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?

[Daisy4RN]

6 hours ago, LilPeanut said:

I would like to point out that the link that you posted about Obama "lying" about the AHCA, there was never any lying about it. It was very transparent that we needed to put all the healthy people into the paying pool to be able to support the sick people. That article just rephrases it as "redistributing wealth from healthy people to sick people", which is a way of looking at it, if you are incredibly selfish and kind of evil. Overall, the reason AHCA didn't work as intended was because it wasn't implemented as intended.

As for the illegal immigrants etc, they still are entitled to live and to have emergency services here while in the country. Nothing would change, unless someone is proposing that we should check someone's immigration status before treating them like a human being?

Quote from the article:

"Gruber admitted that the Obama administration went through "tortuous" measures to keep the facts about the legislation from the American people, including covering up the redistribution of wealth from the healthy to the sick in the legislation that Obamacare is in fact a tax"

Did we read the same article, this is well documented and you can find this info in other articles as well. And you stated " the reason AHCA didn't work as intended was because it wasn't implemented as intended". This is exactly my point: the gov either lies to begin with or doesn't implement it (for whatever reason) as intended.

As for the illegals, yes it would change, because they would receive full medical coverage under Medicare, not just emergency/limited care that they now receive. The question is how much will this extra burden affect already strapped working middle class people financially and also how much will it burden the healthcare system when we add many more people.

I hope this would work as they say but I have serious doubts.

[MunoRN, RN]

1 hour ago, hppygr8ful said:

One of my biggest problem with the ACA is it has no provisions for providing quality mental health care. In my opinion the mentally ill are the single most underserved population when it comes to any kind of health care. In almost 20 years of taking care of this population I have seen nothing change. Yet when a mentally Ill person goes off the rails and actually hurts someone - Everyone clamors for something "to be done about these people!" yet no one offers any solutions.

Hppy

The ACA was the largest expansion of mental health coverage and treatment in recent history, the ACA wasn't my cup of tea either, but one thing it did do was give more people access to mental health care.

https://www.medpagetoday.com/blogs/mental-notes/75209

[MunoRN, RN]

32 minutes ago, Daisy4RN said:

Quote from the article:

"Gruber admitted that the Obama administration went through "tortuous" measures to keep the facts about the legislation from the American people, including covering up the redistribution of wealth from the healthy to the sick in the legislation that Obamacare is in fact a tax"

Did we read the same article, this is well documented and you can find this info in other articles as well. And you stated " the reason AHCA didn't work as intended was because it wasn't implemented as intended". This is exactly my point: the gov either lies to begin with or doesn't implement it (for whatever reason) as intended.

As for the illegals, yes it would change, because they would receive full medical coverage under Medicare, not just emergency/limited care that they now receive. The question is how much will this extra burden affect already strapped working middle class people financially and also how much will it burden the healthcare system when we add many more people.

I hope this would work as they say but I have serious doubts.

A "redistribution of wealth from the healthy to the sick" is the basic definition of health insurance, how else should it work? If we leave it only to the sick to pay for system then the system collapses.

The ACA is a tax in that people who are able to are (were) required to pay for their potential costs for services that are legally required to be provided to them, why shouldn't that be how it works?

Medicare doesn't cover illegal immigrants currently so I'm not sure why you're convinced it would if it was expanded. There is a reasonable argument to had however that maybe we should provide preventative care to those that can't legally be turned to away for far more expensive acute care. Why pay a few hundred thousand for someone's acute life threatening condition when we could have just spent a few hundred to prevent it or manage it in the first place.

I pay the average amount for an employer provided health plan for my family, just shy of $20,000 a year, I'm not sure why you don't think that isn't already a burden, and even in the most conservative estimates I would be paying less than that under a medicare for all plan, possibly much less.

As to how illegal immigrants pay into SS and Medicare/Medicaid (payroll taxes) https://www.marketplace.org/2019/01/28/economy/undocumented-immigrants-quietly-pay-billions-social-security-and-receive-no

[LovingLife123]

I don’t know if this has been mentioned or not, but reimbursement from Medicare does not even begin to cover hospital expenses. Fewer nurses would definitely be hired and wages would go down.

