RN4MERCY

Attitude like solidarity for patient safety? And willing to take a stand to change unsafe working conditions that increase risk of harm to patients? Why on earth would you call those who voted against hapless victims? Intimidated by their managers maybe and feeling sorry because manager-friends fed them the buster-scripted line "I'll lose my job if the union wins".

Classic victims believe their abusers don't really mean to hurt them and that they must some how deserve the punishment. Texas couldn't even defend itself against Mexico and the union army had to protect the people. Together we can form a stronger and more powerful association in solidarity for our patient's safety!

Horribly sad for those nurses who tried so hard to overcome an employer who puts profit ahead of patient needs. The nurses who continue to advocate for the right to control their professional practice are very brave pioneers in Texas. Eventually they will prevail over the union busters ideology of oppression and achieve autonomous control of their profession at Rio.

I'm not sure anyone's missed the point here. It's just that if more money were going into the public system to pay for actual care instead of being diverted into private coffers to pay for marketing, advertising and glistening corporate headquarters, providers would get paid more fairly and more patients who need comprehensive care would receive it. That's not happening now, and I think there are loopholes in the new law that will find people falling through the cracks. It's not fair to deprive the public system of resources and then call it a failure; administrative costs are low with publicly administered and financed systems. Whether or not the states expand medicaid remains to be seen; clearly that was the intent of the law. Some states like Vermont and California are in the process of accepting the challenge put forth by President O'Bama to come up with a better, more inclusive and equitable publicly financed system such as single payer. Only about 20% of the population at any given time requires medically necessary care for an assortment of chronic, acute, or traumatic illnesses or injuries. If everyone who is able pays into the system, the benefits--whether they include screening and prevention, dental/vision, medications, homecare supplies, and if needed, acute care services, will be available, accessible and covered at the time of need.

Clearly, even tax-aphobics realize we can't cut our way out of the deficit, and no acceptable path away from the edge of that cliff can avoid the revenue side. According to a CNN poll last year "tax the rich" initiatives are supported by 55% of those voters who identify themselves as republicans. In considering this further, I'm wondering why is there just the one break point for the added tax? Why not escalating rates? The higher the bracket, the higher the percentage. For that matter, why not a return to such a setup for all income? That's what we used to have — it was known as a "progressive” tax for those who don't remember. It was part of a quaint concept called "fairness.” The idea was to better share the nation's wealth rather than let just a few hoard it. It could then be used for the greater good, like garbage collection, police and fire protection, and education. Shouldn't healthcare be one of those public "goods" as well? There are decent arguments about the so-called "Cadillac" plans: whether, like the luxury cars, they are wasteful and do more harm than good. For instance, I see weathier patients and/or those with "better" insurance get more testing--not because the tests are really necessary to confirm or exclude a diagnosis, but because of likelihood the bill will be paid. I see other patients with the same kinds of diagnoses who do just fine without all the sophisticated and expensive tests, because their doctors and nurses relie on critical thinking skills and the application of experience and good judgement in non-routine situations. But those who can pay for the "Cadillac" plans probably can also afford a little more to make sure nearly everyone else at least has the basics. It's essential for the overall health of a nation that provided them the opportunity to prosper. The hard fiscal realities are getting more difficult to ignore, prompting even republicans to say "yes" to new taxes. Poll after poll shows that the American people want higher taxes. That's not the same as liking higher taxes. The people have simply concluded that in order to have things like social security and access to medical care higher taxes are preferable to the alternative. Ultimately though, I think the argument can be made that if we expanded and improved Medicare to provide everyone with a comprehensive set of benefits and single excellent standard of care, we would realize a great savings by eliminating high overhead costs, administrative waste, and expenses for marketing and advertising.

I suppose that depends on your personal situation, in terms of how it's going to help and what it's going to cost. From all the studies I've seen, I believe costs over-all are going to continue to rise for all of us. We certainly spend much, much more, per capita, than other OECD nations, and our costs rise at a significantly faster rate. Economists and health policy experts assert that's because we don't have some form of a single payer system that covers everybody, assuring uniform and equitable benefits--like Medicare. http://www.oecd.org/dataoecd/46/2/38980580.pdf

