Socialized Medicine the myths and the facts

[madwife2002]

The first and the most obvious concern is the cost to the patient and their family, we all know how devastating an illness can be for patients and their family many times I have witnessed the despair when a diagnoses meant further treatment which insurances question and in some cases wont cover. I have seen patients needing costly drugs to keep them alive and being unable to afford them, causing repeated admissions to repair the damage so called none compliance has caused. The first question in none compliance is were the pts actually refusing to take their medication or was it simply they could not afford to buy their medication because they don't have enough money and other bills need to be paid first? If the real reason is the cost then surely it would be more simple of we provided these medications at a more effective price or that all medications cost $5 no matter what they had? Outrageous I hear you shout but the cost of the repeated admission is far more costly than by helping prevent a repeat admission, by providing medicine they can afford.

How about blood tests could these not be done in the doctors office before the pt leaves for home and forgets to go and have a blood draw, or simply cannot get to the lab to have them drawn. I have personally waited in doctors office hours (and paid for the privilege) then been sent to the lab, miles away to sit and wait for blood work to be done. Why could the doctors not employ somebody to be at the office to draw blood on patients?

We should be looking at improving preventative medicine rather than patch it up and see.

Many times I have seen patients discharged with a new diagnoses of diabetes, no follow up at home can be organised because in my city nothing exists to assist these people. There should be a diabetic home nurse who monitors these patients in their own home-rationale, this would again help prevent admissions for diabetic complications, and none compliance.

So you wonder what has this got to do with socialized medicine. Well, in the UK if you have...

• Children
• Over 60 for women and over 65 for men
• Diabetes
• Asthma
• Thyroid problems, etc...

...then you get all your medicines for free.

There are in place specialized RN's who focus is on preventative care in the community. There are telephone help lines which anybody can utilize for free.

Maternity care is free a midwife will be assigned to you for the duration of your pregnancy and up to 6 weeks later. The cost of the birth-nothing no matter how you deliver.

I have been asked what kind of care do you receive in a socialized medicine country and I ask them, I am a product of socialized medicine you tell me how my care differs from nurses who have paid outrageous amounts of money to train as a nurse?

Of course even in the UK you can have private care if you chose to pay, this is an advantage if you need hip replacements, knee replacements, eye surgeries-other wise you may have to wait. There are initiatives in place to reduce waiting times for surgeries in the NHS and I hear that dr's can now book surgeries from their office at hospitals all over the UK which helps reduce waiting times, plus hospitals get fined if they don't meet their quota.

I agree MRI's and CT's are not as freely available, but again initiatives are in place to improve the waiting times. Emergency care no different all patients will receive emergency care.

Poor conditions yes there are poor hospitals and there are excellent hospitals, no different to Phoenix AZ.

Questions??

[chani]

There are many interesting and thought provoking posts in this thread. As an ozzie I have lived with some aspects of socialised medicine plus private cover all of my life. Not sure if we have the right balance and ofcourse our current government is proposing the whole sale takeover of the hospital system (currently each state is given a 'share' of taxes to run most health services in each state. The system is definitely in trouble at the moment especially here in NSW where we have had at least five health ministers in the last 3years (and on our 3rd premier [=governor in US]) so there is almost complete inertia in our current system. As we pay for our own private health insurance we dont need to worry about our next job and the cover it includes. From my perspective this is one of the biggest problems in the US, and of course because of the need to make a profit by health insurance agencies and their strong political clout.

Choice is available in Australia, but only if you are informed and can pay, which of course a number of people are not qualified on both accounts.

It will take some major changes in societal norms before health is sorted. Firstly the profit imperative at mulitple levels of health, from private providers, insurance and doctors.

Secondly the general public be willing to pay what its going to cost to support the type of health outcomes they want. At this point the public do not know or wish to know how much it costs.

Lastly a huge reality check regarding what should be available. In Oz recently there was hugely devisive story about a young mother who had caught HEp C and developed liver failure. She had a transplant and then went out and took drugs again, so her liver failed. Her family successfully obtained a $600 000 interest free loan from the state government for her to have another transplant overseas. Their only argument was that her children deserved to have a mother. Now ofcourse her children do BUT what was the opportunity cost for other mothers, fathers and children now that that $600 000 has been wasted (she died by the way). Tragic though this story may be this girl had had her chance and threw it back into the faces of the health system and the original donor family.

