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]

3 hours ago, DARLA766 said:

You are incorrect. He just discussed it about 30 min ago at the PA townhall. He used the VA as an example of what his healthcare plan would look like...government run. You would not be able to have your own private insurance.

The quote from tonight's townhall you're referring to:

"We are not talking about government run healthcare, the Veteran's Administration, and most Veterans think that's a pretty good healthcare system... That's government run, what we are talking about is simply a single payer insurance program."

[TriciaJ, RN]

3 hours ago, PeakRN said:

I see healthcare being expensive in the US for three reasons.

One is that we have a system where private companies develop drugs and recoup costs through profit rather than government research grants, we also tend to prescribe new expensive medications though too.

Second is that American culture is so litigious that it drives up healthcare costs. Providers order more tests than are often necessary so that they can 'prepare their chart' in case of legal defense. This also drives up malpractice insurance for medical staff and hospitals which results in high costs to cover the expense.

Third is that Americans expect to be treated like VIPs when they come to the ED or hospital. They want their earache to be sorted out in under an hour in the ED and they expect a cure, when really things of this nature should be seen by their PCP. Same for admissions, patients want an instantaneous response for their blankets and percocets, and the food better be gourmet. Americans want to go to big beautiful hospitals and a lot of money is spent renovating what is already functional patient care areas.

The assumption that healthcare costs are purely driven by corporate greed is a bit naive and lacks introspection. The university adult hospital and academic children's hospital charges more than the for profit system here, and has no better outcomes.

I agree with this. Everything costs more because people expect more. One of the criticisms of Obamacare is that it did nothing to address tort reform.

[Leader25, ASN, BSN, RN]

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

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?

Please stop repeating un proven rumors,there is no such thing as this and there will never be .

[Emergent, RN]

6 minutes ago, Leader25 said:

Please stop repeating un proven rumors,there is no such thing as this and there will never be .

I can say whatever reasonable questions I want, thank you very much...

[Leader25, ASN, BSN, RN]

Be my guest,go for it.

[nursej22, MSN, RN]

1 hour ago, TriciaJ said:

I agree with this. Everything costs more because people expect more. One of the criticisms of Obamacare is that it did nothing to address tort reform.

Many states have already passed tort reform. As of 2016, 33 states have passed some form of tort reform. And yet, according to the American Action Form, this has resulted in only an average of 2.8% reduction in costs.

I think costs are up partly to recoup the costs for uninsured or underinsured patients using EDs for primary care. I believe a lot of preventative care could reduce EDs visits for diabetes complications, for instance. Or the consequences of untreated hypertension or even cancer. I think this was part of the hope of the ACA but with so many states not participating not everyone is getting cost-efficient preventative care.

[PeakRN]

4 hours ago, RobbiRN said:

Check the numbers here. Another myth supporting profiteering is that US drug companies need years of exclusivity to recover their large investment in developing new drugs. Most R&D is funded by taxpayers and the drug companies are allowed to profit anyway. According to this article: "A recent study found that all 210 drugs approved in the U.S. between 2010 and 2016 benefitted from publicly-funded research, either directly or indirectly."

https://thehill.com/opinion/healthcare/376574-pharmaceutical-corporations-need-to-stop-free-riding-on-publicly-funded

Most of that money is spent on the molecular MOA research, not patient trials or drug development. My center is a stage II center, although mostly for oncology drugs, and the pharmaceutical industry takes on most of that cost.

The pharmaceutical industry is certainly profitable, I'm not disputing that. But we have placed a large burden of cost on them. It could possibly be cheaper for the tax pays to pay for all of the research, but that isn't the system we are in.

[LilPeanut, MSN, RN, NP]

On 4/14/2019 at 3:23 PM, 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?

Except the problem was those plans were often not even worth the money you paid into them. You could pay 10,000/year for insurance, and then when you break your leg, you're still going to have to pay for most of it out of pocket.

On 4/14/2019 at 4:52 PM, MunoRN said:

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.

