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Nursing Shortage is Well Advertised, But Why Is It Happening?
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FAQ
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PERSPECTIVES IN PREVENTION
"If the nation is to achieve its full potential for better health, public policy must focus directly and actively on those factors that represent the root determinants of death and disability." So wrote McGinnis and Foege, in a landmark 1993 paper contrasting the 10 leading diagnoses of death in the United States in 1990 with the actual causes of those deaths. These authors found that 50% of deaths were attributable to behavioral choices -- as opposed to genetic and external factors -- and thus were potentially responsive to public health education and prevention interventions. The distribution of causes of death was essentially stable 10 years later when assessed again by Mokdad and colleagues in 2000. [EINO: the US spends less per capita on public health work than any other OECD. Partially, because such expenditures are not seen as saving public health care dollars (our system is nominally private). This is another assuredly enormous source of savings once the US accepts the fact of no other option but government guaranteed universal access to care.]
According to the National Center for Health Statistics, about 2.5 million people die in the United States each year. If the root causes of death as determined by Mokdad and colleagues are considered, half of these deaths potentially are preventable, and thus are appropriate for public health attention. Fully one third of deaths are caused by tobacco use, dietary factors, and physical activity patterns. This means that approximately 800,000 people die annually from smoking, eating too much, or being physically inactive. Continuing down the list of root causes of death, alcohol consumption (85,000 deaths) and microbial agents (75,000 deaths, including those from influenza, pneumonia, septicemia, and tuberculosis, though not HIV) each are responsible for between 3% and 4% of deaths; toxic agents (pollution), motor vehicles, firearms, sexual behavior, and illicit drug use combined cause about 7%.
This article is from THE AMERICAN COLLEGE OF PREVENTIVE MEDICINE, Posted 10/03/2006, Joshua Lipsman. You might request a copy from From Medscape Public Health & Prevention CLICK HERE
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The "nursing shortage" has been well covered by the major media, but we haven't heard much about why nurses are leaving the profession, feeling they cannot recommend young people to enter it and are generally frustrated in recent years.
It is a shortage by design, to break the move to unionizing nurses and to create greater profits by downsizing and deprofessionalizing nursing services.
Reference: AJN 1996 96(11):25 
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INFANT MORALITY BY NATION
Numbers are the deaths per 1000 live births.
Are we really a nation concerned with Right to Life?
Let’s see some activism around the issue of innocent infant lives being sacrificed to maintain our injust market-driven system of funding and providing health care.
From the OECD 2003 (Organization of Economically Developed Countries)
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Life Expectancy by Nation year of 1999
Would you buy your house for twice the market value of a properly completed house?
Would you consider doing that if yours had no plumbing? Would you brag about your great deal and high quality living conditions?
From OECD 2003 (Organization of Economically Developed Countries)
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CHILDHOOD IMMUNIZATION SCHEDULE IN US DEEMED COST SAVING
From both the direct cost and societal perspectives, the 7-vaccine childhood immunization schedule routinely used in the US provides substantial cost savings, according to a report in the Archives of Pediatrics and Adolescent Medicine for December. Previous reports have suggested that childhood vaccinations yield cost savings, but most studies have focused on just one vaccine, not on an entire immunization schedule.
The analysis incorporated population-based vaccination coverage, reported vaccine efficacy, historical data on disease rates prior to vaccination, and disease rates reported from 1995 to 2001. From the direct cost and societal perspectives, the immunization schedule provided cost savings of $9.9 and $43.3 billion, respectively, the authors note. The direct costs without and with this schedule were $12.3 and $2.3 billion, respectively, whereas the corresponding societal costs were $46.6 and $2.8 billion.
"Although not reflected in this analysis and difficult to quantify, a dramatic decrease in the loss and suffering of patients, family, and friends is also a direct result" of the routine childhood immunization schedule currently used in the US, the authors state. Vaccination against the pathogens included in the schedule "is a remarkable medical accomplishment that achieves significant public health benefit at a substantial cost savings."
Arch Pediatr Adolesc Med 2005;159:1136-1144.
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VA BETTER DRUG BUYER THAN MEDICARE PLANS
The prices of drugs negotiated by ten of the largest private Medicare drug plans are 84% higher than those obtained by the federal government (VA); 61 % higher than the prices negotiated by anada; 3.5 % higher than the prices at Drugstore.com; and 2.9 % higher than the prices available at the large retailer Costco, according to a Congressional investigation. Medicare beneficiaries with high expenses will be particularly harmed by high drug prices, because once their costs exceed $2,250, the plans stop paying and seniors must pay the next $2,850 out of pocket.
Committee on Government Reform - Minority Staff "New Medicare Drug Plan Fails to Provide Meaningful Drug Price Discounts," U.S. House Special Investigations Division, November 2005
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CORPORATE MONEY AND CARE
The Medical-Banking Complex: UnitedHealth and the Blue Cross/Blue Shield Association are chartering their own banks to get a share of the estimated $10 to $20 billion projected to be in health savings accounts by 2010. The "Blue Healthcare Bank," will begin operations by summer 2006. The bank will allow members to save and withdraw money for health expenses and will offer "credit lines" to pay for care. The move follows the creation of a jointly branded BC/BS debit card with VISA for accounts linked to health plans. HSAs add the administrative cost of banking and debit cards to the already high administrative costs of the insurance industry.
