How would Medicare for all affect nursing?

allnurses Guide · Apr 20, 2019

In all my 42 years of hospital nursing we had snacks and such available for patients. I remember in the early 1980s a young AIDS patient less than an hour before he dies thanking his family, friends, and nursing staff for very specific kindnesses. My thank you was for making him a cup of instant hot chocolate at 3:00 am about a week before.

In my memory the patient who wanted a filet mignon and baked potato dinner delivered at 2:00 am and reported to his physician that we only gave him a sandwich was typical of some. A couple days after that request he turned his call light saying, "I want my Demerol now, and six packets of crackers, six pats of butter, three jellos, three puddings, and orange juice. When told his Q 4 H Demerol wasn't due for 1/2 hour he signed out against medical advice.

Thankfully patients who appreciate their care are the norm.

I think expanded and improved Medicare For All will help most of us.

allnurses Guide · Apr 20, 2019

Dr. Garrett Adams MD's opinion:

Quote
Don't believe the lies about single-payer health care
American health care is in continuing crisis. Access is declining, and costs are out of control. Medical bankruptcies, unheard of in other developed countries, still plague us. Even though the U.S. spends nearly twice as much per capita on health care, our health outcomes are far worse than other comparable nations. For example, way more American women die of pregnancy-related complications than in any other developed country, and the rate is rising.
Statistics are people with the tears wiped dry.
What’s wrong? Corporate profiteering. Corporations squeeze the insured, you, for every nickel to pay their dividends and increase cash value. Insurance companies raise premiums, deductibles and co-pays; they deny claims and contrive to insure only healthy (cheap) people...
... Medicare Advantage, which privatizes Medicare, is burdened with fraud and poor cost control. Insurance companies selling Advantage plans bilked the government for an estimated $70 billion between 2008 and 2013.
The U.S. system isn’t about improving health care; it’s about profit. Single-payer changes the dynamic; with single-payer the system becomes patient-oriented, not profit-oriented.
Single-payer means ONE payer, the government, pays the bills while health care delivery (doctors and hospitals) remain in private hands. The wasteful bureaucracy of private health insurance goes away. The government becomes the insurer. Coverage is unhooked from employment, allowing workers to change jobs or start new businesses...
... Drug companies, for-profit hospitals, insurance companies and others invested in profit-based care are campaigning vigorously against single-payer, spreading misinformation and fearmongering. Industry-aligned anti-single-payer individuals are posing as ordinary citizens spreading misinformation about single-payer....
... Don’t believe the lies. National health plans work extraordinarily well in every other industrialized nation. Canada, Scotland, Sweden, Taiwan, and Japan (among dozens of others) cover their entire population for a fraction of what the U.S. spends (wastes!) and enjoy longer lifespans and better health outcomes. How will we pay for it? An American single-payer plan will pay for itself by redirecting wasted administration and profiteering funds into patient care. Consider the vast difference in cost: From 2007 to 2014, spending in private plans grew nearly 17 percent per enrollee, while Medicare spending decreased 1.2 percent per beneficiary.
Single-payer will have an immediate healing effect on all our people, and it will arrest our surging wealth inequality. Rev. Dr. Martin Luther King, Jr. said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” With single-payer, in one transformative action, on at least one level, everyone becomes the same, and we seriously commit to a true democracy with justice for all.
https://www.courier-journal.com/story/opinion/2019/04/15/health-care-single-payer-system-puts-patients-over-profits/3469593002/

nursej22, MSN, RN · Apr 20, 2019

On 4/18/2019 at 2:10 PM, LovingLife123 said:
It will come to ... patients not ever having private rooms....
Look at countries where there are no frills in the hospital
there is no cable or phones. No more private rooms with private bathrooms. No more room service food. Everyone gets the same tray at the same time of day.

I don't see a problem with this. When I had my children I was given the choice of private or shared room, knowing that a private room would cost more. The shower was down the hall, shared with others. And you got your tray, and if you wanted something else, your family brought it in. When my father had his first open heart surgery in 1978, there was a TV in the room, but you were charged for its use.

And after surgery, pain relief was an IM shot, q 3-4 prn, until you could take po, and then you were thankful to get tylenol #3.

However, under Medicare for All, hospitals could still be private, and if they want to offer posher accommodations , then that would be up to them. I can't believe that there is any evidence demonstrating that choosing one's meals or having cable TV affects the healing process.