I've been following the debate about the health care law and it seems like most commenters are totally for it or adamantly against it. I've been watching my family, friends, and patients face bad choices and rationed health care because of our current health insurance system. What I really want to know is if this law will fix it. First, let's look at some of the key parts of the Affordable Care Act (ACA), most of which are phased in by 2014: - The best parts of the law are the provisions that people cannot be denied health coverage because of pre-existing conditions, that insurers can not drop you when you get sick, and that eliminate annual and lifetime caps on coverage. What worries me are the loopholes that insurance company lawyers will use to continue to cherry-pick who they cover. For example, the law doesn't say how much they can charge to cover people with pre-existing conditions. - Almost everyone (even the insurance companies) agrees that it's good to let parents keep their children, up to the age of 26, on their health insurance (if they have it). - Large companies that don't give their workers health insurance will have to pay $2,000. - People who do not have health insurance where they work and choose not to buy it will have to pay a penalty. Is the individual mandate a fee, a tax, or a penalty? I don't really care what we call it. I understand why everyone should be part of the healthcare system. Medicare does this, covering everyone 65 and over. The individual mandate is a clumsier way of creating one risk pool, through private insurance companies. I've don't like it because it requires people to give money to profit-making insurance companies. - If you are very low income, you may qualify for a government-funded subsidy to buy insurance through a health exchange, or, for the most low income, become eligible for Medicaid which is set to expand. - It shrinks the Medicare donut hole in prescription drug coverage, where there's coverage to a certain point and then nothing until a higher spending cap is reached. Since 2010, 5.2 million seniors and people with disabilities have saved $3.7 billion on prescription drugs. I believe the donut hole should be entirely eliminated. - All insurance plans will be required to include preventative care (i.e. mammograms, vaccinations, colonoscopies, physicals) with no co-pay, by 2018. - Medicare coverage will now include an annual physical and no co-pays for preventative services. - Before, small businesses paid as much as 18% more than larger businesses for premiums. Now, they will get tax credits (up to 50% of the cost of premiums) for offering health insurance to their workers. In 2011, this affected 2 million employees. - Pharmaceutical, medical device manufacturers and health insurance companies will have their taxes increased. I agree with this. This law gives them millions of new customers. They can help pay. - The law increases funding for community health centers, one of the best provisions of all. - For the first time, the law taxes health benefits, and the main target is the comprehensive, best plans. In 2018, those plans (more than $10,200/single; $27,500/family) will be taxed. The insurance company has to pay, but they're going to pass the cost along to anyone lucky enough to have a good plan. I think this will push more people into plans that cover fewer health needs and have large out-of-pocket costs. - In 2013, if you make more than $200,00 (individual) or $250,000 (family), you will pay a Medicare tax on investment income (before Medicare tax was only on wages). - The Medicare tax rate goes up to 3.8%, from 2.9%. Although the advocates for the law say that it will bring down health care costs. I believe that some of these benefits are over-stated and ignore some remaining very large problems. What the law doesn't or maybe won't do: - Despite the all the claims about cost controls for individuals and families, most of them are weak. Insurance companies, drug companies, and hospitals will still largely be able to charge what they want. Although there are limitations on rate increases, this is not enough protection, 9% increases for several years is just as untenable (although it is better than the current, unfettered, increases). - I expect that people will continue going bankrupt because of high medical bills or choosing to skip or delay doctor visits or needed treatment. - Insurance companies will still be able to deny care recommended by a doctor using the same excuses ("experimental," "not medically justified," etc) as now. - I read that the non-partisan Congressional Budget Office said that up to 27 million people will still have no health coverage. Since the Supreme Court decision allows individual states to opt out of the Medicaid expansion for low income people without a federal penalty, that number will probably grow. - Some people are worried that employers will drop existing coverage because the exchanges will now be a more affordable option. I'm not too worried since before this law, employers could drop or reduce coverage any day they wanted (and many did). There's nothing in ACA which makes it more attractive to drop coverage, in fact they might have to pay a penalty for dropping coverage. - The law promotes IT systems in healthcare, many of which are wasteful and have been used by some employers to erode RN clinical judgment. - There are similar misguided incentives for "wellness" programs that penalize people who have diabetes, high blood pressure, or other medical conditions often beyond their control. - The windfall for insurance companies, big pharmaceutical firms (who were exempted from strong cost controls to win their support for the law), further strengthen a healthcare system already too focused on profits rather than patient need. For me, the bottom line is the ACA law didn't go far enough. Insurance companies are going to be a little more restricted more than they were in the past. It will help some people but doesn't cover all Americans. Polls show that a majority of Americans would rather that Medicare cover everyone. We would still have to work to improve it, but it would be easier and more cost-effective. It would eliminate the higher administrative costs (ACA limits insurance companies to 15%, even assuming they don't find ways around that, Medicare's is 3%) and the corporate profits - billions of dollars removed from the health care system and not spent on health care.

