Is socialized healthcare in our future?

user69 · Mar 31, 2004

Does anyone on here know what the cost of becoming a doctor is in a country with socialized healthcare? Or what a physician or nurse makes in those countries? I am assuming it is elevated over the bulk of the population, but not in the 500K range of many US doctors.

Obviously if they change the healthcare system to a socialized version, education for health providers would also have to follow. Who could afford to go to med school if they were not making the big money?

fergus51 · Mar 31, 2004

Depends on the specialty. They published salaries of town docs in one of the smaller towns I worked in. The ENT was pulling in 600K a year, internist was in the 500K range. Couple that with waaaaaayyyyyy cheaper malpractice insurance and administrative costs and some docs do better here. I know 2 who moved to the US and then came back because they were tired of the hassles with billing and companies not covering their tests. Stats show doctors make less on average in Canada, but we also have more GPs and less specialists.

Some nurses make more in Canada, some more in the US. That's generally why Canadian nurses move to California and not to Alabama.

University education in Canada is generally A LOT cheaper than in the US, that's why I moved back here for my degree!

I think people are forgetting that the government doesn't just say "This is what we'll pay you" and that's it. Doctors negotiate their wages and have a lot of power. Nurses also negotiate wages. It isn't any different in the US.

gwenith, BSN, RN · Mar 31, 2004

MSummer/Bluesky, I would argue that there are both good and bad things about socialized medicine. The good points include almost universal availibililty of services (at least some services), and greater consistency in their quality. The downsides include lesser availibility of "state of the art" treatments, and perhaps a slowing of medical R&D.

How many times have I got to tell you people that we have state of the art treatments - in fact there are many treatments where we lead the world - intraunterine surgery for a start and we definitely are not behind the eight ball when it comes to research. We don't have as much research as the USA but we do not have the population to support it either.

We don't have CRNA's because we never have had them - ever - Anaesthetics is a medical field and always has been here - different registration requirements.

Our universities are goverment owned - mostly there are some private uni's. It costs very little more to study to be a doctor or a lawyer than it does to be a nurse. tertiarly education is subsidized.

keepingitreal · Mar 31, 2004

Okay, Gwenith what would you say were the advantages of our system relative to the single payer or socialized model? My criticisms reflected those often mentioned by academics when the subject is discussed in those circles (note I also mentioned typical benefits commonly attributed to that system.)

fergus51 · Mar 31, 2004

LOL!!! I love you Gwenith:) People don't seem to realize that even in government funded systems, drug and technology companies still charge money for their products and make a budle (so they are still motivated for R&D).

Benefits of the American system I've seen:

-you can make a lot of money as staff if you are willing to move to the right places

-great standards of care in some hospitals (if you can afford them)

-good research done (but this is also the case in other systems)

-lots of roles for AP nurses

Roland · Mar 31, 2004

I think Fergus, and Gwenith make good arguments for an alternative system. However, I think that there are also good things about the current system. For one most research indicates that the vast majority of Americans have health insurance (although a significant minority do not with estimates ranging from ten to thirty percent of the population). I would favor seeking to expand current programs to cover those NOT eligable now for Medicaid, and Medicare, VA ect or who don't have insurance via work. However, I would want this to be done in conjunction with other efforts to control the rising costs of healthcare. Among the proposals that I believe would be helpful would be:

1. Tort reform. I believe that in all but exceptional cases that damages should be limited to actual, compensatory damages (which includes pain& suffering, lost income ect) I would limit punitive damages, but also step up criminal penalties and enforcement for gross negligence, or even more nefarious behaviors. In addition, I would offer subsidized "pool malpractice insurance" for physicians operating in certain specialties such as Ob/Gyn. How is it that fast food and gun manufacturers can be statutorily exempt from litigation, and Dr's cannot (within certain parameters).

2. I would seek to expand the role of NP's. At the same time I would encourage more physicians to be accepted into medical school. I remember listening to an NPR report several years ago that detailed how the AMA lobbiedcongress to LIMIT the number of internships, and residencies available in order to control M.D. supply. I would also encourage easier access into the field for physicians trained in other countries so long as they could pass the required board certification, and licensing examinations (currently it is my understanding that many such doctors cannot even sit for the examinations because their oversea's residencies were not "approved").

3. I would encourage employers to mandate at least a $1000.00 dollar deductable on all health insurance policies, and some significant co-pay for all but catastrophic situations. I would also create UNLIMITED medical savings accounts where the money would be tax-exempt so long as it was used for medically related purposes.

4. I would allow prescription drugs to be imported from Canada and elsewhere so long as such importations were tested for their chemical composition (that is to say there would be a monitoring process that ensured that all imported drugs were of the same quality as those sold here within certain parameters). In addition, I would reduce the period of time that new drugs could be exempt from generic composition in the United States to no more than five years. This might make "new" drugs more expensive initially (since Pharmaceutical companies would have less time to recoup R&D costs), but it would allow more general access to next generation drugs within a relatively short period of time. In addition, it would put additional pressure on pharmaceutical companies to come up with new, more effective drugs.

