We may need fewer nurses in the hospital...

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 with you. We don't get what true preventative is. Our minds are small. We think, obesity, smoking, drugs and etoh, but what you gave as examples in your country make much more sense to me and my sensibilities. Thank you!

Excellent points (both of you). For example here lung cancer is the leading ca cause of death. In women as well. People who have quit smoking long ago are still at risk not just current smokers. In fact over half of newly diagnosed cases are former and never-smokers. Found in early stage it's quite treatable but by the time symptoms show it's in late stages and far too late with dismal survival rates and astronomical costs. But the insurance companies don't want to pay for the spirals, the conservative wing of medicine argues that some carcinomas will never develop, etc. Well, so what, baseline them. Problem is that's additional ct's and the insurance companies certainly don't want to pay for that.

Rationing care is logical and also, inevitable. It will happen either formally or informally. I think formally would be more even handed. I don't know what you mean by cutting services, so I can't elaborate on that point. Preventive services are the way to go, no question.

Arguably rationing is well established here. HMO's, PPO's, and max payouts have been around since the 70's and have become commonplace. I do think there should be common sense in application. People really shouldn't be making direct appointments to cardiologists without seeing thier PCP and similarly, herculean and exorberant procedures on the very elderly probably don't make sense.

People took better care of themselves when they knew the cost of thier healthcare was not covered by the rest of society. Granted we didn't live as long, but we knew we had to eat right, excersize, listen to what the Dr told us.

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Back then the framework of the country was entirely different. Before transnational corporations and corporate farms and walmart people worked in farms and small businesses and inherently got more excercise and ate fresher food. Mostly they ate what they could afford though and there wasn't much thought into it. And largely when they got sick they died. It was not the good old days by any means though some things were certainly better many weren't at all.

Arguably rationing is well established here. HMO's, PPO's, and max payouts have been around since the 70's and have become commonplace. I do think there should be common sense in application. People really shouldn't be making direct appointments to cardiologists without seeing thier PCP and similarly, herculean and exorberant procedures on the very elderly probably don't make sense.

Oh, I think we can be assured there aren't going to be anymore exorberant procedures on the elderly. In fact, how often they can even go to the doctor will be drastically limited....and, their conditions will get worse quickly, and then they won't qualify for anything else because of how sick they are. Poor Grandma and Aunt Lulu....

You hit the nail on the head. THERE IS NO MONEY!!!! 45% of America works and pays taxes the rest milk the system. The top 2% pays 50% of the taxes and the bottom 40% of tax payers pay 2.9%, you cannot sustain any social safety net when the entire system is nothing but takers and and very few givers.

Single payer would be the death of the best health care system to ever be! The entire world comes here for there care, no one flys elsewhere because it is better, NO ONE! I don't want the greatest care on earth destroyed.

that's a LOT of misinformation for two paragraphs.

The top 2% does not pay 50% of the taxes, not even the federal taxes. the federal tax code is the only progressive tax code in the country (well, used to be progressive). Lots of people who pay plenty of taxes are not paying most of them in federal taxes, but rather plenty in sales taxes, FICA and a host of consumption taxes on non-discretionary purchases like gas and clothing for their kids. Similarly the wealthiest individuals and corporations in the nation do not typically pay taxes on wages and salary because see, they live on bond interest which is exempt from taxation and also aren't included in your pool.

Single payer is extremely efficient. It offers economies of scale and allows for much MUCH reduced administration and overhead costs. It is NOT 'socalized medicine' or anything like it. It just allows for hospitals to have like, you know, 8-10 doctors in every hospital for every bureacrat instead of the opposite.

Wait until they surrender that.

Socialism doesn't work.

yet another candidate for a McCarthy award ...

A comprehensive national health service is not 'socialism' there are none of the tenets of marxism or any of the further perversions of the theoretical model proposed by Marx and others in the C19th.

The US 'system' is a joke as every objective outcome measurement shows , accessibility, overall clinical outcomes, quality of care overall ....

Not to mention some of the jokes like the majority of the USA being served by Ambulance services where 110 hours is considered adequate training to be an emergency ambulance crew, in the Uk Patient transport staff have more training than that and the nearest they come to emergency work is doing first aid and BLS + AED either as a community responder or if they happen across / get flagged down to a 'running call'.

