We may need fewer nurses in the hospital...

WIN007 · Apr 21, 2011

i agree health care is unsustainable as we know it. when you figure an individual may pay into their health insurance plan (if they have insurance) for years, what they actually pay won't cover the cost of their care if they become chronically ill. chronic illnesses are costly. a contributing factor to the increase in health care costs is that we live longer, usually longer than the amount of time we paid into medicare and social security. the longer we live, the higher the chances of chronic illnesses.
prevention is key with education starting in elementary school and continuing. this is where nurses can make an impact. those who work in the hospitals are limited in the amount of time they have to educate their patients. nurses in other settings like home care, outpatient, doctor offices, schools, employee health can provide education.
we pay doctors based on a fee for service which means the more they do, the more money they get paid-another driver of health care costs. some states and insurance companies are struggling to build patient centered homes where pcps provide the needed care and focus on prevention. but pcps don't want extra work that they have to pay for-like staff, equipment, electronic medical records systems. individuals need to take control of their own health, but it seems people are not motivated. within my own family, a large number are obese. they will say "i need to lose some weight and exercise, but this hurts, that hurts, i can't live without my pasta and bread". we can not motivate people to care about themselves, that has to come from within themselves. all we can do is provide the information and resources and offer support and encouragement.
check this article out on how people hide assets, so they can collect medicaid in their declining years: [color=#606420]https://www.cms.gov/medicaideligibility/downloads/annuities.pdf
"individuals who might have paid for long-term care costs themselves or would have purchased private long-term care insurance have turned to various methods of estate planning and asset sheltering activities as a means of qualifying for medicaid coverage of their long-term care expenses."
some of those on medicaid are senior citizens. some are legitimately poor and can not pay for their health care/medications and still eat. (the largest portion are disabled children). but there is a large portion of seniors who give their assets to their children, so it is not used for their care. my feeling is if you want mom's money and home, then you should take care of her, not expect the taxpayers to do so. medicaid's look back period is 3-5 years..it should be 20.
this article written in april 2010 by the kaiser family foundation shows how stressed medicaid will be going forward: [color=#606420]http://www.doh.state.fl.us/alternatesites/kidcare/council/8-3-10/27_medicaidbeneficiaries.pdf
here are some articles on who comprise the medicaid population:
"the medicaid program is in effect three distinct health care
programs, each with a different beneficiary group and different proportional
uses of funds. the percentage of total spending devoted to each of these
efforts varies greatly from state to state, because state officials may exercise
considerable discretion about which of these three programs to encourage.
the three groups are as follows. (1) low-income elderly people represent
13 percent of medicaid beneficiaries, but their use of services accounts for
32 percent of all medicaid expenditures. this aspect of the program provides
primarily long-term care. most of these senior citizens were not poor
when they retired, but their incomes have been eroded by inflation, loss of
spousal income, or other factors. as they age, one-fifth of the elderly find
themselves alone in nursing homes, forced to look to medicaid for support
that is not provided by medicare.5 (2) the severely mentally retarded, the
blind, and the physically disabled represent 15 percent of medicaid beneficiaries
and generate 36 percent of all medicaid expenditures. medicaid provides medical care and nursing home services for persons with severe, permanent disabilities and higher-than-average needs for medical care. this group includes an increasing number of people with acquired immunodeficiency syndrome (aids). (3) low-income children from single-parent families and their parents comprise 72 percent of beneficiaries; their care represents only 32 percent of all medicaid expenditures (based on 1993 stats)"
[color=#606420]http://content.healthaffairs.org/content/12/1/132.full.pdf
"jointly financed by the states and the federal government, in 2010, medicaid covered nearly 53 million people and accounted for about 16 percent of all health care spending.[color=#606420]1 it accounts for 17 percent of all hospital spending and is the single largest source of coverage for nursing home care, for childbirth, and for people with hiv/aids.[color=#606420]2 it covers one out of four children in the nation as well as some people with the most significant medical needs.[color=#606420]3 while children account for most of the beneficiaries, they comprise only 20 percent of the spending. by contrast, the elderly and people with disabilities account for 18 percent of enrollees but 66 percent of the costs.[color=#606420]4"
"over the past three years, despite rising enrollment due to the economic recession, nationwide state spending on the medicaid program dropped by 13.2 percent (equivalent to a 10.3 percentage point decline in the state share of the total costs of the program) as a result of the added federal support provided to state medicaid programs through the american recovery and reinvestment act of 2009 (the recovery act).[color=#606420]5 in 2009 alone, due to this action, state medicaid spending fell by 10 percent even though enrollment in medicaid climbed by 7 percent due to the recession.[color=#606420]6 however, this enhanced federal medical assistance percentage (fmap) support is set to expire on june 30, 2011. "
[color=#606420]http://www.hhs.gov/news/press/2011pres/02/20110203tech.html
this is a difficult time for everyone, but maybe we can achieve some of the goals of health care reform, before we are broke.

thank you for including citations in your message. i agree with a lot of what you say. it is an issue that people are living longer when considering healthcare costs as 80% of our costs outlays are spent on the elderly. however preventative care only goes so far; as people age parts wear out. also, as others have explained well prevenative care is more than losing weight; it's mammograms, ct scans, dental work, scopes, et al. insurance companies don't like to pay for these things even though the savings are proven to be well worth it.

the other thougt to consider is although people in elder years are using expensive healthcare services, perhaps more than they paid into, not necessarily in real dollars. the present value of their payments must be considered.

healthcare inflation can be helped by (dare i say it) a certain amount of community planning - having 5 luxury hospitals in a small city is in itself inflationary. likely they aren't needed, but the resident providers are competing with each other. we need to get sensible about what's needed. medical malpractice is actually not a big component of health care costs. it can easily be addressed with simple tort reform; i prefer that to putting limites on caps so that a person who has a legitimate malpractice case (say the daughter died of gross negligence) is not only able to get 45,000 dollars for their loss versus say some patients family wants to sue the rn because they had to wait 45 minutes for pain medicine while she was attending to a code.

i like canada's legal system with respect to frivelous lawsuits so much better. you can file a frivilous lawsuit, but people rarely do it. why? becuase if the court decides it is friviously the palintiff will be charged for the costs of the court and the defendants legal costs. pretty big incentive to stay out of the courts if you don't have a good case. plus those who do can actually get a court date.

metal_m0nk, BSN, RN · Apr 21, 2011

Put simply...

Someone who makes over $380,000 is taxed at the same 35% rate whether he makes $500,000 or 2.5 million dollars - while someone who sees an annual income increase from $32,000 to $80,000 pays 10% more.

You do the math and tell me how "unfair" it is to tax the wealthy.

WIN007 · Apr 21, 2011

The problem with Mass system is insufficient federal repayment, capitation, and trying to coordinate the 3rd party payers. We need a single FEDERAL payer system, ala France, i.e. REAL socialized medicine. I think fewer nurses are inevitable either way. The money simply isn't there.

Not to quibble but I don't think France is socialized medicine. Socialized medicine is not federal payer. Single payer by state or federal is just adding efficiency and reducing beuracracy. Socialism is when the government actually owns the healthcare institutions and the clinicians are employees of the state. The only western country that I THINK has that is the British primary system.

Sorry if I'm being nitpicky in advance; there's just so much deliberate rhetoric put forth by entities with an agenda and their radio/television demagogues that I felt I needed to say it.

WIN007 · Apr 21, 2011

Put simply...
Someone who makes over $380,000 is taxed at the same 35% rate whether he makes $500,000 or 2.5 million dollars - while someone who sees an annual income increase from $32,000 to $80,000 pays 10% more.
You do the math and tell me how "unfair" it is to tax the wealthy.

If someone pulling in half a million dollars is paying 35% in the USA then they need a better accountant. The federal tax code is not five miles long for the loopholes for people making a nurses wages I can tell you.

By accounts I have read the truly wealth (and I'm talking about the top 1/10th of 1%) pay roughly 5% or less in federal taxes as a percentage of their income. Or, as Warren Buffet aptly noted, his secretary was paying a much higher percentage of her income in taxes than he was.

Meanwhile when I add up all the taxes I pay between state, federal, sales, consumption, FICA, local and everywhere else I'm nickel and dimed I bet it's at least 50%. Socialism my orifice. The USA is far more resemblant of a plutocracy and growing more so all the time.

WIN007 · Apr 21, 2011

Huh? Why do you think the elderly will be limited in how often they can go to the doctor?

Medicare and supplementary procedures have been putting restrictions on services for some time. Healthcare costs in the USA have been spiraling for 30 years and the population has been growing. Some of their restrictiosn make sense (why SHOULD the payor have to pay for a nosocomial acquired infection the pt. gets because somebody didn't use sterile technique inserting a cath, or the attending physician didn't order taken out by guidelines) and some don't IMO -like mandating care in expensive (and usually understaffed) SNF's instead of home health which would be often cheaper AND better for the pt. I think that's changed now under the current medicare law recently thank Goodness.