Disgusting! They're anticipating that a victim might need counseling for PTSD, perhaps, or surgery to repair scar tissue or medications? That kind of information should be exchanged only between a patient and her healthcare provider anyway. Having to list it on an insurance application is demeaning, not to mention unjustifiably intrusive. Another reason we need a universal, single payer healthcare system; so that insurers don't have the right to engage in practices that harm people. Insurers don't provide any actual care anyway, as you've noted. They're just expensive, wasteful, inhumane, self-interested middlemen!

Studies have shown that women are more likely to seek medical treatment; women have historically been the primary health care providers and health decision makers for their families. In addition women seek medical care more often than do men. I suppose it's no accident then, that insurers view the price gouging of women as a sure-fire way to maximize their profits! The World Health Organization (WHO) defines gender equity in health as: “the elimination of unnecessary, unjust, and avoidable differences between men and women and their potential for enjoying good health and in the likelihood of becoming ill, disabled or dying from preventable causes.” Charging women a higher rate for health care is a repulsively discriminatory and inhumane barrier to access! Again, insurers do nothing to provide actual care; they're in the business to make money and they often co-opt provider groups into delivering only "focused" assessments and limited treatment, knowing that women will return more often is a perverse way to maximize provider profitability as well. Ahhhh, speed up and through-put. Manufacturing and assembly line terms that are insulting and dehumanizing, but that's how the industry views us...like widgets! Historically, research has shown, compared with the treatment given to men, health providers may give women less thorough evaluations for similar complaints, minimize their symptoms, provide fewer interventions for the same diagnoses, prescribe some types of medications more often, or provide less explanation in response to questions! The current health industry has created and contributed to increased morbidity and gender inequalities in health and medicine. As a result more women are advocating for gender equity in healthcare. And, to that end, National Nurses' United, a union and professional association representing a predominantly female workforce, leads the movement for a single payer, universal health care system in this country that will eliminate the co-optation of sound health science policy by for-profit corporate insurance interests. We all deserve healthcare that meets our needs and providers who truly treat us as unique individual human beings and not as revenue generators.

Let's face it; there are distinguished professors and plenty of wealthy people who are overweight and who smoke. What you are calling a life-style "choice" may be influenced by bio-metabolic, psycho-social, and/or genetic factors and it's intellectually dishonest to ignore those facts and disparage individuals rather than blame the commodification of health care in this country. If you have money and employer subsidized health insurance, you can afford your co-pays and deductibles. You will have access to treatment, counseling, medications, decent housing, sick leave and, your health outcomes will be better than those who have limited or no access. In Canada, everyone has access. The OECD has an extensive peer review process and their data has been referenced and published in many well-respected and peer- reviewed journals, such as the American Public Health Association. Your hypothetical question and comment is intended to make what point exactly? I suppose if you have a concern about the reliability and validity of their data, you should take it up with them. There are no confounding variables that limit the generalizability of the findings as far as most reputable health policy analysts are concerned and it requires a huge leap of faith to buy into your accusation of academic dishonesty on the part of the OECD. Where's the evidence and what's your motive for making that assertion? If you look closely at the socio-economic demographics of the major studies on health outcomes, prematurity, low birth weight, and infant mortality statistics are higher in populations where maternal access to pre/perinatal health care services, pure water, wholesome food, decent shelter, and education is limited. Canada, for instance, made news by sending high risk infants to US hospitals for tertiary care when their own NICUs had to go on divert because they'd reached capacity. Unbelievable as it may seem to us here, the Canadian government's Medicare system paid for it. And, here's another commentary you might find interesting, regarding the costs of care put forward in a column by nobel prize winning economist Paul Krugman. He quotes a Commonwealth Fund study, so if you have any concrete references, rather than conjecture or speculation, to substantiate any flaws in their methodology, take it up with Krugman. As he puts it, "Canadian health care is roughly comparable in quality to US care, except that everyone is covered-and it does so at far lower cost." Be sure to read: Phantoms in the Snow: Canadians Use of Health Care Services in the United States. Among the references are several peer-reviewed journals. Enjoy! .

