How would Medicare for all affect nursing?

Trauma Columnist · Apr 14, 2019

1 hour ago, nursej22 said:
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?

I should have probably clarified that when I lived in Korea and Spain I was a military family member so only had Tricare which covered on-base care as well as off-base care. However, Tricare was funded by the US government.

MunoRN, RN · Apr 14, 2019

58 minutes ago, TriciaJ said:
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.

No matter how we move forward, combatting fraud needs to continue to be a priority. Rates of fraud of private insurance is lumped into their administrative costs, so while we can't pull those numbers out of their overall administrative costs, we do know that private insurer administrative costs are much higher than that of medicare, so it would appear medicare is able to reduce fraud more than private insurers.

Insurance is just the costs of healthcare beyond the coverage cutoff for everyone in the plan, so the costs except for administrative costs are fairly fixed, the only way to make it significantly cheaper is to limit coverage or kick-out people once they get sick. If done properly, their shouldn't be a lot of money left over at the end of the year to hand-out, that would just mean they overcharged in their premiums.

turtlesRcool · Apr 15, 2019

On 4/13/2019 at 4:33 PM, hppygr8ful said:
The average nurse with 20 years experience gets around 34,000.pounds a year. That amounts to about 26,000.00 dollars a year in US dollars.

I think you maybe reversed your pounds to dollars calculator. The current exchange rate is $1.31 USD to 1 GBP. So 34,000 pounds would work out to $44,500. It's for sure less than nurses make in many areas, but around what some nurses make in other parts of the country.

RobbiRN, RN · Apr 15, 2019

First, I'd like to second the financial breakdown and arguments well-stated by MunoRN in this thread. I've researched this subject extensively (five books and hundreds of articles) over the past two years and talked with many people while traveling outside the US. I firmly believe private insurance tied to employment is the root cause of our exploitative, inequitable system. Consider or reconsider the following:

1. The majority of bankruptcies in the US are due to healthcare bills, and about 75% of those bank bankruptcies are people who were "insured."

2. About 30% of all healthcare dollars spent in the US are spent on employees hired by providers to argue with employees hired by insurance over denials, coverage, and payments.

3. Government should be the single payer, but providers should remain private, and regulation should be a joint effort.

4. We are drowning in clutter and complexity.

5. Those profiteering form our system spend heavily to promote the arrogant notion that we are superior to the rest of the world and we have nothing to learn from them.

6. The US is spending about 18 % of our GDP while lagging countries who spend a third of what we do in broad measures like life expectancy (we're number 31 on the list) and infant mortality. The next most expensive country is Switzerland at about 12% of GDP.

7. Most countries that get better health for less money spend more than we do on social services and solve problems before they become medical problems. They promote health instead of enabling a few extremely wealthy people to profit from illness.

8. No matter how we do this, those who pay will always pay for themselves and everyone who doesn't pay.

9. Quoting myself (and I won't sue me for doing it): “We are the only industrialized country held hostage by fear of a medical crises. Everyone else has a backstop, but not the U.S. You lose your job? You just lost your health insurance, and you better not have a serious problem until you get more. Financially, you could retire at sixty-two, but you can’t afford private health insurance, so you’re forced to work longer. You want to have a party for your twelve-year-old, but you’re afraid some kid might get hurt at your house. If he does, you’ll have to pay a big deductible and fight with your homeowner’s insurance because that kid’s health insurance will deny the claim and tell his parents to sue you for his ER visit. We live scared in the U.S. In countries with universal coverage, you can retire, move, change jobs, and party when you want to without the overhang of being wiped out by one catastrophic medical event.”

And to answer the original question, could nurses get paid less under some form of Medicare for All? Yes. It's a sacrifice I would make for the sake of honor.

Those enriching themselves at the cost of human lives here would make billions less, and many would be out of a job.

RobbiRN, RN · Apr 15, 2019

21 hours ago, hppygr8ful said:
Just read that the average wait to see an oncologist following DX is 21 days. This was based on a statistic from 2013. But further reading indicates the target to be seen is 21 days as well.

