[pickledpepperRN]

Regarding your assignment of up to 15 patients I'm curious about the type of patients and your system.

I work in critical care. We are blessed with fine nurses who came to us for a two year adventure and stayed. One told us that she had never started an IV in England. A doctor was available at all times.
Night nurses could wake up this doctor to start and IV or help when one or more patients got worse. There was a lot of overlap in medicine and nurse ine with regard to this doctors duties.
He would take vital signs and do many treatments that only nurses do here except for the very rare attending.

[HM2Viking]

Originally Posted by KayMichelle

The example of how universal healthcare would be beneficial is unsound.

The poster used the example of diabetes, stating that if a person had healthcare he/she would use it before becoming very sick (ie getting renal failure, amputations, etc.) and this would save the system a great deal of money.

Now, I think we all know from personal experience that these folks who do not treat their DMII fail to do so because of lack of discipline, and refusal to accept lifestyle changes, not because they do not have health insurance.

Please, let's not use emotional arguments. Let's live in the real world. These issues are very important to us, especially the quality of care issues, the shortage issues, the salary issues.

The French have addressed the problems of chronic illness in a rather unique way:

Problem is, studies show that individuals are pretty bad at distinguishing necessary care from unnecessary care, and so they tend to cut down on mundane-but-important things like hypertension medicine, which leads to far costlier complications. Moreover, many health problems don't lend themselves to bargain shopping. It's a little tricky to try to negotiate prices from an ambulance gurney.
A wiser approach is to seek to separate cost-effective care from unproven treatments, and align the financial incentives to encourage the former and discourage the latter. The French have addressed this by creating what amounts to a tiered system for treatment reimbursement. As Jonathan Cohn explains in his new book, Sick:

In order to prevent cost sharing from penalizing people with serious medical problems -- the way Health Savings Accounts threaten to do -- the [French] government limits every individual's out-of-pocket expenses. In addition, the government has identified thirty chronic conditions, such as diabetes and hypertension, for which there is usually no cost sharing, in order to make sure people don't skimp on preventive care that might head off future complications.

The French do the same for pharmaceuticals, which are grouped into one of three classes and reimbursed at 35 percent, 65 percent, or 100 percent of cost, depending on whether data show their use to be cost effective. It's a wise straddle of a tricky problem, and one that other nations would do well to emulate

Evidence based practice is part of the solution to getting better quality care.

[HM2Viking]

Tort reform has minimal to no effect on health care costs. See:

No evidence of significant effects on health care costs
The cost of medical malpractice claims and litigation is so small a part of national health care expenditures as to be insignificant—even as calculated by Towers Perrin, which indicates its tort cost estimates (Chimerine and Eisenbrey 2005). According to Towers Perrin, medical malpractice tort costs, broadly defined to include the costs of insurance industry overhead (including profits) and claims handling, as well as all claims paid without litigation, totaled $28.7 billion in 2004, only 1.5% of the nation’s $1.9 trillion bill for health expenditures. The Congressional Budget Office (CBO) concludes that “even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 to 0.5 percent” (CBO 2004, 6). To put the insignificance of this into context, health care inflation in 2004 would have been 7.8% instead of 8.2%.

If, as Towers Perrin has claimed, damages awarded to plaintiffs are 46% of total tort costs (Tillinghast-Towers Perrin 2003, 17), and non-economic damages are about half of all damages awarded to plaintiffs, then fully eliminating noneconomic damages in medical malpractice (and the attorney fees associated with them) would have a negligible effect on U.S. health expenditures, reducing them by 0.5% or less.5 It follows logically that legislative changes like those recently debated in Congress that would cap such damages at $250,000 would have an even smaller effect.

http://www.epi.org/content.cfm/bp174

A much bigger target is administrative simplification. (As well as defining a minimum set of benefits so we have consistent health coverage between insurances. Many "bare bones" health policies are penny wise but pound foolish.

[Katie82]

Originally Posted by whaley

The NHS does have to be careful with resources, for example certain drugs like cancer drugs aren't available to everyone, which has recently caused quite a lot of controversy.
The perfect sysytem would be that everyone could have free health care and there would be no money issues or waiting lists, however that's not going to happen, but I do believe that everyone has a right to good quality free health care.

