Working as a nurse in the US?

I'm a nurse working in a hospital in the US where most patients are on some form of public health (subsidized) insurance. Our new director is giving perks to the privately insured. Is this right?

• Answer:

  This chart may help with understanding the economic dilemma inside many hospitals (courtesy L.E.K. Consulting): Economically - the uninsured, Medicare and Medicaid are all negative margin. The only positive margin is commercial/private insurance. The Director at your hospital knows this - so he's doing what he's paid to do - which is to keep the doors open (and the hospital at least somewhat profitable). Having said that - the behavior is reprehensible - for a larger reason. The U.S. healthcare system has been optimized around revenue and profits - not safety and quality. As a result - and given your position in the ecosystem - you're likely to see (and hear) things that are morally objectionable. The Affordable Care is our first step out of this healthcare abyss, but it's only the first step - and it's really only designed to address healthcare coverage. There is more healthcare reform needed - and more coming - because we haven't really addressed the 800lb elephant in the room - cost. The cost issue has created some truly staggering headlines: http://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals [hint - it's now the 3rd leading cause of death in the U.S. behind heart disease and cancer] To put that figure (a range of 210,000 to 440,000 per year) in some perspective - it's effectively the equivalent of the world's largest passenger airliner - the Airbus A-380 - crashing daily - with no survivors. Reaction would be swift and global - and likely have every version of the A-380 grounded by day 3. The U.S. healthcare industry is basically an economic unit the size of Germany http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/ http://www.commonwealthfund.org/publications/press-releases/2013/apr/new-health-insurance-survey There's also a two sentence quote (not mine) that highlights why it's so hard to change the U.S. healthcare system: