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Obama-Care Boosts (The SEIU’s) Nurses

This is an Associated Press article from last week, which is suddenly getting a lot of attention:

Doctor shortage? 28 states may expand nurses’ role

By CARLA K. JOHNSON (AP) – Apr 13, 2010

CHICAGO — A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."

For years, nurse practitioners have been playing a bigger role in the nation’s health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.

Those newly insured patients will be looking for doctors and may find nurses instead.

The medical establishment is fighting to protect turf.

Oh, it’s just a ‘turf war.’ There can be no other objections.

In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills.

We thought that waving a white lab coat was enough to carry the day? It was for Mr. Obama.

The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.

Nurse practitioners argue there’s no danger. They say they’re highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.

"We’re constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she’s just like a doctor "except for the pay."

On top of four years in nursing school, Cockrell spent another three years in a nurse practitioner program, much of it working with patients. Doctors generally spend four years in undergraduate school, four years in medical school and an additional three in primary care residency training.

So you see, nurses really are just like doctors.

Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85 percent of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60.

The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make — and that may be just the beginning.

Of course it is “just the beginning.” And that is exactly what this is all about. Getting the government to pay nurses more money – in fact, just as much money as doctors. That is ‘social justice.’

Never mind that we were promised that Obama-care was going to lower the cost of health care across the nation.

States regulate nurse practitioners and laws vary on what they are permitted to do:

— In Florida and Alabama, for instance, nurse practitioners are barred from prescribing controlled substances.

— In Washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in June.

— In Montana, nurse practitioners don’t need a doctor involved with their practice in any way

In some states, nurse practitioners with a doctorate in nursing practice can’t use the title "Dr." Most states allow it

The feud over "Dr." is no joke. By 2015, most new nurse practitioners will hold doctorates, or a DNP, in nursing practice, according to a goal set by nursing educators. By then, the doctorate will be the standard for all graduating nurse practitioners, said Polly Bednash, executive director of the American Association of Colleges of Nursing

The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups

So, you see, it is ‘settled science.’ The AP has ruled. A nurse is just as good as a doctor. At least for you poor schlubs on Medicare and Medicaid –and Obama-care.

The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of health professionals, recently called for nurse practitioners to be among the leaders of primary care teams. The foundation also urged the removal of state and federal barriers preventing nurse practitioners from providing primary care.

The American Medical Association is fighting proposals in about 28 states that are considering steps to expand what nurse practitioners can do.

"A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians." …

Massachusetts, the model for the federal health care overhaul, passed its law in 2006 expanding health insurance to nearly all residents and creating long waits for primary care. In 2008, the state passed a law requiring health plans to recognize and reimburse nurse practitioners as primary care providers.

That means insurers now list nurse practitioners along with doctors as primary care choices, said Mary Ann Hart, a nurse and public policy expert at Regis College in Weston, Mass. "That greatly opens up the supply of primary care providers," Hart said

Gee, why did Massachusetts have to resort to lowering the bar for what it means to be a "primary care provider"? And why is Obama-care causing the bar to be lowered for the rest of us?

We were told that ‘healthcare reform’ would improve the quality of our medical services.

The new U.S. health care law expands the role of nurses with:

— $50 million to nurse-managed health clinics that offer primary care to low-income patients.

— $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients.

_ 10 percent bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.

A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor’s.

The American Nurses Association hopes the 100 percent Medicare parity for nurse midwives will be extended to other nurses with advanced degrees.

"We know we need to get to 100 percent for everybody. This is a crack in the door," said Michelle Artz of ANA. "We’re hopeful this sets the tone."

Lest we forget, the Service Employees International Union is the union that represents nurses in this country. Nurses are so important to the SEIU, they have their own ‘Nurse Alliance.’

And while we are on the subject of the SEIU’s influence on Mr. Obama’s legislation, here is a good reminder from their website:

A Closer Look Inside Labor’s Fastest-Growing Union

» The 2.2 million-member Service Employees International Union is the fastest-growing union in North America, and its membership is among the most diverse in the labor movement. Since SEIU President Andy Stern took office in 1996, nearly 1.2 million workers have united in SEIU.

Focused on uniting workers in three sectors, SEIU is the largest health care union, including hospitals, nursing homes, and home care; the largest property services union, including building cleaning and security; and the second largest public employee union

And, coincidentally, what are the (real) ‘three pillars’ of Mr. Obama’s administration?

Healthcare reform? “SEIU is the largest health care union, including hospitals, nursing homes, and home care.” Obama-care gives the federal government, indeed the White House, the ultimate control over where the money goes and for what in the health care sector.

