Now that President Obama supports Medicare for All,

[ismnotwasm]

146. Affordability can come in steps

Because just as with the ACA, once everyone is fully insured we will NOT have enough healthcare workers. I stay out of many arguments, but this one point gets ignored and it makes me crazy. Hospitals are already under-reimbursed for care provided by Medicare, yet without Medicare, hospitals won’t function at all. As it is, people still show up to Emergency as their primary care providers.

This is why I wanted a public option, why I still want one. A combination of public and private insurance, along with, say, more incentive grants (we have incentive grants for poorer areas and for areas like psych in nursing). There are also other avenues, nursing leaders are already working on it.

What I’m trying to say, is payment and how to pay for is, yes, a big huge deal—one that could be solved by shrinking our military budget but that’s most likely not going to happen in significant enough numbers, even with a Democratic majority—but it’s not the only or most immediate problem. I wish this conversation was broader. I hate catch phrases, because they don’t convey the entire picture.

What the average person think M4A looks like is show up to the doctor, get diagnosed with, oh, appendicitis check into a hospital to get a laparoscopic remove along with the nursing care medication, radiology and post-surgical teaching and follow up—and it’s all paid for by the government. Sounds good right?

Unless the lap turns into open surgery and you develop peritonitis and go into septic shock including respiratory failure, requiring a 3 month stay instead of a 2 day, along with extensive rehab needs. Your price tag has just increased exponentially. So, fine the government pays for this as well, kismet.

What I’m trying to say to “cost” includes a lot of variables and there are no hard numbers, even though Medicare now bundles costs—so much and no more for a hip replacement for instance. Hospitals that take on more of the underserved—like the one I work on, get a little bit more money because we do it. A M4A plan would theoretically remove the need for this, right? Except it won’t. Things will get paid for, but it’s my belief that difficult to care for patient, whether by diagnosis or behavior will still land on certain hospitals, because we will have the resources to care for them, (talent, diagnostics equipment, number of staff) whereas a country hospital in a small county would not.

I’m not being as clear as I would like, I want to convey that as fucked up as our system is, a wholesale Medicare expansion will have to come with a variety of “fixes” and absolutely have to a provision to get the number of healthcare workers we need to par. It also needs powerful focus on preventative care. It also needs, yes a viable way to pay for it. The drug companies need an entire separate rant.

I want universal healthcare. We discharge people that the streets, because their home is their car or van. We find shelters. We do emergency dialysis on renal patients who missed their dialysis for one reason or the other. We take care of junkies. We takes care of adults who have been in and out of the system since the day they were born. We take care of people who have half their livers removed to save their lives or who need intricate valve and aortic repair because of complex aneurysms. We take care of plastic reconstruction surgeries for the disfigured.

We do so much, we are distanced from the cost of it all, or we were, but now cost is brought into everything.