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?

[MunoRN, RN]

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.

[brownbook]

I have never understood much about my own health insurance coverage.....but if someone’s argument against changing our current crazy health care system is nursing wages will stagnate or go down. I think that’s a lousy reason.

No, I did not become a nurse because it was a calling. I had no idea what a nurses salary was, and have never even known, nor paid attention to, what my hourly wage was.

As an ADN floor nurse I think nurses make damn good money, dare I say even too much.

[Daisy4RN]

My biggest problem with this is that most things the government tells us is either not the truth to begin with, or simply changes later on their whim for whatever reason. Do we really think that the gov can do a good job with healthcare/agencies. I am not so sure about that! I have heard the money issue as explained by Muno, but that assumes they will provide policies etc as they state and will not raise taxes. I am afraid it will be the middle class that gets the short end of it. Also, I have heard that it will end private care so no you wont be able to choose. Right now I just think we don't have answers.

[TriciaJ, RN]

Until the advent of Obamacare, I had a self-pay insurance policy. It was a catastrophic policy, with riders. Basic preventative services were covered in full, there was a fund for doctor visits that carried over into the next year with a bonus if it wasn't used up completely. The premium was just over $300/mo and my out-of-pocket maximum was $7500/year. And I qualified despite pre-existing conditions.

I do believe any form of universal health care should be mainly catastrophic, with private insurance to cover other things. Health care savings accounts should actually work like savings accounts, not use-it-or-lose-it insurance policies in disguise.

[Daisy4RN]

7 minutes ago, brownbook said:

As an ADN floor nurse I think nurses make damn good money, dare I say even too much.

Ha Ha, No, you better not dare say ? "too much" LOL

[MunoRN, RN]

14 minutes ago, Daisy4RN said:

My biggest problem with this is that most things the government tells us is either not the truth to begin with, or simply changes later on their whim for whatever reason. Do we really think that the gov can do a good job with healthcare/agencies. I am not so sure about that! I have heard the money issue as explained by Muno, but that assumes they will provide policies etc as they state and will not raise taxes. I am afraid it will be the middle class that gets the short end of it. Also, I have heard that it will end private care so no you wont be able to choose. Right now I just think we don't have answers.

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?

[nursej22, MSN, RN]

I live very close to the Canadian border, and I have never seen or heard of this "Americans go to the front of the line". In fact, if you seek health care other than emergent, they want cash up front, period. We used to get transfers from north of the border where they would stabilize an MI, and then arrange for transport to the border, and be met by US medics to transport to acute care. My hubby sustained a fractured ankle in a softball game, and I drove him home for an Xray and walking boot.

If people are so suspicious of the government, then why don't we privatize the military? Or the fire department? Or FEMA? Or the CDC? Or the national parks? Or ICE and CBP?

[Daisy4RN]

36 minutes ago, 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?

I read somewhere that they wanted to do away with private healthcare so maybe it wasnt accurate info, I dont know. I dont mean we dont know how Medicare works per se but how it will work once that is all we have (if no more private). And of course i know we have other gov agencies but they are not always ran well/efficiently, too much waste, IMO. Also, if we end up with Federal Gov ran insurance, and because fed law trumps state law, that means the those facilities could impose whatever ratios they want. For instance, the California VA does not have the state imposed ratios that other hospitals have.

[Daisy4RN]

https://www.bloomberg.com/news/articles/2019-04-10/sanders-to-unveil-medicare-for-all-bill-as-marker-in-2020-race

[MunoRN, RN]

1 hour ago, TriciaJ said:

Until the advent of Obamacare, I had a self-pay insurance policy. It was a catastrophic policy, with riders. Basic preventative services were covered in full, there was a fund for doctor visits that carried over into the next year with a bonus if it wasn't used up completely. The premium was just over $300/mo and my out-of-pocket maximum was $7500/year. And I qualified despite pre-existing conditions.

I do believe any form of universal health care should be mainly catastrophic, with private insurance to cover other things. Health care savings accounts should actually work like savings accounts, not use-it-or-lose-it insurance policies in disguise.

Prior to the ACA there were much cheaper individual-market insurance plans, although they were also of little actuarial value. Unlike the requirements of the group (employer provided) insurance market, the individual market plans could drop coverage at any time and for pretty much any reason. This is why the rate of major claim denials in the individual market had risen to 1 in 8 just prior to the passing of the ACA. As a result, the majority of those filing for bankruptcy had insurance, often this low-value individual market plans. This meant that their costs were increasingly becoming the burden of those in the group-market.

There is certainly some value to Healthcare Savings Accounts for more common costs, but it doesn't really work for major costs, how do you envision that working?

Currently, medicare covers 80% of hospital costs after you've paid up your deductible with private insurance as an option for that other 20%, should medicare be more catastrophic in nature than that?

[MunoRN, RN]

12 minutes ago, Daisy4RN said:

I read somewhere that they wanted to do away with private healthcare so maybe it wasnt accurate info, I dont know. I dont mean we dont know how Medicare works per se but how it will work once that is all we have (if no more private). And of course i know we have other gov agencies but they are not always ran well/efficiently, too much waste, IMO. Also, if we end up with Federal Gov ran insurance, and because fed law trumps state law, that means the those facilities could impose whatever ratios they want. For instance, the California VA does not have the state imposed ratios that other hospitals have.

I think you're maybe confusing private healthcare coverage and private healthcare providers and facilities, although even private healthcare coverage wouldn't go away with medicare for all.

Just like now where medicare enrollees go to privately run hospitals, clinics, providers, etc, we would continue to do this under medicare-for-all.

Outside of the VA, hospitals are not federally run or licensed, they would still need to follow local and state laws including staffing laws. And speaking of the VA, one of the advantages of medicare-for-all is that it would facilitate transitioning the VA system to using existing non-government hospitals, ideally there would no longer be VA hospitals.

In terms of waste, which in the case of health insurance is usually measured by administrative and other overhead costs, current medicare administrative costs are typically less than 2%, where private insurers have administrative costs around 12%.

[TriciaJ, RN]

21 minutes ago, MunoRN said:

Prior to the ACA there were much cheaper individual-market insurance plans, although they were also of little actuarial value. Unlike the requirements of the group (employer provided) insurance market, the individual market plans could drop coverage at any time and for pretty much any reason. This is why the rate of major claim denials in the individual market had risen to 1 in 8 just prior to the passing of the ACA. As a result, the majority of those filing for bankruptcy had insurance, often this low-value individual market plans. This meant that their costs were increasingly becoming the burden of those in the group-market.

There is certainly some value to Healthcare Savings Accounts for more common costs, but it doesn't really work for major costs, how do you envision that working?

Currently, medicare covers 80% of hospital costs after you've paid up your deductible with private insurance as an option for that other 20%, should medicare be more catastrophic in nature than that?

Not sure. I didn't realize private insurers had such a bad track record to deny claims. The one HSA I was offered through an employer looked like a giant ripoff. Only certain things were covered, and any unused money at the end of the year was forfeit.

Not sure how Medicare should work. Just know there's a lot of waste and fraud that needs to be cleaned up.