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Of Hospitals, Health Reform, Republicans—and Blue Dog Democrats!


It is going to affect all of us, it’s meaningful and exciting and full of opportunities, and it’s safe to say that it’s complicated and painful! It, of course, is healthcare reform. Here’s the rundown.

On June 19th, the House Tri-Committee released a draft bill on health reform that includes a public plan financed by premiums. It would initially reimburse healthcare providers using Medicare’s lower rates. This, in turn, triggered predictable responses from the American Medical Association, the health insurance industry, and House Republicans:

  1. Doctors and hospitals say a public plan that forces them to accept lower payments (Medicare rates) would shrink their incomes dramatically.
  2. Insurance companies say a public plan would have “built-in advantages” that would allow it to “take over” the insurance market.
  3. Republicans worry that a public plan would amount to a “government takeover” of health care that would cost untold trillions.

In response, the House Republicans proposed individual tax breaks for buying health insurance and “pools” of states and small businesses to get lower-cost healthcare plans. They also proposed increasing incentives for people to build health savings accounts, allowing dependent children to stay on parents’ policies until age 25, and encouraging employers to reward employees for improved health. This, of course, assumes that the uninsured/underinsured have the money to save, get tax refunds, etc.

The Obama Administration says that a public plan with millions of members would:

  • Use its large market share to negotiate lower reimbursement rates for doctors and hospitals
  • Let Americans keep their coverage when they moved, changed jobs, or weren’t working
  • Have lower overhead because it would not have the marketing expenses, broker commissions, and profit margins of private insurance and so would have lower premiums
  • Would provide uniform and large-scale reporting of healthcare procedures and costs—-data that could be used to improve efficiency.

On June 19th, the Senate Finance Committee leaked a 10-page draft of four alternative views of what a public plan might look like:

  1. A Medicare-based plan in which providers would be paid the same rates as Medicare reimbursements. Premiums would be the lowest of any model, but government costs would be the highest.
  2. A self-sustaining plan in which premiums would cover the cost of claims. Patients would pay more than under the Medicare model but less than for private insurance.
  3. A triggered plan in which the “public plan” would kick in only if private insurers did not sufficiently expand coverage and lower costs to certain mandated levels at some as-yet unspecified future date.
  4. Regional co-ops that would be owned and operated by states/regions and would collect premiums and provide coverage (keeping the Federal Government out of it).

So where are the Blue Dog Democrats? Pretty much between a rock and a hard spot!

Fiscal conservatives are concerned about costs (estimated at $1 trillion—and government estimates are notoriously low!), yet facing a public that actually is demanding reform and a Democratic Administration that is determined to reform health care. They are both caught and key. Without their support, Republicans will prevail…and the U.S.A. will continue its failed experiment with market-based reform. There’s no escaping it: Healthcare reform is bitter medicine. Lawmakers are going to have to stifle their reluctance to impose mandates and—yes—some form of taxes. Lobbyists for the insurance and pharmaceutical industries are fighting tooth and tong to protect their constituent’s profits. And AMA, while favoring reform, is not supportive of any plan that will cut physician reimbursement. So far, the hospital industry is the only one making any concessions. Last week, Vice President Biden announced that the hospital industry pledged to contribute $155 billion in Medicare and Medicaid savings in the next decade. And this undoubtedly will affect how much everyone who works in a hospital, including nurses, actually gets paid.

So where are you nurses? Make your voices heard…whatever happens, you, we, all of us, will feel the results!

19 Comments. Leave new

  • Not this reform
    August 28, 2009 2:19 am

    The ANA has not spoken for me by endorsing this amorphous health care reform. I have read the HB3200 and there is plenty in it that should raise alarms for nurses. I am disappointed that the ANA has endorsed Obama care based on the cult of personality, and not based on actual improvements in care delivery and access. I wish I could have my 30 years of dues back.

  • Maybe politicians should start listening to what the people are saying in regards to healthcare reform. The American public has legitimate concerns that a system will be created that is inefficient and costly, particularly to middle class taxpayers. Yet when the public does voice opposition, they are termed un-American, extremists,etc. The problem has been around for years – why hastily implement a reform that won’t work just to promote a political agenda?

  • This public option cannot happen! The government can’t run anything. Now our health care??? yes reform is needed but not this socialist reform. Yes I will make my voice heard and I pray the republicans and blue dogs prevail.

  • I think that I would definitely be more in favor of government funded care/insurance if I saw evidence of the benefits being distributed fairly- to those who truly need them. There are many ways to work around the system (and there probably always will be), but why can’t we work first on eliminating these ‘leaks’ in the system and then reform things?

