Obamacare: are you for it, against it, or unsure?

BlueDevil,DNP, DNP, RN · Sep 6, 2012

It is the Affordable Care Act, and in my opinion it doesn't go nearly far enough. I support it only because it is better than the alternative, not because I think it is wonderful. It still allows for too much waste and doesn't cover enough preventive care. I believe we need true, single payer, government run socialized medicine in this country. Medicare in it's current form needs to be abolished. I believe unnecessary QALY improvement issues should be paid for out of the patient's pocket.

No one should be entitled to elective procedures such joint replacements or extraordinary measures like transplants unless they can pay for it, but everyone should be entitled to free preventive and emergency care at no charge. The affordable care act offers none of these things. France has the best model, and we should be emulating them for improvements in expenditure and outcomes.

Asystole RN · Sep 6, 2012

I am generally against the PPACA.

For one, I believe that health coverage should be a state issue, not a federal issue. I firmly believe in Article 1, Section 8. I do not know why people in Arizona should dictate their health coverage to people in North Dakota, or visa versa. Allow the states to decide their level of coverage.

Secondly, I do not believe that the federal government should dictate the terms of how Medicaid should be implemented, again I believe that individual states should decide what is best for themselves.

Thirdly, I am not a big fan of the third party payment system. I believe that, preferably states to provide if they so desire, a voucher system should be enacted instead of the third party payment system. If healthcare payments were all routed through the patient, and costs were identified upfront, I firmly believe that the consumer discretion would provide the quality improvement incentives that the VBP program is attempting to artificially create.

sapphire18 · Sep 6, 2012

I believe healthcare is a right, not a privilege, so yes- I am very much for the Affordable Care Act. Not sure how it will really affect nurses, though.

amygarside · Sep 6, 2012

Not sure how it's going to affect nurses, but I am for it because it's best alternative so far. Hopefully, the government comes up with a much better one in the near future.

brandy1017, ASN, RN · Sep 7, 2012

I wish we all had national healthcare like the rest of the modern world does. I don't understand how we can have the richest people in the world and yet we only have healthcare if we are lucky enough to get it at work or a govt program. It will force insurance companies to insure people they have refused before, but will people be able to afford the rates. On top of that so many of us are stuck with crappy insurance plans that steal thousands out of our pocket each year if we have the misfortune to get sick or have a chronic illness! I really don't know how families pay for family coverage and the ridiculous spousal charge and thousands out of pocket, usually twice as much as single coverage. No wonder so many bankruptcies are tied to medical bills! Then they wonder why people aren't saving for retirement, with what, all the money goes for medical, dental bills and the raises are pathetic. They are raising out of pockets another $1,000 this upcoming year for single coverage and any copays don't count to the maximum. They have high deductible plans but they don't pay for anything from prescriptions to doctors visits till the deductible is paid and we all know how insane prescription prices are since the govt refuses price controls and the pharmaceutical companies know anything goes in America. The rest of the world is smart enough to limit the pharmaceutical companies that way it is so much cheaper to get meds from Canada! No one is dealing with healthcare cost and inflation, instead the companies just require workers to pay thousands more out of pocket and too bad for them if they get sick and can't afford it!

SC_RNDude · Sep 8, 2012

I am generally against the PPACA.
For one, I believe that health coverage should be a state issue, not a federal issue. I firmly believe in Article 1, Section 8. I do not know why people in Arizona should dictate their health coverage to people in North Dakota, or visa versa. Allow the states to decide their level of coverage.
Secondly, I do not believe that the federal government should dictate the terms of how Medicaid should be implemented, again I believe that individual states should decide what is best for themselves.
Thirdly, I am not a big fan of the third party payment system. I believe that, preferably states to provide if they so desire, a voucher system should be enacted instead of the third party payment system. If healthcare payments were all routed through the patient, and costs were identified upfront, I firmly believe that the consumer discretion would provide the quality improvement incentives that the VBP program is attempting to artificially create.

Yes. When a third party is paying, the consumer has less interest in looking for the best value in care, and providers have less incentive to provide the best quality and value possible.

If the consumer is in charge of where the payment goes, the competition created would encourage quality, innovation, and value.

SC_RNDude · Sep 8, 2012

Not sure how it's going to affect nurses, but I am for it because it's best alternative so far. Hopefully, the government comes up with a much better one in the near future.

You may be right. If you would, help me out and give me one of the alternatives it is better then, and why?

uRNmyway, ASN, RN · Sep 10, 2012

Well I come from Quebec, where they have socialized healthcare. I worked as an RN there for almost 3 years, and hated the way things are run. When you don't pay out of pocket for anything, you don't know how much things cost, and you abuse the system. To ER nurses out there: Who abuses the ER more? Who tends to go in for broken nails and the sniffles? Is it the private pay, those with poor coverage from their insurance providers, or those covered by Medicare/Medicaid? Of course, I realize that there is no catch/all. Not everyone on Medicare/Medicaid abuses. But it is more likely that there will be useless visits or hospital stays if you have to cover some of the cost. You have more incentive to do things that will make your health better, to try every other thing before rushing to the hospital.

