How would Medicare for all affect nursing?

[Emergent]

There's talk and hope in many quarters that the United States will end up with Medicare for all. How would this affect nursing?

I currently pay a lot for my portion of high deductible insurance through work. It's basically mainly useless to me since I'm healthy, don't take meds etc. Even going to the doctor would cost me.

Honestly, the middle class has become the new underserved in America. Frugal, responsible people think twice about going to the doctor because of huge copays that have made basic healthcare a budget buster.

How would Medicare for all affect the middle class, nursing in particular? Employers would no longer have to pay for insurance. Would they pass savings on to us in the form of higher wages? How would we fare economically with higher taxes? Would the poor government compensation to facilities drive down wages?

[osceteacher]

On 4/18/2019 at 10:10 PM, LovingLife123 said:

It will come to having 4-5 patients in the icu at once, things being missed, patients not ever having private rooms, people being discharged way before they are ready. 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.

Maybe if you weren't so incorrect people might take your post more seriously.

To suggest 4-5 patients in the ICU would be the norm is objectively nonsense and just scaremongering and in fact its the opposite. A study in 2007 showed In the UK the standards are 1-1 for level 3 patients and 1-2 for level 2, in the US its 1-1 and 1-3 with only one state (California) actually taking a legal stance to guarantee a 1-2 ratio, something that the UK has always had in place. Weirdly this change had no impact on patient outcomes.

Per capita US ICU healthcare costs are exorbitant, as we all know the US always pays more than anyone else per capita and this is obviously the case in ICU.

The US mortality rate in ICU is lower than the UK, thats an objective reality, however we're not comparing apples with apples because the US mortality of ICU patients is actually higher AFTER discharge, considerably higher.

There is no objective reality where your demonisation of universal healthcare is supported.

And it’s about go bankrupt. http://time.com/5575482/medicare-insolvent-by-2026/

I'm sure there could be cross party agreement on an $80 billion increase just like they did for the bloated military budget...

[OUxPhys, BSN, RN]

18 hours ago, 10GaugeNeedles said:

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.

I dont know about RN wages dropping, I work VA and my wages actually went up when I went from a private hospital to VA.

[kbrn2002, ADN, RN]

On 4/21/2019 at 8:06 AM, GrumpyRN said:

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.

I did the math out of curiosity and would you believe 13.8% off the top of my paycheck equals the same amount as my combined insurance premiums within pennies, literally only $0.13 difference. That includes medical, dental and vision plus $75.00 a check that I have taken out for an HSA to cover any deductibles and co-pays I might have so if I need more medical care than expected I would still have a balance of $1050 to cover my entire annual deductible. But then the HSA account does continue to accrue a balance as it's not a use it or lose it type of health account so I already have more than enough money in there to cover any additional deductibles I might have. About the only thing I regularly use it for are medication co-pays which are pretty minimal for us.

So it's seems I am paying pretty much exactly for insurance what you are across the pond. So now the question remains which coverage is actually better? I honestly don't know as I have nothing to compare it to.

[GrumpyRN, NP]

2 hours ago, kbrn2002 said:

I did the math out of curiosity and would you believe 13.8% off the top of my paycheck equals the same amount as my combined insurance premiums within pennies, literally only $0.13 difference. That includes medical, dental and vision plus $75.00 a check that I have taken out for an HSA to cover any deductibles and co-pays I might have so if I need more medical care than expected I would still have a balance of $1050 to cover my entire annual deductible. But then the HSA account does continue to accrue a balance as it's not a use it or lose it type of health account so I already have more than enough money in there to cover any additional deductibles I might have. About the only thing I regularly use it for are medication co-pays which are pretty minimal for us.

So it's seems I am paying pretty much exactly for insurance what you are across the pond. So now the question remains which coverage is actually better? I honestly don't know as I have nothing to compare it to.

Thank you for taking the time to do this?. Did you factor in the results of long term and/or repeated illness? How would your premiums change if you required several hospital visits/stays?

As an example, over the years I have had a cancer requiring a couple of surgeries and chemotherapy, a bowel operation, an MI with CABG and meningitis with ICU stay. Also required surgery on my back (this will identify me to anyone who knows me and reads this). Also included in this are various examinations and tests that were performed over the years.

