So what's going to happen to health care now?

WoundcarePhilRN · Dec 7, 2016

The ACA has caused my families insurance to go way up. Next year our vision plan is being kicked off, more for less. They should have simply helped people that needed it without dragging everyone in the country into their *********. I work in a LTACH, and our admissions have dropped. We can no longer do direct admits for people that need it. It's a mess.

Skippingtowork · Jan 1, 2017

My point Elkpark was that healthcare is not free. Furthermore, I've lived in Canada all my life, and I'm now working in the system. It's been deteriorating significantly over the last 10 years, and many Provinces have quietly moved to a two-tiered system.

you've lived in Canada all your life and call the system universal health care? Check what it's really called.

WoundcarePhilRN · Jan 1, 2017

I hope this mess gets straightened out soon. Many American's want the best health care they can get and for someone else to pay for it. The ACA has failed miserably, like many of as anticipated. So many will soon be fined by the IRS because they cannot afford a $1300 a month premium with a $7,500 deductible, it's pure madness. Hopefully we will see some real change in the nation.

MunoRN, RN · Jan 1, 2017

I hope this mess gets straightened out soon. Many American's want the best health care they can get and for someone else to pay for it. The ACA has failed miserably, like many of as anticipated. So many will soon be fined by the IRS because they cannot afford a $1300 a month premium with a $7,500 deductible, it's pure madness. Hopefully we will see some real change in the nation.

The median 2017 cost for a $5k deductible plan for a family is $1k per month, and I would agree that a family making say $50k a year would find that prohibitively unaffordable which is why it's doesn't actually cost them that much under the ACA. A family making $50k would only pay $225 per month after subsidies. We could instead take the higher cost patients in ACA plans and move them to their own plans, but all that does is change the route by which we're covering those folks, usually adding cost in the process.

Basically, there's not getting around paying our overall healthcare costs, which are quite high and only getting higher as more aggressive/advanced (expensive) therapies become more and more common. Changing the route by which we pay for them doesn't reduce how much it costs us as a whole.

nursej22, MSN, RN · Jan 1, 2017

The ACA will be repealed, insurance companies will resume selling inexpensive policies that don't cover anything, preventative care will decrease, late diagnosis of serious conditions will increase, and people will continue to use the ED for primary care.

Medicare will change to a voucher system that will result in health care that is too expensive for seniors, block grants will replace Medicaid so more people will lose what little coverage they have, and people will continue to use the ED for primary care.

Life expectancy will decrease, infant mortality will increase, bankruptcy related to medical bills will increase.

Republicans will have their ideal healthcare plan: don't get sick, and if you do, die quickly.

WoundcarePhilRN · Jan 2, 2017

I know people who are in the 50k or less boat and their premiums are much more than 225. Many also don't get anything from the Gov. but lip. Now those that could not afford the high premiums will be fined. Only in America. The cost of healthcare is pathetic and overly expensive for everyone. The inflated cost is crushing the people. Those with no knowledge of how things work in the hospital really get gouged. I had to go to the ER with ABD pain, turned out to be gallstones. Had my gallbladder out

in an out-patient center. The bills were ridiculous. The ER was the worst. 450 for an EKG, 350 for EKG read fee. 25 puncture fee for the lab draws. 160 for 2mg IV Dilaudid. I could go on, then the bills for the surgery started rolling in. It was profoundly inflated. I have no problem for services I received. I can only imagine the bills the guy is getting that had CP, cath lab, CABG, 3 days in CVICU, then 4-7 days on the step-down. If their insurance is lousy they are in deep trouble. I hope Trump pulls the ACA out by it's roots.

Palliative Care, DNP · Jan 2, 2017

We will return to the Haves & the Have Nots. A lot of people that voted for Trump especially coal miners will be screwed. Black lung was covered by ACA and now they will no longer have that nor will their jobs return. Double whammy! That is only one example. ERs will see an influx of uninsured using them for everything again. It's going to a very sad state of affairs.