I don't worry so much for the current crop of recipients. It's the generation directly behind them I worry for. For example Paul Ryan's budget proposal to replace medicare with (worthless) 8k a year vouchers (conveniently paid right to private insurers speaking of socialism)) has proposed a cutoff age of it only being effective for those under 55. He's smart enough to know the elderly vote religiously no doubt. But that doesn't leave those behind them in a good place as no insurer is going to cover a person much past 55 for anythign resembling affordable rates while offering the coverage that medicare offered. Oh, and by the way the people who are to be cut off get to continue to pay into taxes for the current crop of recipients. Lovely eh.

RNCCMMS, RN · Apr 21, 2011

Thank you for including citations in your message. I agree with a lot of what you say. It IS an issue that people are living longer when considering healthcare costs as 80% of our costs outlays are spent on the elderly. However preventative care only goes so far; as people age parts wear out. Also, as others have explained well prevenative care is more than losing weight; it's mammograms, ct scans, dental work, scopes, et al. Insurance companies don't like to pay for these things even though the savings are proven to be well worth it.
The other thougt to consider is although people in elder years ARE using expensive healthcare services, perhaps more than they paid into, not necessarily in real dollars. The present value of their payments must be considered.
healthcare inflation can be helped by (dare I say it) a certain amount of community planning - having 5 luxury hospitals in a small city is in itself inflationary. Likely they aren't needed, but the resident providers are competing with each other. We need to get sensible about what's needed. Medical malpractice is actually NOT a big component of health care costs. It can easily be addressed with simple tort reform; I prefer that to putting limites on caps so that a person who has a legitimate malpractice case (say the daughter died of gross negligence) is not only able to get 45,000 dollars for their loss versus say some patients family wants to sue the RN because they had to wait 45 minutes for pain medicine while she was attending to a code.
I like Canada's legal system with respect to frivelous lawsuits so much better. You CAN file a frivilous lawsuit, but people rarely do it. Why? Becuase if the court decides it is friviously the palintiff will be charged for the costs of the court AND the defendants legal costs. Pretty big incentive to stay out of the courts if you don't have a good case. Plus those who do can actually GET a court date.

I include mammograms, scopes, etc in my definition of preventative care. Regular physicals are necessary..but how many people have you heard say "I only go to the doctor when I am sick"..by that time, it could be too late. In NJ most of these preventative services are mandated by law, (there are currently 50 of them)so if you do business in NJ as a health insurer you must cover them. I understand that many other states do not have such stringent laws..shame on their legislators.

Another area I did not touch on is the fraud in Medicare and Medicaid, and in private insurances-that also drive health care costs. There are so many aspects that contribute, that it can be mind boggling-where to start. I guess if each of us does our part, eventually others will follow suit.....:)one can hope

WIN007 · Apr 21, 2011

I also feel that if you work in the healthcare industry-it should assist in your healthcare coverage so that we might be cared for by serving our lives in the care of others. I'm just hoping that doctors will continue with the professional courtesy discount.

I agree but I don't think nurses and healthcare workers should have to rely on professional courtesy discounts. As with police there's a certain amount of hazard inherently in the jobs. Most nurses have a hard backbreaking job and are exposed to a host of things from chemicals to viruses and nosocomial microbes ALL the time. heck, it's even been proven that working night shift can cause someone to more likely get cancer. Then there's violence against nurses, crazy families that want to sue you because their father who smoked for 60 years and lived on red meat and has a hx of COPD, MI, CAD, etc finally dies on your shift.

That's leaving aside the fact that nurses have been taxed and paid into medicare and ss like everyone else. Any politician that wants to end it should be prepared to at minimum reimburse every one of us for the present value dollars (accounted for inflation) for every nickel we paid into it.

metal_m0nk, BSN, RN · Apr 21, 2011

If someone pulling in half a million dollars is paying 35% in the USA then they need a better accountant. The federal tax code is not five miles long for the loopholes for people making a nurses wages I can tell you.
By accounts I have read the truly wealth (and I'm talking about the top 1/10th of 1%) pay roughly 5% or less in federal taxes as a percentage of their income. Or, as Warren Buffet aptly noted, his secretary was paying a much higher percentage of her income in taxes than he was.
Meanwhile when I add up all the taxes I pay between state, federal, sales, consumption, FICA, local and everywhere else I'm nickel and dimed I bet it's at least 50%. Socialism my orifice. The USA is far more resemblant of a plutocracy and growing more so all the time.

Indeed.

What amazes me is that even the published numbers show a glaring disparity - and yet, no one actually reads them. Instead, they turn on the boob-tube and gather talking points from some hot-headed egomaniac masquerading as an investigative journalist...Why??