hi there mewilmot. i clicked on the link to the legislation and this is the description: "increases medicaid reimbursement payment aggregate for private duty nursing services and care by 15 million dollars for period 7/1/11 to 3/31/12, and by 20 million dollars annually thereafter for each period from april 1 to march 31; allocates $20 million for such reimbursement on an annual fiscal year basis thereafter." why is it that we can't afford this? it looks like important legislation that will help really vulnerable injured, disabled, and seniors get access to the professional nursing care services they need at home. isn't that a good thing? what's the alternative--warehousing and institutionalization in chronic "lack of staff" facilities? or having victims languish at home until becoming so sick from complications that a neighbor or family member has to call 911 for transport and delivery to an er as a critically ill patient? how cost-effective is that? it certainly isn't a humane or civilized solution. please, tell me what i'm missing here, if anything? what about if we tax wall street, instead of denying people access to vital services? and, why is there rarely, if ever, talk about the deficit and affordability with regards to war spending? must we keep cutting funding for our schools, eldercare, disability care, jobs and public works programs, health and safety inspectors/enforcement officers, and health care to pay for undeclared wars and occupation and rebuilding programs in the middle east? how can we not afford health care, jobs at living wages, adequate shelter, wholesome food and a quality education for each other? it's because the wealthy, many corporations and financial speculators aren't paying their fair share.

If you do a little research, you'll find that there are complaints about "wait times" in both Canada and the US. A Commonwealth Fund study found that 42% of Canadians waited 2 hours or more in the emergency room, vs. 29% in the U.S.; 57% waited 4 weeks or more to see a specialist, vs. 23% in the U.S., but Canadians had more chances of getting medical attention at nights, or on weekends and holidays than their American neighbors without the need to visit an ER. In the United States, access to health care is primarily determined by whether a person has access to the money to pay for treatment and whether or not services are available in the area and by willingness of the provider to deliver service at the price set by the insurer. In Canada the wait time is set according the availability of services in the area and by the relative need of the person needing treatment. However, Canadians aren't restricted to seeking treatment only at the hospital closest to them; they have implemented a system so patients and providers can self-refer for an appointment to be seen and treated at any available hospital. Canadians are, overall, statistically healthier than Americans and show lower rates of many diseases and enjoy a longer life expectancy. So, regardless of what anyone says about lines and wait times, the Canadian system is more just and the evidence shows a longer lifeline as the outcome.

FTTs can be designed so that they are very difficult to avoid. The best example of this is the UK, where they have a stamp duty of 0.5% on all share transactions. The UK's major competitors do not have this and yet it is a successful FTT that raises around £5 billion pounds each year. It is designed so it can't be avoided and London remains one of the biggest stock markets in the world. Financial transaction taxes are targeted at casino banking operations and experience in other countries demonstrates they can be designed in a way that protects the investments of ordinary people and businesses. Just like other taxes, specific exemptions and regulatory measures can be written in. Evading FTTs can be made more difficult, more costly, and in some cases actually impossible, by developing incentives to comply or disincentives to evade (including, for example, making non-taxed trades legally unenforceable), according to Owen Tudor, Trades Union Congress (TUC). The International Monetary Fund has studied who will end up paying transaction taxes, and has concluded that they would in all likelihood be 'highly progressive'. This means they would fall on the richest institutions and individuals in society, in a similar way to capital gains tax. This is in complete contrast to the Value Added Tax, which falls disproportionately on the poorest people. The financial sector is highly competitive, which also makes it less likely that institutions will pass on the costs to customers because they will lose business to others who don't.

