How Will Universal Health Care Change Nursing?

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How will universal health care change the Nursing profession? Will we finally get ratios? Will our pay go up, or down? What about benefits? Will the quality of care improve, slide, or stay the same? How would a "single-payer" system be structured? Would this be the end of the insurance industry as we know it? I would like to hear from everyone who has an opinion about any of these questions.

Specializes in MICU, neuro, orthotrauma.
The system of sliding scale payment for health care already exists in the US. It is the system found in the Community Health Centers. Based on your level of income you pay a certain amount. A clinic visit can cost you $5 if you are a family of 4 and below the poverty line and as much as 100% if you are a family of 4 with good income. The clinic is staffed with young physicians and NPs. Lot of Residents moonlighting. You can actually get pretty good care there.

However, this is where "poor" people go. Middle class and up go to their private physician. Insurance pays. Their copays are anywhere from $15 to $50. The waiting room is nice and usually has a flat screen TV.

Just like the "dumbing down of America" within the public school system perputated by the federal government and the educators unions you will see a "leveling" of the health care provision field. Eventually, under UHC, we will all go to the big building in town, sit in an overcrowded waiting room for hours, be seen by a "physician extender" and treated for our ailement. This is the promise of health care reform.

That's very very city/region dependent. I would have to drive three and a half hours to have a hope of finding somehting like that. Now, when I lived in Houston, I didn;t think it was that big of a deal to be without insurance, because there were many free/low cost services, but after living in numerous towns and cities in the US, I have come to find out that most places are not so "rich" in funded clinics for the poor.

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Very true. Little towns will have to have travel to bigger towns to receive treatment. Little hospitals, defined as anything under 120 beds will be turned into urgent care centers. There is already a model being tested here in Atlanta where a community of considerable size will not have a hospital but they will have an urgent care center that replaces the hospital. Consolidation of hospitals and the closing of "excess" beds will continue. Just look at what happened in Philadelphia.

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Specializes in CTICU.

Your "these terrible things will happen" theories are just that, theories - not based on fact. You do not show any basis for your theories.

Perhaps under this plan, something like an MRI won't be able to charged at several thousand dollars, when it costs nothing like that to provide. The amounts charged and reimbursed are ridiculously inflated - who's getting all the bonus?

My home country has both UHC and private insurance. Why would anyone take private insurance? Because you get to skip lines, and choose your surgeon, and go to fancier facilities. Why else? Because you get a tax break - you pay a lower medicare levy. Plus, tax rates are NOwhere like 54%.

I think it's interesting that the people who are most against UHC are the people with no actual experience of it.

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Interesting. My MBA is in Health Care Administration. I have a Post Graduate certificate in managed health care. I was the President of an HMO. What qualifications do you have other than "I worked in UHC?"

I have studied other systems of health care including UHC in depth for over 25 years. So, how do you dispute all of the evidence that UHC has rationing and endless horror stories? The evidence was given to us by previous posters, no need for me to repeat it.

You are also underestimating the American people. Americans don't walk into a hospital and say "give me only what I need, I will take a Yugo instead of a Cadillac if it is available." Everybody wants the absolute best no matter what the cost will be. Rationing of health care in the USA will not be tolerated. It is not tolerated by the lowest class, just go to an any ER and you will see it, and the middle and upper class certainly will not stand for it.

Frankly, I doubt we will see UHC in the next 25 years. The democrats do not have the backing on the hill to ram it through. And they run the risk of having the sheeple that follow them wake up and turn on them. Their opinion polls are coming in and telling them this. They will back off because it is politically expedient to do so.

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A full 16% of the uninsured, the study found, have incomes above $75,000 a year and could obviously afford insurance if they chose to buy it. Roughly a third of those lacking insurance earn $50,000 a year or more.

Not obvious that you can afford it, if you have been living on a stagnant income for 10 years, sole earner loses job, COBRA costs 20K/year, no cheaper policies available in state, housing costs 25K, previous layoff ate up savings with one year on COBRA...we took our chances and put the mortgage first.

Fortunately that last time, layoff was only 3 or 4 months, so income was still 75K, but heck no, we couldn't afford insurance.

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Specializes in OB, HH, ADMIN, IC, ED, QI.

looking4wrd (with trepidation): You need to get yourself a more positive outlook, girl!

I was in Canada at the time Universal care was started. More jobs, not less for nurses and every other employee involved in patient care, became available.

As a Public Health Nurse in Windsor, Ontario, Canada, I saw patients getting medical care sooner, therefore having preventable diseases prevented. More babies were brought to our well baby clinics, and to doctors' offices. No one cared about bills being paid......

When I examined the sight of students at the 4 schools where I was the school nurse and found corrective glasses were necessary, parents actually abided by my recommendation to have an ophthalmologist see their children, and glasses made all the difference in their school work (even though parents still have to pay for them). I was thanked a lot, for drawing their attention to the problem.

Not as many pregnant women wanted to give birth at home (this was before the loss of trust in hospitals happened, due to pressure there, to have analgesic measures). Private agencies did nurse home visits more than Public Health nurses did...... and now those agencies are covered by the government program.