This what we must ask ourselves, if we say we can fund large sums of money to keep one person alive would we say the same thing if it was denying one of our family a strong chance at a healthy life? I dont think so. When public money is being used for health costs then we have to be real about it

[talaxandra]

You may all be interested in this - two cardiologist bloggers have taken a pair of hypothetical patients, one wealthy and one less so, and run through the treatment they'd get in the UK and the US for the same condition. The background is here, the UK case studies are here, the US versions here.

No question there's more information missing that would be useful, but it's a start :)

I also came across this interesting article by two US physicians, discussing some non-patient-based reasons why the US health care system is so expensive.

[lamazeteacher]

the following information was taken from the website elk park recommended. blue cross is well known as an illegal monopoly business that has profits in the multi billions. they shuffle figures throughout theiur enormous holdings, to make points. the loss reported for 2009 of $95 million was from the dip in the stock market taken by their investments. non profits, by definition don't have investments, as there shouldn't be funds left over to buy "assets".

at the end of the report, a kick in the reform of health care act assumes that "government regulation" will make them charge higher premiums because of higher medical costs. the author, tara murphy could not have read or doesn't understand the act, or she'd know that the costs of care will be reduced, so premiums needn't be higher.

the fact that they claim an enrollment of 2,194,133 members of mcbsma + 500,000 members outside that state who are also members of that state's plan which gives them the majority of those covered in massachsetts bates the question of why they include out of state members in their plan for ma.

after i worked for blue cross, i realised that it is an unconscionable, huge profit making organization with no interest in patient care, other than lowering their responsibility for its costs.

blue cross blue shield of massachusetts files 2009 financial results

contact: tara murray

[phone]

[email protected]

boston-february 26, 2010 -- blue cross and blue shield of massachusetts, inc. (bcbsma) and blue cross and blue shield of massachusetts hmo blue, inc. (bcbsma hmo blue) announced its 2009 calendar year, statutory financial results today and is reporting a combined after-federal tax net loss of $149.2 million.

"like most other businesses, blue cross blue shield of massachusetts has been affected by the worst economic downturn since the great depression," said allen maltz, bcbsma's chief financial officer. maltz said the company's 2009 results were the result of an adverse employment market which reduced membership; increased utilization of medical services due to the seasonal and h1n1 flu; a rise in elective procedures such as knee, hip and back surgeries, and in behavioral health utilization; as well as higher than anticipated costs associated with merging the individual and small group markets.

maltz added, "nearly two thirds of our net loss or approximately $95 million is due to our adoption of a more conservative view of existing accounting rules which caused us to write off certain investment assets with a current market value that is below the price we initially paid." maltz said the decision was consistent with best practice accounting standards.

bcbsma has already taken steps to improve its 2010 financial results. "before the downturn even began," said maltz, "we took action to reduce our administrative and medical costs which will help improve our financial position going forward." maltz specifically pointed to initiatives underway to reduce medical costs by eliminating the overuse, underuse and misuse of health care services that don't improve patient care but do add unnecessary costs that drive up premiums. maltz said he is concerned that future regulatory action by state government could negatively affect the company's 2010 results if premiums that reflect the cost of medical care are not approved.

bcbsma continues to be the leading private health plan in massachusetts, with 2,924,133 members as of december 31, 2009.

blue cross blue shield of massachusetts ( http://www.bluecrossma.com ) was founded more than 70 years ago by a group of community-minded business leaders. today, headquartered in boston, bcbsma provides coverage to more than 3 million members, 2.5 million in massachusetts. bcbsma believes in rewarding doctors and hospitals for delivering safe and effective care, and in empowering patients to take more responsibility, become educated health care consumers and become stronger partners with their doctors. blue cross blue shield of massachusetts is an independent licensee of the blue cross blue shield association.

blue cross blue shield of massachusetts is an independent licensee of the blue cross and blue shield association.

® registered marks of the blue cross and blue shield association.