By Skidmore, in the San Diego Union Tribune 12/06/05
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INSURANCE MERGERS REDUCE COMPETITION, REWARD EXECS $590 MILLION
Indiana-based insurance giant WellPoint is buying New York’s WellChoice for $6.5 billion in cash and stock. WellChoice, which owns Empire Blue Cross Blue Shield, is the largest insurer in New York state with five million members. The new firm will have more than 33 million enrollees in 14 states (Kaiser Policy Report, 09/28/05 and 10/03/05). Wellpoint was created last year by the $18.4 billion merger of Anthem, Inc. the owner-operator of several (formerly non-profit) Blue Cross plans, and California’s Wellpoint Health Networks. A handful of top executives received $245 million in bonuses from the deal.
UnitedHealth Group bought PacifiCare Health Systems for $9.2 billion in cash, stock, and assumed debt. PacifiCare’s 2.5 million commercial plan enrollees and 716,000 Medicare-Advantage plan members will bring UnitedHealth’s membership to 26 million. The deal includes a $345 million windfall to top executives at PacifiCare.
[That's $590 MIL to execs between the UnitedHealth and Wellpoint mergers].]
Analysts expect the nation’s 13 remaining publicly-traded managed care operators to continue merging and purchasing smaller companies. Already, just 5 health insurers enroll over half (88.6 million) of the 173 million Americans with private health insurance: WellPoint (32.7 million), UnitedHealth (25.7 million), Aetna (13.7 million), Cigna (9.7 million), and Humana (6.8 million). ().
Axis Benefits Consultants "Renewal Outlook," Vol. 4 No. 2, Fall 2005; Kaiser Policy Report, 11/18/05 and Foundation for Taxpayer and Consumer Rights, Press Release, 1/21/06
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CORPORATE-GOVERNMENT REVOLVING DOOR
The former chief lobbyist for HMO-giant Humana, Ray Ramthun, is now the senior health policy advisor for the White House’s National Economic Council.
Former Republican aide John E. McManus, who-formed his own lobbying firm after helping draft the Medicare drug bill for the Ways and Means committee Republican members, received $620,000 in consulting fees from PHARMA, Merck and other firms to help them navigate the bill.
Wholesale prices for brand-name prescription drugs increased an average of 6.6 % between 2004 and 2005, more than twice the rate of inflation (.
Congressional Quarterly, 5/13/05; New York Times 08/19/05, by Pear and "Trends in Manufacturer Prices of Prescription Drugs Used by Older Americans," AARP November 2005, by Gross, D. et al
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DRUG LOBBY EMPLOYS 1,300 LOBBYISTS TO SWAY CONGRESS
The pharmaceutical industry spent $800 million on federal lobbying and campaign contributions between 1998 and 2004, the most of any industry. The industry employs 1,291 lobbyists - more than any other - more than half of whom are former U.S. government officials. More than 3,000 individuals have lobbied for the industry since 1998, including 75 former lawmakers. Drug companies spent $116 million on lobbying in 2003, the year Congress approved the new Medicare drug bill. The bill, which prohibits Medicare from negotiating drug prices, was crafted by former Rep. Billy Tauzin, now president of the dru industry’s trade association, PhRMA.
"Drug Lobby Second To None," Center for Public Integrity, 07/07/05, by Ismail, M.
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GOP GIVES HMOS $22 BILLION GIFT
HMOs will receive $22 BIL in overpayments over the next decade if congressional Republicans have their way. In "one of the rawest displays of lobbyists’ power in the Capitol," staff and GOP lawmakers, meeting behind closed doors, "tweaked" a budget bill to hand "HMOs a $22 BIL gift by protecting the inflated reimbursements they currently reap through Medicare." Republicans took out a provision that would require HMO premiums to be risk-adjusted for the health of their enrollees, a provision that would, according to the Congressional Budget Office, save Medicare $22 BIL over 10 years, and which was recommended by MedPAC.
New York Times, 1/25/05, and "Closed Door Deal Makes $22 Billion Difference" and Washington Post, 1/24/05
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AARP PROFITS FROM MEDICARE DRUG BILL
The American Association of Retired People (AARP), a pivotal backer of the 2003 Medicare drug plan, made a deal with UnitedHealth to sell the insurer’s Medicare drug plan under the AARP name. AARP will receive a "royalty-based fee" from UnitedHealth. AARP already makes $300 million (39 % of its total income) annually from insurance royalties.
Alonso-Zaldivar, LA Times, 06/08/05; BusinessWeek 01/24/05
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FRIST'S WINDFALL, JUST LUCKY
Senate Majority Leader Bill Frist (R-TN), a potential presidential candidate in 2008, sold all his stock in HCA, his family’s hospital corporation, about two weeks before it issued a disappointing earnings report and its price dropped 15% . Frist’s shares were sold by July 1 and those of his wife and children by July 8, five days before the July 13 earnings report. Frist’s father (Thomas Frist) founded the company, and his brother (Thomas Frist Jr.) is a director and leading stockholder. The family is worth $1.1 BIL
Katz, Washington Post, 09/21/05
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REFERENCES
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Data from American
Journal of Nursing
BACK TO DATA
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J Nurs Schol
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