WoundcarePhilRN · Jan 2, 2017

When did we ever depart from the Haves & have nots?

Palliative Care, DNP · Jan 2, 2017

When did we ever depart from the Haves & have nots?

That is true but in my experience it was less pronounced under ACA. In my clinical rotations through primary care the last few years we definitely had many more patients that had not been seen in years. They were able to be seen directly as a result of the ACA. As difficult as it is to imagine there were many grateful patients. Enrollment was up when mentioned on the news recently. Yes, the ACA does need work but there are people that were genuinely assisted. Two of the offices I was at had a dedicated ACA representative onsite to assist people.

Not_A_Hat_Person, RN · Jan 2, 2017

The end of the ACA could mean the return of lifetime coverage limits. We would be back to the days of chronic illness, cancer or an organ transplant leading to bankruptcy.

nutella, MSN, RN · Jan 2, 2017

I think it is also important to look a little bit closer about what is going on with our healthcare system and the care that is "available" in the US.

Somebody mentioned that instead of offering "something" or "basic coverage" to everybody - wouldn't you want the best and most comprehensive care and treatment options?

It is worth looking more at it - I have heard this a lot during the last years. I grew up in a country that has a very comprehensive social system including healthcare - which is mandatory and "expensive" compared to what a person pays in the US.

From working many years in hospitals and also in the community, I can say that the way people approach healthcare or the way money is spend does not automatically result in something "meaningful" or a high quality of care. Obviously, there is a difference between spending money on healthcare that is preventative or for illness that can and should be treated and spending money on trying to "fix" something that is not fixable with a questionable quality of life.

And I also question the admission of the 90+ person with dementia and several other comorbs who now has another pneumonia to an ICU to receive very expensive treatment for something that cannot be fixed.

When people ask for "more and better" options and healthcare - what do they actually mean?

The US is doing good with cancer care and treatments in terms of survival - this is all very expensive care.

There is an underlying false belief that medical science can "fix anything and everything", that "miracles happen when you fight hard enough" and "do not give up" and that we "can cure everything nowadays". I am not sure when that idea started but it is very prevalent now and not rooted in any reality. That goes hand in hand with putting more value on the "time to live" as opposed to "quality of time" especially when we get to the higher age and multiple illnesses.

People are not that willing to accept a physician's recommendation or accept their level of expertise anymore. Not that long ago I was a witness of a conversation between a surgeon and a family in which the surgeon told the family that based on high age, severe illness with multiple comorbidities and low functional status he recommended to proceed with comfort measures and not to do surgery for another new issue as this surgery would be very high risk. He was clear in saying that there is no way the patient will survive one way or another and even if surviving surgery would be depending on a ventilator and most likely die of other problems related to the post operative stay.

He was very clear and talked with great empathy. Guess what - the family insists on the patient being a fighter and wants to give the patient a chance. When I asked if they understood the implications and tried to explore further what "a chance" means there was no answer to it.

So why are people not ready to let go and even consider treatment that boarders on futility?

US Spends More on Health Care Than Other High-Income Nations But Has Lower Life Expectancy, Worse Health - The Commonwealth Fund

U.S. Health Care from a Global Perspective - The Commonwealth Fund

I am a strong advocate of providing a basic healthcare to everybody and I am also a strong advocate for not throwing money out of the window so to speak. Avoidable re-admissions, "last ditch efforts" to "fix" something that can't be fixed, and admissions to the hospital because people do not want to pay for custodial care (nursing home longterm care) and come up with all kind of medical complains to get their loved one admitted is not on my list of things I support.

