I’m all for the improvement of healthcare… our system needs a change for sure. As you may have heard, President Obama signed new healthcare reform into law last week. Let’s take a look:
Positives in Obama’s Healthcare Reform
- Insurance for those people who have “pre-existing conditions” (someone with cancer cannot be denied healthcare coverage because of the known cost of the treatment)
- Reduction of the “donut hole” for seniors’ prescriptions (greatly reduces the cost of seniors’ medications)
- Expanded eligibility for medicaid coverage (more people will be able to sign up for medicaid assistance)
- Reduction in Medicare co-pays for preventative care (cheaper co-pays to allow/encourage people to get preventative care, such as regular check-ups, vaccinations, and cancer screenings)
- Children can stay on their parents’ insurance until their 27th birthday (reduces the number of young adults without health insurance)
But, as you take some time to read into what each of these points mean, you may see some not-so-great pieces.
Negatives in Obama’s Healthcare Reform
- Reduction in medicare payments to hospitals/physicians (meaning that hospitals/physicians may stop accepting medicare patients and patients may have a difficult time finding a provider)
- Families who currently have insurance coverage may see an increase in their deductibles (as insurers are required to cover everyone, even people with preexisting conditions, their costs will go up, as will the cost to the consumer)
- The fine for people who elect not to have health insurance (proposed at approximately $700/year) may not be enough “encouragement” for healthy people to purchase insurance. Insurance will generally cost more than $700/year for these consumers, so it may be cheaper to elect to forgo coverage, which negates the benefit of having everyone insured.
- The changes require individual states to continue or expand existing programs to receive matching federal funds. Coming from someone who lives in a state with an intense budget crisis, I don’t see how adding to each state’s budget is feasible at this time. Governor Brewer wrote a letter to President Obama after the healthcare bill was signed, outlining the issues that the reform will create for Arizona. (Governor Brewers Letter pdf)
How does the reform affect my patients and my career?
Preventive Care
Personally, I think the expansion of preventative care to our citizens is amazing – the more people that go into their doctor’s office to get check-ups when they feel like something is slightly wrong, such as a cough that just won’t go away, the more problems/diseases that we can find and treat before they get out of control and require hospitalization.
We have patients come into the hospital everyday who haven’t seen a doctor in years, although claim they have no “medical history”. Once you start talking to them, you learn that they are a smoker, they have had increasing fatigue over the last few years, and have had this on-and-off chest pain for the last 6-8 months. This person was a perfect candidate for a check-up, but he didn’t take the preventative care because he didn’t have health insurance or an ability to pay for the doctor’s appointment, he didn’t go because seeing a doctor is not a priority for him. How is the health care bill going to fix the mentality of “if it ain’t broke, don’t fix it”?
Healthcare Provider Availability
As insurance companies are required to cover people with pre-existing conditions, their costs will be substantially increased. They didn’t cover the patient with leukemia previously because they were aware of the costs of treatment for this patient. But, as they start paying out these large claims, they will need to make up the coverage elsewhere. Two of the obvious ways that insurance companies will make up their costs are by increasing premiums paid by customers and reducing the reimbursement to physicians and hospitals.
Currently, there is a lower reimbursement rate to doctors by some insurance companies when compared to others and many private physician groups will not accept patients with the lower reimbursement insurance. When more insurance companies decrease their reimbursement, more physicians will refuse to accept that insurance.
There is a certain specialist group in the east valley of Phoenix who has a hold on the market; there is not another group under this specialty within 30 miles. As this group of doctors refuses to accept insurance companies, we are already at a loss for physicians. And, as we continue to decrease physician income, we will lose people who would have been otherwise interested in attending medical school but cannot afford to take out the student loans required for the multiple years of schooling.