© 2010 blue cross and blue shield of massachusetts, inc., and blue cross and blue shield of massachusetts hmo blue, inc.

landmark center, 401 park drive, boston, ma 02215-3326 | 800-262-blue (2583) | tty# 800-522-1254

[Ginger's Mom, MSN, RN]

Ooooooh, ya got me! I'm not a CCM, I wouldn't live in MA for love or money, and I haven't taken a "240 hour insurance course, " whatever the heck that is ...

You made a broad, vague statement, "(Y)ou are incorrect, in my state health insurance is non profit," that implied there was no such thing as for-profit insurance in MA, and I questioned that since I'm not aware of any state in the US that has no for-profit health insurance providers (indeed, in some states, there are no non-profit options available). I was already aware that there are a number of well-respected non-profit programs available in MA, but thank you for providing the links. You misunderstood my point for profit patients come to MA ( their insurance is not written in MA)

You have now responded with a statement that states there are at least two for-profit companies providing health insurance in MA, United Healthcare and Aetna, so it turns out my misgivings (or misunderstanding) about your initial statement were correct, so I don't see what you're kvetching at me about.

Whatever --

What is your insurance background? I am saying that I do have an expertise in my state, there are NO non profits allowed to write policies. Since MA has world class health care, patient with profit insurances are admitted to the hospital. They pay almost double what Medicare, Medcaid, the other insurances pay well too. This new bill won't effect me personally since the

changes have been made. But now I have to pay extra income taxes and student loans are revamped,

You have not proven to me one "profit" insurance that is in MA. So my point is you are factually correct.

But I would be happy to review any companies that are for profit in MA, so I can be educated when dealing with patients.

I thought this thread is about factual information.

[Ginger's Mom, MSN, RN]

Ooooooh, ya got me! I'm not a CCM, I wouldn't live in MA for love or money, and I haven't taken a "240 hour insurance course, " whatever the heck that is ... Ceri

You made a broad, vague statement, "(Y)ou are incorrect, in my state health insurance is non profit," that implied there was no such thing as for-profit insurance in MA, and I questioned that since I'm not aware of any state in the US that has no for-profit health insurance providers (indeed, in some states, there are no non-profit options available). I was already aware that there are a number of well-respected non-profit programs available in MA, but thank you for providing the links.

You have now responded with a statement that states there are at least two for-profit companies providing health insurance in MA, United Healthcare and Aetna, so it turns out my misgivings (or misunderstanding) about your initial statement were correct, so I don't see what you're kvetching at me about.

Whatever --

Ceritified case manager.

NO non profit companies write policies, unlike you these patients love coming to MA since other stated have refused to treat them for their life threatening - Sorry I was unclear, NO Profit making insurance companies write polices. You have misinformation, and like you I would like to see you supporting documentation , just a courtesy since you asked me it would be only fair to see where you get your information,

[Ginger's Mom, MSN, RN]

REALLY!! You make more than $200,000/year as a nurse? Those are the only people whose tax will increase as a result of Reform of Health Care...........

No, I make less than half, but now state taxes which provides double service. There are federal taxes for this new plan, the $200,000 salary every body is paying extra taxes.....there is no limit ..they are taxing medical supplies, health insurance.

I said in previous posts I was confused, but it seems like you have not kept up with the bill. Plus I forgot to mention health care preminums are going up.

No raise - higher costs I guess you must be so wealthy you can pay taxes with out question, as a middle class worker I try hard not to pay anything extra,

[elkpark]

What is your insurance background? I am saying that I do have an expertise in my state, there are NO non profits allowed to write policies. Since MA has world class health care, patient with profit insurances are admitted to the hospital. They pay almost double what Medicare, Medcaid, the other insurances pay well too. This new bill won't effect me personally since the

changes have been made. But now I have to pay extra income taxes and student loans are revamped,

You have not proven to me one "profit" insurance that is in MA. So my point is you are factually correct.

But I would be happy to review any companies that are for profit in MA, so I can be educated when dealing with patients.

I thought this thread is about factual information.

Ceritified case manager.

NO non profit companies write policies, unlike you these patients love coming to MA since other stated have refused to treat them for their life threatening - Sorry I was unclear, NO Profit making insurance companies write polices. You have misinformation, and like you I would like to see you supporting documentation , just a courtesy since you asked me it would be only fair to see where you get your information,

"Massachusetts regulators issued their first batch of health care price controls on Thursday, rejecting the vast majority of small business premium increases sought this year by the state's major insurers. Insurance Commissioner Joseph Murphy said he had rejected 235 of 274 proposed rate increases because they included 'excessive increases and rates unreasonable relative to the benefits provided.' ...