I'm not sure fraud is as big of an issue as you think. I'm sure it happens, but I think the majority of fraud is people just trying to maneuver around health insurance companies who want to deny everything.

17 hours ago, OUxPhys said:

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.

First: It really wouldn't be. Say that right now, you are contributing 250/month for your family of four to have health insurance, and then your employer covers the rest. Now, instead of that money going to a private insurance company, that money will go to medicare. And since everyone would be paying into it, it would bring total costs down. One of our biggest issues is that our insurance pools are so split, with healthy people not paying in as often.

Secondly, even if there is medicare for all, you can still have private health insurance. It just means that as a default, everyone can receive care without concern.

Thirdly, while wait times for elective and non urgent things will invariably get longer, because we will have to absorb the number of people who would have never gotten treatment in the first place, but typically, urgent and emergent care is not delayed. I haven't seen those statistics on cancer that someone posted, I'd be interested in seeing the original document they came from.

Lastly, while the US is big, that does not automatically mean it cannot work. You could argue just as easily about democracy not being able to work because we're too big, or anything else. I think we'll find we can do it if we want to. We're smart.

Medicare for all would be the hybrid system that France and Germany and most countries have.

15 hours ago, Mini2544 said:

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.

They are paying into the system actively, just like they would be with insurance. And yes, there will be people who receive health care who "float the system". Are you arguing that those people don't deserve healthcare or to live? Because it kind of sounds like that's how you feel.

Med school could become either subsidized or forgiven through service, same with nursing. But I think medical education needs a complete overhaul anyway.

We already have universal health care in that care at ER exists. We just give it in the worst and most expensive way possible.

1 hour ago, nursej22 said:

Many states have already passed tort reform. As of 2016, 33 states have passed some form of tort reform. And yet, according to the American Action Form, this has resulted in only an average of 2.8% reduction in costs.

I think costs are up partly to recoup the costs for uninsured or underinsured patients using EDs for primary care. I believe a lot of preventative care could reduce EDs visits for diabetes complications, for instance. Or the consequences of untreated hypertension or even cancer. I think this was part of the hope of the ACA but with so many states not participating not everyone is getting cost-efficient preventative care.

Yes, covering the uninsured and underinsured is a large reason why our health care costs are so high. We're all paying for universal coverage, just doing it really inefficiently.

And it was what the ACA was intended to do, by forcing everyone to join the insurance pool, but the republicans fought so hard against it and ripped it apart, that it never happened. But if everyone is paying in, it works better than if only sick people are paying in. (because sick people take out more)

38 minutes ago, PeakRN said:

Most of that money is spent on the molecular MOA research, not patient trials or drug development. My center is a stage II center, although mostly for oncology drugs, and the pharmaceutical industry takes on most of that cost.

The pharmaceutical industry is certainly profitable, I'm not disputing that. But we have placed a large burden of cost on them. It could possibly be cheaper for the tax pays to pay for all of the research, but that isn't the system we are in.

I disagree, because they are still posting record profits, which is what you have after all your spending.

If someone in the US is uninsured and needs a knee replacement, they cannot get it. (unless they gofundme) A person who is rich can get it easily, either with insurance or self pay. In Canada for example, you may wait 6-9 months for the knee replacement, but no one is excluded. You are willing to wait a little longer to make sure that poor people can get taken care of too, instead of only just caring about yourself.

I also agree, it should not be state dependent what your insurance will cover. Moving isn't feasible for some and it is difficult for most, and just not practical to expect people to do that.

Of course, I'm not a huge fan of the state concept, because I view many states as having very diverse populations too, and the biggest difference in needs are rural vs urban vs suburban. Personally, I think we should get rid of a lot of the state level of administration, it's just extra cost to double the work. We should have a set of goals, rights and standards that we adhere to as a country, and then municipality subgroups (that might cross state lines, I'm looking at you Kansas City and Cincinnati) then administrate using tools the government has given them.