Reimbursement rates also affect hospitals. As the insurance companies decrease reimbursement to the medical facilities, the hospitals will have to cut costs in other forms, with the obvious measures being by decreasing staff in the hospitals. As we decrease the number of nurses, nurses’ aides, respiratory therapists, radiology techs, etc, it’s only going to decrease the quality of healthcare in our country. The fewer hospital staff we have, the less the patients will see their nurse, which increases the time it takes to get their medications, and even discharge instructions. With a decrease in other staff, we will see longer wait times for treatments, such as respiratory treatments, physical therapy, etc. All of these things lead to a decrease in patient safety, which is of utmost importance in the field of healthcare.
Bottom Line on Healthcare Reform
I’m not saying that the healthcare reform is completely positive or negative because I think there is a great deal of both in it at this early point. I will continue to watch the news and be cautiously optimistic about the future of our country. Hopefully, as the country finds limitations with the reform, the government will react and make additional positive changes.
It’s up to everyone to stay educated on the healthcare situation in our country. Even for people who claim that this bill doesn’t affect them, it does – they just need to take them time to read and find out how.
Amy, all the stuff you say is true, but…although some specialists refuse to take insurance, most can’t afford not to, because patients don’t pay out of pocket.As a doctor, you have to have a practice of a certain size, and the good thing about Medicare is that it pays little, but pays within 30 days/
Primary care reimbursement will go up, too, which will equalize doctor pay, and encourage more students to go into primary care.
As for nursing shortages, from what I hear, many quick-care clinics will be staffed by nurse practitioners or physician assistants, which should give nurses more power.
I’m pretty enthusiastic about the reforms, except that I think we should have gone to a single payer system altogether to reduce the paperwork and standardize care
Francine,
Can you elaborate on your comment about the nursing shortage?
I’m not sure how increased nursing “power” will affect the shortage of qualified nurses.
It seems that the quick clinics would further increase demand on a profession that already suffers from a dearth of quality practitioners.
I do think that the next 10 years will show us a greater reliance on Nurse Practitioners (NP) as providers of primary health care. I think we’ve already seen an increase in respect for NPs and their education and knowledge base; I see one each year for my gynecology check-up. :)
But, as Nurse Practitioners take a larger role in primary care, and physician reimbursement decreases, where are we going to get the physicians to take on the extra schooling for specialty positions? A passion for a specialty is one thing, but the bills from medical school are outrageous and the ends have to be worth the means; no one wants to live in debt their entire life.
And, in reply to your comment about physicians not being able to refuse insurance, it actually happens more frequently than one might think. With the large elderly population in our area, physicians get a majority of patients who are on Medicare, so refusing the small number of patients with Acme Brand private insurance doesn’t seem to hurt their pocketbooks. I have had physicians tell me that depending on the patient’s diagnosis, that they can actually lose money on a patient who has a lower paying insurance.
The US has too many specialists compared to PCPs (and other countries) because the money is in specialty medicine. So, med students choose to specialize because they will get more money for their services to pay off those large student loans. I believe this bill supports more doctors who stay in family practice, which is crucial for the preventative care push (which I also find crucial).
The healthcare bill focuses on the education of nurses to pursue advanced degrees (i.e. NPs and educators) and pay off loans for nurses choosing to work with specific “needy” populations. That is how it will help empower nursing (i think).
I like your comments on it Amy, I agree with you that the country needs a change and hopefully as problems are identified, more changes will come to the bill. I love being part of history in the making!
Amy, it’s very interesting to read your perspective as a nurse. I’m still trying to read and understand a lot of it myself, and always appreciate reading various perspectives. Your points are well stated.
Thanks for the comment, Grace. :) There is an abundance of information out there on the bill and most of it is difficult to dissect. I’ve had to read an insane amount of news articles to find enough of the ones that I’m able to fully understand.
Anybody else concerned that there health care will be managed by the IRS?
The IRS was scary enough without the addition of the nation’s healthcare to its plate :-P
Amy,
Thanks for a great post.
One of my biggest concerns is the working poor.
Nothing in this bill will actually make insurance more affordable.
That’s a great point Brevemike. Unfortunately, there isn’t a whole lot of help for the working poor in this country.
I agree with you – I didn’t see a way that this reform would actually make insurance affordable, just “accessible”. I’m very interested to see how things come about as the items in the plan start to actually come into play. I’m very nervous about my healthcare premiums and how they will potentially increase in the next few years. Time will tell, right?
