts in anticipation of this shortfall. In fact, it is becoming alarmingly stringent with reimbursements and now will not pay for 10 hospital-acquired conditions. The government is considering adding other conditions to this list.

These changes in reimbursements may force some hospitals to close down. One of the large teaching hospitals in my area is operating on a razor-thin profit margin (1.8%). Many small community hospitals are operating in the red.

The more the government gets involved (i.e., single payer system), the more ominous things might be for nursing. As proof of this, one only needs to examine the vast Medicare/Medicaid system and what its track record has been. A full quarter of the American population (70 million people) now have health care coverage under CMS. The reimbursements are so low, that many physicians refuse Medicare patients. Many nursing homes evidence questionable quality resident care, presumably because of low Medicaid reimbursements necessitating very low numbers of licensed nurses on staff (and atrocious nurse-resident ratios).

When the aging Boomers enter the CMS system, it will be strained beyond the point of sustainability. The government may use this as an excuse to further cut/restrict the services of licensed nurses and hire more people off the street to do nursing tasks (deprofessionalization and deskilling of nursing), presumably to save taxpayer $$$$. We already see this in NC, with the "Medication Aide" unlicensed position in nursing homes.

To what lengths might a single-payer government health care system go to reduce health care costs? How will this ultimately affect health care and the profession of nursing?

We need to be asking these tough questions, before the CMS government system is expanded to cover all healthcare in the US. :twocents:

dlatimer · Jul 14, 2009

Everyone in Congress has a government run health care policy. The elitist have spoken.

dlatimer · Jul 14, 2009

The Problem with Nursing

Nurses are trained to care for people. Mostly, people in need of health care. Hospitals, which employ the vast majority of nurses are ostensibly in business to care for the health of people. Somewhere along the way hospitals have become profit industries. The primary goal has changed, from helping the people in communities in which they are established, to create profit for their shareholders, probably not in the communities that they are built. What was once an altruistic, benevolent institution has become a voracious animal that preys on the ill and employees alike. This places nurses in a very precarious position. What happens when the hospital allows patient health and welfare to become secondary to making profit? What happens to the nurse (trained to have a humanistic and social conscience) that complains about short staffing and patient safety? Will the nursing boards, doctors and institutions that are established to insure patient safety stand behind the one person who has the most intimate knowledge of care being questioned? Or, is the influence of the cash rich hospitals, insurers and healthcare corporations too much for them to resist? And about that nurse. Does she keep quiet and allow the corruption of her practice to continue for the security of her job and welfare of her family? Maybe these are the questions that should be addressed. Maybe this is the part of healthcare reform that is the most important.

bulldog01 · Jul 14, 2009

I would definetly NOT support everyone getting health care that is not working. I should not have to pay for anyone that does not try to help themselves. I would do away with Medicaid and also anything that is given to illegal immigrants - that just plain does not make sense. :cry:

lynette.johnson · Jul 14, 2009

Dear Viviana, Is Medicare working fine. We are paying for it but we probably won't have access to it when we get to retirement age. I really don't think that it is working out as good as you think it is. Just because there are no complaints from those who recieve it doesn't mean at it is "working fine" as you put it. People who go to an ER for a sore throat because they can't be turned away due to lack of insurnace think that the ER's run fine to (aside from being too slow), but our emergency rooms are shutting down because of it.

Viviana, ASN, RN · Jul 15, 2009

Vicky, patients get the care they need. The financial insolvency you cite is 10 years away, and I believe that it will be worked out, probably similarly to the way that public health care issues of this sort are worked out in most of the first world countries on our planet.

People come into the ER with sore throats because they don't have insurance and they are sick! If they had Medicaid or Medicare and access to physicians--and had to pay a 10 dollar at the ER before being seen, it would make a big difference.

ssing45 · Jul 15, 2009

No, I would not support a federally controlled public healthcare option. Let look at the facts.

1. Fannie Mae and Freddie mac, thought to be the major culprits in the mortage crash, were under federal oversight.

2. There is no money to pay for a change in health care. We are already in debt over our great grandchildren's heads because of these pork infested stimulus packages.

3. Federal healthcare will eventually disembowel private insurers. Do YOU want to be subject to it? Look hard at Canada and England. It is so far below what we have worked hard to obtain and what is available now.

4. Despite what many might believe healthcare is not a right.

5. Health care in this country would suffer in the talent department. The pay motivator would be gone.

6. I am not responsible for bringing the mediocre in this country up to my standard of living. I have worked hard to get here. I do volunteer in clinics for the underserved. If we all did that then this would not be the problem that it appears to be and speaking of appearances, what has changed to make this such a pseudo crisis? Only the administration.

