I just read a post on Facebook that concerns health care funding by the feds. The website is www.protecthealthcare.org and, of course, I'm being asked to sign a petition. I know what this means, or what it usually means - I sign a petition and now get hit on to give money so that this petition will carry some weight. It's always the same story, isn't it?
But, I must say that having lived through the 1980's and the Reagan austerity era, I have a perspective that may help quiet any panic one might feel over this important issue.
I began a comment citing a small bit from a study done in 1990 that looked back at those 1983 -4 funding cuts and its ramifications. It was within just a few years after the budget cuts that small hospitals in rural places of the country began to feel the pinch, cut services, staffing and some even closed. If you were a nurse at that time, you were keenly aware that you had more patients on your assignment list and less assistance from LPNs and nursing aides to help care for them.
After the initial scare that your one, local hospital was not going to be around much longer, lo and behold, larger entities "came to the rescue," buying out the previous small group of shareholders (often local doctors and professionals sat on most small hospital boards). Hospital Corp. of America was our local take-over company here in central Tennessee, and elsewhere, I'm sure. Whether this scenario will again occur, I think it already has begun. Our own small hospital, once owned by HCA was again purchased by a coalition of local professionals probably a decade or so ago. Today, it is again owned by a large corporation, St. Thomas Healthcare. But to fend off fears regarding this change, large ads have been noted in the local newspaper saying the hospital will retain its former name. What a coup, eh?!
In short, this is nothing new. Our federal legislators always make choices which take away from the needy when they can get away with it. At the same time the aforementioned 80's budget cuts were put in place, the funding for mental institutions was so severely cut that thousands upon thousands of patients were turned out into communities with little or no follow-up care. I saw this myself in the mid-90s when severely handicapped people that formerly resided in institutions suddenly went to live with family members. This was often aunts, uncles or grandparents who knew little about how to care for them except for assisting them with hygiene, food and shelter. As Home Health personnel, we provided as much support as we knew how, but often this was only to oversee the patient's physical infirmities or illnesses as they occurred. I recall it was always a depressing state of affairs to deal with, for us and them. Today, there is still a grave lack of services for the mentally and psychologically impaired.
Not only was Medicare/Medicaid funding cut at that time, but payments for practitioners were capped and limited. Remember DRGs? Diagnosis related categories? This happened at the same time, too. This affected insurance reimbursements for "lengths of stay," depending on what category your illness fell within. The health care team no longer had the say-so in when a patient was ready to be discharged. This is still the way it is, although the medical profession as a whole has adjusted and managed to find a way (creative documentation, manipulating ICD codes, etc.) to take care of most patients the way they feel they should. It was also about this time that Home Health took to the forefront, providing the missing care that recently discharged patients still needed. Now, in 2015, many small, rural hospitals have no orthopedic care, no OB/GYN or Neonatal care, and many of them have been "bought out" by larger hospital corporations, thereby making a monopoly of sorts in many areas of the country.
So, again, this is not new, but it is "news" and we must do what we can to keep what little decent health care we have access to. Local, small hospitals will not disappear altogether, but they will change along with the funding cuts. Creative ways will be devised to deal with these set-backs. And like it did in the 90's, the pendulum will swing back again, following studies done about increases in hospital mortality rates, infection rates caused by staffing shortfalls, etc. and the ensuing public outrage. If the pendulum gets stuck, perhaps it's time to look into Holistic healing practices and healthier living alternatives. It couldn't hurt.