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July 5, 2012

Addressing The Real Healthcare Problems

Patricia A. Kelly

I don’t fully understand President Barack Obama’s healthcare reform act, although, as a working nurse, I do understand a lot. While our president rejoices that the Supreme Court upheld the constitutionality of the requirement of individuals to purchase health insurance, he should be tossing and turning at night over the meltdown that will soon be coming if this bill governs our health care system.


If financial waste is not addressed, healthcare alone will bankrupt the country, never mind the national debt. If the failure to provide needed, less costly, common sense care is not addressed, 98,000 deaths per year in the U. S. due to medical errors will soon seem like small potatoes.


The bill’s focus on reducing provider reimbursement will worsen healthcare, and probably decrease provider availability. This has already been tried by the private insurance industry, with the result that physicians, in order to cover costs and make a decent living, increase the number of patients they see. Since they don’t know their patients, they order more tests than ever. Many of these tests are not only expensive and wasteful, but they are actually dangerous.


Unless the physician becomes a manager, delegating care to mid-level providers, he will not be able to afford to practice. The number of physicians will likely decrease, except for foreign-born physicians who find the American reimbursement system better than the one they left behind.


Physicians, who can avoid taking the patients with the lowest reimbursements, will certainly do so, just as many now refuse new Medicaid patients.


Americans are afraid of “Death Panels” under the new law. Some of that reflects misunderstanding of the provision for physician reimbursement for end-of-life family conferences. These conferences do not sentence people to death. Rather, they provide an opportunity for patient and family to understand likely outcomes and benefits of certain treatments, so they can get only the care they deem appropriate.


Rationing, which already exists in the form of claim denial, can only grow worse if the government pays for everything.


What really needs to happen to our medical system is the opposite of where we’re going.


What should happen is that medical insurance should be insurance-against big ticket items that might or might not happen. Other care should come from medical savings accounts.


People who can afford it should be required to purchase health insurance, unless they agree in writing to refuse any medical treatment. Just like the question of wearing a helmet while riding a motorcycle, or a seatbelt in a car, it’s okay not to do it if you agree not to seek or accept care for any injury.


Consider, as a society, how much treatment reimbursement there should be for people who are causing their own illnesses. Should a current heavy drinker be eligible for a liver transplant?


Utilize healthcare personnel differently. Instead of two-story hospital lobbies with waterfalls and player pianos, add a few nurses and ancillary personnel.


There is clear evidence that nurse patient ratios influence safety of care. Now, it is common for nurses in telemetry to carry a patient load of four to six, and on medical surgical units, six to eight patients, during the day, more at night. In intensive care, two to three patients with no ancillary assistance is not at all uncommon. In my experience in one intensive care unit, there was a very appropriate requirement to turn all patients every two hours to prevent skin breakdown. However, there was often no one available to assist with this process.


Just imagine trying to turn a patient who weighs 250 lbs, who is connected to a ventilator, has a feeding tube, multiple intravenous lines, a urinary catheter and electronic leg compression stockings – by yourself! It is amazing that there is not a turning team in every hospital in the country. One nurse and three techs, 24-hours a day vs. bedsores, pneumonia, unrecognized infections and all the complications of bed rest would be a small price to pay.


People are, more and more, bringing family to stay with them in hospitals due to lack of care. Nurses should have time and adequate physical help to assess and properly care for their patients, not to mention meal coverage. Would you really want care from someone on a 12-hour shift who had no break and no assistance? What do you think his skill level would be at hour 11?


Nurses should be rewarded for critical thinking – and have the time to do it. We’d all be better off.


Twenty years from now, when all the people getting unnecessary CAT scans because their doctor doesn’t know them well enough to trust them to come back for persistent symptoms, come down with cancer, maybe we’ll take a look at what’s really wrong.


That is, if we’re not completely bankrupt.


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