A major goal of health-care reform is affordable treatment. To achieve it, however, the Obama administration may temporarily upset another aim: effective care. The trouble extends from the president’s pledge to make the new reforms “deficit-neutral.” That will require billions of dollars in funding cuts, primarily at hospitals, which stand to lose $155 billion in Medicare and Medicaid cash during the next few years. The loss should be offset by a boom in insured patients after 2014; for now it’s deepening a clash between hospitals and nurses.
Last month in Minnesota more than 12,000 R.N.s picketed to pressure local hospitals to cap the number of patients seen per nurse. The strike, which was larger than any other nurses’ strike in U.S. history, comes after a University of Pennsylvania study found that smaller workloads can lower the risk of patient death during surgery. So far hospitals across the country have resisted patient-per-nurse limits, calling them unneeded and impractical amid a fiscal crisis and looming reforms. With 18 states considering caps or related regulations, however, they may not always have a choice.