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Monday, April 12, 2010

AN INSIDER'S VIEW OF OUR BROKEN HEALTH CARE SYSTEM

I got a very nice email recently from a former classmate, now a nurse, who has followed my blog and its various posts on our pathetically profit-driven and chronically broken health care system. She provides some behind-the-scenes insights on the day-to-day frustrations and horror stories now being faced by many of our nurses and hospital workers in this increasingly greedy and corrupted system. My own comments follow her email in bold, at bottom below.
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Jack,

I still love your blog, it makes me think way too hard, so I have to always plan some time to read it. Your information and thoughts take time to read, consider, and always learn. You should join the bloggers that make an income blogging. Though finding sponsors may be a bit difficult with your views on caring for and improving the lives of the people of our country.

I was a little, well very worried about your April 1, 2010 blog until I got to the end. GREAT READ.

Here are some thoughts for you to think about:

As you may know the big hospital industry in Minneapolis is trying to negotiate the MNA (nurses union) contract. According to the Mpls Startribune the hospital CEO salaries in the metro run from $957,300 (David Cress at North Memorial) to $1,738,300 (Richard Petingill-Allina). The hospitals cite the need to make changes because of declining reimbursement, increased uninsured patients and anticipated changes of reimbursement due to the national health care program.

The hospitals have some "great" ideas of how to cut their costs by changing the way patients are cared for by delivering the care in a more efficient way. Efficiency includes redefining the care provided to each patient and taking away reimbursement to the nurse in terms of pension. Nurses do not have the luxury of profit sharing, stock options and bonuses given for meeting corporate cost saving quotas like many professionals.

Key issues during the MNA (Minnesota Nurses' Association, the nurses' union-Ed.) negotiations include nurse-to-patient staffing ratios and the hospitals’ desire to slash the nurses’ long-standing pension plan benefits. The hospitals also want the ability to change nurses' daily assignment to fill in at the site and unit most in need for that shift. I for one do not want to be called 90 minutes before a shift and told to go over to United and work in the OR. A patient or a surgeon does not want to see me show up at that site and pretend to know what I am doing.

As a nurse I can cite many daily examples of wasted time or resources. I can testify to the consequences of working short staff. As a mother of an uninsured 25 year old son I worry about any injury or illness he may have that requires medial care. Medical bills cause a large amount of bankruptcies and that is not good for society. I also have a child with a serious and persistent mental illness. The mentally ill are truly neglected by our society. Day to day living is a challenge at best for them. As an abandoned wife of a director at United Health Care, I see the huge corporate profits and the excessive compensation executives make by negotiating health care payment, determining what health-care procedures are going to be paid depending on the diagnoses and finding legal loopholes to continue to make excessive profits at the expense of the ill. As I watch my 47 year old brother die from cancer, I grieve for all the terminally ill people stuck in such system that seems more concerned about profit than patient care.

Is there a nursing shortage? Ask the RN graduates of 2010 or 2009 or 2008, how many recruiters are banging on their doors begging them to work at their health care corporation. I know a few 2010 graduates, and none of them have been recruited, they are are all aggressively looking for a job-any RN job. The nursing shortage? Yes. The average age of nurses is high and someday they will retire. Others will go into another career. My unit had 2 nurse managers return to staff positions. The important nurse manager job is left to a "rotating charge nurse" situation which is a band-aid for a shift but provides no one able to see the needs of the patient or the unit in a consistent manner. No one advocates for the patients or unit. Last week, we temporarily closed one of the small units because of vacancies, secondary to MDs being on vacation. Four to six staff were told to stay home each shift. Last summer almost every shift experienced the need to reduce staff, sometimes the staff voluntarily took the shift off and took a vacation day or no pay, sometimes they were mandated to stay home. Try to pay your bills when your vacation is all used up and you are mandated to take the shift off. Try to plan a vacation-we bid vacations in Feb but if all your vacation time is used up by leaves you do not get the vacation time.

Other shifts we are truly short a nurse. The number of patients on the unit require so many nurses and one calls in sick or there are admissions causing the number of nurses to be less than ideal. Admissions are always happening, causing nurses to take on more patients. The hospitals staff for the number of patients in the unit. The patient number determines the number of nurses. There are no accommodations made for acuity or anticipated admissions. Getting 4-5 admissions on a shift is a nightmare for the staff.

