[Mijourney]

Hi feistynurse. Your post is what it's all about. We're learning from one another and expressing our opinions on how we would like to see health and medical care shaped. You are an activist in what you believe. I congratulate you on that. I appreciate everyone else's input on this important topic.

RNed, I do agree that health care and insurance are not interchangeable, and I don't believe that anyone necessarily tried to drive that home. In an earlier post, I admitted that I had errored in combining the two. In fact, I will go so far as to write that just today, I heard that managed care has essentially been a failure in making provisions for good quality care and access. So, that definitely indicates a need for further reformation of the US health care industry.

Having wrote that, fiestynurse, I do have concerns about the version of the single payor program you support. You wrote that with the proposed single payor plan you support that doctors will have three options for payment. Wouldn't most doctors naturally gravitate to the fee for service if they could? Especially when they have someone advocating on their behalf? I wonder how the fee for service option will help keep overall costs down unless there was a predetermined cap on how much could be charged? I also wonder about controls on outpatient or ambulatory care costs since that seems to be where most of the health care dollars are going right now. Even though we know that physicians are the primary revenue generators for hospitals, why should everything continue to completely revolve around them? Shouldn't hospitals have options to request fee for service or daily charges? Are nurses and other staff now to become global fees instead of the current room and board?

I feel that a program like single payor may play a role in helping to get more standardization in many aspects of the health care industry. I think that it was under this topic or another in which a poster pointed out the importance of information systems. A single software system used in the US that could handle all sorts of data including expansions and upgrades may do wonders to help increase the quality of care and access in health and medical services if done in a well thought out manner.

[fiestynurse]

First, all health care systems, including single payer, allow people
to use their own money to buy whatever they want outside of the system. There are some procedures or types of care that would not be covered under a single payer program, for example cosmetic surgery.

Second, I am not quite understanding what you mean when you say that quality health care insurance and quality health care are not interchangeable, and must be discussed separately. For me, they are so closely related, that I must always discuss both, and sometimes it does seem that I am interchanging the two terms.

This is how the lack of insurance affect people's health?

1) People without health insurance do receive some health care, but often too little and too late. Sometimes the neglect of chronic conditions in their early state leads to more expensive care later on.
2) The uninsured are three times as likely to lack a usual source of care than insured.
3) Children without insurance are nearly twice as likely not to receive medical care for acute conditions such as asthma and ear infections.
4) The uninsured are twice as likely to have not seen a doctor even once in a year.
5) The uninsured are only two-thirds as likely to receive preventive examinations such as mammograms, pap smears, prostate exams and physical exams.
6) The uninsured are four times more likely to postpone care due to costs.

[Mijourney]

Hi feistynurse. It's true that the lines of distinction are blurred for quality health care and health insurance. But, I feel that you can separate what is paid for health care from what type of health care is delivered. You can clearly see if something is not paid for, then you may or may not get the service.

For instance, in insurance, from my short experience, you're graded solely on whether you can make the numbers and keep the customers satisfied. Usually, that means making it more comfortable for them to go to h***. That's by and large how quality is measured. I'm not sure if there's any intrinsic value to that. I think you can separate that from providing true quality health care.

[RNed]

A single payer system only resolves the issue of funding. It does not change the quality or delivery of healthcare.

Healthcare is a business line, a commerical product driven by profits and commercialization like any other business line in the States.

A single payer system sounds like a good plan but if efficiency and reduced costs is the only measure of support than shouldn't we support auto insurance, life insurance and housing insurance with a general fund?

Will it include increased risk premium for smokers, alcoholics, obesity and couch potatoes and/or will it include low risk discounts for joggers, vegetarians and the health wise.

The point is we need a healthcare policy first. We need to see what is for sale - before we buy it.

[fiestynurse]

The single payer system does not only resolve the issue of funding. It will change the quality and delivery of care by taking the control of health care dollars out of the hands of private insurers. The single payer system eliminates corporate profit as an operating goal. You just cannot compare this to other types of insurance. What type of health insurance you have, if you have it at all, does effect the kind of health care you will recieve. And quality health care is a basic human need and a right of every citizen.
The managed care system has been one big experiment, that has failed. Why do you want to hold on to it so tightly? Managed care cuts care and proliferates waste, doesn't provide adequate coverage, doesn't provide health care of a superior quality, and compromises the patient-physician relationship.
While the numbers of uninsured continues to grow, you want to "study health care policy" to see what is for sale before you buy it? First of all, multiple health care policy studies have already being done, some spanning many years. We already know that we are paying up the wazoo for a crappy system. There is no way to improve delivery and quality within the present system--it's already been tried and it has been a dismal failure. We cannot continue to provide bandaide solutions to a dysfunctional system. We need MAJOR reform!!

