I suddenly don’t feel so sorry for myself about cutting back on dining out. CBS News is reporting that our souring economy is causing millions of Americans to think twice about even the most basic healthcare:

"Is it worth the $300 to go into the doctor's office, to tell me I have strep, and then get a prescription filled that my health insurance doesn't cover for another $50?" [Gabrielle] Revere asks.

The effects of the economic crisis are only just beginning to hit Main Street. But, already, a new survey shows that over 80 million Americans – even those with health insurance – are being forced to cut back on healthcare.

According to the CBS News report, “thirty-six percent of Americans are delaying care - a big jump from six months ago. About 30 per cent skip a test or treatment; 27 percent don't fill a prescription.”

The most obvious effect of this is on the health of the people who avoid care and let their condition worsen. But, the ripple effect it will have on the role of caregivers to provide more acute care could be especially powerful.

Even when our economy is strong overall, America's ERs are overcrowded and short staffed.  All the more reason during this economic freefall for our next administration and our next Congress to take the preventive approach and agree to make fixing our nation's healthcare system their first priority.

Check out video from the report here: http://www.cbsnews.com/video/watch/?id=4537751n.

As a way to thank all of you for helping to grow the healthcare movement, we recently offered free bumper stickers to caregivers who have invited their friends to join Healthcare United.

Requests came in by the hundreds - from all across the country - and we thought that it’d be fun to show just how large Healthcare United spans.

We’ve just received pictures from our community members, and we’d like to share them with you.

Here’s Joan from Florida with a Healthcare United bumper sticker on her car:

And here’s Ernie from North Carolina, with a bumper sticker on his pickup and his mailbox:
As more pictures come in, we’ll keep sharing them with you.

We’d also like to extend this offer to all members of the Healthcare United community.  To request your free bumper sticker (free shipping, too, while supplies last!), click here. 

And, don't forget, once you've received your sticker, take a picture and send it to sticker@healthcareunited.org for a free t-shirt!

From October 22nd through the election, Healthcare United is asking caregivers to participate in a nationwide online poll on who caregivers are supporting Nov. 4th.  You can participate by submitting your preference in the form below. We'd appreciate if you could promote this poll on your blog or website, and to colleagues via email. Just send them to this permanent link: http://www.healthcareunited.org/thepoll

Yesterday, the American Health Line reported on a new Economic Policy Institute report that claims the “health care proposal announced by Republican presidential nominee Sen. John McCain” would “prompt many employers to drop health insurance for employees.”  

According to report authors Josh Bivens and Elise Gould, “as many as 27 million of the 165 million U.S. residents who have employer-sponsored health insurance would lose their coverage under the proposal.”

While Bivens and Gould concede that the current system is “far from perfect,” it does “pool and spread risk,” whereas the McCain plan would not.  They concluded that “kicking away the foundations of this system should only be done if there is a well-crafted alternative.”

That “well-crafted alternative,” of course, does not exist. Just the other day, the New York Times reported that officials in pro-business organizations like the U.S. Chamber of Commerce, the Business Roundtable and the National Federation of Independent Business, were voicing concern about Senator John McCain’s healthcare plan.
 
Their main gripe?  Senator McCain’s plan, which eliminates the exclusion of health benefits from income taxes, would “accelerate the erosion of employer-sponsored health insurance.”
 
The executive vice president for government affairs at the Chamber of Commerce, R. Bruce Josten, was quoted as saying:
 
“To some in the business community, this is very discomforting.  The private marketplace, in my opinion, is ill prepared today with an infrastructure for an individual-based health insurance system.”

Link: http://www.epipolicycenter.org/researchbulletin100.html

When Barack Obama answered straight up in the last debate that he considered healthcare a right, I leapt to my feet and cheered.

You see, I’m an R.N., and recently I’ve come to the brink of professional hopelessness. I really needed to hear that word “right” coming out of my TV. 

One day, I had a meeting with the administrator to whom I reported (I’ll call him Ernest).

I took a seat in Ernest’s sunny office. Meanwhile, Ernest pulled a chair from behind his desk so as to sit directly in front of me.  The way he leaned forward, the concerned frown that somehow didn’t entirely negate his smile—yes, everything about Ernest’s affect said that he’d be fair, that he’d hear me out.

I didn’t know Ernest that well. He was relatively new to his position. For the most part I’d found him intelligent and pleasant to work with. In recent days I’d been communicating a lot with him—meetings, emails, memos.