Fiddleback · Apr 20, 2019

On 4/14/2019 at 4:25 PM, MunoRN said:
Medicare already exists and covers 60 million people, so I'm not really buying that we have no idea how it would actually work.
As for whether a publically run agency can do a good job at providing medical coverage, medicare already controls healthcare cost inflation far better than private insurers, and all the existing quality measures, even those utilized by private insurers, come from public agencies.
Taxes would replace what we currently pay, with an overall reduction in costs. The typical employer-provided family insurance plan is $19,000 per year, with the employee paying about $5,000 of that. Since employers would no longer be allowed to skirt this responsibility, the per-plan cost would go down, and most likely the amount that was previously the employer's contribution would become an employer tax, and same with the employee's contribution. So while your $5,000 annual cost would now be paid through taxes rather than payroll deductions, the amount you pay would go down by at least 6%.
Currently, much of the middle class pays far more than their fair share for healthcare coverage, removing that unfair burden is more likely to help than harm the middle class.
I'm not sure where you're getting that "it will end private care", has current medicare somehow ended private care?

The “end of private care” probably comes from Bernie Sanders stating that BCBS would be reduced to only being able to cover nose jobs.

Tenebrae, BSN, RN · Apr 21, 2019

On 4/19/2019 at 9:10 AM, LovingLife123 said:

It will come to having 4-5 patients in the icu at once, things being missed,

Oh puhlease, I cant believe people actually believe this crap

Universal healthcare here and our ICU nurses have a ratio of 1-2 maximum depending on how sick those people are it may be 1:1

patients not ever having private rooms, people being discharged way before they are ready.

Again, we have private rooms, they tend to be used for those who are the sickest or perahos need a single room due to being infectious

I know in this utopian world Medicare for all sounds great. I know other countries have it, but they also don’t have the standards that e have in place here.

What standards? Chronically mentally unwell getting a whole 100 days in their life time covered under medicare

Or people not being able to pay the deductible portion of their health expenses, having to sell their homes etc

Look at countries where nurses have 15 patievts in acute care, supplies are at a minimum, and there are no frills in the hospital.

Oh I am getting a serious case of eye strain right now. In acute orthopaedics I have a maximum of 4 patients total, the worst ratio i ever had was working in plastics with a ratio of 5, one of which was a preop patient who my gorgeous colleagues helped me with because my other four patients were needing a lot of input

No more private birthing suites.

Again, universal healthcare here. Sorry to burst this misconception but women arent lined up eight in a room giving birth side by side. Every woman giving birth has a private birthing room, gasp they even have their own private room too in our local hospital

I agree healthcare needs to change. The problem is it is such a huge undertaking and we don’t have actual healthcare people trying to reform it.

One of the big problems is that those who are anti a single payer system often are propagating downright falsehoods about the reality of universal healthcare. Dont get me wrong, its far from perfect however posts like this one are full of bunk its not funny

Not to mention your political system allows people from health care fields to line the pockets of politcans under the guise of poilitical donations which is hardly going to inspire the senators and politicans to try changing things when it goes against their livelyhoods

cec0007 · Apr 21, 2019

On 4/14/2019 at 3:35 PM, MunoRN said:
There seems to be a misperception that Medicare care for all would add $32 trillion in healthcare spending, when the $32 trillion would replace about $34 trillion in spending, so I don't really get the argument that we can't afford to pay less for the same healthcare.
In terms of reimbursement, I think people confuse Medicaid, which reimburses poorly, with Medicare. The highest profiting hospitals in the country also have some of the highest proportions of medicare patients.
While there is potential for decreasing healthcare costs beyond just the $2 trillion in administrative cost reductions, even if costs otherwise remain the same it would still result in a much better healthcare system. Currently there are large discrepencies in how we spend our healthcare money which produces a lack of access to healthcare services and long wait times for specialists in parts of the country with large uninsured and Medicaid populations.
Medicare for all would just expand medicare to those under 65, it wouldn't change the basic characteristics of medicare; you could still choose to use an HMO, you can still purchase medicare plans through a private insurer, you still see non-government employed doctors and nurses and go to non-government run hospitals.

If you think there will ever be a $34 trillion reduction in spending, you must live on a different planet than I do. The current Medicare system for those over 65 is a huge drain and goes in the hole. There is no way we can extend Medicare to everyone without tripling our income taxes, which few people could financially survive. Do you have an inkling of how much $32 trillion is? It's an unimaginable number and insane to even consider it. It will have to come from somewhere, and the U.S. is broke as it is. We are already so far in debt we'll never get even again, and MC for all would more than double that debt. Those chickens will come home to roost someday, and we've been doing our children and grandchildren a huge disservice for many years already.

Socialism has never worked long term because you eventually run out of other people's money. (That's a quote from someone smarter than I am.) We're already out. There is no free ride.

I would love to do a lot of things--buy my adult children nice homes, buy us a little family island for vacations, put my nine grands through college--make it Harvard while we're wishing. I don't plan to do those things because I don't have the money. Reality check.