You have just listed two issues that will prevent Universal Coverage from working in the US. THe first is the need to be politically correct in the face of an impossible situation. I have case managed cancer patients who have cancer in a site that promises a poor prognosis with mets to a couple of other bad areas. The possibilities of recovery are two - slim and none. Yet we spend tens of thousands(even hundreds) of dollars on chemo and radiation for a patient who has no hope for recovery because we want him (or more likely the family) to feel as if someone is doing something. I know this is a difficult decision to make, but the bottom line is should we really spend $100k to prolong the inevitable for 6 months? This is the kind of issues we face with Univ HC.
The second point you tried to make is that everyone has a right to good quality free health care. THis is an oxymoron in terms of what we can afford to provide given the budget we would have.

[Katie82]

Originally Posted by KayMichelle

Please, let's not use emotional arguments. Let's live in the real world. These issues are very important to us, especially the quality of care issues, the shortage issues, the salary issues.

You said a mouthful here...I case manage diabetics on Medicaid and I can tell you that most of my patients are diabetic because of poor lifestyle choices, and will end up with every comorbidity in the book because they refuse to take care of themselves. You can give a patient free supplies and medications, but you can't believe how many people I have with an A1c of 12.0 who refuse to test their levels daily, much less adhere to a sliding scale. We pay a lot of money for laziness and ignorance, universal healthcare is not going to solve that one.....

[Katie82]

Originally Posted by ZippyGBR

blame the 'victim' why don't you

case management in the USA is about maximising profit, case management in the Uk is about optimising resource use...

These people are usually not victims, but creators of their own situations. As to your analysis of case management - what is the difference between maximizing profits and optimizing resource use. Both result in savings. The only difference is that in your system (and my employer's), the money you save is non-profit, while we are still part of the free enterprise system.

[jjjoy]

Originally Posted by ksilty

The second point you tried to make is that everyone has a right to good quality free health care. THis is an oxymoron in terms of what we can afford to provide given the budget we would have.

I don't know if it's an oxymoron, but it is a good point that there are limits to the type and amount of care we can afford, either as individuals or as a society. The question is how do we balance the costs between individuals and society. If we leave it fully up to individuals, the only those with substantial resources can afford to be chronically ill or have a lengthy hospitalization or have this or that life-saving treatment. In a more socialized system, individuals will have to abide by whatever options are determined to be most cost-effective overall, which might mean less care (or less quality, less modern care) than they'd choose for themselves. On the other hand, it could be more care than they'd ever have been able to afford on their own.

[whaley]

Originally Posted by ksilty

The second point you tried to make is that everyone has a right to good quality free health care. THis is an oxymoron in terms of what we can afford to provide given the budget we would have.

Originally Posted by KayMichelle

There is no such thing as "free". Unless of course, you are a volunteer nurse, drugs cost nothing, and there is no need for research and development.

This is the big problem with universal healthcare. It is not "universal". As you say, cancer drugs aren't available to "everyone", so who decides who gets them? The Queen? The Archbishop? Just curious. In America, we really don't accept that kind of authoritarian system. That is why we fought the Revolutionary War, you see!

Another statement that is an oxymoron: "Everyone has a right to good quality free health care..." But, realistically, care that has made you wait is not quality at all.

It is neither free, fair or of high quality.

The true answer is tort reform.

I'm sorry what I meant was, in a utopia wouldn't it be lovely if we had no problems!!!! sorry to confuse! However I am very realistic and can see the disadvantages of both systems and one'll never have the "perfect" health care system. There is no way one can make everybody happy all of the time.

In regards to who decides on treatments, well like zippygbr said NICE (national institute for clinical excellence) and primary care trusts (PCTs) and within those PCTs there is a public health department, which my housemate (a junior doctor) worked for. She looked at research and the whole case and used an objective perspective to decide whether a patient should get a certain treatment (she didn't do any cancer related work, but other procedures and very new drug/treatments that GPs or consultants wanted funding for). She said it was quite a hard job, especially the very rude emails that she got when she refused people!

Spacenurse, I work on a very busy 29 bedded respiratory ward, I start IVs, but can't take bloods or put cannulas in, I have to go on a seperate training course for this. Often on a shift we will have 3 trained nurses and 1 untrained (or health care assistant), this means that 1 nurse is in charge, dealing with discharges, staffing levels and coordinating etc, and then the other two trained take half the ward each, doing drugs, obs, dressings etc. the untrained floats and helps whoever needs it. It is very busy and we are trying to get more staff, but funding is an issue! Hope that helps.

[Nurse4years]

Society changes, inevitable. I see it as obvious societal growth that every human being on the planet have access to proper healthcare.
Perhaps it is time that our priorities change.
It will be difficult to balance life, liberty, and the pursuit of happiness with universal healthcare, but we have lots of time.
Either majority agrees on the change to universal healthcare, or fate tends to lend a hand.

[Nurse4years]

double posted-sorry