Is Sanford the "Walmart" of healthcare?

[Oxbow6]

Sounds like we should go out for a drink sometime : )

You think ONE drink is going to help!?!?!?

[Cratter]

The answer becomes and I know its not popular, but the government needs to take it out of your check. Everyone pays the same from life til death. Why do I pay for retirement right now but not health coverage. Almost seems backwards. If I get slapped with a million dollar health care bill, the last thing on my mind is how to pay for retirement.

[yzerman19]

But then the government determines your care...the end game is universal coverage as you describe for the masses, where you will get "basic" healthcare- people with money will buy commercial and get the best care in the world...it'll be like flying first class vs coach, but the difference will be your health and life expectancy.

Under obamacare your premiums will not go up if you get sick- they will start higher and stay there.

In the current world, they don't go up dramatically unless you let it lapse. Also, you can hit your lifetime max and be screwed either way!

[undhockey]

I am currently a floor nurse at Sanford and was there when it was Meritcare. I know as far the the nurses who work the floors, most are very unhappy and things are only getting worse, not better on our working conditions. We are taking higher acuity patients and they are cutting back our floor budgets and patient to nurse ratios. Nurse are getting burnt out and many looking for new jobs. We have no say in any changes and none of them make any sense. They are decided by someone who works in an office and has never been on the floor and we are given no input.

Some counselors have been sent out to floors with low morale and high turnover. They have been instructed by the higher ups to tell staff that if your not happy about whats going on then leave, you are replaceable. Our health insurance is absolutely horrible and over priced. I know some floors are not getting granted vacation times because they are so understaffed and their scheduler cannot approve them, but they are told they have to use their vacation before they loose it because they are nearing their max hours. They are understaffed because people are leaving because they get paid better somewhere else and just can't deal with the working conditions.

The amount of turnover has greatly increased since they took over. The nurses who have chosen to stick around are carrying the floors with all the new nurse which are mostly new graduates and have little to no experience. Anyone who is a nurse knows that you do most of your learning on the job, and there is so much you do not know after graduation Our floor does a good job of trying to pair each new nurse with an experienced one, which makes the experienced nurses almost have a double assignment because we are the ones making sure their patients are being taking care of and nothing is getting missed.We are also teaching them the skills they need to be a good nurse. Needless to say because of this, we end of being overworked and stressed and this has made many experienced staff begin to dread coming to work and our leaving.

Instead of doing something to keep the nurses who are here, they choose to try to bring in new experienced nurses with a $15,000 bonus. This pretty much was a slap in a face to us who have stuck around and we lost even more nurses. We were told we got bonuses and raises, that should be enough. I am sorry but a $300 dollar a year bonus and a our 1-3% raises up until last year it was 3-4%, does not make up for the $15,000 bonus they gave to these nurses.

I will say though, I would go to Sanford if I was sick. They are very good at bringing in highly recruited physicians and they do a lot of things that other hospitals aren't capable of because of their recruiting. I know that our floor does a great job of making sure all the patients are taken well care of due to the fact of our pairing of nurses and making our experienced nurses watch the new nurse closely and check on their patients often throughout your shift. I will also say that I don't know how much longer we can keep this up. We are running out of experienced nurses because of burnout and many people are leaving that had worked their for 20+ years.

I hope that things do turn around but time will tell. I am not anticipating that to happen if Sanford doesn't figure out that they need to be treating their nurses well because they will not run if they do not have us. I just had to paint the picture of what I have seen because I don't think a lot of people in the general public know what goes on behind the scenes. This is only my experience. Different areas may have a completely different experience.

[Cratter]

But then the government determines your care...the end game is universal coverage as you describe for the masses, where you will get "basic" healthcare- people with money will buy commercial and get the best care in the world...it'll be like flying first class vs coach, but the difference will be your health and life expectancy.

Under obamacare your premiums will not go up if you get sick- they will start higher and stay there.