... All 33 plans offered by three out-of-state, for-profit insurers-Aetna, ConnectiCare and United HealthCare -- were approved."

http://www.google.com/hostednews/ap/article/ALeqM5hruF7V08UtA2aqZBT7ZLCncP3NbAD9EQDJD80

"Making good on Governor Deval Patrick's promise to reject health insurance rate increases deemed excessive, the state Division of Insurance yesterday denied 235 of 274 increases proposed by insurers for plans covering individuals and small businesses. ...

... Several proposals, including those from for-profit, out-of-state insurers such as Aetna, ConnectiCare, and United HealthCare, were approved after the companies worked with Insurance Division staffers on ways to reduce costs."

http://www.boston.com/business/healthcare/articles/2010/04/02/state_rejects_health_insurance_rate_hikes/?page=2

If you want to claim that you're right and I'm wrong because Aetna, ConnectiCare, and United Healthcare corporations aren't physically located within Massachusetts, I will happily concede that is the case. However, it looks like private-for-profit healthcare insurance coverage is available and can be purchased in Massachusetts.

[Ginger's Mom, MSN, RN]

Just because they obtained approval that is only one small step of the process. Doesn't mean they are writing policies.

https://www.mahealthconnector.org/portal/site/connector------This is site where the state sends you for information.

The is the "official state site".. I have tried every potential situation and none have revealed a for profit insurance.

I choose to believe a government site over your Google search.

Please answer my question, what insurance background do you have besides a RN? I live in this state and have passed a national exam regarding case management and have a degree in health care admin. Other then your goggling skills what is your qualification other than citing sources from a failing Boston newspaper?

The bigger point everyone (98%) of MA citizens have health insurance and things have gone for good to bad.

Another question, if you are such an activist why doesn't you home state have universal care?

[Ginger's Mom, MSN, RN]

I am bowing out of this discussion, hope you all get the health care you want. I am glad everyone has lots of money to pay extra taxes with lower salaries for this new bill.

I just wish people who cite their credentials which give them an expertise in this area. And I hope nurses know the difference between and Google search and an official government site. I give up, time will tell who is correct.

[talaxandra]

Could we move away from specifics about individual US states and who has what qualification, and return to the issues raised by the OP? Madwife asked the followng in her original post:

Having worked in a country which has socialised medicine I can certainly see the pit falls and the benefits. What I dont understand is the fear behind having socialised medicine In my opinion socialised medicine has more positive benefits than negative benefits. (emphasis added)

She added information about the pressure cost adds to patients and families, asking if admissions caused by 'non-compliance' with medication could be due to the cost of preventative care (including meds), and wondering if subsidising medication would be cheaper for everyone than repeat, emergency presentations. Also along preventative lines, what about follow up at home for people with newly-diagnosed diabetes (and other chronic conditions), free phone help lines, and ante- and post-natal care? Madwife commented that these were all elelments of the UK universal health care program but sadly unavailable to her patients in the US.

Whether or not the US changes to a universal health care model makes no difference to me personally - though I've enjoyed visiting your lovely country, I have no intention of moving there to join my two siblings. I've participated in this long, and often interesting, discussion because I hope that my experiences of universal health care will be of use to some members unsure of how different systems work, interested in alternatives, or wanting facts. I have to admit that I find it annoying when I post a factual response to a question about the practice of universal health care, or to counter a fallacy or misunderstanding, only to have it wholly ignored, but that's part of online life.

And I'm still fascinated by the first point raised by MadWife - why the idea of universal health care rouses such fear and antagonism. Whatever your stance on the issue, surely we can all agree that both universal health care (in its many guises) and the US model have positive and negative elements, depending in part on where you are in the community your system serves. None of the UHC models is perfect, and nobody lauding them has, to my knowledge, claimed that. Similarly, the US model has flaws for at least some users. Can we use this as a launching pad to discuss differences and benefits?

[lamazeteacher]

When something seems confusing, follow the money. The way the anti-health care reform folks have tried to sabotage it, is to threaten higher taxes. Taking away what people have, is frightening, and fear causes resistance.