We can't come close to affording Medicare for all. And if we could it would be detrimental to health care workers and patients. I'm not confusing it with Medicaid. We.don't.have.the.money.

To bring a little perspective to large numbers, ask Alexa how many seconds are in a lifetime of 85 years.

32 trillion of anything boggles the mind.

Flame away...

GrumpyRN, NP · Apr 21, 2019

2 hours ago, cec0007 said:
If you think there will ever be a $34 trillion reduction in spending, you must live on a different planet than I do. The current Medicare system for those over 65 is a huge drain and goes in the hole. There is no way we can extend Medicare to everyone without tripling our income taxes, which few people could financially survive. Do you have an inkling of how much $32 trillion is? It's an unimaginable number and insane to even consider it. It will have to come from somewhere, and the U.S. is broke as it is. We are already so far in debt we'll never get even again, and MC for all would more than double that debt. Those chickens will come home to roost someday, and we've been doing our children and grandchildren a huge disservice for many years already.
Socialism has never worked long term because you eventually run out of other people's money. (That's a quote from someone smarter than I am.) We're already out. There is no free ride.
I would love to do a lot of things--buy my adult children nice homes, buy us a little family island for vacations, put my nine grands through college--make it Harvard while we're wishing. I don't plan to do those things because I don't have the money. Reality check.
We can't come close to affording Medicare for all. And if we could it would be detrimental to health care workers and patients. I'm not confusing it with Medicaid. We.don't.have.the.money.
To bring a little perspective to large numbers, ask Alexa how many seconds are in a lifetime of 85 years.
32 trillion of anything boggles the mind.
Flame away...

You do understand that socialised healthcare is not free don't you? Or do you just listen to the people who tell you that "everything will be given to you?" I left school at aged 15, my very first pay packet had a deduction for national insurance and every pay packet/salary since then has a deduction for this (TANSTAAFL). What that means is that I don't have to look for health insurance or stay with an employer because they have "good benefits". As an exercise for the reader the current national insurance rate is 13.8%. Take that off the top line of your salary and then compare it to the health insurance you pay. Prescription charges in England are £9 ($11.70) per item or £104 ($135.16) for a years worth of everything.

You say socialism never worked long term - seems to be doing all right in Europe. Again don't confuse socialism with communism. You talk of debt but why does the US spend twice on healthcare than other countries do with worse results. https://www.reuters.com/article/us-health-spending/u-s-health-spending-twice-other-countries-with-worse-results-idUSKCN1GP2YN

The ridiculous education debt that Americans are saddled with is a whole other discussion.

I am going to back up what Tenebrae wrote earlier, ICU ratio is 1-1, HDU ratio 1-2, ward ratio can vary but would depend on how ill the patients are, sicker patients get more nursing care, less sick patients require less nursing care. When I did my maternity rotation I can assure you that delivery was done in a single room.

I know that the NHS is not perfect but we try. The system has been brought down by continuous conservative governments trying to destroy it to bring in an American system. The NHS is great at the life saving stuff but not quite as good at the life enhancing stuff.

kbrn2002, ADN, RN · Apr 21, 2019

To say our current system is less than ideal is maybe the biggest understatement of a lifetime. To keep somewhat on point of the original post as to how it affects nursing I'll tell you what my companies employees face.

We changed insurance providers, yet again. This current policy only pays if you see a provider within a specific health system. Several staff, including myself had to change primary providers or pay out of pocket with no guarantee of reimbursement.

Getting the insurance to actually pay for services is a nightmare. One nurse I work with with needs a second surgery that she is putting off because the insurance company still hasn't paid for her first surgery which was over 6 months ago. I personally know three nurses, two CNA's and a social worker that haven't had their major medical bills paid by the insurance company despite it being months since the care was provided. They are constantly dealing with the health systems bill collectors for bills they shouldn't even be responsible for. In at least one case the employee started paying on the bill herself to avoid the ding to her credit since she's trying to buy a house and can't afford anything negative on her credit report.

The cost for this so-called health care is outrageous. I pay $248.00 a check for medical for my husband and myself. Plus an additional $17.00 for dental and vision. That's over $500/month for insurance that we never use as we are generally healthy. The co-pays aren't too bad, but the deductible is pretty high at $3000 each. Those premiums took a big jump, almost doubled two years ago. The explanation we were given was the change in insurance providers caused the huge increase. We were promised by corporate that this year the rates would go down considerably. If you consider going down less than $5.00 a check considerable I guess they didn't lie. Oh, yeah, they also changed insurance providers again, I guess that means they can continue to justify the higher premiums with less actually covered?

