Wisconsin has gutted Medicaid, no mandated ratios!

Nurses Activism

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So with all the craziness befuddling many Wisconsinites lately a new tightly kept secret was finally brought to light. Governor Scott Walker has not only gutted Badgercare (Wisconsin's Medicaid) which many farmers rely on as well as low income and buy ins by people who have two part time jobs for instance, Seniorcare which is an RX drug program for low income Seniors (which had a $20mil surplus), cut the end-stage chronic renal program, and Familycare which helps to pay for long term care for disabled and poor elderly individuals. Also, there is absolutely no nurse to patient mandated ratio in Wisconsin (let alone hourly mandates).

Many of our hospitals that give care to Medicaid patients are already overburdened as we have had hospitals close, not to mention the many who have lost insurance only going in when they catastrophically need emergency care. This is going to shift the costs to hospitals who will then do two things, raise rates on cash paying patients, and cut staff to the smallest possible amount even if that means 12 patients to a nurse, as I see it anyway.

Most hospital systems are non-profit but having worked for one that is supposedly religious in nature, I can assure you it is a farce in some cases as I worked on the "for-profit" side. It is hard enough as a new RN to find a job but with hospitals tightening their belts not only do I fear it hard to find a job (even at a nursing home), I fear the patient safety aspect of this.

It has been well documented that not only hourly mandates over 12 hours but high nurse to patient ratios can be directly tied to medical error and patient mortality. Is it going to even be safe to practice nursing in my state?

I love my state so dearly and if what I fear happens, I fear our world-class award winning health care system will look like one of a third-world country, little supplies, rationing care, deciding monetarily if a life is worth saving because "we cannot afford it".

What are your thoughts?

Specializes in emergency, neuroscience and neurosurg..
Really because my url even says nursing-patient-issues?

and the same amount of patients will be in the hospitals with the same needs or worse because they only come to ER during catastrophe instead of when things are easily treatable.

I have to interject here. I am an ER nurse of 10 years. Yes we see patients who delay seeking care because of financial reasons and are critically ill when they arrive because of this. They are a minority. With a terrifying frequency I see patients who present to the ED for a pregnancy test, ingrown toenails, prescription refills, narcotic abuse, etc., etc. Patients present via EMS because, "I didn't have ride." Yet their family members arrive by POV (private owner vehicle) to sit at their bedside. I have patients complain about the inability to afford medications while they continue to smoke, abuse alcohol, have their nails done every week, wear more expensive clothing than I do, talk or text on the cell phone/smart phone during the entire visit, and become insulting, verbally abusive, and threatening physical and legal assault because the physician did not prescribe or order their preferred medication, or are not given "some samples to take with them."

There is great abuse of this system. Patients readily admit to using the ED because, 1: their physician does not accept the medicaid they use, or 2: their physician refuses to see them because they have outstanding accounts. ( The state of SC has privatized medicaid to a certain degree. There are several plans to choose from. If a participant does not choose a plan and a provider (they have 60 days to complete this) the state will choose for them. Participants also frequently fail to "renew" their medicaid, which is basically filling out a form every year, and it is cancelled. They then must go through the enrollment process again. Most of the local physicians will not refuse a patient if there is any effort being made towards payment. This is sign that the outstanding debt is delinquent for over 6 months with no payment history in that time.

Mandatory staffing ratios will not fix a broken system. The ED is also getting the brunt of this. While the state of SC does not have staffing ratios, the facility where I work does have a staffing matrix. And while this can be beneficial to an inpatient nurse, the ED NEVER GETS FULL!!!!!!!! We cannot refuse to accept another patient because we don't have enough nurses; part of EMTALA says they must be screened by a physician or physician extender (NP or PA) if they present to the ED. This doesn't happen until they are placed in a room. The hospital and the ED is liable for their care when they come onto the property. We cannot tell them I'm sorry but we can't see you, we've reached our staffing limits. Recently we were holding more psychiatric patients than the department has rooms (Education room became women's dormitory with security at bedside and board room became the same for the men), I had 1 patient on a vent, 1 on heparin, 1 on insulin drip, and the hallway patient assigned to me was a chest pain with cardiac history (CABG, AAA repair, and an ICD). Both the PCCU and CCU refused to accept the patients being admitted to them because of "staffing" This is a frequent occurrence. I would love to say it's only my facility but it's not. I have worked small rural community hospitals and level 1 trauma centers. It's the same at all levels. It's always amazing how a patient who is one of 3-4 in the ED is critical enough to become one of 2 in the unit. There is no patient safety in this. Confounding this the ED is still responsible for all psych holds. (The national crisis of mental health or lack of mental health is an entirely different thread) The potential is there for my 1:3 ratio to become 1:4 or 1:6,7,8 (we are also a total care unit. No CNA's or techs). But the nurse upstairs cant accept another patient because they are understaffed.

