[msummar_smc]

Hi all! I just wanted to post a general question about the socialization of healthcare. Does anyone think it may happen in our lifetimes (or maybe in the next 10-20 years)? I follow politics very closely and the back-and-forth between the republicans and democrats on this topic is very odd. They have 2 completely different viewpoints, but act very differently in their actions. For instance, Bush is against socialization ... but he does not want to 'validate' the practice of advance practice nurses which would keep costs down.

Back to the question: Does anyont think it may happen in our lifetimes?

This post is not intended to be flamed ... I just want to here from other like-minded folks with the same career goals. Would it affect the scope of CRNA's practice or compensation levels?

[bluesky]

I'm not planning on seeing it my lifetime but sure I am hoping for it...

[Roland]

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.

You also mentioned that Bush opposed socialized medicine. While this may be true in terms of his rhetoric the Medicare prescription drug benefit that he promoted and signed represents the greatest expansion of governmental involvement in healthcare since Medicaid/Medicare were created. If Clinton had signed something like this Republicans would be screaming and Democrats applauding (while still calling for more). We already have socialism in this country both in medicine and elsewhere we just don't have it to the EXTENT of many other nations. Socialized medicine substitutes one type of rationing for another (economic rationing which we have now for centrally planned rationing based upon models developed by health care experts). Many countries like Canada which have a form of socialized medicine (single payer system/independent provider model) STILL have grave difficulties with cost containment. Keep in mind also that there may be other ways to control healthcare costs which include as you pointed out greater use of NP's, and tort reform! Other possibilities include legalization of importing prescription drugs from other countries where they are cheaper (but still controlled for quality) and lowering the period of time where a drug company can maintain an exclusive patent on a drug. Although, these interventions also raise problems of their own.

[fergus51]

No. And socialized is not the same as universal.

[mato_tom]

Originally Posted by fergus51

No. And socialized is not the same as universal.

whats the difference? not arguing, just learning

[Roland]

One can argue over semantics it is not a "black and white" issue, but rather a continuuem. Universal coverage or single payer system implies the government PAYING for not directly owning, and operating the healthcare system (this is the system found in Canada). Complete socialized healthcare would mean that the government took the next step and actually owned and operated health care delivery rescources as well as paying health care workers directly who would work for a national agency. However, few experts would argue that a universal, single payer system is a huge step TOWARDS socialized medicine in that it involves a further increase in governmental involvement in the private sector. The United States today with Medicare (which has just been expanded) and Medicaid (which was expanded under Clinton to encourage states to cover children of lower income but working individuals) has a more socialized approach to healthcare than it did ten years ago, and is much closer to socialized medicine than it was thirty five years ago when these programs didn't even exist.

As I said above such interventions have both positive and negative ramifications and whether or not someone supports such measures has much to do with their views on the proper role of government in society. Those of us who believe that government should simply provide a basic EMERGENCY, temporary safety net for the poor and unemployed generally oppose significant additional expansions. However, people that believe that government has a basic, and intrinsic obligation to provide for the fundamental needs of their citizens generally advocate more intervention.

[Kiwi]

I would hesitate to comment positively on socialized health care. I've got relatives in New Zealand who talk against it. Not only is a big chunk of their pay taken out, but they've told me that a client must wait months for a simple surgical procedure. The reason for this is simple - if everyone is entitled to healthcare, everyone jumps on the band wagon. Can't say I blame them.

In a perfect world, soc. healthcare would be great. Here in the US we've got all the best technology and personnel. Albeit available to very few clients.

[Roland]

Also, to answer your question I DO believe that it is in our future (although I oppose such measures). Furthermore, I think it likely that a future Republican administration will set the stage if not actually implement such a plan. Why? Because of the modern political notion called "triangulation" where you adopt the political positions of your opponents in an attempt to take issues away from them in elections (it would be like blowing up your own bridges in war to keep the enemy from having targets to bomb in my opinion). The practical ramification of triangulation is that Republicans move to the LEFT while sitting Democrats move to the RIGHT in an attempt to keep political power (Clinton did this with NAFTA, and Welfare Reform while Bush has demonstrated this trend with huge social budgets, deficits, prescription drug benefit to Medicare, Mccain/Feingold election reform, and proposed immigration reform). Politicians have largely ceased to argue for their fundamental beliefs be they conservatism, liberalism, or socialism and instead focus on ISSUES that they believe will gain them election.

[fergus51]

Socialized implies government controlled, funded and operated and generally makes people think that health care is not set by the patient or medical professionals. The system in Canada is government funded, but not micromanaged. The government doesn't decide how to manage patient care. It monitors standards, same as in the US. My biggest pet peeve is when Americans tell me that Canada has a socialized system so patients have no say in their care. ("You can't choose your doctor, you have no say in treatment, blah, blah")

Universal just means everyone gets care. This can be in a socialized system or not. It can be in a single payer system or not. It can be government funded or not. For instance, countries like Britain have private hospitals and public hospitals, but it is still a universal system.

[user69]

If the insurance companies and doctors would stop the escalating war between what is charges, and what is paid we might not need a socialized plan. But the price of medical care has reached a point that an uninsured person has to weigh emergency treatment vs. extreme financial hardship. I went to a doctor knowing I had a sinus infection and needed some antibiotics, one hour later and $1200.00 later I was on my way home. If I had a serious problem I am not sure that I would go to a doctor and commit to receiving treatment (if the condition or death was not TOO painful). Lets fact it, if you do not have insurance you are looking at (from my experience)

Angioplasty – $25,000.00
Major Cancer - $100,000+
Badly broken leg - $20,000.00

This is due to doctors charging a little above what the insurance companies will pay, and insurance companies agreeing to pay a little under what doctors ask.

I also have a major problem with the whole low co-pay thing. If everyone that had insurance had a $1000.00 deductible, and was still paying a percentage of the total over the deductible, you would see a lot more patients arguing for reasonable pricing, instead of looking at it just costing the $10 or $15 they have to pay out of pocket.

Allen