42 days. If you can see one at all. Another major failing of the US system is that the ER is the only place forced to provide treatment without upfront payment. We find the cancer, then refer uninsured or under-insured patients to an outpatient oncologist who requires an upfront payment they can't afford. They flounder in in the outpatient world until they are close enough to dying to justify admitting them through the ER.

allnurses Guide · Apr 15, 2019

11 hours ago, turtlesRcool said:
I think you maybe reversed your pounds to dollars calculator. The current exchange rate is $1.31 USD to 1 GBP. So 34,000 pounds would work out to $44,500. It's for sure less than nurses make in many areas, but around what some nurses make in other parts of the country.

I stand corrected sorry!

OUxPhys, BSN, RN · Apr 15, 2019

There is no way we would ever go to what the UK has. First, it would be a huge tax increase on the middle class (don't let those candidates who say the rich would pay for it fool you). The middle class is already struggling to keep their head above water. Secondly, there are people out there who have employer insurance plans that are actually good and they like them. Most do not want a repeat of Obamacare. Thirdly, yeah, wait times would be even longer. Number 4 (can't think of the term for 4 haha), we are too large as a country. Some US states have a higher population than some of these countries that employ a NHS style system.

I think the best option for the US is to adopt a hybrid system that countries like France and Germany use. We also need to get rid of medication ads on TV and work on controlling medication costs.

OUxPhys, BSN, RN · Apr 15, 2019

14 hours 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 asked in the CA forum if the VA abides by the staffing ratio there and they said they did. As for getting rid of private care entirely yes, there are candidates who said they would eliminate private care entirely (Sanders, Booker, Harris) but Harris eventually walked back her comments.

DARLA766, BSN, RN · Apr 15, 2019

16 hours 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?

Bernie medicare for all plan ends all private care.

Hematocrit13 · Apr 15, 2019

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 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?

The question I have, is that Medicare is not free. It's pretty bare bones on its own and supplemental is all but mandatory. I admit that I don't understand everything about Medicare, but still.

Mini2544, ASN, RN · Apr 15, 2019

58 minutes ago, Hematocrit13 said:
The question I have, is that Medicare is not free. It's pretty bare bones on its own and supplemental is all but mandatory. I admit that I don't understand everything about Medicare, but still.

I also dont think that people understand Medicare is what it is because people pay into the system for 30,40 plus years. Then like you said, its bare bones at that. How can they say "Medicare for all" when the people who will be covered, have never paid into the system? There will still be people who dont work/pay taxes and will receive the same exact healthcare as those who float the system. It will never happen here. Physicians would not put themselves through the kind of schooling and debt they do, in order to make less money and be burdened with terrible govt regulation (worse than it is aready is) There is a reason we have as many foreign physicians as we do. Nurses would make less and work more.

ThePrincessBride, MSN, RN, NP · Apr 15, 2019

On 4/13/2019 at 4:33 PM, hppygr8ful said:
I just read an article comparing the UK system of universal health care as it is done in the UK and how that would compare to US Medicare for all. This comparison is relevant because Bernie Sanders proposal is largely modeled on the UK system .
The average wait time in the UK for planned medical procedures is 9 months and the treatment queues just keep getting longer. It takes 62 days for the average cancer patient to be seen by an oncologist. The percentage of patients who die of cancer is markedly higher in the UK than in the US.
The average nurse with 20 years experience gets around 34,000.pounds a year. That amounts to about 26,000.00 dollars a year in US dollars.
It has been estimated that Medicare for All would cost 32 Trillion over 10 years. An increase in the national debt the US cannot afford.
Hppy
https://finance.townhall.com/columnists/danieljmitchell/2019/04/09/medicare-for-all-would-copy-the-bad-features-of-the-uks-governmentrun-system-n2544488
https://www.google.com/search?q=How+much+does+a+nurse+make+in+the+UK&ie=&oe=
https://www.x-rates.com/calculator/?from=GBP&to=USD&amount=1
https://www.google.com/search?q=cost+of+medicare+for+all+32+trillion&ie=&oe=

You've got the conversion wrong. The pound is worth more than the dollar. 34,000 pounds is worth 44k in the US. Furthermore, the UK nurses do not have the exhorbitant medical and University costs as their American counterparts. They also have far more in paid leave as well.