5. I would encourage companies to donate money for starting and operating, low-cost, community based clinics by giving them a tax deduction that actually EXCEEDED the cost of the donation (maybe 125%). I would also offer similar incentives to fast food restaurants that increased their sale of low fat, food items (letting them deduct the food cost of things like salads and grilled chicken sandwitches at say 110% of actual cost ).

6. I would expand the NIH office of Complementory and Alternative Medicine such that ANY alternative treatment with significant, published evidence (whether in labratory animals or epidemilogical studies) could receivestate, subsidized funding of double-blind clinical trials to prove their safety, efficacy, and effectiveness. Furthermore, any treatments which proved themselves useful under such a program would remain in the "public domain" with any company being able to apply for liscensure to produce the item.

Under these circumstances, I would encourage the expansion of Medicare, or Medicaid to cover any individual not otherwise covered by health insurance (although they would be required to pay some percentage of their income into the program, unless indigent).

fergus51 · Mar 31, 2004

I like a lot of the ideas, but number 3 makes me want to barf. A 1000$ co-pay at a minimum? This is just a simple way insurance companies use to ration healthcare, something that supposedly only happens in socialized systems.

gwenith, BSN, RN · Mar 31, 2004

1. Tort reform. I believe that in all but exceptional cases that damages should be limited to actual, compensatory damages (which includes pain& suffering, lost income ect) I would limit punitive damages, but also step up criminal penalties and enforcement for gross negligence, or even more nefarious behaviors. In addition, I would offer subsidized "pool malpractice insurance" for physicians operating in certain specialties such as Ob/Gyn. How is it that fast food and gun manufacturers can be statutorily exempt from litigation, and Dr's cannot (within certain parameters).

In this I can agree with you Roland - don't faint.

We are seeing the phenomenon of out of control litigation and it's affects upon the health care system now. Goverments are starting to act to put the brakes on payouts and limit the time frame for litigation to be initiated BECAUSE we can see where this is draining the system.

Lawsuits are a drain upon the purse of health care - not just in the multimillion dollar payouts but also in the myriad of "nuisance suits" and the need for defence plus the social pressures it puts on the bedside practitioner. Time and again I have seen complaints of "customer service" versus "patient care" and a lot of this is driven by the fear of litigation.

The question remains though - what will happen to our rights if you take away the right to sue.

My response is that at present lawsuits are fulfilling two functions one, of course is a lottery for money and the second more legitimate function is quality assurance. Prevention of the problem recurring. However QA through negative feedback is not effective. A QA system that looks at continuous improvement and identification of potential problems is a much safer and better system.

To return to the original question - I don't think you will move toward socialised medicine in the near future there are too many vested interests. What you need to do however is look at the various systems world wide and choose the model you would feel most comfortable with.

keepingitreal · Apr 1, 2004

3. Actually, number three should have said $1000.00 dollar deductible (for the year) not co-pay. On top of that I think a reasonable copay (maybe five percent) up to a total out of pocket of maybe $2.000 per year would discourage over useage of medical rescources. Many health plans already feature something like this, but it would be even more powerful when combined with medical savings accounts.

fergus51 · Apr 1, 2004

It wouldn't just discourage use, it would completely stop it for some people. That's just rationning dressed up as "discouraging waste".

gwenith, BSN, RN · Apr 1, 2004

I had a patient pull the dying swan on me the other day about "just another 24 hours in hospital - you can't send me home now" I told her straight that there were no beds and that when the doctor said discharge that was what happened. Sorry but I see more waste in private hospitals where this attitude is pandered to than in public hospitals.

One example of us intelligently cutting costs. We used to do micro urines twice a week on all catheterised ICU patients to screen for infection - now we just test for leucocytes and if and only if they show leucs do we screen - we save $16 a test - not much unless it is multiplies by the number of patients and the frequency.

Roland · Apr 1, 2004

I think that I mentioned this before in a post in the "General" area. Has anyone looked at the Austrialian model where they have a "dual" public/private system? Have there been any studies since that system was implemented that examined the effects upon health care sector inflation (comparing the inflation rates in both public and private services since the system was implemented). Something is going to have to give in the United States. Medicare is set to go bankrupt in less than twenty years, and health care sector inflation is rising at double the rate of inflation in the overall economy. I think that a "dual" system would offer everyone basic coverage while allowing those with more money to access premium healthcare (just as the rich can afford nicer homes, safer vehicles, and healthier food&lifestyles). I don't think that the solutions that I referenced above are politically feasible, and the majority of Americans view healthcare as a basic human right (as evidenced by several Gallup and Roper/ Pew/ polls).