In the current world, they don't go up dramatically unless you let it lapse. Also, you can hit your lifetime max and be screwed either way!

That's what happens now. Insurance companies determine your care. Rich people right now are still buying commercial and a gettingthe best care in the world. Didn't I just read most hospitals also already get millions from the federal government right now?

[fightingsioux4life]

I think it is important in this debate to remember the difference between health care insurance and health care delivery. They are closely linked, but are not the same thing. The British health system is 100% owned and operated by the government. The Canadian health system has single-payer government health insurance, but also has some privately-owned hospitals and clinics. I think the United States would be best served with a Federally-funded public option alongside private insurance options, along with the current system of public and private health care delivery organizations. Also, get rid of the state-by-state insurance rules and have a 100% national health insurance market so that insurance companies will have to compete for customers and can't monopolize each state. Obamacare was a step in the right direction, but it certainly isn't perfect and we are not finished with reforming our health care system.

[Cratter]

All I need is "basic" care. Doubt Altru or Sanford couldn't treat me. Insurance companies right now can deny things and are only required to do the "basic."

[fightingsioux4life]

That's what happens now. Insurance companies determine your care. Rich people right now are still buying commercial and a gettingthe best care in the world. Didn't I just read most hospitals also already get millions from the federal government right now?

You are forgetting Cratter, some people think if it's a private company determining your care, it's "free enterprise" (even though there is little if any competition). But if the government is determining your care, it's "socialism" and "tyranny". I guess I don't see much of a difference between the two scenarios.

[Oxbow6]

I think it is important in this debate to remember the difference between health care insurance and health care delivery. They are closely linked, but are not the same thing. The British health system is 100% owned and operated by the government. The Canadian health system has single-payer government health insurance, but also has some privately-owned hospitals and clinics. I think the United States would be best served with a Federally-funded public option alongside private insurance options, along with the current system of public and private health care delivery organizations. Also, get rid of the state-by-state insurance rules and have a 100% national health insurance market so that insurance companies will have to compete for customers and can't monopolize each state. Obamacare was a step in the right direction, but it certainly isn't perfect and we are not finished with reforming our health care system.

Your 1st sentence is key in any discussion involving healthcare.

[fightingsioux4life]

Your 1st sentence is key in any discussion.

Yeah, but I don't think most politicians in this country understand the difference.

[Oxbow6]

Yeah, but I don't think most politicians in this country understand the difference.

Neither do most hospital/clinic administrators!

[neoflex]

I’m in the health care delivery system and unfortunately this year we had to change our model of "health care delivery" as now we can only provide what the insurance allows or will pay for. The statement that rich people have better insurance and better care, goes along with most any commodity (hate to use that term), but you get what you pay for. In my instance, With certain insurance providers, we only allow so much time allotted per the reimbursement rate, for better payers, they get more time. Previous to this year, we worked with patient’s regardless of their insurance, and provided each patient with equal time and services,

It's unfortunate that it has come to this, but the reality is that many hosptials are also going to this philosophy, and will only treat or provide health care services "to a point". The obmacare is a very scary model of care. For those that can afford it, will be paying up 2X the premiums they are now but will get excellent health coverage, and those with the "basic" plan so to speak, will get basic care which means bare-bones and only what is deemed medically necessary treatment. What Sanford has done, was well stated by UNDhockey poster, in that administratively Sanford will reduce staff and increase the health-care provider to patient ration. Less nurses, more nurse assistants, more physician assistance, and less physicians. Increase working hours, reduce staff, reduce pay and freeze benefits. This is often the case in any hospital takeover.

[yzerman19]

Insurers deny what they did not contract to cover. It isn't a blank check. In order to manage risk and price appropriately, they set benefits ( or in the ASO space- your employer actually sets the benefits). No company would last if they did not do what they say they will do. You could have everything covered, no deductible, no lifetime max, etc- it would just cost a ton! Not to mention you'd have to sign in blood never to sue if you rec'd inappropriate care.

