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?

[LovingLife123]

On 4/23/2019 at 3:06 AM, osceteacher said:

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.

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

Ha! Take my post seriously? You do understand that many hospitals are already going to 3-4 in ICUs? Less money to reimburse, less money to pay nurses. It’s actually quite simple.

And in other countries in the world, those that get private rooms and all the ammenities are those with private insurance. Yes, most European countries have a what is close to a single payer system, but there is also private pay insurance. Private insurance patients get all the ammenitues similar to here is the US.

Now, imagine here in the US where those on the single payer system get different treatment in the hospital than those with private insurance? There’s absolutely no way that would fly here. I can’t even imagine the backlash.

As it is now, everybody gets the same medical treatment no matter what insurance they have in the hospital. Whether you have the best insurance out there or are a charity case, we treat you the same.

The responses from those that don’t get how this would actually work boggle my mind.

I will state again, our healthcare needs reform. But with the way society is now and what they expect from us, it will not work. Societal expectations need to change. People want the exact same healthcare we have right now, but they all want it for free. That is absolutely not possible.

You cannot take my posts seriously, but I’m actually pretty accurate on things over the years. I have a pretty firm grasp on people and our society here in the US. And what makes perfect sense to us, does not work sign the general public.

[OUxPhys, BSN, RN]

10 minutes ago, LovingLife123 said:

Ha! Take my post seriously? You do understand that many hospitals are already going to 3-4 in ICUs? Less money to reimburse, less money to pay nurses. It’s actually quite simple.

And in other countries in the world, those that get private rooms and all the ammenities are those with private insurance. Yes, most European countries have a what is close to a single payer system, but there is also private pay insurance. Private insurance patients get all the ammenitues similar to here is the US.

Now, imagine here in the US where those on the single payer system get different treatment in the hospital than those with private insurance? There’s absolutely no way that would fly here. I can’t even imagine the backlash.

As it is now, everybody gets the same medical treatment no matter what insurance they have in the hospital. Whether you have the best insurance out there or are a charity case, we treat you the same.

The responses from those that don’t get how this would actually work boggle my mind.

I will state again, our healthcare needs reform. But with the way society is now and what they expect from us, it will not work. Societal expectations need to change. People want the exact same healthcare we have right now, but they all want it for free. That is absolutely not possible.

You cannot take my posts seriously, but I’m actually pretty accurate on things over the years. I have a pretty firm grasp on people and our society here in the US. And what makes perfect sense to us, does not work sign the general public.

Major hospitals or rural/community hospitals? I cant see a major medical center trying to get nurses to take 3-4 ICU level pts.

[Rose_Queen, BSN, MSN, RN]

9 minutes ago, LovingLife123 said:

Now, imagine here in the US where those on the single payer system get different treatment in the hospital than those with private insurance? There’s absolutely no way that would fly here. I can’t even imagine the backlash.

Would it truly be that much different than the treatment of those with insurance vs. those without insurance? Those without insurance tend to get treated differently because they end up waiting until something is far too advanced and has become emergent or life-threatening, requiring many more (expensive) resources. Why shouldn't every person have access to health care that won't result in financial ruination? And I can guarantee you that Medicare patients are not treated any differently than private insurance patients in my facility.

[GrumpyRN, NP]

17 hours ago, LovingLife123 said:

Ha! Take my post seriously? You do understand that many hospitals are already going to 3-4 in ICUs? Less money to reimburse, less money to pay nurses. It’s actually quite simple.

And in other countries in the world, those that get private rooms and all the ammenities are those with private insurance. Yes, most European countries have a what is close to a single payer system, but there is also private pay insurance. Private insurance patients get all the ammenitues similar to here is the US.

Now, imagine here in the US where those on the single payer system get different treatment in the hospital than those with private insurance? There’s absolutely no way that would fly here. I can’t even imagine the backlash.

As it is now, everybody gets the same medical treatment no matter what insurance they have in the hospital. Whether you have the best insurance out there or are a charity case, we treat you the same.

The responses from those that don’t get how this would actually work boggle my mind.

I will state again, our healthcare needs reform. But with the way society is now and what they expect from us, it will not work. Societal expectations need to change. People want the exact same healthcare we have right now, but they all want it for free. That is absolutely not possible.

You cannot take my posts seriously, but I’m actually pretty accurate on things over the years. I have a pretty firm grasp on people and our society here in the US. And what makes perfect sense to us, does not work sign the general public.