Of all the things this bill does, I also noticed that it doesn’t seem to address to ridiculous costs of medicine. Some would argue that having more people purchasing health care would lower costs…but, when you balance that with higher costs for insurance companies (removing plan limits, taking on people with pre-existing and costly ailments, etc) there’s going to be an increase in cost for the insurance companies and they’re going to need to pass that on to someone.
An example of some of the ridiculous practices: I have a friend who’s a medical physicist in a major country hospital. He told me of one situation where the hospital uses these little foam pillows to prop patients heads up during scans. According to my friend, these pillows probably cost about $10 each to the hospital and could be totally reusable, but the hospital bills the patient/insurance $150 for them.
That’s what I was looking for from the bill…
That should read “county”, not “country”.
To: francine hardaway,
You should get a job for the government because all of your comments are empty non-backed concepts drawn off of your own opinions, this is only further proven when you use such terms as “from what I hear”, Amy Sellers is a well educated, well informed individual working in the field in which you allege to knowing about. Primary care reimbursement will not go up, for all of the reasons Amy mentioned, taking a little pay will never be any doctors MO for accepting patients. I’m a twenty-seven year old neuro-psychology and biochemistry student at Arizona State, myself and a multitude of other students are delaying finishing school because of this bill. You have no idea the amount of students that will change their plans for futures in medicine if this bill swings through senate as is. I personally know many students who have already changed their plans while in medical school to get out of things like primary care, and orthopedics, to get into private practice plastic surgery. If this bill passes as many people will retire because it will no longer be worth it for them to do the same job they’ve been doing for 25 years at a substantially lower rate, you will see a pandemic of shortage of doctors in this country. Aside from the things i’ve mentioned, its becoming easier and easier to attend medical school out of this country, where the future for a young doctor paying off 100s of thousands of dollars in debt is not in danger because of a horrible medical bill with infinite flaws.
wow… Noah, didn’t really need the personal attacks. But to illustrate the point, by you starting out your argument in this way, you seem like a tea party activist with an agenda beyond “better health care”. Also, citing people you know is a lot like “from what I hear”. You live in one area, in one school and hang out with more than likely, like minded individuals. Also, unsupported was more than likely the word you were stumbling around for. I’m not sure but I don’t think non-backed is even a phrase. Just sayin’.
As for my opinion, I agree with the point that there is both good and bad in this bill. I think it’s atrocious to not cover pre-existing conditions. Not honoring care because of the risk is understandable from a business perspective, but not from a human one. To no fault of their own, a patient can get cancer. They should not be punished for it. What I think will help some of the doctors is that there are going to be more patients. I’m not sure what the cost-benefit analysis would say but I think it could even out for doctors. Also, tort reform should have been included in this bill. Obama said he was willing to work with Republicans on Tort reform but they said they still wouldn’t vote for it. So it was mostly dropped. That way, you could equal out a lot of the burden on doctors that this bill has. I don’t think it’s a perfect bill but I think it’s a step in the right direction.
You’re really running with the assumption that there will be more patients in the health care system and I think that you’re mistaken on that point (and the politicians/media have used that same reasoning).
As I mentioned in the blog post, we have patients come into the hospital every day who have insurance and choose not to see physicians for their preventative care. They smoke, drink, don’t exercise, have a hacking cough, but claim “No Medical History” on their admission form because they haven’t seen a physician in 10 years.
I don’t think that any of the measures that the government is proposing is going to get people off of their butt and give them the desire to take care of their bodies.
The government is requiring insurance companies to cover those people with pre-existing conditions, but those people have already been in the healthcare system (or else they couldn’t have a pre-existing condition) and wouldn’t really be “new” patients.
Huge points for your comment on tort reform too.