With what people expect hospitals to provide them these days and it all being about customer service, I do not forsee Medicare for all even remotely working here.

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.

Look at countries where nurses have 15 patievts in acute care, supplies are at a minimum, and there are no frills in the hospital. People think they want universal healthcare, until it actually happens. Then everybody will be screaming and crying that we are there to bring them cokes all the time, there is no cable or phones. No more private rooms with private bathrooms. No more room service food. Everyone gets the same tray at the same time of day. No more private birthing suites.

I agree healthcare needs to change. The problem is it is such a huge undertaking and we don’t have actual healthcare people trying to reform it. We have a bunch of politicians and people tied into big business trying to change it. It’s not something you can do in a couple of months either like Obama and Trump discovered. It’s going to take a person years to come up with a plan to change it. With all dudes of the equation on board with the same thing.

[hppygr8ful, ASN, RN, EMT-I]

7 hours ago, MunoRN said:

The ACA was the largest expansion of mental health coverage and treatment in recent history, the ACA wasn't my cup of tea either, but one thing it did do was give more people access to mental health care.

https://www.medpagetoday.com/blogs/mental-notes/75209

They may have access, but to what. The average length of stay in an acute psych facility is 3 to 5 days. Some may get as many as 7 days but that's not long enough to stabilize a true psychiatric crises. Medicare allow patients 100 life time days of mental health treatment after that it's cash pay all the way. Most private insurance will only cover in-patient treatment if the patient is actively suicidal. What's really needed is for Insurance companies and Medicare to cover several weeks of treatment. My adolescent patients family typically have around a $2000.00 co/pay for a 5 day in-patient stay.

I actually work for a pretty good facility but it is a private for profit hospital and I am often frustrated that admin is pushing patients out the door and soon as their authorized days have run out.

Hppy

[LilPeanut, MSN, RN, NP]

Unfortunately, mental health, vision, hearing and restorative therapy (PT/OT/ST) are often not covered by anyone. I would love to see that change.

[herring_RN, ASN, BSN]

2 hours ago, hppygr8ful said:

They may have access, but to what. The average length of stay in an acute psych facility is 3 to 5 days. Some may get as many as 7 days but that's not long enough to stabilize a true psychiatric crises. Medicare allow patients 100 life time days of mental health treatment after that it's cash pay all the way. Most private insurance will only cover in-patient treatment if the patient is actively suicidal. What's really needed is for Insurance companies and Medicare to cover several weeks of treatment. My adolescent patients family typically have around a $2000.00 co/pay for a 5 day in-patient stay.

I actually work for a pretty good facility but it is a private for profit hospital and I am often frustrated that admin is pushing patients out the door and soon as their authorized days have run out.

Hppy

How The Loss Of U.S. Psychiatric Hospitals Led To A Mental Health Crisis

A severe shortage of inpatient care for people with mental illness is amounting to a public health crisis, as the number of individuals struggling with a range of psychiatric problems continues to rise...

... The disappearance of long-term-care facilities and psychiatric beds has escalated over the past decade, sparked by a trend toward deinstitutionalization of psychiatric patients in the 1950s and '60s, says Dominic Sisti, director of the Scattergood Program for Applied Ethics of Behavioral Health Care at the University of Pennsylvania.

"State hospitals began to realize that individuals who were there probably could do well in the community," he tells Here & Now's Jeremy Hobson. "It was well-intended, but what I believe happened over the past 50 years is that there's been such an evaporation of psychiatric therapeutic spaces that now we lack a sufficient number of psychiatric beds."...

https://www.npr.org/2017/11/30/567477160/how-the-loss-of-u-s-psychiatric-hospitals-led-to-a-mental-health-crisis

[OUxPhys, BSN, RN]

On 4/17/2019 at 9:53 AM, osceteacher said:

I imagine this is the case in regards to the original question, nurses will see far less bureaucracy but outside of that I'm not sure how things will improve or get worse for nurses, they'll just stay the same.