I'm sorry this turned into more of a rant than I thought, but a MANDATE will not fix this and other issues. Neither will continuing to fund defunct programs with little or no oversight that historically been abused on a wide scale and has done more to contribute to the ever increasing poverty stricken population than help.

Specializes in emergency, neuroscience and neurosurg..

The mentally Ill do not end up in prisons.... they end up in the ED waiting for almost nonexistent acute care beds. Sometimes for weeks even months at a time. The ED staff is burdened with caring for them as well as the other patients in the department and somehow trying to make sure everyone is safe including themselves.

Specializes in emergency, neuroscience and neurosurg..
People forget it was the Big Banks and Investment houses that manipulate the stock market and bank rates that caused the recession, not poor people or old people.

Yes, and the banks and investment houses were instructed by the government to negotiate those risky loans with buyers regardless of their ability to pay. There were members of congress who purchased multimillion dollar homes using housing monies. I'm pretty sure none of them were or are low income. Banks, regardless of size, do not set interest rates, again.... the GOVERNMENT does. And yes, some of the responsibility lies with the buyers, if you have $1200/month spendable income and the mortgage is $900, you can't afford it. Doesn't matter if the bank "approves" that amount you still can't afford it. I am all for helping those in need, and do so often in my personal and professional time. The key word is help, not do for them.

Good string of posts, edrnbailey. I work in EMS and I completely sympathize with your frustration. Nothing bugs me more than bringing a patient to the ER in my ambulance whom I know is simply gaming the system. We have some known frequent flyers whom we take in and out of the ER several times a week for completely bogus reasons. They either have psych issues, are drug seekers, or both. I feel so bad for the nurses in the ER that have to deal with this.

Then there are the "disabled" who spent the decades of their youth destroying their own bodies with tobacco, ETOH, drugs, or food and are now living completely on government support from their housing to food to health care. It makes me crazy when I have to bring a Medicaid patient to the ER for SoB 2° COPD exacerbation, and the patient presents in a government-subsidized apartment, on O2, surrounded by overflowing ashtrays in a room that reeks of stale cigarettes. I'm sorry, but willful continued use of organ-destroying toxic chemicals ought to be a disqualifying factor for Medicaid eligibility.

Virtually every person I see who is receiving extensive government aid still somehow seems to have huge flat-panel TVs, cellphones, and money for cigarettes and/or ETOH. For all our modern good intentions, we are creating a HUGE population of completely dependent people who will take absolutely no responsibility for themselves whatsoever, and it is crushing our healthcare system.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

So...our health care delivery system is too expensive and the best way to control costs is to insure that only those who have insurance or can afford the cost receive the care? And those who have mental illness or substance abuse are not worthy of care? Do we begin to deny care for the diabetic who cannot control their diet, and the hypertensive who is overweight, the anorexic who continues to starve themselves, or the morbidly obese who continue to eat? Or do we treat them only if they have insurance or can pay cash? Are only the poor and the middle class subject to the rationing of care based upon compliance? Or can we deny care to the wealthy smoking COPDer too?

If disabled people have luxury items in their possession should we refuse care until they liquidate those "assets" so that they can pay for the care?

What about those who are unable to care for themselves...children, the elderly, and the infirm? Should their care be determined by their ability to pay? Perhaps we should reconsider NICUs, those patients are VERY expensive and many have no insurance to cover the cost of their care. Certainly abortion would be a much less expensive and more definitive way to deal with those pregnancies.

Which group of people will make these choices? Will this be a type of death panel? What criteria will be used? Will there be option to appeal? Will financial statements become part of the information we will have to give our physicians or the EMTs in order to receive care. Will the first responders need our insurance cards or investment portfolios to resusitate us on the street and transport to the ED? What will the monetary cut off be for those who are "pay as you go"?