The ‘Cap And Trade’ carbon emissions tax? SEIU is the “largest property services union, including building cleaning and security.” All  of Mr. Obama’s new green regulations will require changing, retrofitting and inspecting every building in the country.

The ‘Stimulus’ and other so-called ‘jobs bills’? The SEIU is “the second largest public employee union.” The stimulus and other ‘jobs bills’ have funneled untold billions into the (unionized) public employees’ payrolls in the name of ‘creating and saving jobs.’ Government union jobs.

All of this is by way of a gentle reminder as to who is ultimately behind and who is benefitting the most from Mr. Obama’s political onslaught.

And they have only just begun.

This article was posted by Steve on Thursday, April 22nd, 2010. Comments are currently closed.

13 Responses to “Obama-Care Boosts (The SEIU’s) Nurses”

  1. Rusty Shackleford says:

    SG asks, “And, coincidentally, what are the (real) ‘three pillars’ of Mr. Obama’s administration? ”

    They are, in no particular order:

    Failure, failure and failure.

    • TwilightZoned says:

      Correctamundo, RS.

      “These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.”

      Yes, the very beginning of the U.S.’s decline in medical care. Next thing you know they’ll want to perform surgery too. Aaaaah, yes…Mexico is looking better and better.

    • confucius says:

      Sorry TwilightZoned, but we’re already past that.

      I know two surgeons who routinely allow their physician assistants to operate without supervision. The surgeons are sometimes not even in the OR suite but somewhere else doing who knows what.

      This practice is illegal as the surgeon is supposed to be in the room, scrubbed and gowned. (As an aside, physician assistants have even less training than nurse practitioners.)

      Of the two surgeons, only one was disciplined. And it was difficult. Everyone lawyered up, and it took two years and $250,000 in legal fees.

      At the end, the surgeon was fired. The surgeon never faced criminal charges and never lost his license.

      Go figure.

  2. Georgfelis says:

    Having the option to choose to see a Nurse-practitioner for minor medical things (flu shots, kids stitches, strep throat tests) to save money = good
    Being forced to see a Nurse-practitioner for unspecified illnesses/problems because it will save the government money = bad

    If the Insurance industry were to try to do by consumer choice what the Government is doing by force, there would be no end of screaming by the Libs.

    Just about all of the NP/LPNs are fully capable of doing about 80% of what people come into a doctors office for anyway, but federal regulations, fear of lawsuits, and insurance regulations (the Unholy Trio) often make for a very inefficient visit. Example: I went into my doctors office.
    Me: “I have strep. I know I have strep, my kids have strep, my wife has strep, they were through here a couple days ago, I just need the test and the prescription.” An hour and a half later, after being weighed, subjected to the Insurance Questions, checked by the nurse, and reading all their magazines, in comes the doctor. One look in the mouth, quick poke around the throat, zip goes the test strip.
    Me: “Couldn’t the nurse have done that an hour ago?”
    Doctor: “No, that’s my job. Have a seat, the test should be ready in about 10-20 minutes.”
    Me: “No, I’m going back to work, I have an office, nobody comes in, its all phone work, that’s my job. When it shows positive, send the prescription to my pharmacy.”
    Doctor (hurt): “Don’t you want to know how the test turns out?”
    Me: “I’ll call.”

    Had the nurse that took my insurance and weight, taken the test too, the doctor could have come by with the one sentence I wanted. “Test says its strep, we’ll phone the prescription to your pharmacy, your throat feels normal, go home.” Savings: An hour+ of my time not spent breathing germs all over her office.

    • proreason says:


    • confucius says:

      Some people, like Amanda Cockrell, don’t know the difference between a doctor and a nurse.

      Some people don’t know the difference between good healthcare and bad healthcare.

      Worst of all, many people don’t know the difference between free healthcare and rotten healthcare.

    • proreason says:

      You are a doctor Confucious, and probably a great one…..but every profession has levels of expertise, so why not the medical profession?

      If the work of the guy who changes the oil in your car had to be supervised by the genius engineer who designs the fuel injection system, then an oil change would cost a thousand dollars.

      One of the problems with medical care (not the worst, but one of them), is the myth that a top-1% person who has been intensely trained for 12 years is required to diagnose the sniffles.

      It’s obviously false and obviously a contributor to the high cost of medical care.

      A very high percentage of common maladies SHOULD be diagnosed and treated by people with far less training. The key thing to teach these people is the symptoms that are OUTSIDE the norm. They must be taught to recognize that a single symptom is common to many problems. And yes, there is some risk in mis-diagnosis. But would you claim that you have never made a mistake yourself?