The schools offering nursing programs are doing well. They have several applicants for every open spot. They have a cash cow, expanding their nursing program staff to add more student spots and make more money. I have met many nontraditional students going into health care because of the perceived guarantee of a job. I question if the purpose of this career change is for financial gain or perceived job security. Some males want to be a director (of something) and going into a traditionally female profession gives men an advantage. Real nurses are nurturing healers who want to take care of those needing help or dying. Fortunately, the "old" traditional nurses are just that.

Health care is in crisis, but don't blame sick or mentally ill, handicapped, or nurses. In our society capitalism has created corporate greed. Health insurance companies divvying out health care treatment at the expense of the sick while making huge corporate profit. Politicians create laws which give incentives to hospitals and MDs provide only the minimum amt of care, or not offering some care or treatments, just to increase profits. If an insurance company pays a predetermined amount for a procedure or admission diagnoses, the hospital tries to "get the job done" for the least expense. My daughter broke her jaw and needed 2 surgeries. and the insurance company determined she did not need anesthesia. Where did the actuary or the writers of that plan get their MD degree? I had brain surgery, access to my brain was through nose and upper jaw. This killed my two upper front teeth, causing them to yellow and brown. The insurance company would not pay for the required reconstructive surgery. They explained to me breast reconstruction is required by law but they are not legally required to fix my teeth. Somehow the insurance company never got my 3 requests and my physician's explanation of the need for the surgery.

One MD on MPR reported that 1/4 (or some significant amount) of every health-care dollar does not go to health-care. Is this the time I am paid to triple document education and pathways? This takes time away form patient care. Then one of my managers audits charts to make sure all documentation is entered. Then insurance companies or Medicare audits the documentation. I understand that if all required documentation is not entered the claims may be not paid or medicare or the state or someone can fine the hospital. The outside auditors-medicare need to be paid I believe my taxes pay them. I would prefer my taxes go to caring for the sick or homeless, or working poor paying way too much for a small apartment for their families leaving little for food, a car and no health insurance.

I hope you and Nick Coleman pay attention to what is happening to our negotiations. Nurses are not the problem in the health-care crisis. I love being a nurse and cannot think of anything I would rather do except to be at home taking care of my high school age daughter and my grandchildren. Some shifts I actually get to spend quality time with one of my patients.

Take care.
P
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HERE IS THE TEXT OF THE MNA's MAR. 16 PRESS RELEASE:

ST. PAUL (March 16, 2010) – Saying their 12,000 members are committed to standing united in the coming months, Minnesota nurses formally began labor contract negotiations with six Twin Cities hospital systems on Tuesday.

“The safety and quality of care for our patients is on the line,” said Minnesota Nurses Association President Linda Hamilton, who works as a registered nurse in the Newborn Intensive Care Unit (NICU) at Children’s Hospital in Minneapolis. “Nurses always have and always will be an outspoken advocate for the men, women and children of Minnesota who are put under our care. These negotiations are all about the bottom line. For nurses, that bottom line remains the same – patients before profits.”

The current labor contract between 12,000 Minnesota Nurses and six Twin Cities hospital systems (North Memorial, HealthEast, Allina, Methodist, Children’s and Fairview) expires on May 31, 2010. After several weeks of bargaining, nurses will vote on May 19 to either ratify the new contract or authorize a strike. The last time there was a large-scale RN strike in Minnesota was 1984, when 6,000 nurses walked off the job for 35 days. It remains the largest RN strike in U.S. history.

At the forefront of 2010 talks are two issues – RN staffing levels and the nurses’ pension fund, which has been in place since 1962.

“More than 72,000 people in this country needlessly die every year because hospitals don’t have enough nurses on staff,” Hamilton said, referencing a 2005Medical Care Journal study. “The numbers don’t lie. If you don’t have enough nurses working, people are going to die when they don’t need to. So we’ll keep saying it until we’re blue in the face: Safe staffing saves lives.”

