Reflections on Health Care for Nannies

By Polly Psi
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Over the past few weeks we have attempted to take a sober look at the complex and voluminous health care legislation and to present a clear and simple timeline of changes to take effect during the process of implementation. Discarding the hyperbole and demagoguery of political operatives, we found a lot to like about the bill, and some shortcomings. We shall end this series about health care reform with some observations that are uncovered by a mere timeline.

Clearly, the number of citizens and valid residents eligible for insurance will increase the pool of covered patients. And, if these newly insured people are to be integrated into an already overpriced health care system, changes in the pricing and delivery of services will be necessary.

Chronic illnesses, preventable hospital care, and long-term care are the main factors that drives the increases in patient costs and rising insurance premiums. The reform package as a whole emphasizes prevention and wellness programs, more efficient care management by providers and local long-term care facilities.

The most noticeable change likely to occur is between the patient and the type and the venue of the provider. In order to lower costs, the patient might be initially examined by a physician’s assistant, or other trained provider supervised by a physician, but with less training. The patient may not be seen by the physician for common self-limiting diseases, but only for chronic, traumatic, or life threatening illnesses. More research-based protocols are intended to divert patients from specialists to primary care providers.

Instead of a hospital emergency room being used for primary care, those patients who are now uninsured will likely have options for care. Those now on Medicaid, the low-income and uninsured, will be encouraged to find a health care “home” that will provide both preventive service and care for illnesses. These “homes” might be located on non-traditional locations such as pharmacies or supermarkets.

Advances in technologies will allow patients to be “examined” with use of video conferencing equipment or by a computer camera. Thereby “office” visits without going to the office. Telemedicine should be particularly useful for the home bound and the 20% of Americans living in doctor-poor areas.

A cloud of data will be established containing general information about the conditions likely to afflict people of a certain ethnicity, socio-economic status, and age. This cloud of data will also contain the records of you and your family. The digitization of medical records and standardization of claim forms should significantly lower administrative costs.

One factor of cost control not reformed by this bill is that of medical malpractice insurance. Unless there is a national plan to control malpractice insurance costs and to cap lawsuit awards, the cost of care and the use of defensive testing is certain to keep rising.

For most people, the health care changes will cause no changes except for some initial administrative paperwork. The health care changes are intended to broaden care to the poorest, sickest, and most elderly among us. This expansion is occurring while simultaneously trying to reduce per capita cost, now the highest in the world. Some decry these changes as the onset of a “nanny nation.” We hope the nation will be so fortunate and that the changes are so successful that they approximate the care a nanny provides.

Do you think health care reform will help you?


  1. IMO health care reform can only help nannies. Thanks for the great information. It's hard to understand and you made it simple.

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