We may need fewer nurses in the hospital...

[Chin up]

WCVB channel five Boston, is now airing, Healthcare Uncovered. A live panel show discussing healthcare and it's cost in Boston. The moderator, Timothy Johnson, MD. One of the panelist, Zane, the CEO of Tufts Medical Center whose 1100 RN's just voted 70%, to authorize a one day strike. This is what I just heard and this is verbatim.

"We may need fewer nurses in the hospital, but we will need more in the community, helping patients to stay healthy. so there maybe some modest job losses, I think there is a great opportunity to retrain caregivers in new professions."

"Doesn't the rank and file worry though, if I am dislocated as a healthcare worker. The job that may be available for me on the other end is nothing of the caliber of the job I trained for and gone to school for as a RN or whatever."

They avoid that question and go on about being unable to sustain the hospital budgets. Over half of budgets are employee salaries(nurses). We must address these salaries and benefits and look into job revocation. They go on to justify this thinking, due to small business unable to afford healthcare here in Mass and therefore leaving the state. There are great opportunities to shift our thinking from acute care to physician and patient remaining well. (paraphrase).

Helen Zane: what the trajectory we are on, the public will not tolerate. Better we get ahead of it. ( she is addressing nurses who want better nurse/ patient ratios). Fueling her position, against the nurses.

They go on and defend physicians who do needless test...talk about salaries and fraud in the same sentence. Implying, nurses must make sacrifices...my reading between the lines. Then go to prevention and teaching. Intervention is most important right now. (agree,but, where are nurses in this) Their focus, doctors, PA and NP.

You all need to watch this, there is so much more. Primary care doctors aren't paid enough, but no mention of professional nursing. Again, ANA where are you?? BSN's you are not being addressed at all. They are talking about eliminating your job. They are talking about retraining you and "retooling" your career. And you all are worried about the difficult patient? We need to get busy...are we even listening to what is happening right before our eyes? Are you all satisfied with your degrees when you have no say in policy? Do we even care?

The lie has been told so much, ever since I can remember 27 years ago. All we needed was BSN to get taken seriously...really?

[pedicurn, LPN, RN]

which is why the vast majority of income tax and income tax like systems have progressive tax rates i.e. once you earn above a threshold - the income above that threshold is taxed at a higher rate and concepts such as personal allowances to off set against tax on earnings .

it's amazing how few people have any real understanding of how income tax works...

I believe in the US, 35 % is the highest rate for personal income tax - for income over $372,000

Most nurses would pay about 25%

I much prefer their progressive thresholds ...I know we would be a lot better off. They have a progressive system but their thresholds are more generous than ours and obviously their high earners aren't taxed at the level ours are.

So one can be a fulltime RN working lots of weekends plus a bit of overtime and not be considered a high earner.

[talaxandra]

I simply believe EVERYONE should pay their FAIR share of taxes. No more ~ no less. You have a lower income you pay less, you have a higher income, you pay more BUT... Everyone pays the same percent (that is %) of whatever that income is and no matter how they came by that income i.e. paycheck, wellfare check, OR inheritance (I added that one in the spirit of compromise )rags

And that right there would be the way the Australian public health care system's funded - everyone who earns over the threshold (which is assessed annually and linked to inflation) pays 1% of their taxable income as a Medicare levy (Medicare is the name of our system and not the same as the US program of the same name). About a decade ago a refinement was added - anyone who earns over X (also calculated annually and currently $Au73,000 for singles without dependants) who chooses not to take out private health insurance pays an additional 1.5% Medicare surcharge.

[rags]

And that right there would be the way the Australian public health care system's funded - everyone who earns over the threshold (which is assessed annually and linked to inflation) pays 1% of their taxable income as a Medicare levy (Medicare is the name of our system and not the same as the US program of the same name). About a decade ago a refinement was added - anyone who earns over X (also calculated annually and currently $Au73,000 for singles without dependants) who chooses not to take out private health insurance pays an additional 1.5% Medicare surcharge.

THAT might be a cool idea for us rather than the current system we have. I like it. Simple and easy... with coverage for those that choose it.

If I understand it correctly...

rags

[WIN007]

I think nurses are necessary and under appreciated by the hospitals that depend on them. They are only concerned with covering the bottom line, increasing the workloads as a result without compensation. (think this might be a bit more on topic)

rags

You'll get no argument from me! Unfortunately though they're not unrelated to some of these other items. healthcare costs have skyrockted in teh country for almost 40 years and nobody at all until recently has even tried to do a damned thing about it. Rather they've been left to skyrocket with then the hospitals and providers doing all they can to contend with it by slashing and burning nurses salaries and staffing. Near everything is interconnected. Follow the money.

[WIN007]

I believe in the US, 35 % is the highest rate for personal income tax - for income over $372,000

Most nurses would pay about 25%

I much prefer their progressive thresholds ...I know we would be a lot better off. They have a progressive system but their thresholds are more generous than ours and obviously their high earners aren't taxed at the level ours are.

So one can be a fulltime RN working lots of weekends plus a bit of overtime and not be considered a high earner.

only prob is the uber-wealthy don't pay what's on the charts - they have loopholes and estate accountants at their disposal. meanwhile if you're a wage-earning sucker you get hit up by regressive taxes from FICA to state and sales and consumption taxes so I would wager to say that an RN's true tax burden is likely closer to 38%. If not higher. Roughtly around what a Canadian or European would pay except the difference is THEY actually get services back for their taxdollars like, er, healthcare.

[WIN007]

THAT might be a cool idea for us rather than the current system we have. I like it. Simple and easy... with coverage for those that choose it.

If I understand it correctly...

rags

If it was up to me, not that politicians listen to anyone with less than a few mil to offer their campaign coffers, I'd do these things:

1. Immediately reduce bureacracy and overhead costs with streamlined payor efficiency through state run single payor systems. (this is not at all 'socialized' medicine)

2. Continue efforts for outcome improvements in chronic illnesses ranging from registries, evidenced based care implemented through clinical decision support engines, EMR's and state and commercial health exchanges.

3. Continue as a matter of national priority and security a fast paced development of the National Health Information Highway (ie, ability to exchange medical records among providers, payors, labs and pharms) to reduce fraud, redundant orders and to be able to treat patients efficiently.

4. Address medical malpractice issues in the same context as the Canadians. ie, anyone who brings a frivilous lawsuit to court can pay the costs of the courts and the defendents time and legal expenses.

5. Continue the affordable care act's mandate that persons uninsured can buy into semi-subsidized insurance so that the rest of us don't have to pick up for their ED visits while meanwhile insisting that perfectly abled companies like Walmart actually PROVIDE it to their employees.

6. Alter immigration healthcare so that

a) companies bringing over migrant agricultural workers must insure these workers and not the taxpayers including but not limited to their pregnant wives and offspring.

b) companies wanting to hire white collar workers from 3rd world countries like India must also provide them with health insurance AND

c) these workers must become citizens of the United States as a condition of there employment at the expense of their employer rathert than taking a job from an American and get trained here and then go back and take the job to India.

and

d ) above are ineligible to sponsor their decrypt relatives without a minimum of 100k in assets to pay for their healthcare , ie, their parents are ineligible for US medicare.

and

e) no person is allowed to EVER collect from these systems that have not paid into them for a minimum of 25 years.

I think that would aptly take care of things.

[pedicurn, LPN, RN]

only prob is the uber-wealthy don't pay what's on the charts - they have loopholes and estate accountants at their disposal. meanwhile if you're a wage-earning sucker you get hit up by regressive taxes from FICA to state and sales and consumption taxes so I would wager to say that an RN's true tax burden is likely closer to 38%. If not higher. Roughtly around what a Canadian or European would pay except the difference is THEY actually get services back for their taxdollars like, er, healthcare.

But don't forget in the US there are lots more deductions at the end of the year which can make a big difference.

What I know as an Australian is :

I am taxed up the gazoo but medical is there and I'm not going to become bankrupt due to medical bills.

That's the good point.

Now I'm assuming the care will be there for me ??? maybe some of it but some of it wont be because i will be deemed 'too old' or else the govt will deem it 'too expensive' to offer certain procedures to whoever wants it. And I will have to also wait a long time for some of it

Therefore probably won't get (and I don't get) all the medical services I want and need under our system.

Sounds lovely and rosey ...but it's far from perfect and can be pretty much basic in some areas.

I am also unlikely to really do well financially due to high taxes and COL.

[WIN007]

But don't forget in the US there are lots more deductions at the end of the year which can make a big difference.

What I know as an Australian is :

I am taxed up the gazoo but medical is there and I'm not going to become bankrupt due to medical bills.

That's the good point.

Now I'm assuming the care will be there for me ??? maybe some of it but some of it wont be because i will be deemed 'too old' or else the govt will deem it 'too expensive' to offer certain procedures to whoever wants it. And I will have to also wait a long time for some of it

Therefore probably won't get (and I don't get) all the medical services I want and need under our system.

Sounds lovely and rosey ...but it's far from perfect and can be pretty much basic in some areas.

I am also unlikely to really do well financially due to high taxes and COL.

Your points noted, nothing is perfect. At least you're covered for now and will have some kind of healthcare in your old age which is a lot more than I'm feeling about now and we pay higher costs per capita than anyone I think. . I'm unfamiliar with Australia's economic history but I don't think you've been running anything close to the deficits th USA, have you?

[tntrn, ASN, RN]

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?

My personal feeling is that everybody should pay something.....As it is now, 48% pay no federal income taxes at all. So the people who make that obscene 1.2 million, is paying a whole lot more than enough people to make a small city. And the small city just keeps growing and growing, full of people who pay nothing and continually seek more from those who do.

[tntrn, ASN, RN]

Herein lies the problem in the USA, The majority of taxes are paid by the "Middle Class", who do not qualify for the services thier tax money is paying for. Simply put, the Middle class makes enought money to be taxed to pay for free healthcare, but, they make to much money to qualify for said free healthcare.

That just isn't true. I think it's the top 2% who pay 50% of the taxes.

[WIN007]

That just isn't true. I think it's the top 2% who pay 50% of the taxes.

Actually YOU'RE wrong.

First, the number you are parrotting from thbe propoganda mills is actually like the top 5% if I recall correctly.

Secondly they conveniently ONLY include federal income taxes in this misinformation whereas plenty of poor and middle class people pay through the nose on a composite of regressive taxes (regressive means it hits lower income people harder) like sales, state, fica, and consumption taxes which are still, like, you know, taxes.

Third, 5% or even 2% is skewed - when you say the top 5% you're including numbers that include a surgeon or a married pair of engineers in with the Walton heirs and Koch brothers. How very convenient.

Show me what the top 1/10th of 1% pays. I bet it's less than 8%. If not less. Hell, I wouldn't be surprised if it was less than 5% now.

.

[tntrn, ASN, RN]

Actually YOU'RE wrong.

First, the number you are parrotting from thbe propoganda mills is actually like the top 5% if I recall correctly.

Secondly they conveniently ONLY include federal income taxes in this misinformation whereas plenty of poor and middle class people pay through the nose on a composite of regressive taxes (regressive means it hits lower income people harder) like sales, state, fica, and consumption taxes which are still, like, you know, taxes.

Third, 5% or even 2% is skewed - when you say the top 5% you're including numbers that include a surgeon or a married pair of engineers in with the Walton heirs and Koch brothers. How very convenient.

Show me what the top 1/10th of 1% pays. I bet it's less than 8%. If not less. Hell, I wouldn't be surprised if it was less than 5% now.

.

I refer to Federal Income Taxes paid. That, in my opinion, is the only way to have this discussion because other taxes vary greatly due to where people choose to live.

And here you go:

http://www.american.com/archive/2007/november-december-magazine-contents/guess-who-really-pays-the-taxes