what are we coming to?

[LindaC]

This is a repeat of topic in "Managed Care" section: I'd like to hear how nurses feel about our system of health care delivery in the U.S. And from nurses who live elsewhere, how do you feel about the access to health care in your country (and what do you think about the system in U.S.?)?

To me, it is abhorent that people who live in one of the prosperous countries go without needed health care because of financial restraints; that people who have worked hard and saved some money in their lives can be wiped out financially by an illness; that the "working poor" wait until their condition is dire before obtaining care; and that we tolerate a market-driven health system.

I believe that the FOR PROFIT must be taken out of health care. The U.S. has the most expensive system in the world (about 25% of dollars are spent on administrtion of insurance plans), and we have some of the poorest outcomes. WHY?

According to surveys, people who live in Canada and England are largely satisfied with their health care systems, they go to get care when they need it, they pay no money and fill out no forms; and their overall outcomes are better.

I'd like to hear how other people feel about this. Thanks!!!

[sblanchet]

I disagree that the United States would be better off with a nationalized healthcare system. There are many ways of addressing access issues without letting the government take over seven percent of the private economy. I only ever worked in one for-profit hospital which was in West Boca. I stayed four days. What a dump. I have also worked in non-profit hospitals which were also dumps but they had big names and seemed to get by on that. Access to healthcare in Canada has its own set of issues most of which stem from poor utilization and rationing as well as the way physicians are reimbursed. That is why you will see stories about many Canadians crossing the borders to pay for their needed healthcare which they cannot get in a timely manner in Canada.

[Tweety, BSN, RN]

I work for a not-for-profit hospital where everyone is treated equal. We spend millions on indigent care and they recieve excellent care.

I'm not poor. But because I have an income and insurance, I have to pay high premiums plus copays wherever I go. So I as a middle class person might wait before getting medical attention. The poor seem to have more options for free care than I do. Perhaps that's as it should be, but I don't see poor people waiting until their conditions are dire, they go to free clinics or to emergency rooms. I pay out the butt, and consider thoughtfully my before going to an md, as do the working poor.

O.K. end of rant. Thanks.

No system is perfect, and I honestly don't have any answers. But America usually finds a way of paying for their poor.

Are you writing a paper for school?

[KrisRNwannabe]

I think Federal Insurance programs are going to be one of those things that will never be able to win. You will probably get it doesn't cover enough and i can't do this and that. blah blah. I would love it if it worked but I have pretty good insurance and would hate to give it up for something inferior. I do think the government probably wants to do it but it is a huge task and I think coming up with a solution it a long and difficult one. I would hope they wouldn't try anything unless it was the best they could come up with. i think the cost is probably an issue as well.

[SmilingBluEyes]

I agree w/tweety . The crummy systems in the USA mean the middle class is the least-served medically. I know many who work for a living but can't afford medical insurance. Should it be free or the government take over? Well seeing how our government does when it privatizes things (scary), probably not. But SOMETHING needs to happen so WORKING PEOPLE get care, period. It's a national disgrace that anyone in our country should go without care. There is no safety net for the working poor. What is wrong with that picture?

[zacarias, ASN, RN]

People say that the US has the best specialists in healthcare and thus other systems fall short. Is that so?

So what that the US may have cardiac surgeons that can fix rare anomalies. It's sure a feather in our cap but if we can't provide at least some healthcare to ALL of our citizens, then how are we so special? Canada may have waiting lists for treatment but at least EVERYONE can be treated.

I guess the questions are, "Do we treat everyone even if some will die? Or do we treat some people with the best of the west even if some will die?"

[stsdoc]

Who develops most new groundbreaking treatments, procedures, technology, drugs, etc, etc. Canada, Italy? I don't think so. If you take the competition out of medicine, then its quality will decline. The reason that we have the best specialists is because they are paid handsomely, which, like it or not, helps attract the best minds into medicine. If you take away that incentive, the quality of medical school applicants will go way down. When there is no incentive to find a better way to so something (ie $$), then how many people do you think will be working their tails off to come up with these new treatments? This is the essence of the capitalistic society, Which makes the U.S. a GREAT place. All other countries feed off of our medical knowledge, our procedures, and our drugs. JMHO.

We have some access issues, but as it's been said before, I've never seen anyone, no matter how poor, turned away from the hospital. What needs to be reformed is the INSURANCE industry. I have absolutely NO love for these folks.