[yzerman19]

The federal dollars most often referenced are from Medicare. Clearly the old need more healthcare services. Thus huge amounts of money flow from medicare.

Everyone is touching on the elephant in the room. Underlying costs. All of the costs of the provider system and all the margins on those costs I.e. Equipment, buildings, devices, drugs, etc. All add up. Even charity care and lawsuits all build a base cost structure. Budgets are then built to cover costs and provide some margin. Medicare payments are fixed and dictated by the government. The cost burden of the providers is then passed onto the insurers. If the insurers opt not to pay, they lose the provider from their network hurting their chances for sales- or the provider goes belly-up leaving a hole for access, crippling a community, and killing jobs.

[Cratter]

You say you want the penalty increased as an incentive to buy health insurance. Let's increase it to $2,400 a year. I get sick the government says hey your in luck. We took that money and bought a coverage for you. What better way to spend your money you gave us?! Boom problem solved. Everyone's insured. And its not government run?! I agree people will get denied whether its government or insurance. It's a fact of life. Only so much money to go around.

The owner of my company just went and tried to get health care coverage because his wife lost her job. She worked for Pracs. He was denied coverage because of a "preexisting condition. " He previously went to rehab. Wonder how much his coverage will be once ObamaCare kicks in and they can no longer deny him. Maybe he'll just pay the penalty if its too high.

[yzerman19]

You say you want the penalty increased as an incentive to buy health insurance. Let's increase it to $2,400 a year. I get sick the government says hey your in luck. We took that money and bought a coverage for you. What better way to spend your money you gave us?! Boom problem solved. Everyone's insured. And its not government run?! I agree people will get denied whether its government or insurance. It's a fact of life. Only so much money to go around.

The owner of my company just went and tried to get health care coverage because his wife lost her job. She worked for Pracs. He was denied coverage because of a "preexisting condition. " He previously went to rehab. Wonder how much his coverage will be once ObamaCare kicks in and they can no longer deny him. Maybe he'll just pay the penalty if its too high.

$2400 is too low...it wouldn't cover costs

a doctor's office visit with labs costs $250

a cardiac surgery $100,000

a broken hip surgery $40,000

a series of cancer treatments with surgery $500,000 easy

The probabilities add up. In a 40 year span, it is likely the "average" healthcare spend will be $150k...thus your costs are high

think about it this way- people easily spend $300 on a car payment, plus $100 for auto insurance- if 400 per month is okay for a car, why not for your health?

[Cratter]

I didn't say cover costs. I said they went out and got insurance for you. I would assume I could find "basic" high deductible insurance for $200 a month?! And if I can the government could too...hence take my money and do the same for me!

If I can't find insurance for that I'm screwed. I'm thirty no way am I going to or lots of others spend 25% of every month on health care of every check. If its say $500.

Rent. Car. Health and car Insurance.gas.student loan. Leave average person with less than 20% of pay for things for life besides "necessities."

[Cratter]

think about it this way- people easily spend $300 on a car payment, plus $100 for auto insurance- if 400 per month is okay for a car, why not for your health?

That $300 isn't every month for the rest of your life!

I can choose to walk. Everyone in life essentially needs health care. If you want to make everyone buy it you need to take it out of pay checks.

[yzerman19]

you won't be able to have super high deductibles anymore- unless you qualify for a catastrophic exemption.

Covering everything- which ACA (obamacare) essentially does, drives up the cost of a premium.

I question why you want it forced out of your checks vs just buying it yourself? Wouldn't you rather control your own money? I certainly would.

If you are 30 and healthy, and you don't have work sponsored coverage, and you don't care about having access to the best care in the unlikely event that you have a major health event, and you make too much money to get a subsidy, but not enough money to feel good about spending $500 per month, your best bet is to not buy insurance and pay the penalty instead. In the unlikely event that you need healthcare, you can always buy a policy "on the way to the hospital" under the guaranteed issue component of obamacare.

