I'm scheduled to start in a private ED hospital next month. I started at a VA on a PCU unit as a new grad, but I feel like I'm depriving myself of the experience I desire.
As I consider transitioning from a highly political, but stable federal hospital (VA) to a private hospital in order to gain the ED experience that I desire (a broader pt population-not just older vets in for pain med refills and jock itch), I ask myself how the ACA has affected your employer (hospital, school, prison, etc.). Have budgets been cut? Have layoffs taken place (specifically nurses being laid off)? Are you called off less or more? Have PRN positions been eliminated or increased? Is agency/travel used more? Have your benefits been affected? Have your employers anticipated any forthcoming changes?
Sure maybe im not a great healthcare consumer because currently i dont have to worry about my costs if i were to get truly sick like with cancer. i just had a mammogram done along w/drs visit and labs and my out of pocket costs were less than 200.00. but tell me this, how does state aid then help the poor become good healthcare consumers? They have no out of pocket costs. And before i get flamed i would just like to say that i am a big fan of medicaid programs and wish they would be increased so that more people can have that kind of insurance.
the last thing one needs when they get sick is to worry about costs of anything.
Could you clarify what you mean when you ask how does state aid help the poor to become good health care consumers in regard to their having no out of pocket costs? The poor have a lack of choice as to who they can receive their medical care from, and because of lack of funds they are not always able to, for example, buy nutritious foods or choose a lifestyle that will contribute positively to their health. Are you saying that paying for poor people's medical care may lead to their making poor choices about their health, or to making poor choices about who they receive their medical care from?
Here are some facts for you about the healthcare system in the US when compared to other nations. Now I have to go take care of sick people, so I am out....
Regarding the UK health system, I read that according to one study, the UK came first out of eleven countries with respect to access to care and efficiency of care delivery, in eight out of eleven measures of care. Unfortunately, and significantly, where they didn't score well was on keeping people alive through receiving prompt and effective care, where I read they came in at number ten out of eleven. This data is borne out in the experiences of some of my family members who live in the UK. Some of them have experienced literally years of waiting to be diagnosed and treated by specialists. In the meantime, they have suffered irreversible serious medical consequences. They also have experienced their records being "lost" on multiple occasions, experienced specialists with whom they have appointments scheduled "relocating" suddenly without notice to another part of the world, and experienced infections after surgery that many months later they are still waiting for treatment for.
The UK is a great system in that everyone has access to care. Unfortunately, if you need timely, effective care for more expensive health problems, you may not be assured of receiving such care.
However, in the US, not everyone has access to care, let alone timely, effective care.
In the US not everyone has access to medical care or to quality care. This needs to be remedied. The ACA is a good start; not perfect by any means, but it has ensured access to medical care for many people who could not obtain medical insurance at any price due to pre-existing medical conditions. The ACA has improved the quality of insurance plans and thus improved the quality of medical care provided for many people. How various states have implemented the ACA has of course contributed to good or bad experiences with receiving medical care. Because of the ACA, people do not have to be concerned with having their insurance policy cancelled if they become ill, or of being denied coverage because of pre-existing illnesses, or of reaching the maximum amount their insurance plan will pay for and then being without coverage, or of finding out that their insurance policy didn't really cover them for serious illness.
I wanted to add to this to say that I think that if the incentives to provide quality medical care (that many of us are fortunate to receive, both before the ACA and now with the ACA), can be retained in the long term with the ACA, and if those states that are currently refusing to expand their medicaid programs yield - I know this may take time, but it is still early days and the ACA is showing many good results, then I think that even though the ACA is not without deficiencies, and even though buying insurance is still very expensive for many people, that the ACA may provide an acceptable compromise of providing quality care AND access to care while still satisfying the desires (profitability) of the health care industry (individuals and groups) that health care be sold as a business service. I think that retaining quality of care, not just increasing access to care, is very important.
I want to mention too that health care in the UK is funded largely by taxation. Private health insurance is available in the UK, but the majority of people use the NHS. So whether one pays through taxation, or through purchasing insurance policies as in the US, one is still paying, unless one is too poor to contribute. My experience as a patient of the health care systems of both countries is that I have received better quality of care in the US, that I have accessed through good health insurance, but medical care is much more easily accessed in the UK, where if you are unable to pay for medical care you still have the right to receive it. I am seeing the ACA working well in my state with the support of the population, the politicians, and the health care industry, and I am hopeful for the future.
And, how much of one's income is paid into the healthcare system in the U.K.?
The per person cost of all healthcare in the UK is $3,647. In the US it's $8,895.
The UK arguably spends lower than they should, but not their issues could easily be alleviated by increasing their spending by around 10%-15%. We pay pay 240% more than they do.
The per person cost of all healthcare in the UK is $3,647. In the US it's $8,895.
The UK arguably spends lower than they should, but not their issues could easily be alleviated by increasing their spending by around 10%-15%. We pay pay 240% more than they do.
What I meant was how much tax per person does one pay that goes to healthcare?
Most of that $3600 paid for healthcare in the UK is paid in the form of taxes. Most of the $8800 paid in the US for healthcare is paid in the form of premiums. No matter what you call it (taxes vs premiums) it's still money either way.
I can't help but get the impression that the conservative view is that it's preferable to spend twice as much for healthcare so long as the way we pay for it isn't called "taxes". Personally I'm in favor of keeping as much of my money as possible, I don't care about the semantics.
Most of that $3600 paid for healthcare in the UK is paid in the form of taxes. Most of the $8800 paid in the US for healthcare is paid in the form of premiums. No matter what you call it (taxes vs premiums) it's still money either way.
