How Will Universal Health Care Change Nursing?

[arelle68]

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.

[Heogog53]

A friend of mine is paying for private health insurance coverage from BC/BS pays roughly $18,000.00 PER YEAR for coverage. That covers 4 people, two who have some medical problems, but nothing like diabetes, CHF and the like. So, if you take those who make 50k a year and take off the 18k off the GROSS, you have a family of 4 going from 50k to 32k per year...... just consider that they also have co-pays for visits and medications, on top of all that.....suddenly the 50k is even further reduced---and that's before rent/mortgage, food, clothing, and car payments.

OW.

[Fiona59]

I just finished my shift in your dreaded Canadian system. Nobody died (on my unit), nobody had their meds, stay or wound vac rationed.

Everybody that presented in the ER with chest pain was monitored and seen by the appropriate specialists (including cardiologists). Babies were delivered by the Obstetric Team, the Ortho guys dealt with the broken bones and the OR staff kept themselves occupied. Number of bills issued--NONE (OK, those that came in by ambulance will get a bill for the ride in about two weeks).

Number of people who complained about paying taxes to support their heathcare system NONE.

[geekgolightly, BSN, RN]

More from the World Health Organization. As reported by Bloomberg

http://www.bloomberg.com/apps/news?pid=20601110&sid=aykIuUrgXbWc

May 21 (Bloomberg) -- The cost of health care in the U.S., the highest in the world, jumped 47 percent from 2000 to 2006, a study said. That didn’t buy Americans the longest lifespan.

Americans paid $6,719 a person for doctors, medicines and hospital visits in 2006, up from $4,570 in 2000, according to a report released today by the World Health Organization in Geneva. The yearly spending is more than nine times the global average. With a life expectancy of 78 for a person born in 2007, the U.S. trails at least 27 other countries among 193 in the report.

[talaxandra]

good information. and can you tell me what is the overall tax rate paid there? that includes federal, state, local and sales tax if any apply?

thank you.

in australia the taxation rate varies depending on your annual taxable income, from nothing ($180,000). the average australian full time nurse's income falls in the third tax bracket, between $34,001 and $80,000, which is taxed at $4,200 plus 30c for every $1 over $34,000. more simply, if you earn $75,000 you pay $16,500, or 22%. added to income tax is a medicare levy of 1.5% of taxable income. high income earners who do not have provate health insurance are also liable for an additional 1% medicare surcharge.

income tax accounts for about 60% of revenue; the rest is from excise and customs duty, gst and property taxes. the goods and services tax is capped at 10% and included in the posted prices of all goods (with some gst-exempt exceptions) and services. gst-exempt items consist primarily of fresh food and ingredients (flour, eggs, milk and butter are all gst-exempt, a cake attracts gst). council and state taxes apply to businesses and property owners; renters do not pay any local/council or state taxes.

my gross income will spill over into a higher tax bracket this financial year, but i'll be paying tax at the third level rate because as a nurse in the public system i'm able to utilise salary packaging and i have ~ $18,000 of tax deductible items (work and education expenses and charitable contributions), which decrease my taxable income. i'll pay around 16% tax this year, including the medicare levy, on an income of around $90,000 gross.

in 2006 the federal government commissioned a report comparing australia’s taxation rates with other oecs countries; the report breaks down comparisons with both oecd-10 and oecd-30 nations, covering “all forms of taxation collected in australia at national, state and local government levels.”

the oecd sub-set (oecd-10) consists of australia, canada, ireland, japan, the netherlands, new zealand, spain, switzerland, the united kingdom and the united states.

these nine members of the oecd-10 were chosen because they are broadly similar to australia in terms of their overall tax to gdp ratio and the role of the government sector in their economies (chapter 1 provides further details). the size of the subset needed to achieve a balance between the degree of similarity between the comparator countries and a sufficiently large sample of countries to provide meaningful comparisons without imposing excessive information collection demands.http://comparativetaxation.treasury.gov.au/content/report/html/02_executive_summary.asp

i haven't read all of it, but a few things caught my eye. first:

the report shows that australia is a low-tax country. australia’s overall tax burden (31.6 per cent), measured as the tax to gdp ratio, is the eighth lowest of the 30‑member oecd. australia’s mix between direct and indirect taxation is in line with other oecd countries, although the composition differs. for example, australia’s indirect tax mix differs through a lower reliance on value-added and sales taxes, and a relatively higher reliance on property and transaction taxes, further, australia does not levy any wealth, estate, inheritance or gift taxes. [ibid]

second:

a statistical overview

australia has a low overall tax burden compared with the oecd-30, both currently and historically. australia’s tax mix is in line with oecd-30 countries, although there are some distinguishing features.

- australia is the eighth lowest taxing country of the oecd-30.

- australia’s tax burden has typically ranked in the bottom third of countries since 1965.

