How will the new healthcare law in 2014 NOT create more jobs?

belgarion · Jan 30, 2011

Honestly, we can speculate all we like, but we won't know until we're there.

Agreed. For one thing we don't know how many people who don't have insurance now will decide the fine for NOT buying insurance will be cheaper than the cost to buy it. Yes, that WILL happen.

Like Nancy Pelosi said, it had to be passed so we can find out what's in it.

ckh23, BSN, RN · Jan 30, 2011

So now, 40 million more people will be on Medicaid...our country is so broke that it's not even funny anymore. We are given tax returns and welfare checks with money that doesn't even exist. The money that the US government is handing out to programs and Medicare and the such, doesn't even exist...we are that broke as a nation.

We are really going to be up the creek when China decides to stop buying our debt, which allows to "fund" these ridiculous programs that we cannot afford.

kcmylorn · Jan 30, 2011

I am an old baby boomer RN. (1) I remember 20 years ago my Union Pres. going on and on about pensions, retirement benefits and health care benefits as a contract issue so much that I tuned her out because It was in my 30's, it didn't affect ME -wrong, The years went by un noticed and here I am- the union is long gone and so is my retirement and healthcare insurance. moral: lesson learned, it will affect ALL one day. (2)Since I am an older RN( staff bedside) I have worked these damn hospitals for alot of years- the American public has to STOP using the ED's as a family practice doctors office/ clinic - that is expensive. There has to be a re-education of the American public- they equate healthcare with the McDonald's drive thru. They don't get the idea of triage- an active MI vs a sniffy nose. (3)With that- I watched the Sec. of the Health and Human Services, Kathleen Sebelius, in front of the Senate this past week on C-SPAN. Healthcare reform has many facets. One facet being coverage for all. People will not be waiting until their sx are so sever they can't be ignored and end up in the ED and requiring admission( the sinus infection in a diabetic who is now septic). People will have the insurance to go to the neighborhood family practice office/clinic when it is just a sinus infection and it is cheaper to treat. That is what has driven up our healthcare costs. I forsee a 'forced' re -thining of Hospital budgets which are currently and traditionally have been cut from the bottom( cutting the 'licensed, qualified nurses) instead of going after and cutting the CEO's and top management salaries. That is who is fighting this reform because they don't want to give up their VERY cushy over paid salaries- CEO's don't take care of patients, NURSES do. The 'con' arguments to reform is propaganda put out there by these top healthcare system management so they get to hang on to their multi million dollar salaries with fists so tight their knuckles are turning white. Yes this healthcare reform will increase jobs for nurses- but not in the acute care setting. Those jobs will be in community health. I think it's common sence- Providing coverage to the MILLIONS(?46 million) un-insured so they can gain ACCESS TO CARE in the beginning stages or prevention of an illness( so they dont end up in the expensive ED and hospital) Yes, there will be more patients, more NURSES will be needed. Unlicesed healthcare med techs and CNA's can not assess( do a nursing assesment/exam) on any patient now or in the future. RN's are in clinics and doctors offices now and have been doing assessments in place of the providers and running their assessment findings past the provider( to gain verbal treatment orders) The provider is free to continue seeing his regular scheduled( every 15 min.) appts because these settings are so busy now with out the reform We cant safely care for the ones we have now with these staffing ratios, so more nurses are going to be needed both in the hospital and especially out of the community.

Watching that C-SPAN hearing with Secretary Sebelius, it was very clear that those senators do not understand the Medicine part of this reform-they don't have any understanding of disease process. There is a major gap in their knowledge. They are clueless. But mention money and they get it. One senator was blatantly disrespectful and rude to that woman- Sen John Cain. He told the woman to "shut up" in so many words.

Bottom line is this reform is going to be a re-education of the American public. In the words of Secretary Sebelius- "it is shift from an 'illness' focused model of care, to a 'wellness' focus model of care." That is why it is cost saving.( identify the HTN before it turns into a dialysis situation. Lopressor is cheaper than DaVita).

TheChair1 · Jan 30, 2011

Providers won't get paid as much, so they'll still be strapped for cash. Besides that, states don't have the money to pay their Medicaid bills now (at least in IL/CA, and some other states), and are deferring payments to providers, so add that many more people to what equates to Medicaid, and its unlikely the bills are going to get paid. That's why states are suing and saying, look, you can't do this, we don't have the money...
I think the real solution is to get the # of jobs back up (maybe put some restrictions in place to make it less favorable to send jobs to India), so that people have jobs & decent insurance.
I have a personal insurance plan from BCBS now, so if I were to go to the hospital, the hospital would get their full premium, not a Medicaid rate. When that plan comes out, it might be cheaper for me to jump on that Medicaid type insurance bandwagon, then a hospital would only get a Medicaid rate. They'll just be making that much less per patient.