Some day, when I'm the benevolent dictator of the world

[hppygr8ful, ASN, RN, EMT-I]

I just want to say if anyone missed it that I did get the exchange rate wrong and apologize - but the thread has gone off the rails. The OP specifically asked how Medicare for all would effect nursing. Questions about the merits of Medicare for all don't answer this question. And with the passing of the ACA which promised accessible and affordable no one should be with health insurance. If they are they are breaking the law.

Hppy

[PeakRN]

7 hours ago, LilPeanut said:

I disagree, because they are still posting record profits, which is what you have after all your spending.

If someone in the US is uninsured and needs a knee replacement, they cannot get it. (unless they gofundme) A person who is rich can get it easily, either with insurance or self pay. In Canada for example, you may wait 6-9 months for the knee replacement, but no one is excluded. You are willing to wait a little longer to make sure that poor people can get taken care of too, instead of only just caring about yourself.

I don't think that the profits margins are increasing as much as you might think.

https://www.gao.gov/products/GAO-18-40

I'm not going to argue that drug companies don't make a lot of money, that would be ridiculous. I'm not convinced that it is the largest driving force in cost when it comes to healthcare.

Regardless though how would you address the issue of corporate profits? Would you set a market cap? Does that discourage the free market? Do you make the government sponsor all drug development? Do you think this will actually save money? Do you think that Americans would be wiling to pay more taxes to have lower drug costs?

2 hours ago, hppygr8ful said:

I just want to say if anyone missed it that I did get the exchange rate wrong and apologize - but the thread has gone off the rails. The OP specifically asked how Medicare for all would effect nursing. Questions about the merits of Medicare for all don't answer this question. And with the passing of the ACA which promised accessible and affordable no one should be with health insurance. If they are they are breaking the law.

Hppy

I agree since the passing of the ACA there are very few uninsured patients that I see on a regular basis. Typically these are individuals or families in the upper middle class who chose to not have insurance because they take the bet that they won't need healthcare. I don't think I have run into anyone who couldn't have been covered, but rather those who choose not to get insurance. I don't think that insurance was as reasonable as it was promised to be, but that is also isn't unreasonable for the vast majority.

I think that part of the reason nurses are so invested in this is that it doesn't just affect us professionally but personally as well. The majority of nurses fall into the working or middle class, and so the topic of socialized healthcare certainly affects our daily lives.

[xoemmylouox, ASN, RN]

I keep hearing about the wait times in other countries. My question is how many Americans simply just go without care because they can't afford it? How many don't address their health concerns, or receive any treatment because they cannot afford it? Those numbers are going to be hard to come by, yet remain a real problem.

I don't know if Medicare for all is the answer, but I know our current system is awful. When people are in their most need, and least able to work, life is costing the most. How many people who have cancer, heart disease, or COPD can still work full time? How many lose their insurance because they cannot continue to maintain their hours at work? How many are taken to collection during their treatment because they are too sick to work while undergoing chemo/radiation?

Those are the victims of this system. Sure you can get your MRI tomorrow, but the cancer they find on that scan is going to bankrupt you. Sure you can get in with the cardiologist next week, but you're going to lose your job and your health insurance so you won't get to have that surgery done.

[guest974915]

24 minutes ago, xoemmylouox said:

I keep hearing about the wait times in other countries. My question is how many Americans simply just go without care because they can't afford it? How many don't address their health concerns, or receive any treatment because they cannot afford it? Those numbers are going to be hard to come by, yet remain a real problem.

I don't know if Medicare for all is the answer, but I know our current system is awful. When people are in their most need, and least able to work, life is costing the most. How many people who have cancer, heart disease, or COPD can still work full time? How many lose their insurance because they cannot continue to maintain their hours at work? How many are taken to collection during their treatment because they are too sick to work while undergoing chemo/radiation?

Those are the victims of this system. Sure you can get your MRI tomorrow, but the cancer they find on that scan is going to bankrupt you. Sure you can get in with the cardiologist next week, but you're going to lose your job and your health insurance so you won't get to have that surgery done.

Great points! I would gladly sacrifice shorter wait times to be free of the worry that a major medical event could possibly consume my entire life savings retirement nest egg.