Wages were brought up but most single payer healthcare systems have nurses earning higher than the national average, Norway, Australia, Netherlands, Denmark etc all pay substantially above national averages and some are only slightly behind the US. The UK is one of the few where its in or around the national average, but our benefits with the NHS are substantial (3 months full sick pay, 6 months half sick pay, I get 35 days annual leave a year etc) and enhanced pay for weekend and nights are rarely factored in but can amount to a good 30% increase on base salary.

The VA hospital I work at pays the most out of all the major hospitals in my city.

[guest974915]

12 hours ago, herring_RN said:

How The Loss Of U.S. Psychiatric Hospitals Led To A Mental Health Crisis

A severe shortage of inpatient care for people with mental illness is amounting to a public health crisis, as the number of individuals struggling with a range of psychiatric problems continues to rise...

... The disappearance of long-term-care facilities and psychiatric beds has escalated over the past decade, sparked by a trend toward deinstitutionalization of psychiatric patients in the 1950s and '60s, says Dominic Sisti, director of the Scattergood Program for Applied Ethics of Behavioral Health Care at the University of Pennsylvania.

"State hospitals began to realize that individuals who were there probably could do well in the community," he tells Here & Now's Jeremy Hobson. "It was well-intended, but what I believe happened over the past 50 years is that there's been such an evaporation of psychiatric therapeutic spaces that now we lack a sufficient number of psychiatric beds."...

https://www.npr.org/2017/11/30/567477160/how-the-loss-of-u-s-psychiatric-hospitals-led-to-a-mental-health-crisis

This trend towards deinstitutionalization-'community centered care' was an inherently bad idea from the very beginning. As a result of this paradigm, many of these facilities were closed and their chronic, mentally ill patients were sent to SNIFs, group homes, or again, became the responsibility of their families. However, as we have come to see, many of these new "homes" lacked the necessary resources and were inadequate and/or unable to provide care to this challenging population. This myopic thinking contributed greatly to the mental health crisis that we have today and every large metropolitan area is now in crisis as homeless number have swollen to record levels. I can't help but believe these vulnerable people were much better served in these 'institutions', instead of fending for themselves from the many predators on the streets today.

[GrumpyRN, NP]

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

With what people expect hospitals to provide them these days and it all being about customer service, I do not forsee Medicare for all even remotely working here.

...People think they want universal healthcare, until it actually happens. Then everybody will be screaming and crying that we are there to bring them cokes all the time, there is no cable or phones. No more private rooms with private bathrooms. No more room service food. Everyone gets the same tray at the same time of day. No more private birthing suites.

Today I will be your nurse, NOT your waiter. It is a hospital, not a hotel or spa.

If patients want that level of service there are still private hospitals where they can get it but I don't do that.

[OUxPhys, BSN, RN]

1 hour ago, GrumpyRN said:

Today I will be your nurse, NOT your waiter. It is a hospital, not a hotel or spa.

If patients want that level of service there are still private hospitals where they can get it but I don't do that.

Yeah well unfortunately no matter where you work, hospitals today are more focused on "customer service" and making the pt happy so they get good reviews on Press Ganey, which in turn means a better reimbursement from CMS. You know who started that? The government.

[GrumpyRN, NP]

3 hours ago, OUxPhys said:

Yeah well unfortunately no matter where you work, hospitals today are more focused on "customer service" and making the pt happy so they get good reviews on Press Ganey, which in turn means a better reimbursement from CMS. You know who started that? The government.

Yes but remember I am writing from a UK point of view and reimbursement does not rely on reviews and also that this thread is about changing your system. Good service is important but not to the extreme that seems to be the norm in the US.

It's nice to be nice but healthcare is my profession and I don't care if your TV does not show the channels you want and I am certainly not running to a vending machine to get you a coke. Meals will be delivered when they arrive from the kitchen and no, I will not go down and get you something sooner.