Our system is clearly in trouble...I am not certain that rationing care based upon judgements of worth is the way we want to fix it.

Specializes in PACU, ED.

For ways to ration care, we only need to peer across the pond. One advantage to universal coverage is there is only one group making health care decisions for everyone.

http://www.bbc.co.uk/news/health-12964360

In several areas routine surgery was put on hold for months, while in many others new thresholds for hip and knee replacements have been introduced.

The moves are part of the NHS drive to find £20bn efficiency savings by 2015.

The government said performance should be measured by outcomes not numbers.

Surgeons have described the delays faced by patients as "devastating and cruel". Peter Kay, the president of the British Orthopaedic Association (BOA), says they've become increasingly frustrated that hip and knee replacements are being targeted as a way of finding savings.

This has nothing to do with the "far right" as you call it. The country is broke. States have no choice but to cut their budgets. We can not continue to rack up massive debt in this country. We are bankrupting our children's futures.

Then why is Gov walker extending tax cuts and selling off profitable state assets like utility companies, hmmm??

Yes, it IS about far right ideology actually and in the worst sense. Cutting their taxes on the backs of the most fragile is no way to run a government.

PS - where were YOU when George W. turned the 3 billion dollar surplus Clinton left him into 500 billion dollars of red ink , escalating into leaving office with a 1 trillion dollar annual deficit for the new Administration to inherit, along with an unfunded war or two and a long-running recession? Very very interesting you weren't outraged then, or did Fox news channel not talk about it?

Sorry, I've been rather busy with work and school, haven't had a chance to revisit this thread in a few days.

Anyway, to be precise, I'm really not "arguing" about anything on this thread so far: all I've been trying to do is to get through to people the facts of what Social Security ACTUALLY IS - an unsustainable, bankrupt Ponzi scheme. So, now that that point has been made, we can talk about alternatives. Right now, I think we'd all be better off with anything that wasn't an unsustainable, bankrupt Ponzi scheme.

We are really talking about about two different things here: (1) a social safety net of last resort, and (2) providing for a comfortable retirement.

I have no problem with #1; I've never suggested letting our elderly go homeless and hungry. But that's not what Social Security is - it is far more than a safety net of last resort.

When the Social Security program was enacted in 1935, the age of eligibility was 65, and the life expectancy was 62 for men and 67 for women. So, right off the bat, you can see that this was really only meant to provide minimal supplemental security near the end of life. Now, the age of eligibility is 62 and life expectancy is 76 for men and 81 for women. How can a system originally designed to cover minimal end-of-life security for 0-2 years now be expected to cover 14-19 years of retirement? It can't!!!

So, if Social Security is supposed to be what it was originally intended to be, we need to raise the minimum retirement age for collecting to 78. Secondarily, if Social Security is supposed to be a safety net of last resort, it needs to be means tested, based on income and assets, so only the truly needy receive it. Under these criteria, probably nobody in this audience reading this thread would ever receive a penny of benefits from Social Security. But hey, that's what a social safety net is supposed to be, right?

Let's be honest - none of us are as noble as we pretend to be in the anonymity of the internet. We've all been paying into this system for years and expect to get something out of it when we retire, right? Is anybody here perfectly OK with just looking at their decades of contributions to SS as pure (forced) charity, to be given to others, with no expectation of ever getting any when your time comes? Well, that's what CHARITY is, and that's what a social safety net is supposed to be.

But that's not really what we're talking about here. Just talk about raising the retirement age to 78 and/or means testing benefits, and you'll see how much people like the idea of government-mandated charity.

No, most people think of Social Security as a legitimate retirement plan that they can count on to at least partially fund a comfortable retirement. Hence, the unsustainable bankrupt Ponzi we have now. What we are really doing is expecting a guarantee that our children and other people's children will at least partially fund our comfortable retirement (because the money we are paying in right now is immediately blown by the government).

I'm sorry, but the only real solution is to make people more responsible for funding their own retirement years. I think it's tremendously selfish and greedy to live high right now, blowing the money I make on huge $50,000 SUVs that get 14mpg, $100/mo cellphone plans, oversized McMansions, and any other frivolous luxury you can think of, but not actually saving anything and then think I can retire at 62 and have my kids and grandkids pay for it.

