NurseWeek: Editor's Note

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Editor's Note

It's broke–fix it!
Adequate funding of medicare could ease the nursing shortage
Beth Ulrich, Ed.D., RN, South Central Editor
July 9, 2001

Today’s nursing shortage has spawned a number of legislative efforts at the state and federal level. Legislators are trying to help, but it strikes me that the solutions they offer, while well-intentioned, will solve only a small part of the problem. People are trying to fix the nursing problem when what they should be fixing is the health care problem.

I worked in adolescent psychiatry for a while early in my career and it seemed that more than half the time the adolescent who was admitted (the identified patient) turned out not to be the major dysfunctional person in the family. Well, right now, nursing is the identified patient in the health care family, but there’s a lot more wrong with the health care system than a nursing shortage.

If legislators really wanted to fix the system, they could. It would be easy to do. How? Adequately fund Medicare. Regardless of all you hear about insurance companies and HMOs, the core of the health care system is Medicare.

There has always been a connection between Medicare funding, the number of RNs and RN salaries. When Medicare was implemented in the mid-1960s, the number of registered nurses in hospitals increased significantly. Why? Because suddenly there was money to pay for them. Medicare started out paying the lesser of costs or charges, so hospitals could at least recover their costs. When Medicare moved to case rate reimbursement (DRGs), it forced cost-cutting. The number of RN positions in hospitals declined and RN salaries plateaued.

As the federal government has continued to cut Medicare reimbursement, we’ve seen RN salaries further decrease on an inflation-adjusted basis. Even the HMOs no longer can make money on Medicare patients. Look at how many have stopped offering their products to senior citizens during the last three years.

If Medicare were adequately funded, the health care system would get better fast. Adequate funding would include not only paying the true costs of providing care, but also would cover health care as well as illness care. It would include payment to all types of health care practitioners, regardless of the letters behind their names. With adequate money to pay for the care of Medicare patients, hospitals and health systems could afford to hire more nurses, provide higher salaries, or both.

Now, I didn’t come in on the turnip truck yesterday, so I know there will be some hospitals that will try to bank the additional revenue and not pass it on to the staff. However, where that happens, I am confident enough in the decision-making skills of my nursing colleagues to believe that they will find other places to work.

Am I advocating national health care? No. While it looks good on the surface, the reality is far different. Talk to nurses from Canada or Europe about their health care systems and you’ll hear the flaws. Need hip surgery? Wait in line (or go across the border to the United States). Need dialysis and you’re older than 55? You won’t get it in some countries unless you have supplemental insurance.

What I am advocating is that the government take the lead in paying what it really costs to provide adequate care. Where Medicare goes, others follow.

How do we make that happen? We all aim for the same goal of improving the health care of the American people. We do that by assuring adequate funding of the core of our health care system. On the way, we take what we can get in bits and pieces. Right now, nursing is at the forefront and we should take advantage of that.

While we lobby for money for nursing, we need to talk about the bigger picture of health care. No legislator should believe that providing money to attract nursing students and faculty will fix the nursing shortage or that the nursing shortage is all that is wrong with the health care system. We also need to work together with people inside and outside of health care. Physicians, hospital administrators, pharmacists, OTs, PTs, legislators, church groups, etc., are all potential partners in improving the health care system.

As nurses, we are called upon every day to see the total picture of a patient—to look beyond the most obvious symptoms and coordinate the work of all the providers in helping the patient get better. We become the hub of the wheel. How powerful it would be if we used those same talents and skills at fixing the health care system while we also improve nursing.

What do you think?
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