Some 12,000 nurses in Minnesota went on strike today after failing to reach an agreement with 14 Minnesota hospitals about pensions, wages and, most importantly staff-to-patient ratios. The nurses are arguing that they take care of too many patients and work in too many departments, sometimes performing tasks they have not been specifically trained for.

“We’ve been put into so many positions, where we’re not able to take care of very sick patients the way that we want to. But furthermore, most importantly, the way they deserve to be taken care of,” Mary Ann Vertin told the local CBS affiliate. “We don’t have enough nurses to take care of the patients in the hospitals and it puts the patients at risk. And another thing is, it puts my license at risk. It puts my family at risk. It puts the room over their heads at risk. I make a mistake, because the staffing is unsafe, that’s my license, that’s my livelihood, that’s everybody’s livelihood out here that you see. That’s really what we’re fighting for,” nurse Ryan Giacomini said.

Hospitals are concerned about the increased costs associated with minimum ratios and have cited the uncertainly surrounding the new health care law and the coming end of the fee-for-service system as reasons to forgo a more significant investment in the workforce. But that would be a fundamental misunderstanding of the direction of health care in America. The reality is, the government is moving towards paying for outcomes, not procedures, and if hospitals don’t rely on nurses and other professions to help coordinate care, prevent unnecessary hospital re-admissions, and ensure patient safety, they’re going to get dinged in their reimbursement rates. If hospitals don’t begin in building teams of health professionals — nurses, social workers, educators, tech, counselors, etc — to produce better health outcomes, they’ll be left behind.

The patient safety point is also worth reiterating. As of September 2009, just 14 states and the District of Columbia “had enacted nurse staffing legislation and/or adopted regulations addressing nurse staffing” and at least one RWJF-funded study concluded that under California’s minimum laws, nurses experienced less job burn out, “job dissatisfaction were lower, and nurses reported consistently better quality of care.” That sounds like something worth investing in.

In the latest issue of Health Affairs, Jon Kingsdale — who until recently ran the successful Commonwealth Health Insurance Connector Authority in Massachusetts — suggests that the new state-based health exchanges should function as shops for insurance and help customers choose a compatible insurance plan. A purchaser of insurance should be able to “generate rate comparisons for any level of benefits simply by providing his or her date of birth, household size, and ZIP code. These rating rules make it possible to automate insurance pricing and facilitate comparison shopping in an exchange,” Kingsdale writes.

In July, the Department of Health and Human Services (HHS) is preparing to unveil a new website that will allow individuals and small businesses to comparison shop between different coverage options, “including private insurance plans, high risk pools, CHIP and Medicaid.” Here is how Karen Pollitz — head of the new Office of Consumer Information and Insurance Oversight — explained the new web portal during yesterday’s ‘web-chat’:

POLLITZ: The first thing we’re going to do is open a new website. That’s going to be a great big website. I don’t have the name of it yet, but that is a big project that’s in the works and that will show, on July 1st, all of the big health insurance policies that are for sale, for individuals and small businesses throughout the country. So you can go on the website, look up your state and see what’s available for you. A little bit later this year, we’ll put out information about pricing, sort of what, at least the sticker price is for those policies. And then, a few months down the road after that, we’ll start loading up some really important performance information. So how do these place really work for people. What kind of enforcement actions and complaints and what are the things they do well, so that folks can have a really better understand of what their options are.

Watch it:

The federal government hopes that states will adopt the new portal as a model for providing consumers with information in the exchanges and all the different stakeholders are advising the agency for how best to design the new site. As Politico’s Pulse notes, “Reform proponents like Families USA want HHS’s new consumer insurance portal to include an ‘in-depth compendium of plan information‘ in multiple languages. Others, such as Aetna, say that HHS’s sky-high demands for information go beyond Congressional intent and that the portal should ‘not be a mandatory, comprehensive and continuous reporting obligation for insurers on all open and closed insurance products.’”

Kingsdale notes that the exchanges will have to determine how to present information to consumers in the most useful and usable manner. “How many choices to offer, and of what kind, are matters of judgment and consumer preference,” Kingsdale suggests. “Too much choice may confuse consumers and lead to adverse selection. On the other hand, too little choice may conflict with consumers’ preferences and stifle innovation in the design of insurance policies and benefits.” Kingsdale writes that exchanges have to create administrative efficiencies and add transparency to the health care system. “Today, in the absence of exchanges, the non group and small-group markets offer a bewildering array of benefit choices and crate hurdles to purchasing coverage.” “Many of the functions associated with sales, enrollment, premium billing, and collections could be streamlined through a combination of manual rating and economies of scale,” he predicts.

TPMDC’s Christina Bellantoni is reporting that Democrats are ramping up their efforts to portray Republicans as taking away health reform’s early benefits with a new 60-second ad that’s “timed to coincide with the government mailing to seniors the first $250 Medicare rebate checks fixing the so-called prescription drug ‘donut hole.’” The strategy here is to portray the GOP’s “repeal and replace” or simply “repeal” strategy (depending on which conservative you talk to) as an effort that will literally take away very tangible benefits from individuals and give them back to insurers and drug companies, pissing off enough seniors to really build some momentum for the health bill.

During his health care tele-town hall on Tuesday, President Obama framed the new strategy this way: Republicans “would roll back the rebate to help you pay for your medicine, if you fall in the doughnut hole. They’d roll back the free preventive care for Medicare recipients,” Obama said. “They would roll back all of the insurance provisions that make sure that insurance companies are not cheating folks who are paying their premiums. … They’d put insurance companies back in charge.” “I refuse to let that happen. We’re not going back. We are going to move forward. That’s why I was elected.”

The GOP response has been a bit scattered. There is a chasm in the party between the repeal purists and repeal and replacers, but even the later category is having some trouble explaining why giving seniors money to pay for prescription drugs is a bad thing. Here is Sen. John Barrasso (R-WY) on today’s Washington Journal:

BARRASSO: 1 in 10 senior citizens are going to get a check. You have to show that you want to help folks, but who is going to pay for that? The nine other people. If someone does not get a check, you have just paid for someone who it is.

Watch it:

This is quite silly. First, the doughnut hole provision is closed with the many pay-fors in the bill, including about $80 billion from the pharmaceutical industry. Second, not everyone will receive a rebate check because not everyone falls into the doughnut hole. As Sonia Sekhar explains in CAP’s new by-the-numbers item, “more than one in four, or 26 percent, of Medicare Part D enrollees who filled any prescriptions in 2007 (excluding beneficiaries who received low-income subsidies) reached the coverage gap.” CMS will mail out partial rebates this week to 80,000 Part D beneficiaries who have reached the coverage gap, and will continue to mail out rebate checks to beneficiaries quarterly, as they reach the gap. Ultimately, approximately 4 million seniors will benefit and as Barrasso discovered, those are numbers that are hard to argue with.