There was less stress felt by patients fearing their inability to compensate for their missed work and the expense of a hospitalization. Yet I have to say that the cost of hospitalization then was about 1% of the present charges for it in the USA now. There were also fewer errors in billing (in favor of the hospital) than there are now.

Since everyone will be a government employee, the many benefits of that will be given all HCWs. It's doctors who fear less income, and well they should. They have murdered the health care system as it's weighed down so heavily paying them exorbitant fees. The reason their malpractise insurance costs so much, is because they make so much that if their income was threatened, the amount of money they'd be paid from their insurance company, if they lost the ability to practise medicine, would be gigantic (especially if retirement age is a long way off).

Nurses are far more flexible, and make less than doctors (which is why our malpractise insurance cost is so low), so if they lost their licenses, they'd find something that might pay more....... like being a paralegal for a malpractise lawyer.

The environment in which we work would change in about 10 years, as costs of providing such lavish furniture and decorative touches wouldn't be a priority. Cheap plastic chairs in the lobby will probably replace upholstered ones made of wood, and unless someone donated a fountain for the entrance, forget it.

There would be more emphasis on quality of patient care, than on myriads of paper work, as computers would replace the expensive charts and paper used now.

I can go on and on about the benefits of a well run government program - run by professionals who are well educated, which is not the norm in other government agencies. Comparisons with the DMV are desperate efforts by those who want the "status quo". Don't you just love the TV commercials showing steam shovels destroy -----what? doctors overpayment? The company paying for those ads, CPR is paid by insurance companies desperate to survive.

There would still be a need for financial types, not for billing and dunning patients to pay, but to assure maintainance of positive financial function. Gee, no more stickers from equipment, dressings, etc. to place on the right space in the right patient's record. We'll miss that, won't we?

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Specializes in OB, HH, ADMIN, IC, ED, QI.

Hi! It's me,RN,BBA,MBA - I'm RN, PHN, ACCE, CICN

I'm from Canada and still have family there who are very satisfied with their healthcare. My neice is a family physician there who lives in a lovely home, in a great neighborhood, and has a very nice car (not a cadillac or any other expensive brand). Her 3 boys went to excellent Canadian universities that didn't cost half the fees that ours do. Their educational system is far superior to ours! I'm very concerned about what my grandchildren don't learn at their schools, that is taught well in Canada.

I was working as a Public Health Nurse in Canada when their Universal/single payer/sensible healthcare plan started. No one whined about their taxes paying for the care of others. Doctors didn't complain about their incomes, until they attended conferences in the USA and found out what doctors in the USA make.

So those who love money more than the welfare and well being of their patients, went south. Those with whom I still speak/email who did that, have regrets about leaving. They aren't proud of their choice, which might as well be engraved on their foreheads.

You've bought the propaganda of those who want the focus on 16% of Americans, who gamble with their future well being, rather than 84% who are not as foolish, most having jobs and families they want protected from the financial disasters that occur by the dozen, daily. They want their medical care to be their right, not the privilege of few.

I feel sorry for you, as your predictions won't materialize and you won't be able to gloat about your superiority as you work as a staff nurse, rather than being an administrator, since there's more need for "indians" than "chiefs", in universal healthcare settings.

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Specializes in Gerontology, nursing education.

A few weeks ago, I met up with an acquaintance who has IDDM. She told me she went for four months without insulin because she couldn't afford to see her doctor for an appointment to review her diabetes management. Her partner has a neurological condition and is unable to work. Her condition is poor and she will likely end up in a LTC before she dies. The medical bills have bankrupted this couple. Neither can get private insurance and the woman who's working does not get insurance through her job. The governor of her state has cut medical benefits to adults, even those at or near the poverty level, to balance the budget.

How much more will this couple cost the health care system because they aren't receiving appropriate care now? The woman with IDDM---who's going to pay for the complications of her disease? We are. Wouldn't it be less expensive to make sure she has access and coverage now---to pay for her insulin and other meds----rather than to let her disease progress and cause problems such as retinopathy, renal disease, amputations?

The fundamental question is---do we, as a society, have a moral obligation to ensure access to affordable health care to all our citizens? The marketplace model says, no, we don't. The other side of the coin is---if we have a moral obligation to provide health care access, how do we allocate our limited resources?

Americans are unwilling to admit that we have limited resources and that the money we spend on futile care in the last days of life for a few could be better spent on preventative care for many. We're horrified at the idea of rationing health care and yet, through marketplace medicine, we're doing exactly that.

I guess I'm not horribly afraid of how UHC might change nursing. Concerned? Yes. Afraid? No. I lived through the changes in the 1980s and 1990s and saw the advent of DRGs, short hospitalization stays and drive-through surgeries. (Okay, the drive-through surgeries are an exaggeration but you know what I mean.) IMHO, the DRGs destroyed nursing care as we knew it and I'm not sure things could get much worse. Provider autonomy is a thing of the past. Insurance companies (and, yes, Medicare) dictate what treatments should be done, what tests should be run, how much an institution is going to be paid for taking care of each one of us. Insurance companies determine what's "elective" or "unnecessary" and often consumers are stuck with huge bills after tests and procedures are already done. Doctors are not in control, nurses are not in control, and the consumer is CERTAINLY not in control.