No disrespect but I do not think you understand how big business works. You see the rich do not care if everyone has a job. They just care about increasing their profit margins so this is why jobs get shipped overseas. They can make a product in a cheaper environment or pay people lower wages to have a product made. Making a statement such as "I think the real solution is to get the # of jobs back up" is so basic and has no real world application. Now if you would have said something like, we need to push education so that our kids can compete with indian and chinese kids in the world market then I could jive with you. Now if someone were to follow your logic the real solution would be for americans to accept lower wages and outbid the folks from these developing countries. If we said to big business, "please bring our jobs back to america. we will lose the unions and work for peanuts" ALL our jobs would come back but this isn't going to happen because americans have PRIDE and we are accustomed to MORE. Now to address you remarks on the healthcare issue.

Everyone is not paying into medicaid and this is why programs like this **** off the working class because we are the ones who carrying a huge share of the burden. If there are MORE people REQUIRED to pay into the system there will be more funds available. Afterall if people can be on medicaid and still somehow afford cigarettes and fancy phones then we need to be FORCING these folks to BUY insurance. This is a simple economic concept. Of course providers won't get paid as much. So what! The medicare/medicaid piggybank is running out and thank goodness. These programs have been looted and taken advantage of for decades. It's time for fiscal responsibility and accountability. These "providers" need to be forced to set reasonable billing practices. There is no reason one aspirin should cost 15 bucks while in-patient status. They need to be forced to cut back on all the money they waste on administrative expenditures. Why should nurses and healthcare workers have to accept 2 years of no cost of living adjustments or raises just so that admin can "save" enough money to make sure that the CEO's and managers get their yearly bonuses? This will force providers to spend money on actual patient care which is what they are suppose to be doing anyways. Of course they are fighting it but greed is a deadly sin and is ultimately going to be unsustainable.

There WILL be NEW demand and they will NEED more nurses. We just have to watch and see how they are going to try to shaft the patients and the workers in order to make their pockets fatter. Stop being afraid of trying something new, afterall what we have right now sure as heck isn't working. It's illogical and irresponsible to try and tell people that things will definitely be worse.

TheChair1 · Jan 30, 2011

I am an old baby boomer RN. (1) I remember 20 years ago my Union Pres. going on and on about pensions, retirement benefits and health care benefits as a contract issue so much that I tuned her out because It was in my 30's, it didn't affect ME -wrong, The years went by un noticed and here I am- the union is long gone and so is my retirement and healthcare insurance. moral: lesson learned, it will affect ALL one day. (2)Since I am an older RN( staff bedside) I have worked these damn hospitals for alot of years- the American public has to STOP using the ED's as a family practice doctors office/ clinic - that is expensive. There has to be a re-education of the American public- they equate healthcare with the McDonald's drive thru. They don't get the idea of triage- an active MI vs a sniffy nose. (3)With that- I watched the Sec. of the Health and Human Services, Kathleen Sebelius, in front of the Senate this past week on C-SPAN. Healthcare reform has many facets. One facet being coverage for all. People will not be waiting until their sx are so sever they can't be ignored and end up in the ED and requiring admission( the sinus infection in a diabetic who is now septic). People will have the insurance to go to the neighborhood family practice office/clinic when it is just a sinus infection and it is cheaper to treat. That is what has driven up our healthcare costs. I forsee a 'forced' re -thining of Hospital budgets which are currently and traditionally have been cut from the bottom( cutting the 'licensed, qualified nurses) instead of going after and cutting the CEO's and top management salaries. That is who is fighting this reform because they don't want to give up their VERY cushy over paid salaries- CEO's don't take care of patients, NURSES do. The 'con' arguments to reform is propaganda put out there by these top healthcare system management so they get to hang on to their multi million dollar salaries with fists so tight their knuckles are turning white. Yes this healthcare reform will increase jobs for nurses- but not in the acute care setting. Those jobs will be in community health. I think it's common sence- Providing coverage to the MILLIONS(?46 million) un-insured so they can gain ACCESS TO CARE in the beginning stages or prevention of an illness( so they dont end up in the expensive ED and hospital) Yes, there will be more patients, more NURSES will be needed. Unlicesed healthcare med techs and CNA's can not assess( do a nursing assesment/exam) on any patient now or in the future. RN's are in clinics and doctors offices now and have been doing assessments in place of the providers and running their assessment findings past the provider( to gain verbal treatment orders) The provider is free to continue seeing his regular scheduled( every 15 min.) appts because these settings are so busy now with out the reform We cant safely care for the ones we have now with these staffing ratios, so more nurses are going to be needed both in the hospital and especially out of the community.
Watching that C-SPAN hearing with Secretary Sebelius, it was very clear that those senators do not understand the Medicine part of this reform-they don't have any understanding of disease process. There is a major gap in their knowledge. They are clueless. But mention money and they get it. One senator was blatantly disrespectful and rude to that woman- Sen John Cain. He told the woman to "shut up" in so many words.
Bottom line is this reform is going to be a re-education of the American public. In the words of Secretary Sebelius- "it is shift from an 'illness' focused model of care, to a 'wellness' focus model of care." That is why it is cost saving.( identify the HTN before it turns into a dialysis situation. Lopressor is cheaper than DaVita).