In my communications, I’d been saying that we needed to hire at least one additional nursing assistant for the evening shift. I’d been saying that the nursing assistants (most of whom were long-time, valued employees) had been spread too thin.

In his communications, Ernest had always said the same thing: the budget wouldn’t allow for another nursing assistant.  

That day in his office, Ernest allowed me wring my hands and argue passionately on behalf of both the patients and the staff. And when I was finished, he had something new to say: he suggested I resign. 

“There’s no denying you’re a good nurse,” he said, still smiling, with pity now. “But the problem is you’re not suited for this position. You’re too idealistic. You’re working against this team.” 

I saw it clearly then. Ernest had a point. All I had to offer his team was my training, my experience, and my passion for hands-on care. Had the goal been to deliver only excellence in nursing, I’d have been plenty suitable. But the goal was really to provide nursing services, and those services where only as good as they were affordable.

I saw it clearly then. The healthcare workers of America keep striving to take care of people who are sick, or in pain, or vulnerably newborn, or vulnerably old, or dying.  Some healthcare workers—like me—hold fast to the belief that patients have the right to that care. But the truth of the matter is that both the patients and their caregivers are cogs in a system that doesn’t operate on rights.  The system operates on the market. It strives to produce services that sick people can afford to buy.  

I’m thinking of that day in Ernest’s office right now.  And at the same time I’m hearing the hope in my head, over and over: Healthcare is a right. Healthcare is a right. Maybe someday I’ll go back to Ernest’s office, and re-apply. Maybe he’ll be happy to have me back?

We asked you to tell us how your hospital is responding to CMS's October 1st rule that Medicare will no longer pay for ten Hospital Acquired Conditions (HACs).  Here is a brief taste of nurses' responses to date.

More Paperwork, yes; but more staff, not yet.

No nurse has yet responded that her hospital has responded by improving staffing.  Instead, a typical reply from Wisconsin . . .   "We already spend so much time charting that we really cannot see our patients except to do quick assessments.  I know for myself, I am going to starting keeping a time log to show my bosses how much time I spend with the patients vs doing everything else.  Maybe if we do that, we can show that we are more paper-pushers than nurses and that's not right. "

Listen to nurses, or punish nurses?

"In speaking with my co-workers, most of them do not even know of the new Medicare rule because nurses are not kept up to date on the financial workings of the hospitals or the additional cost of the HACs." (Wisconsin) " My hospital has responded by flyers and increased charting and punishment for nurses that are involved with a patient that has 1 of these HACs. they have not addressed any staffing issues and if anything they have actually increased our workload with fear of punishment looming over our head." (Nevada)

It takes a team to care for patients.

"...Hospital administrators need to be more in touch with what their employees including housekeeping. They are equally as important in fighting against infection and injury". (New Jersey)

"...Even the techs are spread too thin. Patients get up who shouldn't and try to make it to the bathroom because their call lights go unanswered or take too long because techs are overworked... Patients are not turned regularly even when they are supposed to be. Little things that add up to possible disasters on the part of both the nurses and the techs." (Missouri)

Unintended consequences

"There has been an increase in C-Diff since this has been occurring. Some of the nurses in the hospital state if they suspect C-Diff they are suppose to discharge the patient. Often we are unaware of the DX of C-Diff until they come to the facility and are placed in a room with a patient without C-Diff. I think Medicare's plan has already backfired. We are infecting more people instead of trying to contain the diseases."

While the jury on how hospitals are implementing the new CMS rules may still be out, so far the verdict from frontline caregivers is not good.  Instead of addressing the root causes, such as short-staffing, of patient care quality problems, hospitals appear to be focusing on charting and documentation - thus adding even more paperwork burdens that drain even more of nurses' time away from caring for their patients.

What's going on at your hospital?  Stay tuned, and we will continue to report back as we hear from the frontlines of patient care.

On Saturday, Oct. 18th, Colorado 4th District Congressional candidate Betsy Markey spoke to caregivers attending a Healthcare United chapter meeting in Fort Collins. We captured a portion of Markey's presentation on video:

After speaking, Markey signed the "Healthcare for American Now!" pledge, which Presidential candidate Barack Obama signed last month.

Healthcare United caregivers ended up submitting 1,390 questions to Steve Chaggaris, the Political Director of CBS News in preparation for this week's final Presidential debate.