And yes, I realize that some people don't go even when they need to, because they can't afford it. My fiance is currently one of those, and I have been working on getting him to go get checked out for a while for a recurring pain we can't explain. I would rather make payment arrangements with a hospital to get him the care required than deal with having to pay funeral expenses.

And it drives me nuts when people think that it will cost them less for healthcare this way. Where do people think the money will come from for all this? Maybe taxes won't go up right away, especially not before elections. That would probably be the nail in the coffin of the Obama campaign. But they will have to go up eventually, probably sooner rather than later. After all, if Obama gets re-elected, what does he have to lose by doing things that would be unpopular with the general masses? Its not like he has to be careful to stay in power. In Quebec, just federal and provincial income taxes add up to around 45% of salary.

Now as far as nursing in this environment. When the hospital and doctors/clinics make less money, they can afford to do less. Doctors will either leave the country, or will limit treatments and all. Why do you think most clinics will only take so many Medicare/Medicaid patients? Because they already barely make pennies on the dollar of profits for those patients. So with less profits, you get less staffing, less functioning equipment, less pay increases. Forget those beautiful renovations. Those fancy gadgets, computers, palm pilots? A thing of the past when there is no longer money to pay for them.

Insurance costs for the general masses will also most likely increase if insurance providers can no longer refuse people with pre-existing conditions. Their purpose is to make a profit. If they have to pay out more for people who are frequently hospitalized, then the prices for everyone will have to go up.

Anyways, I know a lot of people don't agree with me about this. This is just what I have seen from living in a country with socialized healthcare. I understand that Quebec specifically has a bad reputation for corruption. And I hope that it works out better here than there. But honestly, if I start to see those tell-tale signs I witnessed back home, I might just have to look into nursing in the UK or something....

uRNmyway, ASN, RN · Sep 10, 2012

To ER nurses out there: Who abuses the ER more? Who tends to go in for broken nails and the sniffles? Is it the private pay, those with poor coverage from their insurance providers, or those covered by Medicare/Medicaid? Of course, I realize that there is no catch all. Not everyone on Medicare/Medicaid abuses. But it is less likely that there will be useless visits or hospital stays if you have to cover some of the cost. You have more incentive to do things that will make your health better, to try every other thing before rushing to the hospital.

And yes, I realize that some people don't go even when they need to, because they can't afford it. My fiance is currently one of those, and I have been working on getting him to go get checked out for a while for a recurring pain we can't explain. I would rather make payment arrangements with a hospital to get him the care required than deal with having to pay funeral expenses.

And it drives me nuts when people think that it will cost them less for healthcare this way. Where do people think the money will come from for all this? Maybe taxes won't go up right away, especially not before elections. That would probably be the nail in the coffin of the Obama campaign. But they will have to go up eventually, probably sooner rather than later. After all, if Obama gets re-elected, what does he have to lose by doing things that would be unpopular with the general masses? Its not like he has to be careful to stay in power. In Quebec, just federal and provincial income taxes add up to around 45% of salary. And why are taxes so high? Other than corruption, its to pay for all the socialized services provided by the government.

Now as far as nursing in this environment. When the hospital and doctors/clinics make less money, they can afford to do less. Doctors will either leave the country, or will limit treatments and all. Why do you think most clinics will only take so many Medicare/Medicaid patients? Because they already barely make pennies on the dollar of profits for those patients. So with less profits, you get less staffing, less functioning equipment, less pay increases. Forget those beautiful renovations. Those fancy gadgets, computers, palm pilots? A thing of the past when there is no longer money to pay for them.

Insurance costs for the general masses will also most likely increase if insurance providers can no longer refuse people with pre-existing conditions. Their purpose is to make a profit. If they have to pay out more for people who are frequently hospitalized, then the prices for everyone will have to go up.

Anyways, I know a lot of people don't agree with me about this. This is just what I have seen from living in a country with socialized healthcare. I understand that Quebec specifically has a bad reputation for corruption. And I hope that it works out better here than there. But honestly, if I start to see those tell-tale signs I witnessed back home, I might just have to look into nursing in the UK or something....

Oh, and there is also a thread on here about customer satisfaction scores determining repayment from Medicare under the ACA. Anything under an 8/10, and you get no reimbursement for services rendered. Scary thought...

chaka_1709 · Sep 11, 2012

I'm for it as long as we follow a model that works in other countries that have socialized healthcare. Question for Jewels... you do know that UK (and pretty much every modern nation) has socialized healthcare too right? So by hypothetically moving there is it because their system is better or you didn't know it was socialized?

malestunurse · Sep 11, 2012

I'm for it as long as we follow a model that works in other countries that have socialized healthcare. Question for Jewels... you do know that UK (and pretty much every modern nation) has socialized healthcare too right? So by hypothetically moving there is it because their system is better or you didn't know it was socialized?

The NHS is faaaar from perfect, terrible system and full of holes. Still better than the largely privatized system of America though.