RNs in hospitals are held responsible for the well-being of patients, and must carry insurance to avoid law suits. The only people who want less accredited people are the bean counters.

RN to patient ratios used to be 4 or 5 to one for floor nurses. Before my wife got off the floor, the hospital had her and two Assistants – not even LPNs – watching 12 patients. Find some other place to lay the blame. Nurses are like non-comms, they are the ones who keep things going.

You're falling back on pipe dreams of the right. By far, more nurses are not in a union than are unionized.

The shortage of nurses is due to 1) hospitals constantly under-staffing to make a buck 2) abusive doctors who scream at them to cover their own mistakes, 3) frustration with a system that neither encourages nor wants input in the healing process from people who 'merely' work with patients.

I'm going to do you a favor and not let my wife, a nurse of 35+ years, see your comment. She'd kick your butt.

The entitlement programs' unsustainability will be finally exposed, if not before (and I say it will happen before, even if the Faithful and Crusading Defenders of the Status Quo on the Left are dead-set against reform, when not doing other things like robbing Medicare to pay for new federal care).

People (including me) have tried to make this point year after year, despite being ignored or abused.

Reconciliation is inevitable, it's not an “easy, simple” [sic] matter to raise taxes, and have the federal government consume European or higher levels eventually of the GDP to keep these programs operating. (Europe faces even worse problems than we have, something the Left refuses to admit.)
To the latest the latest Trustees' summary. (No use of “unprecedented” here; this will be explained.)

“When cost exceeds income excluding interest, use of trust fund assets occurs in stages. For HI, the process began in 2008 [...] For OASDI, interest income will first be needed to pay a portion of benefits in 2016 [...] the growing burden that the programs will place on the Federal budget well before the trust funds are exhausted.”

“During 2009-17 for HI, general revenues must be used to cover the interest earnings and asset redemptions required to offset the shortfall of HI tax revenues. Similarly, general revenues cover these offsets for the OASDI deficits during 2016-37. In addition, general revenues pay for roughly 75 percent of all SMI costs under current law. [...]

[... B]y 2016, net revenue flows from the general fund would total $369 billion (1.8 percent of GDP). The positive amounts that begin in 2016 for OASDI, and started in 2008 for HI, initially represent payments the Treasury must make to the trust funds when assets are depleted to help pay benefits in years prior to exhaustion of the funds. Neither the redemption of trust fund bonds, nor interest paid on those bonds, provides any new net income to the Treasury, which must finance redemptions and interest payments through some combination of increased taxation, reductions in other government spending, or additional borrowing from the public. [...]

[... T]he difference between outgo and dedicated payroll tax and premium income will grow rapidly in the 2010-30 period as the baby-boom generation reaches retirement age. Beyond 2030, the difference continues to increase nearly as rapidly due primarily to health care costs that grow faster than GDP. After the trust fund exhaustion dates (2037 for OASDI, 2017 for HI), the increasing positive amounts for OASDI and HI depict the excess of scheduled benefits over projected program income. When the statutory SMI general fund revenue requirements are added in, the projected combined Social Security and Medicare deficits and statutory general fund revenues in 2083 equal 9.7 percent of GDP. A similar burden in 2008 would have required all Federal income tax revenues, which also equaled 9.7 percent of GDP.”

http://www.ssa.gov/OACT/TRSUM/index.html

Related to retirement years of the Boomers are reconciliation with government employee retirement costs (“promises” will face long-overdue alteration or breaking) and the specter of a big bear market as the Boomers sell assets to finance their retirement privately (still the major means in the USA, if not in most other countries, of financing retirement — mainly privately, by one's own actions).

But here and now we “should” ignore this and “should” insist on greatly increasing such programs.

Perhaps it explains the lack of the advising the public that the future of these entitlements would involve an unprecedented situation. Perhaps the Obama administration wants this suppressed in order that we not be as worried as we otherwise might be by such thing. Or, they approve of it.

Let's step back a year or so to an earlier Trustees' summary, now, because it includes references to historical experience with the size of the federal government, which for some reason later was not mentioned now that the summary is issued by the Obama administration, which apparently believes it's not important to continue to tell the public the following — or doesn't think it's a bad thing at all.

No use of “uprecedented” in the latest, Obama, Trustees' summary. But in earlier summaries?

“To put these magnitudes into historical perspective, in 2006 the combined annual cost of HI, SMI, and OASDI amounted to 40 percent of total Federal revenues, or about 7 percent of GDP. That cost (as a percentage of GDP) is projected to double by 2042, and then to increase further to nearly 18 percent of GDP in 2081. It is noteworthy that over the past four decades, the average amount of total Federal revenues as a percentage of GDP has also been 18 percent, and has never exceeded 21 percent in a given year. Assuming the continued need to fund a wide range of other government functions, the projected growth in Social Security and Medicare costs would require that the total Federal revenue share of GDP increase to wholly unprecedented levels.”

http://www.ssa.gov/history/pdf/tr07summary.pdf

Inaction cost, $9trillion over the next decade, can not be compared to the balance between estimate and outcome in a worst case of scenario, and this balance could be adjusted each year. ((Some of CBO analysis : While the costs of the financial bailouts and economic stimulus bills are staggering, they are only a fraction of the coming costs from Social Security, Medicare, and Medicaid. Over the next decade, the Congressional Budget Office (CBO) projects that each year Medicaid will expand by 7 percent, Medicare by 6 percent, and Social Security by 5 percent. These programs face a 75-year shortfall of $43 trillion–60 times greater than the gross cost of the $700 billion TARP financial bailout)). Time does not fix endless greed and energy depletion.