ERs are required to treat you no matter what, and there are very inexpensive solutions for things like sinus infections etc- online care anywhere and retail clinics (Target, Minute Clinic).

Now doing this will screw up the system, hurt public health, drive worse outcomes, increase costs long-term, etc. But it is affordable.

[zonadub]

you won't be able to have super high deductibles anymore- unless you qualify for a catastrophic exemption.

Covering everything- which ACA (obamacare) essentially does, drives up the cost of a premium.

I question why you want it forced out of your checks vs just buying it yourself? Wouldn't you rather control your own money? I certainly would.

If you are 30 and healthy, and you don't have work sponsored coverage, and you don't care about having access to the best care in the unlikely event that you have a major health event, and you make too much money to get a subsidy, but not enough money to feel good about spending $500 per month, your best bet is to not buy insurance and pay the penalty instead. In the unlikely event that you need healthcare, you can always buy a policy "on the way to the hospital" under the guaranteed issue component of obamacare.

ERs are required to treat you no matter what, and there are very inexpensive solutions for things like sinus infections etc- online care anywhere and retail clinics (Target, Minute Clinic).

Now doing this will screw up the system, hurt public health, drive worse outcomes, increase costs long-term, etc. But it is affordable.

and under ACA (Obamacare) if you die because you can't get access to decent care, they don't have to insure you as long. A win for them.

[Sioux-cia]

ERs are required to treat you no matter what, .....

Not exactly. Emergency departments are required to do a medical screening exam and, IF your medical condition is an emergency, they are required to treat you. The use of emergency departments is being abused because the majority do treat regardless of presenting complaints. A medical screening exam essentially is doing everything except diagnostic tests, referrals and prescriptions. There is a growing change in emergency care that even my little ED is looking into. Although the MSE takes time (and, essentially, money), some EDs have the providers do the MSE and if the condition is not an emergency, they refer the patient to the clinic. The patient can still be seen in the ED BUT they are required to pay a co-pay (I've seen quotes as high as $200.) before the care they receive extends beyond the MSE such as getting a prescription, x-rays, etc. Of course there is concern that a major problem can be missed but things are missed even after thousands of dollars are spent on diagnostic tests. The money that is lost because of the misuse of EDs runs into the millions! If having to pay a co-pay gives one pause before going to the ED instead of going to the clinic, I'm for it! The wait times in EDs can be decreased, those with true emergencies can be seen quicker and the money lost now can be spent on providing better health care to the community .

Some ED patient quotes:

I have an appointment with my doctor tomorrow but I don't want to wait.

I have had this condition for days/weeks/months and decided to get it checked today.

My relative was coming in for **** so I decided to be seen for this minor whatever since I was here.

My doctor put me on an antibiotic yesterday and I'm not any better.

My child has a temperature of 100 and no other symptoms and, no, I did not give him/her anything for it.

My period is two days late and I want to know if I'm pregnant.

I have a toothache and need pain pills. No I did not call my dentist.

I'm constipated.

My husband stole/dog ate/I lost/ my pain pills and I need more.

I fell at work a year ago and want to go on disability. So you, ER provider that I has never seen me, have to fill our these forms.

I need a handicap sticker.

Oh Lord, I can't go on. I feel I'm invoking their names and they're all going to show up en mass!!!

[Oxbow6]

For a good portion of those under state medical assistance and/or federal medical assistance under the age of 50, the ER has become their PCP. They abuse it the most and it's not even debatable.

[LuvHockey]

How about this one (I swear it was said to my partner once--for real) "but doc--you have to refill my pain pills....I've got a truck payment due!"

[Oxbow6]

How about this one (I swear it was said to my partner once--for real) "but doc--you have to refill my pain pills....I've got a truck payment due!"

Classic! But not surprising.

[Sioux-cia]

Classic! But not surprising.

A ND state drug agent bought oxycontin in an area Walmart parking lot. $1200. for 12 pills!!!!