What a GREAT topic! I am Canadian, and came down to the States to work because one of the drawbacks of socialized medicine is that it suffers the pangs of a poor economy just like everything else. The differences between the two systems are incredible. In any system you will find abusers, people who run to the ER for non-emergency tx. Here you have a lot of medicare and medicaide people who do this because it's free and they can set their own time to come in. But the biggest difference that I see is the overall level of health in the country. Why? Because with socialized medicine people don't have to let their wallets dictate their health. People go to the doctor earlier and prevent complications. This makes compliance easier too as they can go for follow up care even though they may be feeling better. This is especially important prenataly! Do you know that the US has a higher infant mortality rate than some so-called third world countries?!
And talk about waste! I worked in a long term care place that had a medicare unit. When pt's meds were dc'd we had to destroy them! Perfectly good meds were wasted once a month! I also worked on a pedi unit, where I swear we saw every kid who had ever vomitted in that town, and if the kids came in with a fever, the diagnosis was always R/O sepsis and involved a lumbar puncture. I see elderly people admitted for debridement of decubitus (and I've never seen so many decubitus as I have here by the way) then while they are there, lets just do an EGD and colonoscopy on them even though they are like 90 and if we happen to find a hiatal hernia what in the world are we gonna do about it? I see lots of expensive blood cultures being done just because someone has a fever post op, and I see a lot of CT scans done for CYA reasons. I think the biggest shock to me is the number of end stage alzheimers, and CVA people on tube feeds to prolong a life that is basically just an existance and we are merely prolonging their death. Never say never here for fear of a lawsuit perhaps? I see doctors having a very hard time finding specialists to take a patient, even a baby, simply because they don't have insurance.
There's a huge overall difference in the attitudes of the patients too. I see a lot of patients, paying or not, feeling like they are at a restaurant or a hotel and demanding services that people in a socialized system gladly attempt to do for themselves, and threatening lawsuits that people in a socialized setting wouldn't dream of doing. Even in nursing homes, we used to get swamped at Christmas time with gifts from relatives who were grateful! Here because it's all for profit, they understaff, and people don't get the care that they need, so families complain and even when those same families get top level priority because the administrator is afraid of them calling the state in, they will want more from you and never once say thank you for anything.Why, because they feel like they are paying for this directly and they are damned well gonna get every penny's worth. When people aren't paying directly yet they are getting a service, they are much more apprecitative of that service as they view it that you are doing something for them. Even the families helped out a lot more than here too!
As for the Canadian doctors going to the US for tx, I guess it's because they don't have to wait for anything. With socialized medicine we do have to wait for some things but in an emergency you have priority, not because you have money to pay for it! And we get Americans trying to sneak into our hospitals too just like you get Mexicans here in the border towns.
From a nursing standpoint how does it compare? Well, you don't have agencies breathing down your neck to see a bunch of paperwork. Despite what you think, there is a LOT less paperwork in the socialized system. They are looking more for the results, not documentation done in triplicate. The emphasis is not nearly so much CYA stuff like you find here. There is more time to do all the nursey nurse comfort care that we learned in school, like post-op baths so you don't see people with betadine on their belly 4 days after surgery. And as for your salary being taxed higher, yes, it is but when you stop to consider that on top of your tax here you are also paying top dollar for some really crappy health insurance, I feel that it evens out. Our benefits are far superior too. When an employer there advertises great benefit packages, they mean it! We get 12 stat holidays a year as opposed to 5 here, with time and a half, sometimes double time for working those holidays, we get dental benefits that pay for almost everything, even 50% for braces, our drug plan benefits sometimes are so good that you only pay 35 cents for your prescription no matter what it is or what it costs. Our higher taxes there show in the condition of our streets too which are much better lit at night and there are sidewalks on both sides of the street. And all of the other benefits we get, like baby bonus for each child once a month you get a cheque depending on your income, and it can really add up for a low income family! Also, I never saw a doctors bill in my life until I came here. And do you know that services provided in Canada at least are cheaper than here too! It's true, while at home I went to see my old family doctor and it cost me half the price to pay out of my pocket to see him than it did to see my doctor in the states, even though I had health insurance, there is still the deductable and copayment. And one of the nicest benefits is that after you have a baby, you get almost a year off with like 66% of your income and you can even split some of that time with the father.
There is good and bad in every system, but overall I'd take the well run socialized system over this one any day! This one just seems out of control and driven by greed as opposed to need.
[This message has been edited by bunky (edited June 14, 2000).]