- australia’s tax to gdp ratio of 31.6 per cent is below the unweighted oecd-30 average of 36.3 per cent and above the gdp-weighted oecd-30 average of 30.9 per cent. [ibid]

it is true that australia's overall tax rate is higher than that of the us. however, as the authors point out,

one of the reasons the united states has a higher taxation revenue per capita than australia, but a lower taxation revenue as a proportion of gdp, is because it produces more gdp per person than does australia... the higher productivity and higher income of the united states give it greater capacity to raise more taxes than australia, while still potentially leaving its citizens with more disposable income than is the case for australia.[ibid]

the full report, "international comparison of australia's taxes" by richard fe warburton and peter hendy, released in 2006, is available at: http://comparativetaxation.treasury.gov.au/content/report/index.asp?navid=011

medicare has no lifetime cap. i never have to worry that i'll lose my home if i have a stroke, get cancer or am involved in a serious accident, even if i lose my job or am unemployable.

[talaxandra]

It'sMe, you asked Maisie about a few services that - I assume from your tone - you didn't included as part of universal health care access.

In Australia some physical therapy is free and some isn't; hospital in the home programs are free but RDNS and allied programs attract a nominal fee. Dental care is not included here but is in many other countries; I'm not sure what the status of orthodontia is.

Transportation to and from dialysis, and from home to or betweeen any health care service (eg outpatient's appointments) is covered by an annual (optional) subscription to the State's ambulance service. In addition to emergency ambulances we have transport ambulances - a five year membership to Victoria's Metropolitan Ambulance Service costs $300 for an individual (with three free months included) or $60/year. Family membership is double that; most insurance funds fully refund the cost.

Though psychologists are privately financed, psychiatric services are fully covered. All medications are heavily subsidised by the Pharmaceutical Benefits Scheme.

Clothing etc fall outside the purview of Medicare, but there's a strong social service safety net that includes subsidised housing, disability pensions and access to welfare associations that help those who are unable to work due to illness or disability (physical or psychiatric).

[lamazeteacher]

"I sure wish my wait had been only four hours or even four weeks. As it happened it took NINE WEEKS FROM THE INJURY TO THE START OF PHYSICAL THERAPY." quote from redherring, regarding Pacificare's lack of care (last 3 words are mine)

Let this post be a WARNING!!! That HMO is renowned among HH workers for those kind of shenanigans. Your PCP could have referred you to P.T. and diagnostic studies, in any other HMO...... it appears that they don't have enough docs who will take the pay for service your orthopedic surgeon wanted, or no orthopedic surgeons have joined them on their approved list of providers, for the same reason.

I don't hold Canada out as the standard of UHC, as the character of this population's distrust in government won't abide even the role of cashier, not decision making. Yet most of us sign HIPPA, which witholds information that, if patients knew about how many government agencies (incluiding police and courts) and people it allows to see their records, they'd never sign it.

France's system looks very good. I loved the last scene in the movie "Sicko", with Michael Moore struggling up to the White House with his dirty laundry, because in France their healthcare program allows people who are sick to get their laundry done for free!

[lamazeteacher]

"Though psychologists are privately financed, psychiatric services are fully covered. All medications are heavily subsidised by the Pharmaceutical Benefits Scheme." quote from talaxandra's post #88

I'm happy about President Obama's statement that physical and psychological/psychiatric conditions will receive equal funding when his

healthcare program is passed. That has been a failing for a long time that health insurance companies perpetuated, and the cost of those services initiated.

[MedSurgeMess]

So many are stating "crappy,substandard" healthcare. As nurses, we will hopefully be a big part of any new system. We have the intelligence and desire to help sculpt it into either a great system or a "crappy, substandard" system. We hear talk of a lack of supplies, but many times, we can make do if we improvise. I know I'll catch flack for this but it's true. My mom, a RN of 40+ years, talks about all the goodies that we have to make our work easier, compared to the level of supplies that they had way back when. I'm grateful for all of the convenience items that we have to make our jobs flow better, but some of them are not outright necessities.

Case in point: A flood in my state last year required an area hospital to close, and many of their staff came to help with the overflow of patients that we received from the closing of their facility. Their nurses were shocked at the fact we didn't have "this kind of bandage" or "that type of monitor" etc. But they also saw how we made due, improvised, and still took great care of the patients. We are both also Magnet facilities, so it just goes to show that you don't need all the fancy extras to have patients that are satisfied and with great outcomes.

I think the main area where we will see job losses are with private insurance industry. Hopefully, it will be some of the bigwigs who have the multimillion dollar bonuses yearly, because those are the same yay-hoos that have their companies deny just about every claim, while charging high dollar premiums.

We CAN make it better!

[Moogie]

So Maisy, if I understand you correctly you think people are entitled to health care in the USA, as in it is a right. And I noticed you added mental health care as well. So where do you stand on Physical Therapy? Home Health Care? Personal Care? Dental care? Should it all be free to everyone? What about the dialysis patient that can't get to dialysis? Should we pay for their transportation? Who makes that decision? Who pays? And since good health care begins at home, what about a home? Should we provide every citizen a home? And of course nutrition is the foundation of health care so should we provide their food as well? And sense you think that mental health should be covered then should we provide clothes to those that are in need to help them not be depressed? And to feel productive and well adjusted everyone needs a job, should we provide them a job as well? Where do you draw a line Maisy? And who decides what is enough? A government bureacrat? And who is going to pay for all of this? And how?