While many of you took this opportunity to ask hard-hitting questions on staffing, the nursing shortge, and Medicare/Medicaid reimbursements--to name a few--some of the most compelling submissions contained personal anecdotes from the frontlines of U.S. healthcare. A selection of our favorites are provided below:

"I've been a nurse for 20+ years and have seen the end results of not having insurance. It's not a pretty sight. I see so many of our baby boomers (50+) working long past their prime because they can't afford to lose their health insurance. These are folks that have worked hard all their lives and paid their taxes. Now what can we do to help protect their/our health care?

...I also see another group without health care. It's sometimes referred to as the working poor. They make too much for Medicaid/welfare but can't afford the high cost of insurance. There are some states that have insurance for this population but many states do not. They're our future, [and] without adequate insurance the future looks bleak."   - Debbie, RN, Arkansas 

"As a Social Worker who has spent the last 16 years working with children, I cannot tell you how many times that the kids on my caseload have not had access to medical care because they fell between the cracks of what their parent(s) earned and the real cost of living. Many kids have had to go without dental care, without glasses, without braces and without medication which might treat a plethora of illnesses. These have lead to illnesses of more gravity. Parents too, have not had regular medical care, which have caused loss of jobs and sometimes loss of life plunging kids into the foster care system where costs are substantially higher...."   - Denise, MSW

"As an oncology nurse I have watched my patients suffer from many physical and emotional problems. One of the worst I see every day is patients being told that their insurance company does not pay for the best care we could give them. Much of the nurses' and doctors' time is spent filling out massive amounts of paperwork and making time-consuming phonecalls to beg for things that we know the patient would greatly benefit from. This could be a drug for nausea or one to increase white blood cell production. They are denied the newer, more effective, and less painful ones and instead we must use old, ineffective treatments first, have the pt fail, and then we might be able to give a more appropriate remedy."

"Because insurance companies will only pay for one procedure per day the patients are forced to come day after day for each one so that our office will receive compensation.These are people who are suffering from pain, fatigue, nausea, and lack of transportation. My greatest hope is that patient care will someday be placed back into the hands of the doctors."  - Donna, RN, BSN, Michigan

 

In 1986, the Emergency Medical Treatment and Active Labor Act declared that hospitals cannot refuse care to critically ill patients and that an on-call physician must treat them. While this sounds great in theory, it doesn't quite work out this way in practical terms.

Some doctors have reported that up to 20% of the patients they treat at hospitals are uninsured. So what does this mean for these patients? It means unequal treatment. It means that they get shorter consultations with doctors, which could lead to inadequate care.

A 2006 study conducted among physicians reported that 90% of them admitted to changing patients' clinical management based on their insurance status. In some ways, this decision has a negligible effect, such as opting for generic versions of drugs as opposed to more costly name brand varieties.

But what about the heart surgeon who schedules uninsured patients last and regularly bumps them to the next day if his insured patients take longer than expected?  It’d have a detrimental effect on patient health. Or how about the gastroenterologist who routinely is quick to perform colonoscopies on insured patients, but is very reluctant to do so on uninsured patients? You’d think that the Hippocratic Oath would outweigh the profit motivation in modern medicine, but surprisingly in many cases you would be dead wrong.

Not only are uninsured patients regularly discriminated against by doctors, but they are also less inclined to do recommended tests and treatments. Another study, this one conducted in 2003, found that patients without health insurance were 30 % less likely to undergo routine screenings. Over the long run this means that illnesses that could be corrected early or managed with medication are left untreated and eventually become life threatening and expensive to treat. This puts a tremendous burden on our nation’s resources at a time when we can hardly afford it.  

The fact of the matter is that in America we have 47 million people without health insurance. When we consider the current economic climate, with thousands of people losing their jobs and thousands more losing their employer-based health insurance, this figure is sure to rise. We need solutions to this crisis immediately -- and emergency room care is not the answer.

For complete article: http://www.washingtonpost.com/wp-dyn/content/article/2008/10/10/AR2008101002679.html?nav=rss_health

This week’s MedBlogger Roundup is an eclectic mix of posts from over the last week, from wonky policy posts to first-person experience in the medical field.

Here's what's caught our eye:

1) Emergiblog: “The Nursing Shortage: A Sticky Wicket.”  Kim at Emergiblog has a thought-provoking post about the nursing shortage (a subject that we’ve posted about on our blog quite often) and why it’s leading nurses away from the profession that they love.

Says Kim:

“Nurses quit because there is little in the profession that causes them to ‘buy-in’, to be loyal to the profession. Oh, we all start out like that. We ‘buy-in’ to the altruistic, self-sacrificial, ‘angel of mercy’ persona for awhile.