Pension bargaining between nurses and the hospital systems began during early March, and the hospitals have made it clear they want to cut the nurses’ pension funding by a third.

“First of all, our pension funding equals about one percent of these hospital systems’ annual revenue,” Hamilton said. “It’s a minimal expense. These hospitals aren’t going to be closing their doors in order to pay nurses the retirement benefits we’ve been earning for nearly five decades.”

The hospitals’ current proposal would put the nurses’ pension benefits back to 1968 levels, according to Hamilton.

“Gas cost 34 cents a gallon in 1968,” Hamilton said. “A new house cost around $15,000. To ask us to retire and support our families on a standard of living like that would require a time machine to pull off.

“Nurses are not greedy people. It’s not in our nature,” she continued. “We sign up to do what we do because we put the well-being of others ahead of ourselves. At the same time, we need to advocate for our families the same way we advocate for our patients. We need a livable pension plan to ensure that we can retire when we’re ready and that our spouses and children have the support they need from us.”

Minnesota nurses will hold a large rally for patient safety on March 27 at Hopkins High School as part of their united stance on the labor contract’s key issue.

“When it comes to the people of this great state, Minnesota nurses want everyone to know that we care,” Hamilton said. “We care for each and every patient we see. And we’ll keep fighting to ensure we’re allowed to do that to the very best of our ability and that your experience with us is as safe and comfortable as possible.”



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This attempt by Twin Cities hospitals to shake down their nurses is an outrage I'm sure a number of you were never aware of or ever thought about. It's the same old story, though: wealthy corporate CEOs are trying to further increase profits and line their pockets at the public's AND THEIR OWN WORKERS' EXPENSE! In this case, their greed is not only cheapening the "product" their institutions provide, but directly and negatively impacting the care sick and dying people will be receiving. "Free market" economy advocates: this is a perfect example of "free market" economiucs gone astray, and why there MUST be government oversight in the marketplace. If these greedy CEOs are to succeed in rolling back employee pensions and further cutting back staff, they will be the ONLY beneficiaries. The patients certainly won't benefit, nor will the nurses. Should a handful of self-centered individuals be empowered with the ability to negatively impact health care solely to protect and maintain their own already opulent lifestyles? I ask you, everybody: IS THIS NECESSARY? Why should hospital CEOs and directors receive exorbitant salaries when they are doing virtually nothing themselves to heal or comfort their customers, the patients? Why are they attempting to cut employee pensions at a time when the insolvency of Social Security is looming? Why are they, in effect, STEALING from their employees, the very people who ARE healing and comforting their customers? Shouldn't the priority here be the maximization of patient comfort and quality of care rather than the maximization of hospital profit and/or CEO and stockholder earnings and benefits?

This is not an isolated incident. Corporations all across this country have been chipping away at employee pay and benefits for far too long, and the time for a reversal of this is long overdue. It is my sincere hope that, if these purported actions against nurses are taken by Minneapolis-St. Paul hospitals, the Minnesota Nurses Association will respond more vigorously in their negotiations than they ever have before. Enough is enough. When the greed of a handful of piggish individuals begins to hurt patient health care, these piggish individuals have gone WAY too far! They will - if not directly, strongly, and successfully challenged - effectively be instituting their own PRIVATE "death panels" which will be REAL, unlike the fictitious government ones Sarah Palin has lied about. These CEOs are classic examples of how badly broken our existing for-maximum-profit health care system is, and they are walking billboards for a fully government-run, single-payer system like every other civilized country in the world has!

15 comments:

Manifesto Joe said...

Hi, Jack: A co-worker of mine says he just finished reading Ayn Rand's "Atlas Shrugged." I didn't discuss it with him -- I've found that face-to-face political arguments do nothing but alienate the other person, so I stick to blogging. But this brought something to mind about the dark underside of America in general. This co-worker is a good guy, conscientious in his job, a good family man, etc. But he's been sold on the basic idea that about 2% of the world's people are pulling the wagon while the other 98% more or less ride on it. It's a toxic idea that's ironically very backwards. When I drive through the swell part of the city in my old pickup -- I'm sure the locals think I'm a gardener or repairman or such -- it looks to me like a lot of them haven't done an honest day's work in their whole lives. Somebody in their ancestry somehow managed to get their hands on a lot of quid and pass it on, so that makes them feel entitled. They are the real 2% -- and people like me in their beat-up trucks are the 98% who are actually out there doing the grunt work. It's that way systemwide, not just in the health care field.