Marc Hooks,
First off you’re assuming I’ve lived in Arizona my whole life. Second you’re assuming I’ve gone to one school. Third what is that you do for a living? Also you’re not in the know, but pre-medical students are in some of the largest networks of college students in this country, we talk, we network. Far from a tea party activist. I’m just old fashioned I guess and believe that you don’t get anything for free in this world and everything is earned. Just because you cannot afford healthcare doesn’t mean the entire country should have to pick up where one individual falls. That being said, every large system that has ever been enacted into the US government to “better” the lives of the US citizens is now a joke. Medicare bankrupt. Welfare the poor mans job. Systems such as this healthcare bill in a country as large as this one will always be a government drain that a few years in everyone learns how to trick the system, and the hard working man pays the price while the ones with no jobs, and no money sit at home all day and get everything paid for.
I was sent this article via my son’s girlfriend who is in nursing school. I am a “veteran nurse” of 39 years of practice. I too am concerned about the healthcare crisis. Some real life scenarios:
It is difficult seeing patients “hit” the emergency room who have not had care. True, some would not have gotten care even if they did have a doctor. But, many would have. Many use the ER as their primary care provider because they don’t have one. They show up regularly for their unofficial appointments. This care is costly and inefficint.
I lovely lady who was a nurse for 25 years. She is the vicitim of medical negligence. She is not able to walk and barely able to feed and care for herself. She is wheel chair bound. She does have Medicaide but her benefits are limited. She is unable to get the physical therapy she needs. A malpractice suit (another whole bucket of worms) is in process but will not be resolved for several years. This woman will benefit from the healthcare reform.
Another long time nurse is 59 years old. She has survived cancer and now suffers from a chronic back syndrome-too many miles traveling the pavement of hospital hallways. If her back should fail her completely, she is uninsurable. Hopefully she can make it to 2014!
I know that personal examples are sometimes frowned upon. But, all the platitudes of discussion aside, there are many out there who need and will appreciate the benefits of this reform. As a society, do we not have a responsibility to care for those who have worked hard, come upon hard times and face a life in need of medical care????
I stumbled upon this discussion in my quest to further my education as a CCRN. (btw, love your site, Amy! I’d love to know how you did it – would be great to start my own!) I agree with Amy’s discussions as well, and can see both sides of the bill. From one perspective, universal healthcare is the main reason countries such as Australia are so much healthier (as a nation) than the US. Because the government is responsible for the health, or lack thereof, of their people, it’s more likely to educate the public on harmful effects of their environment. There’s a TV commercial in Sweden in which graphic pictures were used to educate teenagers on the harmful effects of sex without protection. Their STD rate is one of the lowest in the world. Kellogg’s brand cereals are illegal in Australia because they’re considered a public health risk (links to obesity), as well as aspartame (clinically proven to cause brain damage). These are the kinds of changes America needs to see. Our public needs to be better educated on the choices they make and the effects of those choices. If we continue with our current public assistance programs like food stamps, I feel we should mandate some changes in the ways those funds are spent. For instance, if we award the funds on a point system instead of a financial system (from the poor man’s perspective), we could award double points for purchasing local fruits and vegetables. The farmer would receive his alloted funds ($5 for that bucket of peaches), but the poor man would only have to use half of his alloted money (“I only paid $2.50 for these peaches). Yes, the gov’t would be out a little more up front, but the future patient just bought $5 worth of peaches because they were cheaper than the $5 Little Debbie’s.
I’m going to have to stop my post mid-thought here, but will return later . . .
I totally agree with you (as you may have gathered from the post)! :) We need the change to the healthcare system, I’m just not entirely sure that it’s being done in a way that is best for the country. But, then again, I’m not a lawmaker… just a nurse with a blog. So, we’ll continue to talk about it and hope that the government’s changes help the nation, right?
Starting a blog is relatively easy – this one is built on http://Wordpress.org . It’s free to sign up and create your blog. You can even use the free URL that comes with the wordpress account, or you can go to a site like http://namecheap.com and buy an individualized domain to link your WordPress site to. So many options! Hit me up on email if I can help!