But within a few years we find our altruism singed around the edges. We have increasing responsibility with very little power to control our work environments. There is little incentive to advance our education, as if we had the energy to actually do it. The patients are emotionally demanding. The work is physically demanding, especially for those of us (cough!) who are veterans of the profession.”

Kim concludes:

“Oh, there were times it looked like the grass was greener outside of nursing and I thought about what it would be like to do something else. But nursing is in my blood at the genetic-molecular level; map my genome and you’ll find it. My chromosomes are shaped like tiny nursing caps.

Nursing isn’t something I do, it’s something I am.”

Read the full post here: http://www.emergiblog.com/2008/10/the-nursing-shortage-a-sticky-wicket.html

2) Effect Measure: “Annals of McCain – Palin: The Medicare Fraud of John McCain.”  Over at Effect Measure, Revere (the handle of all of the authors) writes about Senator McCain’s proposed $1.3 trillion in Medicare cuts.  The author, who depends on Medicare, isn’t too thrilled:

“Here I am watching 20% of my retirement savings going down the toilet and John McCain tells me he will be doing me a favor over the next ten years by cutting $1.3 trillion from the Medicare and Medicaid budgets. $1.3 trillion. I'm on Medicare and I am not too happy about this.”

“He wants to give me a $2500 tax credit for health insurance that will cost me much more. Meanwhile my Medicare benefits will likely shrink. Thanks, but no thanks.”

“The savings by squeezing out fraud and abuse in Medicare and Medicaid is supposed to be $1.3 trillion? Yeah, right. So my benefits won't go down? Yeah, right. Like the economy is fundamentally sound. If change means making things even worse, then McCain is for change.”

Read the full post here: http://scienceblogs.com/effectmeasure/2008/10/annals_of_mccain_palin_xxi_the.php

3) WSJ Health Blog: "Obama, McCain Debate Whether Health Care Is a Right or Responsibility." Following our coverage of last week’s medblogger debate on whether healthcare is a right or a moral obligation, the Wall Street Journal’s Health Blog covers a section in last week’s presidential debate where Senators Obama and McCain debate this very subject:

“Is health care in America a privilege, a right, or a responsibility?”

Tom Brokaw threw that question at John McCain and Barack Obama in the middle of last night’s debate. Their answers went beyond the already-familiar details of each man’s health care plan to suggest an underlying philosophy.

McCain said:

    I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. … But government mandates I — I’m always a little nervous about. But it is certainly my responsibility.

Obama said:

    I think it should be a right for every American. … for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.”

Read the full post here: http://blogs.wsj.com/health/2008/10/08/obama-mccain-debate-whether-health-care-is-a-right-or-responsibility/

As always, if you have a blog post to submit for consideration, please e-mail me at brad@healthcareunited.org!

Teri Mills is the president of the National Nursing Network Organization and is a strong Healthcare United supporter.  You can read her own blog here.

Our nation’s healthcare system remains in critical condition and unless significant policy changes occur, we may be spending up to 20% of our gross domestic product (GDP) on healthcare in just a few short years.  This equates to $4.2 trillion dollars -- more than six times the $700 billion bailout package passed by Congress earlier this month (Poisel, 2007).

Nurses around the country are determined to make a difference, and are reaching out to other nurses to make sure they too know what is at stake with this upcoming election.  

Here in Oregon, nurses gathered on what turned out to be a particularly gorgeous Saturday morning. While the leaves were falling off the trees and children were taking advantage of playing outside before the rain returned, we gathered around desks and called every nurse that has been registered to vote in Oregon's Fifth Congressional District.

We found out that each nurse we spoke with overwhelmingly wants to see all Americans receive affordable and accessible healthcare.  They were interested in hearing about the candidate's past voting records and indicators of what they would do to change the system.  Most of them had made a decision of whom they would vote for President, but surprisingly few knew the voting records of the U.S. Senate candidates.  

There is about three weeks left until voting begins, but in our state, voters will begin receiving their mail-in ballots on October 17th, which is in just a few days from now.  There’s a lot more work to be done, however.  Healthcare workers are familiar with advocating for our patients at the bedside and in the community.  Now we must take our advocacy one step further and speak up for the American public in the political arena.  Our country and our people are depending on us.  Nurses respond when called by another peer! Please visit http://www.healthcareunited.org/action/phone_calls/ and start making your own calls.