I've only read Ayn Rand's ranting nonfiction, which is quite hard to tell apart from her fiction. But the con job that came from her ideological cult, as well as many other right-wing sources, is that one should work even harder toward becoming part of that rarefied 2% of the deserving privileged. Not all, but a great many, Americans have been sold this bill of goods. They call themselves different things, but one thing they tend to consistently call themselves is "Republican."

With your permission, I'm going to use this comment as a blog post.

Jack Jodell said...

Manifesto Joe,
You indeed have my permission. I think you have nailed that2%/98% scenario perfectly. Those trust-funders you describe are deluded and disgraceful. When I am introduced to a wealthy person, I am usually always suspicious and certainly don't gush over that person or stoop to kiss ass. Quite frankly, I would much rather be in the presence of an honest, hard-working cook, warehouseman, assemblyperson, mechanic, nurse, or educator!

TomCat said...

Jack, or Your Holiness if you prefer ;-), this is a real eye opener. I also know people in health care, and the stories they tell me are quite similar. It is truly an outrage, and clearly shows that health care is too important to leave the decisions to greedy corporations for whom profit trumps health. Please convey my thanks to your friend and ask her to keep us updated.

Gwendolyn H. Barry said...

They are trying across the country to break the Nursing unions. I was in hospital recent (last two years) and I have an RN next door neighbor... the nurses are the HEALERS in the hospitals... without them, we are lost. Nurses all over the globe have my unconditional support. I have to agree with M. Joe here, too. Jack, pls tell your friend, she has my prayers and Light to find the resolutions in MN for her job security and the general healing she and her brother/sister nurses bring to allopathic health care in our country. A very eye opening piece, indeed. Great post Jack... I'm going to FB repost it ....
:-)

Jan said...

Hi Jack,
Great posts about what’s really going on about the Twin Cities nurse contract negotiations. Would “P” be willing to give me a call or email? We would like to make her statements public on behalf of MNA and attribute them of course. See our blog at http://mnablog.com
Thanks,

Jan Rabbers
Member Communications
Minnesota Nurses Association
email: jan.rabbers@mnnurses.org
web: www.mnnurses.org

Jack Jodell said...

TomCat,
You hit the nail squarely on the head. The corporate mentality and mode of operation is in itself a health hazard. These attacks on workers' financial well-being are needless stress. Here you have a large quantity of dedicated employees trying to do their job and actually care for people who need it badly, and these p[iggy corporate CEOs simply take them for granted and try to deplete their old-age income. How low can an executive bloodsucker go?
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Gwendolyn,
It all boils down to one thing: screw the workers so the high ecec salaries and perks can be maintained. And, as you say oh so correctly, nurses are invaluable! The same CANNOT be said for corporate bigwigs drawing undeservedly high salaries!
---------------
Hi Jan.
Thanks for visiting, and I urge you and all of your rank and file to give them all holy hell! Keep up the great work, all of you, for THIS blogger appreciates your efforts! I've passed on your info to P and I'll believe you'll be hearing word back soon. Meanwhile, keep fighting the good fight! :-)

TRUTH 101 said...

As with everything else the general public will blow this off because "it doesn't matter to them."



It does. The scheme to shift nurses from one floor to another to alleviate staffing problems instead of hiring enough nurses indeed puts patients at huge risk. Despite what an ignorant administrator saw on Star Trek, "Dammit Bones! You're a healer!" That's not the way it is in real life. Nurses have specialties just as doctors and any other prpofession. A labor/delivery nurse would not be effective in an ICU unit and vise/versa. Different equipment. Different training. It puts the nurses at huge risk for malpractice suits and no doubt the hospitals have some sharp lawyers that drew up contracts screwing the nurses and shifting liability to them.




