Medicare Turns 50: Familiar Opposition in 1965, Essential and Continuing to Evolve Now

President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration. President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

On this date in 1965, exactly 50 years ago, Medicare (part of the Social Security Amendments of 1965) was signed into law by President Johnson. The debate over government-sponsored health insurance is not new, and opposition to the creation of Medicare was similar to the opposition to the Affordable Care Act and driven by many of the same organizations and arguments.

According to a timeline at SocialSecurity.gov, Congressional hearings on the topic occurred as early as 1916, with the American Medical Association (AMA) first voicing support for a proposed state health insurance program and then, in 1920, reversing its position. A government health insurance program was a key initiative of President Harry Truman, but, as with the Clinton health initiative several decades later, it didn’t go anywhere because of strong opposition from the AMA and others.

AJN covered the topic in an article in the May 1958 issue after a health insurance bill was introduced in 1957. Yet again, one of the staunchest opponents was the AMA. In the September 1958 […]

2016-11-21T13:02:12-05:00July 30th, 2015|career, health care policy, Nursing, nursing perspective, Patients, Public health|0 Comments
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An Oncology Nurse’s Heart: Helping Dying Patients Find Their Own Paths Home

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog.

Heart Break = Heartache graphite, charcoal, water color, adhesive strip by julianna paradisi Heart Break = Heartache
graphite, charcoal, watercolor, adhesive strip, by julianna paradisi

The disadvantage of building a nursing career in oncology is that a fair number of patients die. Despite great advances in treatment, not every patient can be saved. Oncology care providers struggle to balance maintaining hope with telling patients the truth.

Sometimes, telling the truth causes anger, and patients criticize providers for “giving up on me.” In a health care climate that measures a provider’s performance in positive customer satisfaction surveys, paradoxes abound for those working in oncology.

Providers may also be criticized for delivering care that is futile. “Don’t chemo a patient to death” and “A cancer patient should not die in an ICU” are common mantras of merit.

Maybe because I live in Oregon, a state with a Death with Dignity law, or maybe it’s the pioneer spirit of Oregonians, but I don’t meet a lot of patients choosing futile care to prolong the inevitable. In fact, many patients I meet dictate how much treatment they will accept. They grieve when they learn they have incurable cancer, and most choose palliative treatment to […]

2016-11-21T13:02:13-05:00July 24th, 2015|career, Nursing, nursing perspective, patient engagement, Patients|3 Comments
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The Huddle: A New Mother’s Experience of Discharge Planning

By Amy M. Collins, AJN managing editor

John Martinez Pavliga/Flickr Creative Commons By John Martinez Pavliga/Flickr Creative Commons

Three months ago, I gave birth to my first child under somewhat traumatic circumstances. After a fast and furious labor onset, I was all set to be given an epidural when I was informed the baby’s heart rate had dropped dramatically and I needed to have an emergency C-section. Thankfully, everything turned out okay, and my son was born healthy.

Nurses changed shifts every 12 hours during my four-day hospital stay, and each of them provided excellent care. They spent massive amounts of time with me, helping me to get up and walk around, showing me how to expertly swaddle my baby like a burrito, and even helping me get the hang of feeding my child.

On my last day, two nurses were assigned to get me ready for my discharge. They had tons of printed information for me on postnatal care, wound care, postpartum depression, etc. I was told by one of the nurses that we were going to now have a “mother–child huddle.” She then said to the other nurse, with what I took to be a little irony in her tone, “Are you ready for the mother–child huddle?” Curious, I asked why the emphasis on the word.

“I just think the word ‘huddle’ is silly,” she said, adopting […]

2016-11-21T13:02:18-05:00July 10th, 2015|Nursing, patient engagement, patient experience, Patients|3 Comments
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The Challenge of Bearing Witness to Patient and Family Suffering

“How do I honor this pain so that it teaches and blesses and does not destroy?”

By Jacob Molyneux, AJN senior editor

Illustration by Neil Brennan. All rights reserved. Illustration by Neil Brennan. All rights reserved.

This month’s Reflections essay (“Why?“) is by a pediatric chaplain. As the title indicates, it’s about the questions we all ask in the face of suffering and loss. The precipitating event for the author is the baffled, enraged cry of a father who has lost a child, and her own struggles with the impossibility of giving an acceptable answer—to the child’s parents, or to herself as a daily witness of loss and suffering.

How does a chaplain, or for that matter a nurse, witness the pain of patients and their families time and again and keep from either shutting down or being overwhelmed by the stress and emotion? As we’re often reminded, self-care matters or there’s nothing to give the next time: yoga, gardening, humor, family, cooking, whatever works for a person. Is it enough? Yes, and no, says the author. Here’s an excerpt:  […]

2016-11-21T13:02:19-05:00July 8th, 2015|patient engagement, Patients|1 Comment
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Surveys Aside, One Crucial Precondition for Real Patient Satisfaction

callbellBy Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN. 

During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
1. Never
2. Sometimes
3. Usually
4. Always
5. I never pressed the call button

Everyone is talking about patient satisfaction these days. Purposeful rounding, responsiveness, and customer service are discussed in meetings, on blogs, and in conversations at work. An entire science has been created out of satisfaction, with whole journals devoted to patient experience and paid officers tracking scores and strategies. Since hospital reimbursement is linked to how happy patients are, we’ve suddenly gotten serious about satisfaction.

But behind the sterile questions on the HCAHPS survey, real stories about real people reside. I find myself often forgetting the flesh and blood that’s represented by each checked box, and am learning to realize that, while satisfaction is something to be striven for, dissatisfaction is something to be learned from.

In a series of posts, starting with this one, I’ll share stories of my own missteps—ones that may have caused my patients to answer never instead of always to questions about my care. The events described here helped me realize that, score or no score, responding to call bells actually matters at the human level:

Sarah was […]

2016-11-21T13:02:20-05:00June 29th, 2015|Nursing, nursing perspective, patient engagement, Patients|9 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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