Source: Poisal, J.A., et al, Health Spending Projections Through 2016: Modest Changes Obscure Part D’s Impact. Health Affairs (21 February 2007): W242-253

Healthcare United participated in the Citizen Action of Wisconsin press conference (10/7/08) releasing their report on the increasing cut of healthcare spending that health insurance premiums have on divert to waste and profit. You can find the report here.

Janice Bice-Allen, a Green Bay psychotherapist, spoke at the press event, as did US Rep. Steve Kagen (the two are pictured together at the event).

 

It's been seven years in the making, but on Wednesday, Pennsylvania state legislation against mandatory overtime for nurses and healthcare workers passed its last hurdle on its way to the Governor's desk. The Pennsylvania House of Representatives passed a concurrence vote on House Bill 834, accepting amendments made in the Senate. Governor Rendell signed the bill into law yesterday, October 9th.

Nurses and other healthcare workers cheered from the gallery as the vote was announced. This victory is the culmination of a 7-year struggle by nurses and other healthcare workers who repeatedly marched, called, emailed and lobbied their legislators to support this important patient safety legislation. Beginning July 1st, 2009 - except in cases of true emergencies - mandatory overtime will be a thing of the past for any healthcare worker providing direct patient care.

"This is one big positive step forward for patients and nurses across Pennsylvania," said Kathy Magaro, RN. "We had champions in both the House and the Senate, but the real heroes are the nurses and other direct patient caregivers who met with legislators again and again to tell them the reality of mandatory overtime and why this ban is so important to them and their patients."

This is an incredible victory for Pennsylvania caregivers and their patients. When the law takes effect on July 1st, no nurse providing direct patient care will be forced to work overtime except in the case of a true emergency or unforeseen event. Nurses and other caregivers will no longer have to worry about making mistakes or falling asleep while driving home because we had to work over our regularly scheduled shift.

What an amazing moment for Pennsylvania and the future of health care.

• Read an article from the Wilkes-Barre Times

 

Senators, we've heard a lot in this campaign about what ordinary Americans worry about around the "kitchen table."  Alas, the venerable kitchen table has become something of a stump-speech cliché.

I'd like to propose a change from that kitchen table to other kinds of tables.  I'd like the candidates to focus on the tables found in operating rooms, or in hospital waiting rooms or in clinics.

If we go to these tables, we will hear the voices of the people who are both sick and frightened-frightened about what's going to happen to their families, simply because they can't afford the medical care they need.  And you both have already demonstrated your concern for these very people.

But what the American people need now is not convincing that all of America is suffering because of our broken healthcare system.  That's the given. What the American people really need now is for you to debate on the broken healthcare system as though you understand that system from the inside out.  The American people need you to zoom in on the specifics.

And that's why I think the change of your focus - from kitchen table to operating table - would be so effective.  Because in the medical setting you will find another set of ordinary people-the healthcare workers of America.

Senators, the healthcare workers of America don't have to imagine what ordinary Americans suffer when they're sick or in pain. Even as you make your points on issues before the cameras on debate night, we will be right here, hard at work in the rooms of the sick and the wounded-including those wounded in war.   And we have something very important to tell you.

Mostly we'd tell you how terrible it feels to have the knowledge, and the training, and the passion for helping the sick, but to have our hands tied by a broken healthcare delivery system.

This deepening crisis is hurting all of us in this country.  But we healthcare workers are twelve million strong.  Remember that, as we watch you and await to hear your plans for our healthcare system on October 15. 

With constructive criticism of Senator John McCain’s healthcare coming from all ends – from “liberals” such as economist and New York Times columnist Paul Krugman to more traditionally conservative and pro-business organizations like the Chamber of Commerce and Business Roundtable – we at Healthcare United have decided to take a closer look at John McCain’s healthcare plan.

Our research, in the end, has produced three different documents:

1)    A fact sheet about Senator McCain’s new healthcare tax on American workers.  We conclude that this new tax on employer-paid health benefits will cause a number of events to happen that ultimately will eliminate employer-provided health insurance and shift Americans into the private insurance market.  As a result, out-of-pocket costs will increase for patients.

View our fact sheet by clicking here.

2)    A special report that estimates that Senator McCain’s plan will squeeze approximately $77 billion out of hospital systems and patient care.  The plan will drain a) an estimated $21 billion by ending employer-paid health benefits, b) an estimated $41 billion by privatizing Medicare, and c) an estimated $15 billion by putting banks in the healthcare business.

Read the full report by clicking here.

3)    A video, featuring Healthcare United’s very own Cathy Stoddart, RN:

Be sure to check out all three of these features, and let us know what you think by commenting below!