WIN007 · Apr 21, 2011

I include mammograms, scopes, etc in my definition of preventative care. Regular physicals are necessary..but how many people have you heard say "I only go to the doctor when I am sick"..by that time, it could be too late. In NJ most of these preventative services are mandated by law, (there are currently 50 of them)so if you do business in NJ as a health insurer you must cover them. I understand that many other states do not have such stringent laws..shame on their legislators.
Another area I did not touch on is the fraud in Medicare and Medicaid, and in private insurances-that also drive health care costs. There are so many aspects that contribute, that it can be mind boggling-where to start. I guess if each of us does our part, eventually others will follow suit.....:)one can hope

Great points. How many times have we all heard the machoism (men and women), "I haven't been to a Dr. in 5 years). My ex refused to get scoped even though he was 1) over 50 2) had a family hx 3) a host of co-factor risks like a sedentary job and htn. I explained to him finding early cancer ca was easy and routine but if he waited till it was a later stage then second deadliest cancer. No avail. Well, there's a reason he's my ex.

I do think people have a responsibility to use best practice for their health.

My state and others I can think of have very little on the books in the way of healthcare legislation (and many other items). It's like they're proud of not having definitive statutes. Weird.

WIN007 · Apr 21, 2011

Indeed.
What amazes me is that even the published numbers show a glaring disparity - and yet, no one actually reads them. Instead, they turn on the boob-tube and gather talking points from some hot-headed egomaniac masquerading as an investigative journalist...Why??

I wish I could tell you. I have a hunches and that's it. Americans are famous for their short-term memory. Perhaps it coincides with the defunding of higher education. A full 75% of Americans have only a high school education. Then there's the predominance of cable television where people can selectively see what they want and tune out the rest. The internet age where quality checks on what's printed get lost. The concentation of wealth which creates monopolies in the press, and entire mills of propoganda machines. The emotional investment people have put into believing rhetoric may make it difficult for them to accept the truth even when inside they have plenty of doubts as things get worse and worse. Lack of historical understanding and information of what things were like for most people in the Gilded Age or before unions and the New Deal. Maybe it's a combination of all of those things and more. The fact that reality and truth are always far more complicated by rhetoric - and therefore truth is much harder to get across in a 30 second commerical. Only pondering.

Still when you have tried something for 30 years and it doesn't produce intended results (giving a free ride to the wealthy will create jobs and prosperity) you'd THINK people would catch on. After all, the definition of insanity is repeating the same thing over and over and expecting a different result.

metal_m0nk, BSN, RN · Apr 21, 2011

I wish I could tell you. I have a hunches and that's it. Americans are famous for their short-term memory. Perhaps it coincides with the defunding of higher education. A full 75% of Americans have only a high school education. Then there's the predominance of cable television where people can selectively see what they want and tune out the rest. The internet age where quality checks on what's printed get lost. The concentation of wealth which creates monopolies in the press, and entire mills of propoganda machines. The emotional investment people have put into believing rhetoric may make it difficult for them to accept the truth even when inside they have plenty of doubts as things get worse and worse. Lack of historical understanding and information of what things were like for most people in the Gilded Age or before unions and the New Deal. Maybe it's a combination of all of those things and more. The fact that reality and truth are always far more complicated by rhetoric - and therefore truth is much harder to get across in a 30 second commerical. Only pondering.
Still when you have tried something for 30 years and it doesn't produce intended results (giving a free ride to the wealthy will create jobs and prosperity) you'd THINK people would catch on. After all, the definition of insanity is repeating the same thing over and over and expecting a different result.

Ever insightful. Love it.

WIN007 · Apr 21, 2011

"Furthermore isn't it logical for someone who makes 1.2 million dollars a year to pay just a little bit more in taxes than someone who makes 28 thousand a year?"
No. it is NOT logical. The beauty of where we live and way our county is structured has allowed people to progress and better themselves through hard work. We should not punish people for their accomplishments. We should all pay the SAME percentage of tax no matter our current income. Get less of the takers off the grid and make them work for their living too instead of riding on the heals of others.
But ... that is totally a different topic and really has nothing to do with nursing.
rags

Well, it DOEs actually as 1) as RN's we're advocates for our patients and the community and 2) a current proposal to end Medicare is on the table. We are impacted by that personally as well as professionally.

PS - the origin of progressive taxation is not from Marx or similar, but rather from the founding fathers for instance Alexander Hamilton , you know, the First Secretary of Treasury. ;-)