I can't help but get the impression that the conservative view is that it's preferable to spend twice as much for healthcare so long as the way we pay for it isn't called "taxes". Personally I'm in favor of keeping as much of my money as possible, I don't care about the semantics.
I wasn't asking how much is spent per person, which is how I read your reply the first time. I wanted to know how much each person has to pay into the system.
I should have directed my question to the poster as I was really interested to know if someone who was promoting the virtues of the UK system knew all the facts.
My figure is slightly different then yours. The point is that it is true, our tax+premiums come out to be more expensive in most cases. However, if your insurance is through your employer it is subsidized, sometimes greatly. And, most people are now getting subsidized ACA plans. monkeyhq somewhere mentioned they pay $80/month in insurance. She/he would likely be paying much more in the UK. Not to mention, as a nurse, would be making a lot less income.
Obamacare has increased the taxes deducted from my paycheck without increasing my base pay. My premiums went from $150 per paycheck for me and my son (healthy) to over $250 per paycheck. My co-pays and scripts are also higher as is my max out of pocket.
My employer had to implement "Meaningful Use" with a VERY costly software upgrade along with hiring "Meaningful Use" compliance officers. My charting has increased >50% to make sure certain boxes are checked (that don't have anything to do with patient care) and demographics are input (like preferred language??). If these things aren't done and we get audited by Medicare we get fined and a 1-2% deduction in reimbursements - which is huge when you're talking treatment that costs >$100K. I have to create quarterly compliance periods and our treating MD has to take STUPID online tests at a dot gov website as well. All of this is thanks to the ACA and NONE of it improves the quality of patient care. In fact, it has decreased face to face patient time.
They touted an EHR incentive program but what that translates to is "implement electronic health records or we'll deduct your Medicare reimbursements". There was no choice.
What this all really means is that now the government has even more access to your PERSONAL health records. Something that is NONE of their business.
The people who made the statements I referred too had many nebulous statements sprinkled with others that may or may not be true. When I see posts like that, I am suspicious of whether they really have any clue (is x poster's hospital really making more profits due to the ACA? How much? Are their patients really more compliant with meds?), or are they just so emotionally invested in their support of the President and Obamacare that they feel a need to defend it whenever they can?
Your points (which are debatable) aside, I would like to hear about the specifics from the people who made the statements I was referring to.
I really appreciate your survey.. You asked what peoples opinion were. You then appear to be negating what people are saying.. Just exactly what is your agenda in this?
Obamacare has increased the taxes deducted from my paycheck without increasing my base pay. My premiums went from $150 per paycheck for me and my son (healthy) to over $250 per paycheck. My co-pays and scripts are also higher as is my max out of pocket.
My employer had to implement "Meaningful Use" with a VERY costly software upgrade along with hiring "Meaningful Use" compliance officers. My charting has increased >50% to make sure certain boxes are checked (that don't have anything to do with patient care) and demographics are input (like preferred language??). If these things aren't done and we get audited by Medicare we get fined and a 1-2% deduction in reimbursements - which is huge when you're talking treatment that costs >$100K. I have to create quarterly compliance periods and our treating MD has to take STUPID online tests at a dot gov website as well. All of this is thanks to the ACA and NONE of it improves the quality of patient care. In fact, it has decreased face to face patient time.
They touted an EHR incentive program but what that translates to is "implement electronic health records or we'll deduct your Medicare reimbursements". There was no choice.
What this all really means is that now the government has even more access to your PERSONAL health records. Something that is NONE of their business.
Just my 2 cents.
You're referring to the HITECH act and value based purchasing (VBP), not the ACA. Much of what you're referring to was implemented long before Obama took office.
Providers who do a bad job (compared to average) get deductions in their reimbursements, those that do a good job (better than average) get an increase in reimbursements. I think it's pretty reasonable that in a competitive business environment (if that's really what we want healthcare to be) poor performers get weeded out, that's the basic premise of a competitive business environment.
As for EMR's I think we should be embarrassed as a profession that it's taken this long to implement this. McDonalds has had a computer system to make sure you get the right hamburger for about 20 years, and we're just getting around to utilizing a computer system to make sure you get the right medication. It also makes the information you are gathering and charting far more useful in the care of the patient. It's easier to put it on a piece of paper but it's still relatively useless in that format.
Paying more this year than last year for insurance premiums is nothing new, it's something that's been happening for a very long time. In the three years prior to Obamacare passing my premiums more than doubled.
You're referring to the HITECH act and value based purchasing (VBP), not the ACA. Much of what you're referring to was implemented long before Obama took office.
Providers who do a bad job (compared to average) get deductions in their reimbursements, those that do a good job (better than average) get an increase in reimbursements.
HITECH is a part of ARRA - which was signed by Obama in 2009
The American Recovery and Reinvestment Act of 2009 (ARRA) commonly referred to as the Stimulus or The Recovery Act, was an economic stimulus package enacted by the 111th United State Congress in February 2009 and signed into law on February 17, 2009, by President, Barack Obama.
Our deductions (or lack there of because we're compliant with Meaningful Use) have nothing to do with the provider's quality of care. I would like to see the algorithm in place to define "good job" versus "bad job" and the correlations of deductions.
Susie2310
2,121 Posts
Could you clarify what you mean when you ask how does state aid help the poor to become good health care consumers in regard to their having no out of pocket costs? The poor have a lack of choice as to who they can receive their medical care from, and because of lack of funds they are not always able to, for example, buy nutritious foods or choose a lifestyle that will contribute positively to their health. Are you saying that paying for poor people's medical care may lead to their making poor choices about their health, or to making poor choices about who they receive their medical care from?