All Americans, except those who are native to this country (AKA Indians), came from another country where their fortunes were threatened, and they came here to find.....................MONEY! So in everyone's DNA there is a hunger for the stuff, and fear that someone else will take it away.

Another fear people have, is communism. Throughout the past century, cold and warm wars with Russia and especially the Viet Nam war FREEDOM was the war cry. Freedom prevents others from comingling your MONEY, taking it from the average citizen and giving it to others thought not to be worthy.

So socialized medicine means communism and lack of freedom. Liars screamed about "death squads", and some idiots believed that. They also believed claims that everything they like about medicine as it's practiced here today will be gone, once "socialised medicine" occurs in this country. Call it what you will, to them it will always carry the stigma of enforced change.

Of course the only people who will lose anything, is the very rich, who will be taxed 1.3% of the income (not their amassed fortunes) they make/year. Originally that was supposed to be 5% but the hue and cry from those who would never miss that money was enougfh to decrease the amount they'll be taxed, rather than "throw the baby out with the bathwater". Common sense tells us that those, making over $200,000/year and especially those who have higher incomes won't suffer "ourageous fortune" because they already have outrageous fortunes! Their beef is that they want to choose the charity they might care about enough to bequeath 1.3% of that overage, and then deduct it from........you guessed it: their taxes. Then, of course they're used to receiving homage and honors for their largess.

I know these "high rollers well, as I was President of the American Cancer Society's CA coastal cities unit (which included Beverly Hills), 3 decades back. Contributors were rolled out at any possible opportunity, usually at "black tie" events where their clothing and blinding "bling" things worn there, cost more than their donations. The person who had that post before me, was the president of a bank...... I think they wanted some realism after that, and I happened to be married to a big money maker lawyer (whose ability to part with a buck was severely limited). The firm paid for a table at a fund raiser, and that clinched my presidency......

So the government finally decided to persuade monied folk to share their wealth in a meaningful way. So what did those fear mongers do? They're scaring the pants off those with less, to make them suffer too. Unfortunately those who scrabble for less gain, believe that. There's something about havenots, that overpowers reason, and they respect those with riches, so they believe the wealthy, who scream of pain about the small (comparatively) amount they'll fork up for the masses, wanting to make those with less think they'll have to do the same (untrue). The thing everyone has in common, is resentment about taxation. That was why the original "tea party" took place, after all.

Coming from Canada as a child, on a train headed for NYC each Easter and Christmas to visit my aunt, I always knew when we'd passed the border into the U.S. because the housing (near the train tracks) was in worse shape and garbage was all around it. My mother told me those were "slums". Anyone who has visited Niagara Falls knows what I mean, as they may have noticed the difference between the New York side and the Canadian one. Somehow Americans don't mind the blight, as long as it's not in their neighborhood. As Home Health Nurses know all too well, those people residing in poor neighborhoods have little to no knowledge of richer ones. It's just the way it's always been, for them.

The reason the morbidity and mortality rates here are similar to those of third world countries, is because those with more resources, turn away from the poor rather than helping them up, due to a warped idea of their unworthyness. That way they can carry on as if poverty here doesn't exist. Somehow poor people came to agree with the rich and lost their dignity, along with their belief in a better future.

Once health improves, and possibly education, maybe hope will return and we can attain the wellness that other civilised countries have. I wonder though if the wealthy will continue to separate themselves, so they won't see the conditions they caused.

Now obviously one can't believe that all the poor people are good, and the rich ones are bad. Maybe humility will mix with the ability to create wealth, and mutual sharing will become the norm here. Yes I believe in miracles!

[Jstand]

I am bowing out of this discussion, hope you all get the health care you want. I am glad everyone has lots of money to pay extra taxes with lower salaries for this new bill.

I just wish people who cite their credentials which give them an expertise in this area. And I hope nurses know the difference between and Google search and an official government site. I give up, time will tell who is correct.

Nice to hear that you are bowing out. Arguing vigorously over some trivial detail and trying to say that taking a short course on the subject makes you an expert doesn't add much. There truly aren't a lot of people who will be paying extra taxes under this bill. I do hope that physicians take a nice big pay cut though.