    I don’t think it’s so much about a pay cut- it’s about a pay cut that helps those who are capable but unwilling to give back.

  • Something that I can’t help but ask: Where in the constitution does it assure citizens health care? I believe that it is important to take good care of our bodies, but short of those who are unable to care for themselves, why should the government carry that burden? Having cared for patients on medicare/medicaid that can talk your ear off but are, “too sick to work” I can’t help but wonder why they aren’t telmarketers. I think that more than a reform we need to review who is receiving.

  • Leah Curtin
    July 20, 2009 1:32 am

    Compensation Data Healthcare 2009, salaries for registered nurses have increased by 9.2 percent in the last 3 years. Registered nurses’ salaries average $61,300 a year. From year to year, salary increases for nurses have been between $2,000 and $3,000…but this is before health care reform…and the recession…

  • Who can favor a pay cut for nurses? I for one am willing to think about it only if every other person working in health care – starting with Administration – takes a proportionate pay cut!…But I do not think that nurses will suffer deep paycuts – thought there may be some small cuts initially; rather I think many new opportunities will open for nurses, and that we can and will be an important part of the solution to the health care crisis.

  • There really is no good solution to our health care,but something definitely needs done. I agree with the below comments that it seems as though the best plan would be the self-sustaining plan, that way the nurses’ pay would not be affected and the health care system would work more effectively.

  • I was discussing with a physician I work with about employers (specifically in healthcare) rewarding employees for improved health. He brought up an interesting point that we aren’t really the only ones benefiting from getting our health screenings done. The hospital for which we work is also making a lot of money because of the follow-up appointments that are being made for those employees who find out they have hypertension or hyperlipidemia.

  • Someone is going to be treated unfairly but why does it have to be the nurses who work so hard to take care of their patients! I wish that everyone could walk (really run) a day in our shoes and they would find out what we truly do day in and day out. Then maybe they would consider not cutting our pay! It is so important that we as nurses stand up and make our voice heard.

  • I agree with both commentators below. I am also attending graduate school. As a RN already, I feel that we are already underpaid and understaffed. With this new proposal it could only make things worse. After completing graduate school, I hope that I will be able to find a job that pays me for what I have accomplished and for the advanced skills that I have acquired. With this new proposal, this may not be very easy! The saying “nothing is fair in life” is very true in this situation.

  • My comments go from bottom to top.

  • Patients would pay more than under the Medicare model but less than for private insurance. This way no one will get hurt financially. Insured people will not be burdened by big bills out of their pocket and at the same time nurses and other professionals will not get hurt by their wages and the medical system could be more effective.

  • Like Lydia mentioned, either way you look at it, the working conditions would be less than ideal. The efforts being made to try and solve this issue may help somewhat, but in the end someone will be getting the short end of the stick. I was discussing this issue with my father and we both agreed that out of the four plans given, the self-sustaining plan would be the best choice.

  • I do have to agree with Lydia’s comments. I too am a graduate entry nursing student however for me, my opinions are short and bittersweet. No matter what way one looks at this situation, I believe there really is no solution. The medicare and medicaid savings will hurt us as nurses regardless. Having medicare and medicaid save will result in nurses being paid less which can then result in a decrease in the amount of nurses, thus increasing their work load.

  • I had a lot to say! My comments go from bottom to top though!

    Though this may be an extreme case, we have to consider, what will happen if those who carry the burden of health care costs shrug? Costs are clearly rising, and with the population aging and the social security system promising more than it has available, the money has to come from somewhere, more specifically from tax payers, including nurses.

  • As a fiscal conservative, the prospect of health care reform concerns me! This is a costly venture, and there is no guarantee that it will succeed. Something of particular concern is the prospect of imposing a tax on those in the higher tax brackets to cover costs. In Ayn Rand’s, “Atlas Shrugged” the burden of caring for the people was imposed on those who worked the hardest and eventually they grew weary and, “Shrugged” their burden, leaving those who relied on them without means of survival.

  • As a graduate nursing student, it is my hope that I can find employment that provides what I believe is fair compensation for my skills and an environment where I can practice safely. The prospect of changes in the system leave me wondering how likely this is. It IS up to us to make our voice heard in the midst of these changes so that we can influence decisions that will affect our practice!

  • You are right that it is nurses that will feel the results of any changes that occur in the health care system! Your mention of Medicare and Medicaid savings impacting nurses is an especially important issue. In my opinion, the savings can come from nursing in two different ways: Nurses can be paid less, or fewer nurses can carry a heavier patient load. Either way, the working conditions are less than ideal.


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