We'll not even mention the culture that sees Nurses require permission from the all mighty doctor to undertake basic nursing actions, due to billing and/ or control freakery ...

also the ridiculous slioing of skills again due solely to billing

even if people have cover there are still significant issues with access , getting an admission date for an elective procedure next week is irrelevant if you can't get an appointment with your family doctor or are afriad to go to the ED or ring 911 without permission from your insurer ...

we'll not even talk aobut the money wasted by restricting access to primary care, and the consequent overloading and unnecessary admissions this creates for the ED and acute hospital care , nor the insurers who refuse to pay for cost effective care ( e.g. as previously discussed with regard to community IV therapy services )

"The complete collapse of the system" will certainly be escalated by downsizing the nursing staffs in hospitals.

Hospital budgets are unsustainable because of the bad choices almost every hospital CEO has made in the last 15 years.

Every "boutique" birthing center, every "Luxury hospital suite', cost a nurse, or a phlebotomist or a CNA a job. It's not so nice to lay in a wood paneled suite, if there is no one to answer your call bell.

I agree with you on the latter. Hospitals have been competing with each other for an ever diminishing segment of the population with premium insurance plans instead of preparing for the future by demographic trends.

WHO CARES if a hospital has a fancy fountain and artwork. That's sure as heck not what you're there for.

Oh, I think we can be assured there aren't going to be anymore exorberant procedures on the elderly. In fact, how often they can even go to the doctor will be drastically limited....and, their conditions will get worse quickly, and then they won't qualify for anything else because of how sick they are. Poor Grandma and Aunt Lulu....

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

It's already happened, and will continue.

I think the jury is still out. No one knows what is going on with the Healthcare Reform. I think that doctors are building more outpatient centers because they get reimbursed more sending patients to these areas than in the main hospitals. I also see more doctors combining practices to lower the burden of cost. I have also seen a trend that is spreading where the hospitals are buying doctors offices and running them allowing the doctors and their PA's to become employees of the hospitals. That ensures a steady patient population to the hospital but the doctors don't have to hire office employees, or pay benefits and taxes for employees-the hospital does. There is still a hot debate over the amount of money that will be allocated for home health nursing reimbursement through Medicare and Medicaid. Seems like Home Health agencies are not hiring as many nurses trying to wait out what the government decides. I think that hospital nursing will always survive, the patients are going to be sicker when they arrive and that will require strong nursing skills to care for these patients. When the government makes decisions about money, people in leadership make knee-jerk decisions and we go back and forth. The only thing you can control is yourself. Stay up on the latest, be flexible, get your resume' updated and market yourself-but only plan on staying someplace 5 years at the most. It seems like it has to be that way until all this mess is worked out. You just have to ride the tide of change. Doesn't matter about your degree. I still don't think a BS degree is anything but a door opener to a better position (minimum requirement) so do what you love and try not to worry.

Depends who wins their way. One school of thought is to just let it continue to run amok and reduce access. Obviously I vehemently disagree with this camp, replacing medicare with worthless vouchers and so forth.

On the hand is the school EMR's, national health information highways, decision support and holistic records, the of paying for outcomes. Some providers are really on board with this others hate it, sure it's work and change for them. But it truly does attack 1) redundant orders 2) fraud and 3) allows clinciians to see an entire healthcare historys and treatements, issue automatic reminders to patient and doctor, CPOE and resident alerts for contraindications, and most of all help ensure treatments follow best practice guidelines.

For more information see the HHS/CMS ONC (office of national council) website. http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2

This effort is well underway, and yeah, obviously I'm a supporter of (tho in no way affiliated with ONC or CMS)

Some information:

http://www.ntu.org/tax-basics/history-of-federal-individual-1.html

http://www.taxfoundation.org/publications/show/151.html

The Federal Individual Income Tax rate for income and earnings above the top bracket hasn't changed since 2003 - and with the exception of a few year span between 1988 and 1990, it is currently the lowest it's been since 1932. Not only that, the height of the top bracket has increased steadily over the past 18 years, and is more than $225,000 increased from what it was in 1993.

So not only is the tax rate for income and earnings above and beyond the top tax bracket (which is currently over $379,000 by the way) getting smaller over time, the top bracket has been steadily adjusted higher and higher so that fewer dollars are taxed at that high rate. Additionally, the tax rate for income beyond that $380,000 (roughly) is only being taxed at a rate that is 10% higher than the rate that is taxed for the average American income - which is over $300,000 annual dollars less than the top bracket and astronomically less than the amount of money being earned by the people who are actually lobbying for lower top bracket income tax.

Edited Apr 21, 2011 by metal_m0nk