For sure we need some discussions in our country about healthcare and why we spend all this money with a comparable worse health looking at other developed countries. One rising problem is that Medicare skilled nursing in nursing homes (short term "rehab") is used in excess for people who actually need longterm care. Those folks want to be at home, typically have not much or no family support ("they all work", or "nobody lives close and they have their own life") and their families or spouses try to keep them at home but are unable to provide the care. My favorite is the "altered mental status" complaint of the person with dementia who is in an advanced stage and needs 24/7 attendance and care - who is not able to swallow much anymore and continues to aspirate. They get admitted for "something" because there is always something not ok for sure - including acute renal failure due to dehydration, which is often a natural consequence of the illness. Now we hydrate the heck out of those folks who also have a weak heart and push them into CHF. While the family marvels over "I knew something is wrong and hydration always makes him better" instead of " I get it - the dementia is endstage and a terminal illness - this is not really fixable." Ok - that person eventually will leave to "rehab" but of course only for very short time - they are unable to really rehab. They get discharged back home, where after days or weeks the caregiver calls 911 again with complains of "confusion" and the circle continues.

Our country is set up in a very strange way - people who have nothing not much qualify for Medicaid, which will pay for longterm care when they need it due to illness - but Medicare will not. Some people have longterm care insurance but most people do not have that kind of insurance. When Medicaid pays for family to be a "paid caregiver" that can result in other problems including "keeping somebody alive" and pushing for treatments that are close to futility as this is the main income.

Our society that also lives on litigation also drives all kind of costs as physicians will order all kind of tests and images to make "double sure" and will offer treatments or options that make no sense to a person with common sense. Of course patients and families will grab the straw...

Physicians who should have discussions in the community about what happens when you have dementia, end-stage CHF, end-stage liver disease, endstage metastatic disease and so on and who do not talk to their patients or families are also at fault. I have been talking to a lot of families who are really surprised to learn that dementia is still terminal and progresses with problems swallowing that leads to other problems like pneumonia and dehydration. Of course why would they believe the hospital staff after the PCP has not mentioned it for the last 10 years???

Or the oncologist who really cannot face another discussion in which he has to say that there are no options left that would result in something meaningful and who instead gives this vague message of "you do not need to come back to my office but there might be a new treatment right around the corner" indicating the chance of the miracle cure that might happen tomorrow - of course people want to hear that. They do not want to hear that medicine cannot cure everything ad the medicine / technology as limitations.

It literally makes more sense to me to provide universal coverage to everybody including younger people who benefit in a very different way from prevention and treatments - but it needs to be financed. Nothing is ever for free. Where I grew up and worked as a nurse, I paid several hundred euros per month for health insurance. And that covered my children as well but not my spouse who also worked - he had to have his own insurance also paying - you share the costs with your employer and you can not opt out. And you have to have longterm care insurance - the government saw the trend that we see very clearly here in the US as well - more people need custodial care - we live longer with worse health and family is not that available anymore to care for their elders.

Health should be a basic human right in a developed country as outlined by the WHO

WHO | Health and human rights

it does not talk about the right to "crazy futile and expensive last ditch efforts" but it talks about "The right to health includes access to timely, acceptable, and affordable health care of appropriate quality." When some people say they just want to get rid of the affordable care act - what do they actually propose??? Freedom for the ones who have enough money and who do want to accept that as a society we also have some kind of responsibility towards basic human rights?

Mijourney · Feb 28, 2017

OK, I have been on my computer for several hours now, sitting. That is a health risk in and of itself. Should I be punished by paying to be in a high risk insurance pool because my chronic disease(s) and risk factors are exacerbated from long sit times at work and at home? At work, I am expected to be efficient and productive (I work in a non-traditional health setting). I only get short periods of time for breaks and lunch. I also have genes that add insult to my injury. When there are only so many hours in the day to get tasks (such as reading) done along with the risk factors and chronic diseases, what is a person supposed to do? I do not consider myself as liberal in certain aspects of life, but I do believe that a person needs ready access to quality health services and meaningful education. For those of us who are gifted with the responsibility to serve as proficient health care providers for example, how do we to successfully carry out our purpose in life if we don't have the access to health care and education? I've been witnessing healthcare coming apart at the seams. It's not clear to me that any political party can save it.