Thank you for your clear and rational insight!

babyNP., APRN · Jan 30, 2011

I imagine there will be an adjustment period as the country has more people than ever have health insurance, but it will equal out. As others have said, re-educating people on the use of the ER is a HUGE deal. So many people use that as primary care because they have nowhere else to go and know that the ER cannot legally turn them away due to EMTALA.

The system as it stood is broken. We pay for everyone who comes into the ER anyway through private donations to the hospital and government aid and ignore folks who don't seek any healthcare. Now we're going to pay for everyone. Which isn't a bad thing. The health of this nation is very important as it contributes to the workforce capability. If you're sick, it's much harder to be productive.

It may cost more than everyone would like, but it's the moral thing to do instead of putting a band-aid on and looking the other way...

kcmylorn · Jan 30, 2011

Tax return money is out of every individual's paycheck- the federal government takes out, let's Say 25% of your pay each week ( the FICA deduction) because that is the "tax bracket you fall under according to the IRS income table( it's on the IRS website). At tax time, based on your deductions you claim, you get some of YOUR money back. It's not( and never was) the government's money, it's your money that the goverment gives back to you.

The 40 million people who do not have healthcare - alot of them( I think the estimate was atleast 1/2) are working, employed people( alot are employees of small business or self employed, some are even nurses! I am one of them- temps, or per deims who are not offered benefits. That's a whole nother complaint) whose employERs have dropped the healthcare benefit because of the expense of the healthcare insurance( Aetna, BCBS, Cigna, Oxford- google e-insurance and plug in the infor just for fun and see how much those plans are per MONTH) The reform will be offering a public insurance option that the employee will be able to afford.

As for the reinbursement that the hospital gets- The hospital asks for $550 ( because it's finance dept and CEO- top level manangemnt who gets paid off the top before the operating costs of the hospital get paid, are making top level salary, REFUSE to cut their salary or scale down their office staff- their assistant to the assistant, cries poor 'BOO HOO, we have to raise our costs, we're loosing money. The economy. The charity care.) The insurance companies have dug their heels in and refused to up the re inbursement to accommadate these spoiled wealthy selfish brats. So the CEO and top level managers( who have the top of the line healthcare plans inaddition to the million dollar salary) don't take a pay cut, they cut from the bottom- and layoff or dont hire bedside nursing staff.( reality: who takes care of these patients) their crooks and I hope their time is up.

TheChair1 · Jan 30, 2011

Answer: see previous poster. Also, healthcare is a business. Businesses exist to make a profit. No profit? No business. Current philosophy in business: do more with less.
As socialized medicine takes over, states will go bankrupt (or something similar). There will be more jobs, but more jobs for unlicensed and "certified" providers. Physicians will have more clients, much less pay per client or a straight salary with ever growing pressure to see more clients. Less RN's, more nurse practicioners with ever growing pressure to see more clients. Less RN's more "med techs" and CNA's. RN's will see even more part-time positions, per diem positions, few full time ones.
Think a shift is busy now? Just wait... remember: "Do more with less." As the economy spirals even further, jobs we'd have quit due to client safety issues and nursing liability will become more the norm. "Standards of care" will change, likely degrade to meet the challenge of providing some level of care to virtually everyone as funding for almost everything by the then near non-existent middle class will dry up. The only question for me is: how long until this occurs? 5 years? 10? It IS coming.

::Yawns:: this is just more propaganda. You were right when you said that the current philosophy in business right now is to do more with less since we all should know that healthcare is big business driven to make as much profit as possible. You mention that you see a decrease in RN positions and an increase in unlicensed and certified providers. So let me ask you, who do you think is going to be held liable/accountable in our litigation happy society when people start dying and suing when they strip RN's of all of our jobs and just have a bunch of techs running around delivering patient care? The doctors? Admin? I dont think so. Everyone needs to start thinking, researching, and investigating; and stop believing everything they read or hear.

d'cm · Jan 30, 2011

I recommend the OP and those interested in the subject, to read "The Future of Nursing: Leading Change, Advancing Health'. This study done by the IOM is optimistic about nursing and the ACA. Of course the unknowns are numerous leaving the future, as always, unpredictable. I believe though that the ACA and a societal demand for a shift from "pay for doing" to "pay for outcomes" will cause a similar shift in nursing opportunities toward care coordination i.e. case management, disease management, and home care and away from bedside nursing.