Many of you have made good points. I do think we need health care reform, but not the one that is propsed. I am a nursing student and have worked at different hospitals for 7 years. From what I see this bill is not going to “save” the gov’t money. As it is right now, patients come into our ER with medicaid (medi-cal here in CA) for a sore throat rather than going to a our hospitals clinic because the ER has no copay where as the clinic has a $5 copay (FYI-many are illegal residents). This is a huge cost to the hospital and taxpayer. SOLUTION: charge a $50 copay for all ER visits (just like more insurance plans). Also, our beds are full of homeless who again are on medicaid. Usually they are severally intoxicated. The police are now dropping them off at the hospital because of their budget crisis and layoff of staff. So the homeless stay for weeks at a time going thru DT’s just to return again in a month. NOW… when this new bill goes into effect how is the IRS going to force illegals and homeless to purchase insurance; they can’t! I feel the working persons are getting screwed, while the jobless are getting all the benefits. As for perscription go, I think the gov’t should put a cap on lawsuit settlements. Taking a perscription is a risk. Everyones body reacts differently. With a reduced liability like this the drug companies could lower the cost of perscriptions. Something like this could also be put in effect for hospitals and physicans. In the end, I am a healthy (thin, non-smoking/drinking, non-fastfood/soda consuming) person who exercises 3-4 times weekly and I do not think I should have to make up the health care cost for someone else who choses to sit on their a** and eat McD’s with a cig hanging out of their mouth. Maybe we should go back to a CASH only system and eliminate the insurance game all together. That’s my radical proposal.
Thank you for your thoughtful analysis of the new healthcare law. It is refereshing to see a level-headed analysis and then for the most part a calm and civil discourse. There is so much ‘noise’ in the community that these types of discussions need to happen more. Please keep up the excellent commentary on your blog!
Amy,
Excellent summary of Obama’s Heathcare Reform. There continues to be a lack of agreement in our industry on how the bill will impact urgent care. Our national association’s annual meeting is next week. It will be interesting to hear the latest views.
I posted your summary with the link back to this site on our Website, with the appropriate citation to you.
We ask what healthcare reforming is doing but maybe the question should be what is it destroying? I am sure most nurses that work at not for profit hospitals have seen the burden it is causing and this is only the beginning. I am a pediatric er nurse and teacher and I see the effects in both of my jobs. I became a nurse because I wanted to provide care and now I pass meds and start lines, ect. There is no time for caring. We cannot afford the caring aspect. Staffing cutbacks have devastated our profession. In an er and trauma center we currently staff for 160 pts and see 290. We cannot turn pts away from care if it is not appropriate like canada. That is an violation. So what happens with the system when cuts are proposed and initiated, we get less nurses and patients are at risk. I have been a nurse for 8yrs and now question my career. In the er, we on avg have 6pts per nurse and at the same time act as code/trauma team. We have lost over 12 nurses in 2 yrs and gained maybe 4 in return. We work harder and get less pay and no breaks. Govt healthcare doesn’t work when a large portion of the country can’t contribute to paying for it. Hospitals are broke yet we bail out car companies. We act as though we are helping the majority but the cuts hurt everyone. I would love to see a govt official sit through an avg nurse’s day. Maybe even use the health system we access. They have good care but does the public. Sadly, I know as a provider and patient our care has become heartless. We rush through care and hope nothing happens to our pts. I hate what the system has become.
Amy,
I want to ask you your personal opinon on this. I am looking to go to school to become a RN and i am a little scard due to this new health care act that passed. I want to ask you if you feel this is something that i can make a career for myself. I am just looking for feedback anything is great =)
Thank you
I honestly don’t believe that any healthcare reform will change the need for bedside nurses in a hospital setting. Patients are admitted to the hospital for one thing…. the need for nursing care. If they just needed to see a doctor once a day, they would have daily appointments in the office. If they needed testing done, they would make an appointment as an outpatient. If being a nurse is what you can see yourself doing, go for it. Although, due to the economy the market to become a nurse is tough… hospitals do not have the budget to hire staff. I just finished as a clinical instructor for a group of 9 nursing students. They all just passed their boards and are now RNs, but only 4 of the 9 have jobs. So, if it’s something you are passionate about, time to get enrolled. Good luck!