You have already been told that ICU in UK is 1-1 and HDU is 1-2 so why bring up what US is doing - it is irrelevant and only goes to prove that universal healthcare seems to be better.

As far as amenities are concerned - it is a hospital not a hotel. If a patient wants hotel services then yes, they can go private. There are private hospitals for that. They pay for those private hospitals ON TOP of the national insurance. If a private patient is in an NHS hospital they get exactly the same treatment as everyone else. They may get a single room but it is not guaranteed. If that room is required for an ill patient or for clinical reasons they are moved. Also they are using the same kitchen as the other patients. The ONLY difference a private patient in an NHS hospital has is earlier access to surgery/investigations etc. As a nurse my priorities are with the sick patients who need me and not some entitled demanding patient who thinks they have paid for my time and skills - they haven't. They may have paid for the surgeon and maybe even the anaesthetist but they have not paid for me.

ETA; perhaps if you got rid of things like Press Ganey and if your hospitals no longer rely on good reviews to ensure funding then perhaps nurses can do the things they are trained to do and not what the public expects them to do.

[GrumpyRN, NP]

On 5/5/2019 at 3:51 PM, KonichiwaRN said:

lol.

sounds like you're living in the wrong country..

not only that, against the Constitution.

On 5/5/2019 at 6:49 PM, KonichiwaRN said:

Oh no. I'm not on drugs. ?

I just love the part about Grumpy, going all berserk regarding the Electoral system.

Doesn't take much conversation to bring out "your side's" true nature.

"Constitution is for us when it suits us, but we are all for altering the Constitution when it doesn't suit our side."

Must be nice.

We (our side) can see your tax scheme from a mile away.

You do understand that I am not American and I am not in America don't you?

[Kitiger, RN]

4 hours ago, GrumpyRN said:

.

ETA; perhaps if you got rid of things like Press Ganey and if your hospitals no longer rely on good reviews to ensure funding then perhaps nurses can do the things they are trained to do and not what the public expects them to do.

Amen & AMEN!

[subee, MSN, CRNA]

Patients in the US are different than those of other developed nations...we are fat, fertile, eating plenty of pesticides, and getting shot. I don't know what that means ...too complicated to wrap around my little brain...just an observation.

No health care system can ever be perfect. We have to pick our poison. But since Medicare and Social Security are working just fine for me (paid into the systems for 45 + years), it's hard to think what we are doing now is sustainable since we are doing so little to control costs. Not even trying to slice away the toxic fat that adds nothing to quality of care.

[KonichiwaRN]

4 hours ago, GrumpyRN said:

You do understand that I am not American and I am not in America don't you?

Oh my mistake. I thought that you were an American.

I am an American, and my vote counts. ?

[osceteacher]

On 5/6/2019 at 1:12 AM, LovingLife123 said:

Ha! Take my post seriously? You do understand that many hospitals are already going to 3-4 in ICUs? Less money to reimburse, less money to pay nurses. It’s actually quite simple.

I don't take them seriously and I don't take this one seriously either, single payer systems have 1-1 or 1-2 mandated so claiming american systems have 3-4 just goes to show how for profit organisations are desperate to make money at the expense of effective care.

The claim there will be less money is so far an unsubstantiated claim, if you stop giving the money to shareholders of the private insurance companies and pharmaceutical companies, maybe you'll have some left over to properly fund healthcare like everywhere else.

Patients in the US are different than those of other developed nations...we are fat, fertile, eating plenty of pesticides, and getting shot. I don't know what that means ...too complicated to wrap around my little brain...just an observation.

No health care system can ever be perfect. We have to pick our poison. But since Medicare and Social Security are working just fine for me (paid into the systems for 45 + years), it's hard to think what we are doing now is sustainable since we are doing so little to control costs. Not even trying to slice away the toxic fat that adds nothing to quality of care.

Your obesity is only slightly worse than the UK, you're eating less pesticides than in decades due to GMO reducing pesticide use but yes you definitely get shot a lot more.

Your patient groups are really not substantially different than the UK, having lived in both countries the only substantial difference is your ethnicity, which includes migration from poorer Latino countries which we don't tend to have a lot of.

[Susie2310]

22 hours ago, GrumpyRN said:

You have already been told that ICU in UK is 1-1 and HDU is 1-2 so why bring up what US is doing - it is irrelevant and only goes to prove that universal healthcare seems to be better.

