Are you proud to call yourself a Contra Costa County resident? Because we are. We are registered nurses who live and work right here in the county, for Contra Costa Health Services. We believe our community, which includes our kids, our families, our neighbors, our co-workers and you, all deserve the very best medical care that our county can provide.

But that’s not happening right now.

As part of the nearly 1,000 registered nurses who work in the county’s hospital, clinics and jails, we’re here to tell you that conditions for our patients are not always safe, largely because the county refuses to properly staff our facilities with enough registered nurses.

Some units, such as the labor and delivery team that helps moms deliver new babies into the world each day, are so severely understaffed that they routinely lack the bare minimum they need to function each shift.

When nurses don’t feel that they can practice nursing safely and without endangering people, they leave. It’s that simple. Under this dynamic, the only RNs who seek work with the county are new ones, who come to get publicly funded training and experience before they move on to jobs with private hospitals and better working conditions.

And we can’t blame them. Over the past year, we have lost more than 100 nurses — including 22 RNs who have left our emergency room and 24 RNs who have left our labor and delivery room.

In our clinics, too few staff means we can’t see as many patients as we should each day, so people are having to wait weeks or months just for an appointment. When their care is delayed, their conditions often worsen and we end up treating them for serious problems that should have been taken care of long ago.

On top of all that, we are caring for more patients than ever before. With the closure of Doctors Medical Center in West Contra Costa County and people who are now eligible for insurance under the Affordable Care Act, our facilities are jammed with thousands of new patients.

In 2014 alone, our emergency room saw 63,000 patients, and every day, in a dozen clinics across the county, Contra Costa County residents have access to everything from primary care to mental health services. Yet for all the patients we serve, including the many new patients, our hospitals and clinics have not seen a corresponding increase in staff and resources.

Our county patients and our community deserve better. We nurses have been negotiating for more than a year with county health management over this extreme RN understaffing as part of our contract talks.

The county has not heard our concerns, so we have chosen to go on strike for two days, Tuesday and Wednesday, to draw attention to the dangerous conditions we see every day.

We want the county to make sure there are enough of us RNs on duty to keep you and your loved ones safe, every second of every shift.

We want to ensure taxpayer money is being invested in safe staffing and top-quality care for our patients — not in $3.7 million the county board of supervisors recently approved to hire temporary replacements for us, while we call for change.

We believe those funds should be dedicated toward correcting the serious patient care issues that we have brought to the county’s attention — because that’s what our patients deserve.

Please know that we of course would rather be at our patients’ sides than out on the sidewalk, but continuing to participate in a dysfunctional and dangerous system without speaking out and taking a stand would ultimately make us complicit as well.

We hope you will come out to support us Tuesday and Wednesday and help us improve health care for everyone in Contra Costa County.

Liz Isenberg and Sherrie Gordovez are registered nurses in Contra Costa County.

Original post: http://www.contracostatimes.com/opinion/ci_28912097/guest-commentary-its-time-county-invest-safe-patient

To unpack the growing hubbub over the fraudulently named “Cadillac tax” let’s lift the covers off the corporate ideology of both the tax and Affordable Care Act it funds, and ask again, why do we continue to cling to a healthcare system premised on profiting off the sick?

Behind the controversy is a fundamental tenet of the ACA over how to shrink skyrocketing healthcare costs, the primary demand of corporate employers alarmed at how much more they pay out every year in health benefits – one reason President Obama talked repeatedly about health costs harming the economy.

But rather than rein in the profiteering and shameful price gouging by the big drug companies, hospitals, insurance companies and other healthcare industry giants, the main cause of ever rising costs, the ACA “wonks” opted instead to put the burden on workers, families, and patients.

The strategy – accelerating cost shifting, more “skin in the game” in their cynical lingo, also had the effect of pressuring people to skip getting the care they need, even as they were required by the law to purchase private insurance and continue to pay premiums for care they too often could not afford to use.

Nurses, more than anyone else, are left to care for the fallout. Patients and families at the epicenter of this calamity, facing bankruptcy or having to choose between going to the doctor or paying for housing, food or other basics due to un-payable medical bills, or undermining their health by delaying needed care due to cost.

A Gallup poll last December found a third of Americans putting off care due to cost, the highest percentage in the history of the poll. Worse still, 22 percent said they are skipping care for serious conditions, such as irregular heartbeats and kidney stones.

As the poll notes, skipping care can lead to much higher overall costs later when conditions deteriorate and are more difficult to treat, not to mention the increased suffering that results.

That’s where the so-called Cadillac tax, a central pillar of this strategy, fits in.

The tax is a hefty 40 percent surcharge on the amount of plans above the cost of $10,200 for individuals or $27,500 for family plans. Rightwing rhetoric aside, these plans are not the equivalent of workers wanting yachts, but comprehensive coverage that provides health security for their families usually earned in exchange in lieu of higher wages or other benefits.

It was always evident that employers would pass the tax on to workers, and no one above the age of three years could possibly believes those employers will generously reward their workers with higher pay in exchange.

Even before the tax is implemented in 2018, the cost shifting is underway in the form of higher co-pays, deductibles, and other out-of-pocket costs, or workers being pushed into bare bones plans with fewer covered services.

A recent Kaiser Family Foundation survey reported that 13 percent of large employers have already reduced health coverage and more than half are looking into ways to do so. Since 2010, average deductibles have jumped from $900 a year to $1,300; 20 percent of workers, Kaiser found, have a deductible of $2,000 a year or more.

In addition to its ideological role, the tax has another major role. Expanding access, the major political selling point for the law, is achieved mainly through the expansion of Medicaid to the most low-income adults, but also by providing taxpayer-funded subsidies to enable the moderate-income uninsured to buy the private insurance that remain pricey even on the ACA market exchanges.

With its projected $87 billion a year in revenues, the Cadillac tax is expected to be a main funding source for the subsidies. Now that Hillary Clinton has joined Bernie Sanders, and the labor movement, among others, in endorsing repeal of the tax, the subsidies, may well be on life support.

Even more people would risk the penalties and choose not to buy insurance, adding to the 33 million who remain uninsured, and political support for the law would likely crater. No wonder those who have long touted the law, which emerged from corporate think tanks and was first planted by Mitt Romney in Massachusetts, are circling the wagons and scrambling to defend the tax.

And it would bring into sharper focus the still massive failings of a broken, profit-focused system that can only be fixed by enacting a single payer system, most simply achieved by strengthening and expanding Medicare to cover all Americans.

The very reason nurses have rallied behind the candidacy of Sen. Sanders who has not only long called for repeal of the punitive Cadillac tax, but has long been the foremost legislative advocate for Medicare for all.

As Sanders says, in virtually every campaign stop, the time has come “to end the international embarrassment of the United States being the only major country on earth that does not guarantee healthcare to all. To also say that we need to expand Medicare to every man, woman, and child as a single-payer national healthcare program.”

Nurses will also never stop fighting to finally transform an inhumane system, and reject the cynical machinations to protect it.

Original Post: http://www.huffingtonpost.com/rose-ann-demoro/its-not-just-the-cadillac_b_8234210.html