Whether you’re a believer in Medicare For All (or some similar single-payer regime) or more consumer-driven healthcare, there’s little dispute that the costs of the U.S. healthcare system are far too high, and there’s much fat to be trimmed.
Greater reliance on nurses is one way of cutting excess spending. In addition to the benefits of allowing nurse practitioners (and physician assistants, too) to enjoy fuller scope-of-practice in addressing the primary care physician crisis, nurses in hospitals are able to perform many tasks that would otherwise unnecessarily tie up physicians’ time and energy.
A new ballot initiative in Massachusetts could dramatically reduce the efficiency of nurses in hospitals. The Wall Street Journal’s editorial board makes the case against Question 1, on the ballot this November:
Question 1 would limit the number of patients assigned to each registered nurse in state hospitals. For instance, in the pediatric, medical and surgery units a nurse would care for no more than four patients. Patients deemed in non-stable condition in the critical or intensive-care units would have their own dedicated nurse, as would mothers in labor and those under anesthesia.
Question 1 is more restrictive than the only other state in the nation, California, that has a similar regulation. And of course, if there’s a cap on the number of patients a nurse can help, the Bay State will need an additional 3,100 nurses to comply.
In dollars and cents, the implications of the law are even more serious:
The Health Policy Commission estimates the annual costs of Question 1 could rise as high as $949 million a year—and that is “likely to be conservative.” The ballot initiative leaves hospitals with little room to cut back elsewhere, explicitly stating they have to meet the new ratios “without reducing its level of nursing, service, maintenance, clerical, professional, and other staff.”
The arguments for the measure are just another iteration of the “Cadillac argument.” Don’t we want patients to get the best care possible?
But this measure will make nurses far less effective. It will lead to longer wait times, sometimes for no good reason. For example, for various logistical reasons, there’s a lag between when a patient has been given full treatment and when they’re actually discharged. Does it make any sense to make a nurse twiddle their thumbs while waiting for the patient to have a ride home instead of helping another one?
Additionally, this could easily reduce nurse salaries because their ability to provide treatment (marginal product, in econspeak) is reduced, as we have seen in states with decreased latitude for physician assistants to practice.
This measure doesn’t directly deal with nurse licensing, but it’s a kissing cousin of scope-of-practice restrictions, except instead of limiting what nurses can do, it’s a restriction on how much they can do.