As far as amenities are concerned - it is a hospital not a hotel. If a patient wants hotel services then yes, they can go private. There are private hospitals for that. They pay for those private hospitals ON TOP of the national insurance. If a private patient is in an NHS hospital they get exactly the same treatment as everyone else. They may get a single room but it is not guaranteed. If that room is required for an ill patient or for clinical reasons they are moved. Also they are using the same kitchen as the other patients. The ONLY difference a private patient in an NHS hospital has is earlier access to surgery/investigations etc. As a nurse my priorities are with the sick patients who need me and not some entitled demanding patient who thinks they have paid for my time and skills - they haven't. They may have paid for the surgeon and maybe even the anaesthetist but they have not paid for me.

ETA; perhaps if you got rid of things like Press Ganey and if your hospitals no longer rely on good reviews to ensure funding then perhaps nurses can do the things they are trained to do and not what the public expects them to do.

Grumpy, I have a relative in the UK who waited a number of years after their initial surgical consult had taken place for a promised, necessary surgery, and spent much of that time in pain while their condition continued to worsen. I can tell you more examples like this, and some of them had very serious outcomes. This is for care that people pay into; the NHS. So while you have retired with a pension from the NHS and will also receive a state pension when you reach 65, keep in mind that the surveys in the US that you refer to, while disliked by many, are part of the ACA and are intended to provide the largest payor (the government) with information to help ascertain quality of care being provided (for which the government and the patient are paying). The questions are very reasonable from a patient's point of view, and my family members' have completed them. The largest payor, the government, makes considerable effort to control costs and combat fraud. My family members who receive health care as part of their retirement benefits that are provided by the government have received very good medical care (overall) and are very happy (overall) with the medical care they have received. I also don't believe it is reasonable that a patient's experience of the care they received (that they and their insurance company are paying a lot of money for) should count for nothing when it comes to reimbursement.

[GrumpyRN, NP]

58 minutes ago, Susie2310 said:

Grumpy, I have a relative in the UK who waited a number of years after their initial surgical consult had taken place for a promised, necessary surgery, and spent much of that time in pain while their condition continued to worsen. I can tell you more examples like this, and some of them had very serious outcomes. This is for care that people pay into; the NHS. So while you have retired with a pension from the NHS and will also receive a state pension when you reach 65, keep in mind that the surveys in the US that you refer to, while disliked by many, are part of the ACA and are intended to provide the largest payor (the government) with information to help ascertain quality of care being provided (for which the government and the patient are paying). The questions are very reasonable from a patient's point of view, and my family members' have completed them. The largest payor, the government, makes considerable effort to control costs and combat fraud. My family members who receive health care as part of their retirement benefits that are provided by the government have received very good medical care (overall) and are very happy (overall) with the medical care they have received. I also don't believe it is reasonable that a patient's experience of the care they received (that they and their insurance company are paying a lot of money for) should count for nothing when it comes to reimbursement.

I have already said that the NHS is not perfect. The NHS is being starved of funding by the conservative government in a deliberate ploy to bring in privatisation AKA the American system. Patients in certain areas are having to wait long times for surgery. I hate conservative governments going back to Margaret Thatcher and her destruction of the NHS.

If you Google "conservative government destroying NHS" you will find lots of articles showing this.

Did your relative get their surgery eventually? How does that compare with people in America without insurance who never get the treatment required? Did your relative get prescription medication for this pain? How does that compare with people in America having to do without or ration their insulin?

As far as patients reviews go, having been on the end of a couple of complaints that were malicious and wrong I would hate for a vindictive patient to have any part in my salary. Yes complaints need to be looked but they should never be involved in funding.

[osceteacher]

13 hours ago, Susie2310 said:

Grumpy, I have a relative in the UK who waited a number of years after their initial surgical consult had taken place for a promised, necessary surgery, and spent much of that time in pain while their condition continued to worsen.

Why did they wait years? I don't believe it would be due to a lack of available surgery, the NHS is far from perfect but in all my years of nursing I have never come across a delayed surgical procedure of years for any other reason than the patients ill health preventing it.

I just won't believe your story if your family member waited years because they didn't have capacity because it doesn't happen, there will always be a medical reason behind a delay of that length. Objectively the longest wait times for hips and knees for example is 255 days, and those are probably the longest wait times you'll see, those aren't the average.
The Tories have consistently broken the NHS, thats what happens when you vote a right wing government in to power. The US won't follow a UK style system so the comparisons are only marginally useful, the US would never give the government so much control over their healthcare.