[fergus51]

Okay kday, you already know that I'm a bit of a bleeding heart so bear with me. I have returned to Canada to work in this socialized system after spending a few years working in the States, and while I prefer it, it is anything but perfect. But something has to be done to help those in the States.

I was also one of the working poor who didn't have great access to health care. I have a chronic condition (not serious or debilitating when treated), but I never really got treated when we finally went to the doctor in the US (I was about 13 at the time). He pretty much just dismissed my parents concerns and sent us on our way. A few years later we moved back to Canada and saw a doctor again because we could. My doctor ordered tests (which cost money, presumably the reason my last doc didn't) and found out about my condition. I have to take pills and changed my diet a little. Because I got it under control at such a young age, I will be absolutely fine. I found out though that if I didn't, my risks of having an MI would skyrocket, as well as my risk of having a deformed baby or going blind. While the tests may have cost the health care system some money, they will save it a lot more money if I don't have a heart attack or whatever. An ounce of prevention....

I believe that the uninsured in the US run the risk of not seeking treatment early and then wind up costing everyone a lot more money to care for them when their health has gotten much worse and they finally have to go to the hospital. This is the benefit of a single payer plan.

Playing devil's advocate a bit, how do you all propse to institute a single payer sytem that avoids the problems we have? (like people going to the doctor when they stub their toe, cause hey, it's free! or the fact that we can't offer nurses the wages you can so they are leaving in droves, etc) There are a lot of problems with this system other than the philisophical issue of liberty and all that (sorry kday, that stuff is just over my head )

[fiestynurse]

Yes, statistically Canadians get more doctors visits (even for a stubbed toe), but they also get more hospital days, more procedures, more bone-marrow transplants. In the U.S. we are not only rationing high-tech health care (to people who can get health coverage), but primary care. At Cook County Hospital in Chicago, there are 10,000 patients on the waiting list for
primary health care.

National health insurance actually helps nurses. When hospitals aren't seeking ways to make a profit or come up with millions for their CEOs salary, there is more money for the actual delivery of care and for nursing. Public demand for quality medical care is the main factor working for nurses in an accountable system, because then good staffing becomes an issue of public policy.

In addition to national health insurance, we also need more
unionization of health care workers. In Canada virtually the entire
health care workforce is unionized (compared to 16% in the U.S.)
And when you really look at the actual salaries nationwide, Canadian RNs salaries are equal to those of RNs in the U.S. Also,
for every level below RNs, Canadian wages are higher. U.S. wages in nursing homes (a major employer of African American women) are only 62% of what they are in Canada. Over 500,000 U.S. health workers live in poverty.

[fergus51]

Our salaries here are higher than in the States?! Not when I was in the US! I took a fair sized pay cut to come back here. The highest paid nurses in the province make 18$ an hour US. How are we better paid? Am I missing something? Are these figures after the zillion hours I worked in OT or based on hourly wages or do they include benefits, educational subsidies, signing bonuses, relocation expenses, etc.? I am really curious to know where that figure came from.

Anyways, we are also short of primary care here. There are not even enough GPs in our city of 70 000. It's been reported that up to 10 000 people have to rely on clinics rather than having their own family docs. We are also losing specialists (lost a plastic surgeon to Minesota recently). And there is the outflow of nurses. I don't think a system that is used by all citizens can pay the salaries that nurses and Mds get in the US. Believe me, when I see some people post what they're making in the US I am very tempted to go back....

I do think that universal health care should be present in any country as rich as Canada or the US. I just think that a lot of changes need to be made.

[fiestynurse]

I am talking about salaries NATIONWIDE, not just the areas that are attracting Canadian nurses. Hey! I don't make this stuff up! Also, Canada does not put enough money into their health care system. Canada spends $2095 per capita on health care expenditures and the U.S. spends $4090 per capita. (Those are very reliable OECD statistics)

Here's another statistic for you. Applicants per Medical School place in Canada were 5.5 in 1999, in the U.S. applicants were only 2.4. Medical school enrollment dropped for the first time in 40 years. U.S. doctors are discouraging their children from going into medicine. ( JAMA; 282:892; Canadian Education Statistics, 1999:150.)

[fergus51]

Wow. Thanks for the reply feistynurse. Now that you mention it, I have never heard of Canadian nurses moving to Mississippi or Alabama for the money. The money spent on health care is very interesting too.