Yes, I must admit I'm a little uneasy over the prospect of the government running health care the way it runs the Post Office. (Not to dis the Post Office, but after they've lost one package three times, I kind of wonder about their efficiency.) I have a family member who has to haggle with the VA over coverage for deployment-related health issues. (The deployments were to Desert Storm, Bosnia and the current Iraq war.) This family member has PTSD, vague neurological symptoms, and is at risk for developing God knows what diseases due to exposure to chemicals overseas. The government turns its back on veterans like my family member and refuses to treat PTSD or address other health concerns. There are some who deny the existence of Gulf War Syndrome. It is inexcusable and heinous that the government is trying to weasel out of paying these veterans for health problems associated with their deployments---but I digress.

However---the so-called health care system we have in America is not working. We need an alternative---but nothing will be perfect. Every alternative that the government comes up with will have its flaws and drawbacks. What are we willing to do in order to change the system?

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Specializes in Gerontology, nursing education.
Most recent example, a terminal cancer patient told her family she wants "everything done." She comes to ICU and stays in ICU for five months while her cancer progresses and spreads throughout her body. She is ventilated, on daily dialysis, on two pressors and has multiple chest tubes, as well as the typical electrolyte protocols etc etc. She develops infection after infection, all of which are treated, doctors literally quit her case, but the family is unfazed, they want ALL CARE DONE TO THE END. She is unresponsive for the two months prior to her death, but they want all care done. Insurance stopped paying after 30 days, so we picked up the bill. It was either that or a lawsuit, and from what I hear, they are now pursuing a lawsuit as well.'

This is heartbreakingly wrong on so many levels.

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Hi! It's me,RN,BBA,MBA - I'm RN, PHN, ACCE, CICN

I'm from Canada and still have family there who are very satisfied with their healthcare. My neice is a family physician there who lives in a lovely home, in a great neighborhood, and has a very nice car (not a cadillac or any other expensive brand). Her 3 boys went to excellent Canadian universities that didn't cost half the fees that ours do. Their educational system is far superior to ours! I'm very concerned about what my grandchildren don't learn at their schools, that is taught well in Canada.

I was working as a Public Health Nurse in Canada when their Universal/single payer/sensible healthcare plan started. No one whined about their taxes paying for the care of others. Doctors didn't complain about their incomes, until they attended conferences in the USA and found out what doctors in the USA make.

So those who love money more than the welfare and well being of their patients, went south. Those with whom I still speak/email who did that, have regrets about leaving. They aren't proud of their choice, which might as well be engraved on their foreheads.

You've bought the propaganda of those who want the focus on 16% of Americans, who gamble with their future well being, rather than 84% who are not as foolish, most having jobs and families they want protected from the financial disasters that occur by the dozen, daily. They want their medical care to be their right, not the privilege of few.

I feel sorry for you, as your predictions won't materialize and you won't be able to gloat about your superiority as you work as a staff nurse, rather than being an administrator, since there's more need for "indians" than "chiefs", in universal healthcare settings.

Strange, so if health care is so good in Canada why do so many cross the border to get treatment? And why is the news so loud now about the Canadians wanting change in their health care? Odd, the rosy picture you paint is not what the facts describe.

Oh, don't worry about me gloating as I work as a staff nurse, I know it is only temporay until I rebuild my real estate investing business. And the really neat thing is that after only 4 months I have already been offered a VP position. So don't worry about me, I have a very bright future in front of me. Diversification and education with real degrees takes care of that situation. Have a great life.

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Specializes in MICU, neuro, orthotrauma.
Strange, so if health care is so good in Canada why do so many cross the border to get treatment? And why is the news so loud now about the Canadians wanting change in their health care? Odd, the rosy picture you paint is not what the facts describe.

Oh, don't worry about me gloating as I work as a staff nurse, I know it is only temporay until I rebuild my real estate investing business. And the really neat thing is that after only 4 months I have already been offered a VP position. So don't worry about me, I have a very bright future in front of me. Diversification and education with real degrees takes care of that situation. Have a great life.

There are people trying to get into Canada to get treatment as well.

The thing is, with freemarket healthcare, more people suffer and die than not. Look at the facts as you so sweetly put it.

"Among 19 industrialized countries, the U.S. ranked 15th on "mortality from conditions amenable to health care," or deaths before age 75 that are potentially preventable with timely, effective care. The U.S. rate was more than 30 percent worse than the benchmark--the top three countries. The U.S. also ranks at the bottom for healthy life expectancy and last on infant mortality."

Every single industrialized country before us on that list has a universal healthcare plan in place.

That is a staggering fact. And yet, people in HMO's such as yourself, struggle to rationalize your own existence. It would be funny if it weren't so immoral and outrageous.

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