This cost for insurance by the way doesn't include the elective policies for short and long term disability which I opted out of this year as that was adding an additional $250.00 plus a month for insurance I rarely use. If something major was to happen that caused me to be out of work for a period of time I'd be screwed. But on the flip side I can't afford an additional $250.00/month on top of what I already pay so I just have to hope nothing serious happens. The co-workers I have that kept that insurance expecting to have procedures that would keep them out of work for a time have also had a hell of a time getting the policies to pay. So they are out of work, with limited to no income and fighting off the bill collectors with vague promises of paying whenever the insurance payment's actually start coming in.

My pay by the way hasn't even come close to increasing enough to compensate for the rise in rates.

OUxPhys, BSN, RN · Apr 21, 2019

While both have their shortcomings after becoming a RN I am more supportive of a medicare for all type system and not a government run system like the NHS or VA (Im a vet and I also work at a VA, love the one I am at). Ive also seen so many pts get turned down for insurance (at my old job) because MDs who work for the insurance companies don't feel it is necessary.

Something has to change. Id be in favor of having what I pay every month to my insurance go towards a medicare for all system. Yes there would be a tax increase but the people making more money should have to pay a higher tax.

MunoRN, RN · Apr 21, 2019

6 hours ago, cec0007 said:
If you think there will ever be a $34 trillion reduction in spending, you must live on a different planet than I do. The current Medicare system for those over 65 is a huge drain and goes in the hole. There is no way we can extend Medicare to everyone without tripling our income taxes, which few people could financially survive. Do you have an inkling of how much $32 trillion is? It's an unimaginable number and insane to even consider it. It will have to come from somewhere, and the U.S. is broke as it is. We are already so far in debt we'll never get even again, and MC for all would more than double that debt. Those chickens will come home to roost someday, and we've been doing our children and grandchildren a huge disservice for many years already.
Socialism has never worked long term because you eventually run out of other people's money. (That's a quote from someone smarter than I am.) We're already out. There is no free ride.
I would love to do a lot of things--buy my adult children nice homes, buy us a little family island for vacations, put my nine grands through college--make it Harvard while we're wishing. I don't plan to do those things because I don't have the money. Reality check.
We can't come close to affording Medicare for all. And if we could it would be detrimental to health care workers and patients. I'm not confusing it with Medicaid. We.don't.have.the.money.
To bring a little perspective to large numbers, ask Alexa how many seconds are in a lifetime of 85 years.
32 trillion of anything boggles the mind.
Flame away...

We're already paying (a lot) for healthcare, the $32 trillion wouldn't be new healthcare spending, it would replace $34 trillion in spending.

Saying we can't afford to pay $2 trillion less than we would otherwise doesn't make a lot of sense. As an example, lets say you're paying $20k for health insurance, the you get an opportunity to instead pay $18k for the same coverage, and your response is "No thanks, I can't afford $18k, so I'll stick with my $20k a year plan".

The $2 trillion savings by switching insurance carriers to medicare is just the reduced cost in insurance administrative costs, there would most likely also be reduced healthcare cost inflation and reduced overall costs due to Medicare's already proven ability to manage preventive care and chronic disease management better than the private insurance model.

osceteacher · Apr 23, 2019

On 4/21/2019 at 11:45 AM, cec0007 said:
If you think there will ever be a $34 trillion reduction in spending, you must live on a different planet than I do.

Someone doesn't know what they're talking about. Its not about saving $34 trillion for crying out loud, its estimated to cost $32 trillion and the US ALREADY pays $34 trillion so it would save $2 trillion.

If you're going to have an input you need to at least have a basic understanding of what you're talking about, its not about flaming away, its about correcting blatant inaccuracies and falsehoods.

The quote 'you run out of other peoples money' is a dumb quote from a nasty piece of work and should not be touted by anyone. There is always other peoples money when it comes to spending trillions killing poor arab civilians in countries that never attacked us, or supporting violent regimes like the Saudi's or Israel.

People love socialism when it comes to schools, police, firemen, border control and supporting the disgustingly bloated military, but say you want to keep people healthy and its suddenly so unattainable and insert Venezuela here memes.

10GaugeNeedles, BSN · Apr 23, 2019

I’m normally against government. But I could see it working. If all insurance premiums were averaged out and that was the Medicare tax, it could work. The best thing would be to do away with the charge master pricing system. There’s no transparency with pricing. Medicare would make pricing more in line with reality. Face it, private health insurance sucks. Mainly cause of gov regs. However, the whole country pays for only part of the population with taxes for Medicare right now. And it’s about go bankrupt. http://time.com/5575482/medicare-insolvent-by-2026/

so, can we really say it’s a good idea for a program that is about go insolvent to get even bigger? I definitely see wages for nurses dropping. I’m torn. I can see it working but, I can’t tell if it’s actually a good idea. Great topic OP.