I hope the nurses stand up for themselves and their patients. The administrators aren't going to take any pay cuts or make any concessions. They're graded on how much they can screw employees and patients. Despite what the hospital CEO's say, I have no evidence they give a rats ass in reality for patients or employees.

Jack Jodell said...

Truth101,
I, too, hope the nurses will stand firm and kick some butt. And you're right about those CEOs---they don't give a shit about anybody but themselves. That's why they need a little butt-kicking by labor every so often, just to teach them they're not omnipotent.

Holte Ender said...

My wife is a Nursing faculty in the Georgia University system and at her School of Nursing within the next 3-5 years there is going to be a crisis. They are already having reduce classes, in affect turn students away, because they just do not have to faculty, they are 4 people short right now and within the next few years, 5 more faculty will be retiring. So in this part of the world, less 4-year RNs are going to be trained. And as any GOOD doctor will tell you, it's Nurses who run hospitals and do all the caring.

Jack Jodell said...

Holte Ender,
There is a very, very serious flaw in the model of capitalism as we see it practiced today, especially when practiced by corporations. When obsession with maximum profit trumps quality, safety, and even good health, it is time to overhaul the entire system - or replace it altogether. Profit obsession doesn't really belong anywhere, but especially in areas of health and safety. Crapitalism is crap!

Oso said...

Jack,
This is exactly why I opposed and still oppose the bailout of these greedy bastards.

I keep trying to tell people there was no chance of single payer,no chance of a public option.

But for the 100 or so billion dollars a year Obama and Pelosi are delivering to the health insurance industry we should have gotten SOMETHING in return.

Just a basic, catastrophic care package for working Americans with affordable premiums and reasonable deductibles. The medical equivalent of Public Liability/Property Damage for poor peoples car insurance.

Instead we're forced to buy a substandard product with no effective regulation. I've done a lot of reading of the fine print. It's a piece of shit.

This was a one-shot deal. our only chance. 100 billion a year plus deals with Big PhArma-and we got a shitty deal Democrats blithely think will be fixed later. I'll write it one more time-100 billion dollars a year in order to get health insurers-so beloved by Democrats-on board. There's no amount of $ which will get them to wind down their cash cow. Obama sold us out. Republicans scream insanely, but the semi comatose American public will remember one thing-Democrats gave them this POS and Republicans opposed it.

At least when LBJ signed the Civil Rights Bill and commented he'd just lost the South to Democrats for a generation he got something in return.

The Democrats got worse than nothing. Thanks to Obama and Democratic voters siding with the health insurance industry against affordable health care, Democrats are gonna lose a generation of voters nationwide and those of us who don't own stock in the health insurance industry are screwed.

Jack Jodell said...

Oso,
Thanks for venting, and you raise a great many very valid points. I DO believe this is not the end of the health care question, though; that insurance companies have now attained an everlasting bonanza arest of us will be forever screwed. Rather, it is inevitable, with passing time and increasing insurance company corporate gluttony, that there will indeed come a point where the public AND business will rise up in a unified chorus against them. THAT'S when there will be a clamor for a public option and we'll finally get it. Meanwhile, it is up to progressives like you, I, and everyone else here on this page to keep chipping away and to get incrementally, bit by bit, that which we are seeking. Don't give up the faith, Oso. Keep fighting the good fight, even if you have to kick and scream all the while. Destroying the entrenched insurance oligarchy will be in many ways similar to the destruction of the power civil rights segregationists once held for cewnturies. We SHALL overcome, but only with determined, disciplined, and continual action! Persevere, my friend, and don't despair!

amadmike1 said...

Jack, or, as TC refers to you: your holiness, this is truly an eye opener, but unfortunately it is not an exception in America. It is the rule.

Jack Jodell said...

madmike1,
That is the tragedy of our times, and of much of our history. But, with that being the rule, as you say, our task is clear: change the rulers! It's a never-ending struggle, but there are incremental improvements, so we've got to keep up the fight.

Lisa G. said...

Jack-
If hospitals were non profit orgs this wouldn't be happening to the nurses. Instead, now they are having to report to shareholders who don't read the 10K's and Proxy statements to know how much the execs are paid. Nurses are God's angels on earth; they should not be punished for their good deeds.