So, you want an alternative solution? There it is. A means-tested social safety net of last resort. Beyond that, we're responsible for ourselves. A universal retirement plan controlled by the government does not and can not ever work. We've already proven that.

Let's first address your discussion of social security as a 'ponzi scheme'. One should really have citations for this charge. That would be difficult considering that SS has been in surplus for it's existance. In fact Reagan and both bushes ALL used that surplus to offset the red ink (I left out Clinton because he reduced the size of the deficits each year he was were in office ultimately leaving with a 3 billion dollar surplus) The deficits of his predecessors and successors were largely deficits created by the willful reduction of taxes on the best off.

Not once did those tax cuts result in increased revenue for the treasury or the prosperity promised. And Reagan's deficits and tax cuts were in part made up for by what actually WAS 'the largest tax increase in US history' in the form of the 1982 FICA (social security increase).

Reductions in taxes for the most affluent have ALWAYS been offset by taxes on the rest of us, state, FICA, local, consumption et al, typically hurting most the working poor and middle classes.

I don't believe in means testing people out of a program they paid into nor the nonsense about ever increasing the retirement age so that they are dead before they're eligible. A much better solution is to address 30 years of spiraling healthcare costs as we ARE doing through Meaningful Use.

http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2

Sorry, I've been rather busy with work and school, haven't had a chance to revisit this thread in a few days.

Anyway, to be precise, I'm really not "arguing" about anything on this thread so far: all I've been trying to do is to get through to people the facts of what Social Security ACTUALLY IS - an unsustainable, bankrupt Ponzi scheme. So, now that that point has been made, we can talk about alternatives. Right now, I think we'd all be better off with anything that wasn't an unsustainable, bankrupt Ponzi scheme.

We are really talking about about two different things here: (1) a social safety net of last resort, and (2) providing for a comfortable retirement.

I have no problem with #1; I've never suggested letting our elderly go homeless and hungry. But that's not what Social Security is - it is far more than a safety net of last resort.

When the Social Security program was enacted in 1935, the age of eligibility was 65, and the life expectancy was 62 for men and 67 for women. So, right off the bat, you can see that this was really only meant to provide minimal supplemental security near the end of life. Now, the age of eligibility is 62 and life expectancy is 76 for men and 81 for women. How can a system originally designed to cover minimal end-of-life security for 0-2 years now be expected to cover 14-19 years of retirement? It can't!!!

So, if Social Security is supposed to be what it was originally intended to be, we need to raise the minimum retirement age for collecting to 78. Secondarily, if Social Security is supposed to be a safety net of last resort, it needs to be means tested, based on income and assets, so only the truly needy receive it. Under these criteria, probably nobody in this audience reading this thread would ever receive a penny of benefits from Social Security. But hey, that's what a social safety net is supposed to be, right?

Let's be honest - none of us are as noble as we pretend to be in the anonymity of the internet. We've all been paying into this system for years and expect to get something out of it when we retire, right? Is anybody here perfectly OK with just looking at their decades of contributions to SS as pure (forced) charity, to be given to others, with no expectation of ever getting any when your time comes? Well, that's what CHARITY is, and that's what a social safety net is supposed to be.

But that's not really what we're talking about here. Just talk about raising the retirement age to 78 and/or means testing benefits, and you'll see how much people like the idea of government-mandated charity.

No, most people think of Social Security as a legitimate retirement plan that they can count on to at least partially fund a comfortable retirement. Hence, the unsustainable bankrupt Ponzi we have now. What we are really doing is expecting a guarantee that our children and other people's children will at least partially fund our comfortable retirement (because the money we are paying in right now is immediately blown by the government).

I'm sorry, but the only real solution is to make people more responsible for funding their own retirement years. I think it's tremendously selfish and greedy to live high right now, blowing the money I make on huge $50,000 SUVs that get 14mpg, $100/mo cellphone plans, oversized McMansions, and any other frivolous luxury you can think of, but not actually saving anything and then think I can retire at 62 and have my kids and grandkids pay for it.

So, you want an alternative solution? There it is. A means-tested social safety net of last resort. Beyond that, we're responsible for ourselves. A universal retirement plan controlled by the government does not and can not ever work. We've already proven that.