I don't understand why you ruined a great post by denigrating labor leaders. Many of us who are direct care RNs and officers in our professional union consider ourselves to be labor leaders. We weren't necessarily "natural born leaders", but as nurses, we have an obligation and a duty to take the lead as advocates. If the Democrats are not standing up, and Republicans believe they got to where they are as "mavericks" in an "on your own" society, who else is going to speak up for our patients and our communities, but the nurses on Main Street? Labor leaders, nurses, firefighters, teachers, and public sector workers did not cause the financial crisis. Yet, I find it strange that only working people are being asked to sacrifice. Why are we expected to stand idly by, in silence, while Social Security, Medicare, and Medicaid are being gutted and other socially responsible programs like child care programs, senior day centers, and higher education programs are being axed? Where's our bailout? When you and I buy something, we pay a tax on it. Why isn't there a financial transaction tax on currency trading? Those speculators are the guys who wrecked the economy. Shouldn't they have to pay to restore and sustain the social programs that are on the chopping block? An FTT isn't a new or radical idea. The US had one from 1914 to 1966, but now all we have is a .004% tax that is used just to fund the Securities Exchange Commission budget. The Revenue Act of 1914 imposed a .2% tax on all sales or transfers of stock. In 1932, Congress more than doubled the FTT but then phased it out in 1966. In April of 2000, DeFazio and Paul Wellstone proposed Taxing Cross-Border Currency Transactions To Deter Excessive Speculation. (H.Con.Res. 301) From 1986 to 1998, DAILY trading in currency markets went from $0.2 trillion to about $2 trillion, when the trade of goods and services for all countries was only $4.3 trillion. During this time period more than 85% of currency trade transactions were speculative “bets” on whether minute changes in currency or interest values will move up or down. In 1970, about 95% of all currency trades were to build the real economy [goods and services] in some way. Today, because of financial speculation, it is about 2%. Currency trading deals are 50 times more than the trade in goods and services [the real economy] In the Foreign Exchange Market, often designated as forex or FX – the official and worldwide – and decentralized market for trading currencies over the counter, and for placing speculative bets on the change in currency interest rates, the daily volume as of April 2010 averaged about $4 trillion each day, or about $1.5 quadrillion per year [that’s $1,500 trillion] The U.S. financial firms of Citi, JP Morgan, Goldman Sachs and Morgan Stanley alone accounted for almost 25% [23.08%] of the total overall global market share volume of currency trades in May 2011. The US could raise between $175 to $350 billion per annum with a Financial Transaction tax. If it is invested in our infrastructure needs, a simple econometric analysis tells us that it could easily ripple out into between $875 billion to more than $2 trillion being injected into the real economy. {jobs, direct spending, indirect and induced economic effects} In the UK, they're calling the FTT a "Robin Hood Tax." So, I'm not an economist; just a nurse who happens to be a working class labor leader. You admitted that you don't understand or weren't sure about what taxing Wall Street was all about. There's a really good website that might help answer some questions that many of us had when we first heard about this. Try this link. The Center for Economic Policy and Research is also a great source of information. I think this Main Street Campaign an idea whose time has come. This is where politics gets personal. If we truly believe in a participatory democracy, then we must take action. As nurses we see the impact of failed policy on the lives of our patients, in our communities, and within our own circle of family and friends. I think the Main Street Campaign and the FTT deserves special examination for its simplicity and naturalness, because it's a great care plan that's evolving from identifying the immediate needs of the vulnerable and otherwise obscure individuals. As nurses we say, "Tell us where it hurts."

So, did the contract between the union's management and the staff workers' union expire, perhaps? As far as collective bargaining, I'm wondering whether or not negotiations had proceeded in good faith and they were at a point of impasse. Upon expiration of a collective bargaining agreement, an employer is required by the National Labor Relations Act ("NLRA") to "meet at reasonable times and to confer in good faith" with the bargaining representative for its employees "with respect to wages, hours, and other terms and conditions of employment." This is known as an employer's duty to bargain. A violation of an employer's duty to bargain may result in an unfair labor practice charge being filed at the NLRB. Before an employer actually implements its pre-impasse proposals, it must be sure that an impasse does indeed exist. An impasse is defined in the law as the point at which further discussions would be futile. Once a genuine impasse has been reached, the duty to bargain becomes dormant, but is not terminated. The employer need not meet with the union after impasse is reached if the union continues to offer the same proposals which led to the impasse. While negotiations are deadlocked at impasse, unilateral changes are lawful provided the collective bargaining agreement at issue has expired and the unilateral changes are reasonably encompassed by the employer's pre-impasse proposals. Impasse, however, is only a temporary deadlock, and exists until a change in circumstances indicates that an agreement may be possible. Impasse may be broken through either a change in mind or the application of economic force (i.e., a strike). Implementation after impasse is viewed by the NLRB as a method of breaking impasse, and the parties remain obligated to attempt to negotiate an agreement in good faith. The implementation after impasse strategy is not intended to be used to act unilaterally and destroy the collective bargaining process. Therefore, what you've described in your original post may be part of the lawful process; it doesn't necessarily mean there is anything wrong that warrants disparagement of the union's management. I agree that may be a matter of opinion, and in the interests of full disclosure, I'm not a NYSNA member.