When the public health is also one of commodity like a house, we come to a tragic and unthinkable conclusion : As to for-profit business, the more and longer ills patients get, the more profits they make, and it will debilitate the overall economy involving education for the future, not to mention continued bankruptcy of middle class.

Of young adults ages 19 to 29, 13.2 million, or 29 percent, lacked coverage in 2007, and that implies the total of this promising reform will be cheaper than expected, I guess.

In case of an unexpected injury or ill, they might give up their learning or aspiration, in this regard, this reform means liberty, job opportunity, competitiveness for them and future.

1. The contents of savings (below) in this reform 'have nothing to do with' limit to medical access, rationing, tax raise, and deficit etc.

Rather, without wiping out these wastes and roots of bankruptcy for middle class, all fronts are sure to face larger financial ruin than this recession, which leads to more limit to medical access, more rationing, more tax raise, and more deficit etc than today.

$1.042trillion (cost of reform) + $245bn (cost to reflect annual pay raise of docs) = $1.287bn (actual cost of reform).

$583bn (the revenue package) + $80bn (so-called doughnut hole) + $155bn (savings from hospitals) + $167bn (ending the unnecessary subsidies for insurers) + 129bn(mandate-related fine based on shared responsibility) + $277bn (ending medical fraud, a minimum of 3% , the combined Medicare and Medicaid cost of $923.5bn per year, as of July,) = $1.391trillion + the reduced cost of ER visits (Medicare covers some 40% of the total) + the tax code on the wealthiest more reduced than originally proposed = why not ? (except for a magic pill, an outcome-based payment reform & IT effects and so forth).

As lawmakers debate how to pay for an overhaul of the nation's health care system, a new report from The Commonwealth Fund claims that including both private and public insurance choices in a new insurance exchange would save the United States as much as $265 billion in administrative costs from 2010 to 2020.

“Health reform can help pay for itself, but both private and public insurance choices are critically important,” said Commonwealth Fund President Karen Davis, who coauthored the new report. “A public insurance plan can help drive new efficiencies in the system that will produce large cost reductions. Without a public plan, much of those potential savings will be lost.”

Unlike high fuel price and mortgage rate in recent years as the roots of great recession and bankruptcy of middle class, the severity in the high cost of health premiums has come to light lately. Similarly, in an attempt to hide these deficit-driven corruptions and wastes, the greed allies struggle to turn the savings via removing these wastes into limit to medical access, rationing, tax raise, and deficit etc.

In contrast, not to mention a wide range of consumer protection, options across state lines, this promising reform takes initiatives in more primary care docs and improved long-term care. And the bill expands coverage for mental health services, and defines what will be covered. It also prohibits co-payment charges for wellness and preventive medical care. There is no mention of rationing. The use of this term is, again, a gratuitous distraction aimed at feeding fear

Reagan said that passing Medicare would eventually lead to our losing our freedom. Pete notes that it hasn't happened yet (some might argue that, but we'll give him the benefit of the doubt), so Reagan was wrong. Therefore, we should implement more government involvement in health care, since if Medicare didn't end our freedom, increasing the involvement of government won't either.

It's a little like your mother telling you that if you play with matches, you'll burn the house down. After playing with matches for a few days, the rug catches on fire a few times, but you manage to put the fires out before they spread. Based on this experience, you're confident you have things under control and continue to play with matches, and you get out some lighters also. Your foolish mother is just clinging to an old wives tale.

Let me repeat, before anyone jumps to conclusions: I don't know if Reagan was right, but your rebuttal to his argument doesn't make any sense to me.

(There's no question that Medicare does limit our freedom to some extent. Whether the benefits of the program are worth the freedom that we give up–the freedom to prepare for our retirement health care needs as we see fit–is a separate question)

An excellent point. The accreditation path for nurses is likewise narrow and steep, thanks to the tireless lobbying efforts of nurses' unions eager to reduce competition and preserve their six-figure salaries. “Nurse shortage? We've heard ugly rumors, but there never seems to be any at our union meetings.”

The solution is not less private enterprise but more. The AMA and the unions and Enron have all gotten away with their protectionist maneuvering thanks to the gullability or collusion of regulators. The private groups correctly identify the government with it's power to regulate as the vulnerability in the system, the single point of failure, and they take advantage of it.

A competitive market, though, has no single point of failure, no single body lobbyists can bamboozle. No company (or union) can exact too sweet a deal, because the next one will undercut them. We desperately need more competition in all areas of health care.

Aside from the dangers from sleep deprivation of doctors, too, their residencies have been viewed for years cynically as having become an obvious kind of slave labor.