Also , social security was never covering 1-2 years don't know where you got that idea. I do agree people live longer, but then, they also WORK longer. The real problem with SS is that it has been used to offset general revenue deficits and still is.

People ARE covering their own retirement. Pensions have been dissolved by and large since Reagan, and companies have reniged on most of the others. That leaves state employees, currently under attack and not much more.

Most employers match a modicum of 401k if anything. People who aren't stockpiling money into 401k's are likely not doing so because they CAN'T - it' tough on jobs that pay 35k to put the full 15k aside or even 50k if you have kids to feed.

I do agree people have a responsibility to live within their means. Nobody needs a 35,000 dollar truck. I make more than 50k and I've never felt I could afford that. To my experience those buying them though are usally the same people that complain if they have to pay the school 200 bucks for their kids education.

Specializes in PACU, ED.

A Ponzi scheme is a fraudulent investment operation that pays returns to separate investors, not from any actual profit earned by the organization, but from their own money or money paid by subsequent investors (Wikipedia, 2011).

The Social Security and Medicare taxes you pay are not put in a special account for you. They are used to pay benefits for people getting benefits today, just as your future benefits will be paid for by future workers. http://www.ssa.gov/pubs/10006.html

(Bolding is mine.)

Hmmm, it looks like a duck and quacks like a duck.

I just hope it will keep laying duck eggs long enough for me to regain some of the money that's been taken from my pay over the years.

It is a problem that our federal government (spelled with both an R and a D) has been using excess SS funds to live the high life for several decades.

Specializes in PACU, ED.

Clinton did do a better job of making ends meet than any other recent president. However, the national debt still increased every year. How did he have a budget surplus and still manage to add to the national debt? Here's a good discussion of the smoke and mirrors that was used to make the claim that Clinton balanced the budget. Or should we call it fuzzy math?

http://www.craigsteiner.us/articles/16

A Ponzi scheme is a fraudulent investment operation that pays returns to separate investors, not from any actual profit earned by the organization, but from their own money or money paid by subsequent investors (Wikipedia, 2011).

The Social Security and Medicare taxes you pay are not put in a special account for you. They are used to pay benefits for people getting benefits today, just as your future benefits will be paid for by future workers. http://www.ssa.gov/pubs/10006.html

(Bolding is mine.)

Hmmm, it looks like a duck and quacks like a duck.

I just hope it will keep laying duck eggs long enough for me to regain some of the money that's been taken from my pay over the years.

It is a problem that our federal government (spelled with both an R and a D) has been using excess SS funds to live the high life for several decades.

I understand what a ponzi scheme is. I asked you to explain why SS is and you haven't done so bold font aside.

You're making my point for me. it's been in surplus and those surpluses have been used to offset general revenue deficits; like, you know, 30 years of giving the uberwealthy and biggest corps a free ride, cutting taxes while fighting two-front wars and taxpayer insured Russian Roulette in the form of unregulated financial derivatives.

THAT's what's been the ponzi scheme - this nonstop pretending you can get something for nothing. There's no MARGIN on taxing the poor and there's not much sense in taxing nurses at 35-45% while at the same time crying that the nation is "broke" (it isn't broke - it's a wealth concentration problem) and now the programs they've paid into for 30 years and count on must be liquidated to be for crackpot economics. This trickledown crap, call it Reagonomics, Dubyanomics or now Ryanomics has been disproven 3 times on a federal scale and hell only knows how many on state and local scales and STILL the puppets of the perpetrators , with a straight face, are allowed to go on national television and continue to propose it where as in a sane society they'd be running for their lives. You don't lose weight by eating more and excercisng less and it's NO way to run an industrialized nation. What the hell, it's only your retirement, healthcare and the future of our kids grandkids at stake.

Given that if what it takes is to use general treasury revenue to pay me my social security then so be it. It's ludicrous to keep raising the retirement age when almost 1/3 of persons over 50 are chronically unemployed.

Instead of protesting here start rounding up your friends to let your senators and congressmen know what will happen to their careers if you don't get a return on your investment. If people put up half the fuss to the source of their trouble instead of letting politicians and mouthpieces for big interest divide them then they'd get further.

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