Patient Protection

Did you know that if McCain is elected you will have to pay income tax on the value of the medical insurance that your employer gives you? Worse still, he is offering a tax break for people who pay their own insurance, BUT only $2,500 for individuals and $5,000 for families.

Let's say you have a family of four. Your insurance policy costs would be at least $1,500-2,500 per month under a self-pay plan, which cost more than employer group plans. So, you pay $18,000 -$30,000 per year for insurance, and you get to deduct only $5,000 of that. If you paid $25,000 for you insurance, you would be out of pocket $20,000 per year. This is FAR WORSE than the current system, where if you are self employed you can deduct 100% of you medical insurance costs.

So, if you're not self employed, you would stick with your Employer's plan. Employer plans for a family of four have a value of $900-$1,500 per month totaling 10,800-$18,000 per year. Surprise! On April 15th, you owe tax on all of that as INCOME to you. Say your bracket is 25%, and the value of your Employer medical plan is $14,000. You will OWE THE IRS an additional $3,500, and that's ON TOP of whatever monthly premium you already pay to your employer for your insurance.

Many analysts say that McCain's new rules would encourage employers to stop offering health benefits. If that happened, then far fewer Americans would be insured than are insured today, because what family of four can afford $18,000-$30,000 out of pocket per year for self-pay health insurance?

Furthermore, McCain's plan does not require insurance companies to cover pre-existing conditions of people who self-pay their insurance. People under employer group plans have all of their pre-existing conditions covered. This is a hugely unfair aspect of the current system. Insurance companies can afford to cover the pre-existing conditions of the much larger pool of people with group insurance, but they refuse to pay the pre-existing conditions on the smaller pool of self-pay customers. They have been allowed to price gouge the self-pay customers, which is a form of market manipulation that should be illegal.

So let's say one of your kids had diabetes and you have high blood pressure, then your employer stops offering insurance. You now have to buy your own, but you and your child are INELIGIBLE due to pre-existing conditions. Oh, yeah, they will let you buy the insurance, but you can't use it for any pre-existing condition until you have paid on time every month for two years. And you know what happens at one year and 11 months? You get a letter saying your policy has been cancelled. I have many patients this has happened to.

McCain's plan SUCKS.

It does nothing to help middle class working Americans afford or obtain medical insurance. In fact, it makes the current system WORSE.

The single most important thing to prevent errors is communication. A universal electronic medical record that would be available wherever you might get care, from your doctor's office to the walk in clinic to the emergency room to the pharmacist would be a huge step in the right direction. Every day I see patients who don't remember their medicines, allergies, surgeries, or medical history, yet I am expected to make perfect diagnoses and prescribe the perfect treatment based on incomplete information. Expecting the private sector to come up with the best electronic medical record system based on the free market is absurd. The government already mandates many other things that are universally applied, such as DEA numbers, UPIN numbers, diagnosis and procedure codes, and electronic submission of Medicare and Medicaid billing. The VA and the Department of Defense already have electronic medical record systems that are available across the US. The federal government needs to mandate a universal electronic medical record.
K. Smith, MS, ARNP

As a registered nurse, I can speak to items 1 and 3.

Medication errors - Americans take too much medication; we are a drug culture, and believe strongly that there is a pill for everything. There isn't. It is not unusual for patients over age 50 to be on 7 or 8 different medications. The article's advice about asking a doctor about side effects is misplaced - most doctors don't have a good handle on side effects and know even less about drug interactions - a pharmacist is a better person to ask. But ultimately, many of the medication Americans take are for conditions that can be treated or cured by lifestyle changes - exercise, weight loss, stopping smoking, less alcohol. Change the behavior and there is no need for medicine.

The best way to prevent medications errors is to take less medication, or no medication.

Hospital errors - "Bed sores, falls, hospital-acquired infections and failure to aid patients in distress." Three of these items - bed sores, falls and failure to aid - are exclusively nursing errors; hospital-acquired infections are also partly under nursing's watch, but other hopsital disciplines play a part as well. In study after study it has been shown that when nursing staffing is down (and I mean registered nurses, not nurse's aides), bad things happen. Increasing nurse-to-patient ratios decreases or eliminates all four of these preventable errors.

The best way to prevent bed sores, falls, infections and failure to recognize patient distress, as well as medication errors in a hospital setting, is to improve nursing staff numbers.

One of the strengths that nurses have always brought to the table is that of patient advocate. It is unfortunate that as the healthcare system has changed and the nursing shortage has intensified, family members are forced to take on this role - not everyone has a family member who can be at a loved one's bedside, and too many family members are intimidated by the system, and/or don't have the knowledge needed to know which questions to ask.

Taking less medication, behavior change, and improving nurse-to-patient ratios will go a long way towards eliminating many, perhaps most, of these errors.

C. MacLean, RN, MS

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