      Most people who are doctors today should be spending their time looking for patterns across thousands of people, practicing in specialties that really do require intense training and expertise, inventing new procedures and devices, and in high-end research.

      To have somebody like Confucious prescribe the steroids to relieve my poison ivy is a ludicrous waste of precious resources.

    • confucius says:

      Yes and no, pro.

      Where I am, nurses are not allowed to diagnose as this constitutes the practice of medicine which is a privilege extended only to those with a medical degree. The restriction exists because people who don’t know what they don’t know oftentimes don’t appreciate what they don’t know. This kind of ignorance always results in costly and permanent mistakes that could have been avoided.

      Doctors don’t know everything, and doctors do make mistakes. (I hear they’re not virgins either. Ditto for nurses.) However, their lengthy and intense training are a direct result of maximizing what they know, minimizing what they don’t know and most importantly, making them fearful of the unknown.

      This respect for the unknown is the basis for one of the central tenets of the Hippocratic Oath, “primum non nocere.” (Translation: “first do no harm.”)

      Nurses aren’t taught this way. They also don’t take the Hippocratic Oath. (Hell, they aren’t even taught how to insert IV catheters anymore!) This is reflected in the profoundly ignornant statements made by the nurse-doctor-wannabes in the AP article.

      The AP article also highlights another issue that should be irrelevant–title. I know many nurses who exercise better clinical judgement than doctors–and vice versa. What should matter is skill.

      This brings me back to training. We are talking about public policy here and “turf” is important in identifying who is best qualified to do what. There should be no confusion as to the superiority of medical training over nurse training. I would even argue it’s better utilization of limited resources. (As an example, see Mithrandir’s post.)

    • proreason says:

      confucious, thanks for the response. It’s a complex topic that merits a lot of discussion, and we probably are both closer to the middle than the extremes. But I do want to add a couple of points.

      My view is that the traditional stucture of the medical industry should adapt to the explosion of information, medical diagnostic aids, and pharmaceuticals. A doctor is no longer a lone ranger vessel containing all the knowledge about health that there is to know. To continue with that structure actually will impede longevity, not increase it. And I do hear you about knowing what you don’t know, and agree as you can tell from my prior post.

      Also, isn’t the Physician’s Assistant supposed to mitigate the gap between doctors and nurses (who are, as you point out, essentially technicians and care givers)? If PA’s aren’t being trained to be able to diagnose routine ailments, AND be alert to non-routine symptoms, then my argument is that there should be a role that does so.

      The core issue, as always, is cost vs benefit. Medicine cannot get a pass on that rule of life.

    • confucius says:

      I appreciate the discussion, pro.

      I very much agree reality tempers the ideal. (Personally speaking, the ideal is my compass. It guides but neither predicts nor tells me how to handle reality’s inevitable potholes.)

      I also agree that medicine has to address its cost and benefits. The problem has always been defining what is cost, what is benefit and more importantly, who gets to define them.

      Medicine has always been slow to adapt. For example, it is one of the few professional areas remaining (if not the last) that hasn’t embraced information technology. Numerous studies show this lack of modernization can result in a loss of up to 30% in unrealized revenues due to uncaptured reimbursements. On the other hand, who wants their vaginal birth YouTubed for everyone to see? (Pun intended.)

      Where I am, physician assistants aren’t allowed to diagnose. In fact, their practice is more restricted than nurse practitioners.

  3. Mithrandir says:

    Nurse Practitioners are Boneheads!

    See a doctor. Every time I get stuck with one of these bimbos, I always have to beg to see a doctor.

    1. In high school, I had a terrible ear infection, the nurse practitioner, who I called “doctor” and she didn’t correct me, told me to drink 10 glasses of water a day. My ear hurt so bad I couldn’t sleep, so I saw A REAL DOCTOR, and got antibiotics and ear drops.

    2. Another nurse practitioner gave me medicine for an allergy, and one of the active ingredients made me nervous, sleepless, hyper-active, and she suggested I TAKE MORE! I got the real doctor, and he took me off of it completely and prescribed something else.

    These people are horrible. Now with the government taking over health care, you won’t be able to sue if they do wind up killing you because of their stupidity.

    • confucius says:

      Patients will be able to sue. ObamaCare doesn’t rule out this possibility. (He is a lawyer, you know.)

      Personally, I say let these doctor-wannabes be sued. Let them taste their own ignorance.

    • U NO HOO says:

      My grandfather knew the cure for an earache: put water into your ear and sit on the stove until the water boils.

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