[sblanchet]

The idea that it is better to provide care to all citizens rather than address specific issues of access for those who don't have it is absurd. Canada has its own access issues. It is common knowledge that some Canadian citizens die waiting for care because of the bloated bureaucracy and increasing demand on a limited system. Dying while you wait for care even though you are technically entitled to that care by law is a lack of access. No Canadian who needs urgent care and is told to wait can demand care. Is giving everyone the same equally poor care better than a system where advances in technology and treatment flourish? And, yes. I agree with the person who pointed out that other countries, including Canada, feed off our system while looking down their noses at us as if they are somehow morally superior. In addition the Canadian government, by virtue of being a large purchasing entity, demands drastically reduced prices on prescription drugs leaving US citizens to pick up the tab for the development of new drugs, in other words, subsidizing the drug prescription plans of Canada's citizens. So how about paying full price for your medications up there? It costs a fortune to bring a new drug to market here. In addition drug companies spend vast sums of money developing drugs that never make it to market and must be compensated for that expenditure, too; otherwise, no new drugs coming on board from anywhere! Can anyone reasonably expect countries like Canada to pick up the tab for that?

[snowfreeze, BSN, RN]

If doctors no longer make the money they have in the past, will we have a doctors shortage? I can't imagine working as a nurse with no doctor to write orders. Will we function for a while on "protocol" like paramedics do? One doc for 8,000 nurses etc? How will this change our health care system watch dogs? Will facilities be cited for not following the old rules of docs signing verbal or standing orders within 24 hours? Lots of things to consider with changing to a new health care system. If this was a small town of 10,000 or less it would be simple, but this is the United States of America.

Yes I would like to see better coverage for everyone, I would also like to see Much better preventive medicine for all aspects of health, mental and physical.

We are accepting a variety of approaches to health now, many things that in the past were laughed at.

We are a young country and learning fast. We have become a world power in a very short time, maybe it is time to look within our own nation and heal some of our own problems.

[webbiedebbie]

I don't see where paying taxes to cover "free" healthcare would be so bad as where I paid $200/month for healthcare insurance charges and still pay copays, and still get letters from insurance companies asking me questions, or not having any health insurance coverage between jobs because I can't afford $400/month for COBRA, or not having any COBRA or health insurance and receiving a bill in excess of $15,000 for a 4-day stay in the hospital (w/o surgery) that was serious enough to require hospitalization!

I would gladly pay taxes for "free" healthcare because I sure am losing money this way!!!! AND, I can't believe that healthcare charges are placed on a Credit Record...AS IF!

[bellehill, RN]

The last hospital I worked at it was cheaper to get insurance on my own than use their company. Where I am now cost about $100/mo for just me with copays and dedcutibles. I would love a free system but don't ever see it happening. Healthcare is in a crisis but it isn't just insurance or lack of, it is also malpractice lawsuits in the millions. So much to fix and so little time.

[SmilingBluEyes]

capping law suits is a must in the future........

but I don't see that happening too soon, either.

[NurseFirst]

An average salary is probably in the range of 80,000. That is opposed for example to MDs in NYC making about half a million a year in private practice. In Italy, nobody goes into medicine to make money. It is a calling. If you want to make money there you have to pick another profession.

There was an article recently, I think it was in JAMA, about how much the average debt of a medical student has gone up in the last decade or two. And it has gone up tremendously. Have physicians' salaries gone up. No, they have gone down. Pressures from HMO-type organizations and other insurance companies have cut into reimbursement to physicians. Recently, one group of anesthesiologists was kicked out of a hospital because they stopped accepting insurance--they required their fee upfront -- and then the pt could later try and get reimbursed from the insurance company. Only, slight problem. What the insurance companies reimburse is substantially less than what the anethesiologists' fee is. I've heard this has happened in other specialties as well.

What has happened, as well, is that Internal Medicine/Family Practice has dropped in popularity (I guess after they dropped the incentives for people to go into those specialities). IM/FP docs make, oh, 120-150K a year. And they are paying back their medical school loans. I know software engineers that make that kind of money, don't have nearly the responsibility and didn't undertake nearly as long to be educated and start earning an income.

There are, to be sure, some docs that do well. I heard of one doc in our area who agreed to take care of your medical care for a year for $10,000. You be able to be seen immediately, because he would only have 1000 patients. Well, do the math. That doc is making 10 million a year (of course, gross; now, after he pays his office staff and office and malpractice and so on, who knows?). I don't have that kind of money to pay a doc for a year of health care; but, apparently there was definitely some interest. I don't know what came of it.

The docs who make a lot of money (brain surgeons, pediatric heart surgeons, etc.) also have huge malpractice bills and have gone to school for a long, long time. Think about it: 4 years of college, 4 years of medical school, 5 years for a surgery residency, another 3 years for a fellowhip. That means you are 34 before you even can start to pay off your school loans (which, in the meantime, have been accumulating interest.)

NurseFirst