Reform of shift durations and related issues in medicine as well as elsewhere (sentry duty or watch aboard ship, transportation, etc.) is something I've thought about for a long time. Note it's something (fatigue and workload, staffing, etc.) that should be part of an intelligent health care reform mission.

http://www.cirseiu.org/policy/Institute_of_Medi…

http://www.pubmedcentral.nih.gov/articlerender….

http://newsblaze.com/story/2009050808390200004….

http://www.bizjournals.com/triangle/stories/200…

http://www.atwonline.com/channels/airlineFocus/…

http://www.aviationweek.com/aw/generic/story_ge…

http://narap.org/educational/sleep.php

And the lack of Demcare actually addressing it head-on, as opposed to offering a) believe us, it will lower costs, b) hey, we'll find “savings and efficiencies” in Medicare, c), hey, we'll eliminate private sector profits and advertising costs (which comprise somewhere in the neighborhood of 1.5% of annual US healthcare costs…..meaning your cost will go up only 7.5% per year as opposed to 7.8%).

I don't think Rush Limbaugh's radio show cost Obama and Demcare 20 support points. I think the more people hear details, the more they realize this is more about expansion of the cost pool and doing very little for the costs they are now already paying.

But the Dems are content to simply proselytize about their greater moral virtue while public support sinks lower and lower.

I spent six years in the Navy and I can tell you that the healthcare has some problems, but it's better than nothing.

Case in point, my mother, who lives in Texas. She is now retired – but without a pension because nurses in Texas aren't unionized and the employers see no reason to give out pensions. So she lives on Social Security and what little she is allowed to earn on the side. Ten years ago, the doctor told her that she needed her knee replaced. But it isn't considered medically necessary because she isn't crippled. So she could “elect” to have the surgery, but in order to save the money necessary to pay her co-pay, she would be kicked out of the public housing where she lives. Not to mention lose a substantial part of her Social Security.

So my mom limps around the nursing home, providing care for those who are barely five years older than her (or, in some cases, younger than she is). If she were to discover a patient who had fallen, she could not get on the floor to provide first aid, but would have to call an aide and provide direction. Yet her patients depend on her just the same.

Meanwhile, the younger nurses where she works pick up forty hours in three days so they can have four days per week off. You think there's no drop-off in care by the time that thirty-eighth hour hits? Oh well, they bury their mistakes anyway.

If this is the “best system in the world” and the result of “freedom” – well, it's just damn sad.

Good question. I did not mean to suggest that “health reform” = “public option.” But I can understand why that might be less than clear.

My thinking behind the title of the post was based on the following: Certain prominent Republicans have rejected both a “public option” and “co-ops,” describing the latter as a path to the former, and the former as a path to “single payer” … and thus to the end of America as we know it.

Accordingly, I tried to short-hand the baseline sentiment of these Republicans, i.e., the sentiment that any substantive reform (at least any suggested by Democrats or RINO's) will lead to some tragic lessening of “America as we know it.”

You and/or others can debate whether I was precise enough in doing so, or whether it was a fair leap in logic to make, but I hope that at least explains my path from blank screen to the post's title.

Because they are all buying from the same trough. And those programs are getting gouged from the private sector as well. Basic fact is prices are rising way faster than inflation and everyone just accepts it. No one want to take a look at the industry to fix things. For instance, the AMA decides how many types of how many of each specialty they will allow into a field every year. This is their mechanism to keep salaries up. They are the ones in effect who are rationing healthcare. As well as say Pfizer, who sells pills here for $25 that they sell to countries like France, with its socialized medicine and consquent purchasing power, for $6. Why? Because the system is currently structured in a way that this price fixing can go on and most people will never notice. They will simply look at the rising costs and shrug their shoulders as if nothing can be done.

By the way, last year when people were worried about the reinstitution of the fairness doctrine, I actually heard a local conservative morning talk show host say to one of his callers, “now, I don't know that much about Canada, but listen. Canada is not truly a free country!” Idiot. That was the last time I listened to him.

Actually, two-pronged.

a) Reform of “insurance” (pre-paid health care of all kinds), be it mainly regulatory or also conceptual;

b) Medicare (and Medicaid, VA, Indian Health, etc.) reform, to try to approach sustainability at least.

It leaves the private and public health care sectors in better shape, and in better position for integration.

You want to reform healthcare, get the related industries to stop gouging the public. Costs in healthcare are skyrocketing even while pharma companies are showing record profits. When costs go up and manufacturers pockets are bulging, guess what? People are getting screwed. I hate to sound like some sort of anti corporate lefty, but sometimes that's the case.

Except that costs are skyrocketing in all the government run programs as well as in the private non-profit medical sector. How do you explain that?

The point being that there are systemic problems and the “lefty” focus on corporate profits and their perceived evils is misplaced. There's no evidence that eliminating corporate profits completely will make the entire system financially sustainable. I might suggest, therefore, that instead of (or in addition to) a public option, that more fundamental “reform” is needed. The left's narrative that opposition to a public option = opposition to reform is, therefore, self-defeating and wrong.