The reason I am writing this is that I do not have to pay any more or extras on top of my National Insurance (NI) contribution after all these procedures AND the NI also covers a pension from the state when I hit pension age. Will your premiums be as affordable if you had this level of medical need?

Forgot to add, paying the NI means I could claim unemployment benefit when I was unemployed. Should add for clarity, when I tried to get life insurance I was refused or given ridiculous quotes so I am classed as "uninsurable" because of my medical history.

Hope this gives you some comparison to work from.

[brownbook]

Dear GrumpyRN, could you please come across the pond and advise our Congress about health insurance coverage. Thanks in advance.

[nursej22, MSN, RN]

Opinion piece in the NY Times today, computing how the cost of health insurance impacts various income levels, and families.

https://www.nytimes.com/2019/04/29/opinion/medicare-for-all-cost.html?action=click&module=Opinion&pgtype=Homepage

Quote

When single workers decide to start a family, they need to switch from an individual health plan to a family health plan. The average individual health plan has an annual premium of just under $6,400 — with employees directly paying around $1,400 of that. For family plans, the premium is around $19,000 with employees responsible for around $5,200.

This jump in premiums for workers who start families is what ensures that middle-class workers with children put around 40 percent of their labor compensation toward taxes and health care, despite policies that reduce their formal taxes.

[KonichiwaRN]

On 4/13/2019 at 12:25 PM, Emergent said:

There's talk and hope in many quarters that the United States will end up with Medicare for all. How would this affect nursing?

I tend to think it as..

never mind should it be implemented or not.

It's just that, there is no way this nation could afford to do it. Think of the population + tax revenue versus tax expenditure.

[GrumpyRN, NP]

7 hours ago, KonichiwaRN said:

I tend to think it as..

never mind should it be implemented or not.

It's just that, there is no way this nation could afford to do it. Think of the population + tax revenue versus tax expenditure.

Have you been following this discussion? See Nursej22's comment immediately preceding yours as a starter.

[osceteacher]

10 hours ago, KonichiwaRN said:

I tend to think it as..

never mind should it be implemented or not.

It's just that, there is no way this nation could afford to do it. Think of the population + tax revenue versus tax expenditure.

Multiple studies already show that it would SAVE money, we've been discussing that during this thread.

https://www.thenation.com/article/thanks-koch-brothers-proof-single-payer-saves-money/

https://www.nytimes.com/2017/07/07/upshot/why-single-payer-health-care-saves-money.html

Do some reading, watch some Kyle Kulinski then come back and join the discussion.

[KonichiwaRN]

3 hours ago, GrumpyRN said:

Have you been following this discussion? See Nursej22's comment immediately preceding yours as a starter.

Yea. I saw the bold link of an opinion piece of the NY times,

and in my mind are these weird points that just does not make sense.

a) can't force Hospitals (MDs) to take Medicare

b) if you spend more than what you make, it never works out. ever. in all of human civilization

c) again. look at the ratio of our nation's population, its actual taxpayers and the non taxpayers.

Basically, I have the attitude of: I don't care what Politicians do. Just don't raise our income tax rates.

[osceteacher]

12 minutes ago, KonichiwaRN said:

Yea. I saw the bold link of an opinion piece of the NY times,

and in my mind are these weird points that just does not make sense.

a) can't force Hospitals (MDs) to take Medicare

b) if you spend more than what you make, it never works out. ever. in all of human civilization

c) again. look at the ratio of our nation's population, its actual taxpayers and the non taxpayers.

Basically, I have the attitude of: I don't care what Politicians do. Just don't raise our income tax rates.

a) Yeah you can.

b) As discussed you will be saving money on what you already pay...

c) What is the relevance of that?

You'd pay less in income tax than on insurance as explained so your last sentence is a naive position to take.

/deadhorse.gif

[KonichiwaRN]

7 minutes ago, osceteacher said:

a) Yeah you can.

b) As discussed you will be saving money on what you already pay...

c) What is the relevance of that?

You'd pay less in income tax than on insurance as explained so your last sentence is a naive position to take.

/deadhorse.gif

Oh.

So now we are going to "force" Doctors to take Medicare now?

That would indeed be a case that goes in front of the Supreme court.

Somewhat like telling a person that he or she MUST sell a product, with a certain amount that we (government) establishes.

Wow. Just, wow.

It just never ends, does it?

Again, focus on the part: money in vs money out.

money out > money in?

never will be a good result.