Yosemite, RN, ASN, EMT-I · Jan 30, 2011

::Yawns:: this is just more propaganda. You were right when you said that the current philosophy in business right now is to do more with less since we all should know that healthcare is big business driven to make as much profit as possible. You mention that you see a decrease in RN positions and an increase in unlicensed and certified providers. So let me ask you, who do you think is going to be held liable/accountable in our litigation happy society when people start dying and suing when they strip RN's of all of our jobs and just have a bunch of techs running around delivering patient care? The doctors? Admin? I dont think so. Everyone needs to start thinking, researching, and investigating; and stop believing everything they read or hear.

I did not say that ALL RN's will be gone, my guess is that in in-patient settings, the primary caregiver will NOT be the RN (but the RN WILL retain all the responsibility, of course!), but a lower level of care provider, something like 1 charge RN, 2 LVN/LPT, and the rest CNA's and med techs. Health care facilities, when talking to staff ALWAYS rate staffing as their highest overhead expense, hence, that WILL be reduced.

Over the course of time, "STANDARDS OF CARE" will be modified by setting precident. If you don't think hospital administration are not on the same page as their peers, well, that would be a mistake. Take at least parts of California, for instance. When the nurse/patient ratio act came into play, administration everywhere raised a ruckus saying cost of care would rise to the point of having to close, it would be no safer than their traditional staffing models, ect. This went on for a while when, seeminly, overnight, there was a "nursing shortage." Nurses poured into California from all over the world. Suddenly, an RN without current experience in what ever specialty needed filling couldn't get hired. Full time postions became scarce, part-time and per diem are becoming the norm. Just the result of the economy and changing conditions? One might argue that, but a more likely supposition would be that administrators through their corporations and other means learned almost as a whole to change how their facilities staffed and hired. So, "standards of care" will come about by many/most facilities doing so in mass and establishing precident. Poised on the verge of economic collapse, counties, states will not be the alleged "watchdogs" they have in the past. Of course, test cases during civil actions will be the real test, but in the face of economic disaster, I doubt the courts will be as "liberal" as they have in the past. The decades of unions/workers power is coming to an end, the pendulum is swinging back towards business/capitalists assisted by the manufactured downturn in the economy.

Just my guess, though. I'll wait and see and pray I'm wrong, but my faith in collective human nature, big business, state agencies is failing. With the public focused on unemployment, personal financial disasters, most are not going to pay that much attention to the plight of healthcare workers and their clients until they or close family members are directly involved.

kcmylorn · Jan 30, 2011

Another facet of the reform- which is looong overdue, is a $250,000 "cap" on medical malpractice awards. In the congressional hearings, where it was voted to repeal the reform was passed, days before the Senate hearing w/ Sec Sebelius- 2 doctors testified: one was a pediatric orthopod, who stated that Calif, Texas and Michigan are the only 3 states who currently have a 'cap' on malpractice awards. The malpractice awards were so astonomical that it drove most of the OB, Trauma surgeons, Neuro surgeons, anesthesiologist and one more speciality( there were 5) out of the state due to the high cost of medical malpractice insurance premiums. This is also driving up the cost of health care which is passed on to us the receipeint of the care. The scarier side is, as that doc pointed out, what happens if you are in an accident- who do you go to? I know in my area 5 hospitals have closed their OB units- I'm glad I won't be in labor anytime soon.

Interesting, the strongest opposition came from a malpractice Lawyer from Georgia! Guess we know where his prioties are. He was wearing a really sharp looking, nice suit.

ValDonovan · Jan 30, 2011

Very interesting topic. I am currently in LPN school and was at a local hospital on Friday for a MedSurg clinical. As our group was sitting in the cafeteria having lunch, one of the hospital board members approached our table. In his hands he had an article on the future of nursing. He shared with us how the field of nursing will be growing in the future and commented on a couple of recent articles from the New England Journal of Medicine.

I would like to include links to those articles for you to read and draw your own conclusions.

http://www.nejm.org/doi/full/10.1056/NEJMp1012121

http://www.nejm.org/doi/full/10.1056/NEJMp1011639

"This is a critical time to support an expanded, standardized scope of practice for nurses."