Are people entitled to these services or do we, as a society, have a moral obligation to help all our citizens?

Frankly, I believe we have a moral obligation to ensure that all Americans have access to affordable health care, especially preventative care that will decrease their chances of developing costly diseases later in life. That is economically wise. Perhaps we need to look at federal funds guaranteeing the availability of public health nurses or school nurses to teach and model healthy patterns of living. Faith-based initiatives, started by George W. Bush, could help fund parish nurses in a variety of faith community settings. We talk about job creation in our economy---let's create jobs that actually benefit people rather than entry-level service jobs like flipping burgers in fast food restaurants.

Should we pay for transportation to health care? Yes, if there's a need. Why can't we use stimulus money to hire drivers to take people without safe transportation to dialysis, radiation therapy, appointments, PT?

Providing mental health services? Come on---research into brain plasticity is showing us that there are permanent changes in the brain due to stress, depression, even a lack of positive environmental stimulation. Mental health services no longer require that someone spend years going to a psychiatrist three times a week---much progress can be made in short term therapy---in helping people cope with stress so they don't become depressed. If need be, there are medications. If we provide treatment and appropriate medications to those who are depressed and unable to work---is it possible that we can get them back to work and paying taxes again?

Who makes these decisions? Who decides what is enough? Well, right now it's not government bureaucrats but businesspeople who are determining what care is necessary---and what they, as institutions, HMOs and insurance companies can best afford while keeping the stockholders happy. What if the government hires NURSES instead of bean counters to make these decisions?

Who pays? Well, yes, we all pay. Then again, aren't we paying already? Aren't we paying, through taxes, for indigent care? Aren't we paying, through increased hospital costs, for the uninsured who show up in our emergency rooms? Aren't we nurses paying already for increased health care costs by working short all the time and taking unsafe assignments because our institutions "can't afford" to hire more staff? Aren't the new grads and experienced nurses who are unemployed also paying because they can't find work?

Sorry, my liberal bias is showing but I would sincerely rather pay more in taxes if it meant not having to pay for insurance or feel stuck in a job because I'd lose my insurance. I would be happy to pay more in taxes if it meant better care in the hospital, adequate and safe staffing, and lower----or no---medical bills. I would be happy to pay more in taxes if it meant being assured that any tests and procedures I have are already approved and I won't have unpleasant surprises months after the insurance company has denied my claim.

Somehow---I think that although we will pay more in taxes with UHC, our overall costs may be less.

BTW, the point about clothing and feeding the poor---how much of our extra things can we give to shelters or food banks? There even are programs such as "Dress for Success" in which women can donate business-appropriate clothing to low-income women---and provide career counseling and interview tips---so that these women can join the workforce and---you got it---become taxpayers rather than drains on the system.

Just my

[FireStarterRN, BSN, RN]

I think that we waste money on soooo many unneeded things. Spending money on healthcare not money wasted. It will also create jobs at the same time. The money spent will go into the pockets of American workers who will be helping other Americans.

Look at all the money we spend on military operations abroad, blowing things up, using fossil fuels for destruction, without much to show for it but some stressed out soldiers. Nothing accomplished...

One poster said that at the beginning of the 20th century that there was no health insurance. There also wasn't much healthcare. Science didn't have many tools. There WERE big public works projects to overcome sanitation problems that killed off millions of people. Before that people died of cholera epidemics and other water borne illnesses. The government intervened in many ways to improve the health of millions. So the government has always had a concern for the public health.

[rnto?]

Years ago, there was another man, like us, who saw the benefits of science, and believed a society based upon such ideas would ultimately lead to the perfect society with the perfect citizens.

Therefore, I salute you comrade, and I stand ready to shoulder your burden as we continue to lead this great nation to becoming that perfect society!

Am I the only one picturing a small man with large mustache and an agenda?

[NurseBrittney]

Universal healthcare... so much to consider.

Having recently had a baby, and being in dept thousands of dollars, even with the best insurance coverage my facility has available, and having a toothless gentleman tell me while looking at the new babies in the nurse that "having babies can sure make you alot of money", my opinion is a bit jaded.

I do not think that I should have to pay for others to have their children but still be completely responsible for the healthcare costs of my own. It is not fair for me to be punished with the burden of supporting those who are milking the systems and are "having babies to make money" as this fellow proclaimed to me.

Since I am a nurse, and make a decent living wage, I, my child, my husband qualify for nothing. No Medicaid, no wic, nothing. So while I'm paying over $360 a month for health insurance, as well as Medicaid for others, I am still thousands of dollars in debt for having my sweet little boy.

Now, if universal healthcare will fix this gross injustice, I am all for it.

I don't feel it is fair for people who work to be punished for having children.