7. The heath care proposal is not one, not ready, not cement, just vague whisperings.

8. Do we need our government to grow any larger? They are inefficient as it is.

9. The states have programs in place, they work, why screw around?

The free market economy built this nation. Government hand outs and rations did not.

tewdles, RN · Jul 15, 2009

How polarized our country is!!! Read this thread from start to finish and wonder at the animosity that exists simply because people disagree. How sad that discussion of health care ultimately ends up in political nonsense...liberal vs conservative, blah, blah, blah. This is what I know: My husband and I were self employed for a period of 2 years and could not afford the $800 plus/mo premium for basic insurance. No MD in our area would accept us as patients because we had no insurance. I did seek care at a local community health clinic because they would take a cash only patient, however, they were so over burdoned with clients that it was VERY difficult to get appts in any semblance of a reasonable time period. When our income increased adequately we did begin to pay for insurance which promptly denied all claims related to a serious health issue my husband developed which required an emergent surgery at the University of Michigan. They claimed it was pre-existing...imagine that, never previously diagnosed nor treated yet pre-existing. The U of M immediately took legal action to take our only significant asset, our home, when no carrier was willing to pay. While my husband was out of action, approx 6 months, we devastated our savings to "keep the lights on and the wolves at bay". So many people do not financially survive that senario. By the way, we did not and do not have credit card debt of any kind, we live within our means. We now work for other people so that we can afford comprehensive medical insurance, which (by the way) fights my spouse on the cost of his ostomy supplies on a monthly basis. He often makes use of supplies donated to him by a friend with a similar stoma who has insurance that provides more than adequately for his supplies. There are millions of people who work hard for a living and have no insurance right now, there are millions more who have lost their jobs and will have no insurance very soon. There is no question that the vast majority of those people will not be able to afford the COBRA payments to remain insured. This is not a debate about immigration. This is a debate about providing for the welfare of the citizenry of the great United States of America. I am currently working for a Certified Home Care in the greater Detroit area. The number of people who are under-insured and un-insured is staggering. The state of their health is appalling. Can you imagine 50 yr old middle class men with devastating strokes because they were making choices about their medications based upon cost as their insurance was either non-existent for meds or the formulary too restrictive. We can continue to do nothing at a national level to address a national problem that is growing daily. Or, we can agree to examine the state of health care in this nation and strive to improve it so that we have adequate access for the majority of our neighbors. Either way, WE ALL PAY FOR IT. There is too much fear mongering on this subject in the media to suit me. The language employed is often designed ONLY to make people afraid and angry. There is name calling and behavior in our political and public arenas that make the local elementary playground appear down right civil. I am not a liberal. I am not a conservative. I am an American who is concerned about the health of my family, my neighbors, and my country. Do I know what the answer is? Definitely not, but I am very interested in the discussion. I am afraid that the status quo is unable to meet the health care needs of this population in this time. I do know that the people of this country are capable of amazing things and that if we determine to do something we CAN do it, and we can do it BETTER than pretty much any other bunch of humans on the planet. Don't be afraid to make suggestions to your legislators, we, after all, have intimate knowledge about the nitty gritty delivery of care that could be useful to them in discussion of change. Don't be afraid or intimidated by naysaying. People who are afraid, angry, or anxious frequently can only see why things won't work and cannot see past that to possible solutions. As health care professionals we see that in our day to day work.

That's my 2 cents worth. I look forward to your comments.

OC_An Khe · Jul 15, 2009

Medicare is working. Is it perfect, by no means especially part D. The probem with Medicare is that it is underfunded. It is underfunded because that is what a majority of the American people want. Over a quarter of a century ago a law was passed,Medicare premiums were raised to reflect peoples income and ability to pay. The law didn't last because of tremendous public outpouring of public sentiment wanting a continued high degree of government subsidy. We do get what we vote for (sometimes).

I have no problem with a public option, particularly now that virtually all the health insurance carriers are for profit entities. They no longer have a not for profit presence in the market place to compete against. Also individual states are dominated by only one or two companies so there is really little or no competition.

mwboswell · Jul 17, 2009

Our health care system hurts everyone. Premiums are expensive and increasing every year. Doing nothing today will cost taxpayers 2-3 times more in the next few years.
Currently, the "public option" is the biggest obstacle when it comes to health care reform. Many believe that it will be the end of health care as we know it today - others think that it is long overdue.
Would you support a public health care option?

Joe,

sorry for the late reply.

I just came across this thread.

You state "doing nothing today will cost taxpayers 2-3 time more in the next few years.".....

...says who?

What's your source for this?

Please cite your reference on this.

ssing45 · Jul 17, 2009

In a perfect world the US would have enough money to pay for everybody to have all things wonderful. You and I, we cannot afford to pay for everybody. It is just not doable, it's not reasonable and it's not why I work 3 three jobs. I work so much to pay for my children to go to college, a privilege that is 100% paid for, by me and people like me, for other peoples children. I pay for other parents who make less than I do and for their children, whose grades and SAT are below the level of my children's. So, we pay for college, we pay for healthcare, we pay for social security, we pay for big business bailouts, we now are asked to pay for universal healthcare, AND pay for ourselves (we work hard and can expect no help from the government). Do you see that it is one sided? Do you see how our pockets are being emptied? Dream on sister, and play that fiddle cause Rome is burning.

K98 · Jul 17, 2009

Looks like the CBO report has a fair number of democrats (the ones that can count) breaking ranks. Why is Obama in such a hurry to have this legislation drafted and passed? Everything this guy proposes is an "emergency" or a "crisis". Thankfully, the few folks that are paying attention are starting to question the numbers on this mess.