I am watching Michael Moore's "Sicko" for the first time....

[Valerie Salva]

And I am just blown away. I am incredulous.

I have felt for a while that we should have universal health care here in the US, but I didn't know things were this bad. We really should be ashamed that GTMO Bay prisoners get free (and very good quality, from the looks of it) health care and 9/11 rescue workers are suffering from 9/11 related health conditions and have no coverage.

And hospitals removing their names from the pt bracelets of ill, unisured pts, and having cabs drop them on Skid Row?

And insurance company physicians admitting that they know they caused the death of pts by denying claims in order to save the ins company money?

What is the matter with us that our health care system is ranked #37 among industrialized nations?

To me, this is not about politics, not about personal responsibility, it's not about cost- it's just about what is right and what is wrong.

I know the Canadian and other universal health care systems have their problems, but they are not run on a foundation of greed and denial of care as ours is.

I am very fortunate that I have good health insurance, but this could change at any time. I am willing to pay more taxes so that all US citizens can get free or low-cost health care that is not connected with a job, and can move with the citizen and cover them wherever they are and whatever their circumstances are.

Are you?

What do you think?

[hillarypeace2006]

Ya know, one concern about UHC structuring would be the inability to sue and get legal remedy from the government. An argument I've yet to see posed, but one worth examining is the fact that if Physicians providing care through UHC have a contractual agreement with the govt, how difficult will it be to remove incompetent doctors.. Not to say it's actually easy to remove them now. Just think about how difficult it is to fire a govt employee now. There has to be a way to rid ourselves of negligence and incompetence when the need arises.

This is just one of the practical kinks that will probably be worked out in practice (litigation)because folks are too busy having pithy arguments devaluing other UHC systems. Universal Healthcare will be here. Will be up to the best and brightest to design a system worth of our discussions...

[Honnête et Sérieux]

Likely a legitimate concern, but exercising our litigious tendencies in a UHC system would make it collapse more quickly than it would just trying to cover 300,000,000 Americans.

The reality is that in order for a UHC system to survive, malpractice remedies will have to be massively scaled back.

Besides...if everyone is supposedly getting 'unrestricted healthcare' regardless of their ability to pay, they shouldn't have a need for a large settlement.

[XB9S, BSN, MSN, EdD, RN, APN]

Likely a legitimate concern, but exercising our litigious tendencies in a UHC system would make it collapse more quickly than it would just trying to cover 300,000,000 Americans.

The reality is that in order for a UHC system to survive, malpractice remedies will have to be massively scaled back.

Besides...if everyone is supposedly getting 'unrestricted healthcare' regardless of their ability to pay, they shouldn't have a need for a large settlement.

I think this is a really valid concern, in the UK we are now getting increased litigation and the cost to the NHS is astronomical, from what I have read this is a far bigger issue in the US.

For years in the UK government organisations had something called Crown Immunity, which meant we were not able to be sued or prosecuted. Clearly not a good thing, but when this was lifted the increasing cost to the organisations has taken funds from much needed services.

With the US litigation culture, I would worry that there would be no way such a system could support that financial burden there would need to be some way of dealing with that. Not sure that there is an answer to that, my personal opinion is that in the UK more and more people are acting like it is their right to sue, even if it is a recognised complication that has been explained at consent.

[XB9S, BSN, MSN, EdD, RN, APN]

Ya know, one concern about UHC structuring would be the inability to sue and get legal remedy from the government. An argument I've yet to see posed, but one worth examining is the fact that if Physicians providing care through UHC have a contractual agreement with the govt, how difficult will it be to remove incompetent doctors.. Not to say it's actually easy to remove them now. Just think about how difficult it is to fire a govt employee now. There has to be a way to rid ourselves of negligence and incompetence when the need arises.

This is just one of the practical kinks that will probably be worked out in practice (litigation)because folks are too busy having pithy arguments devaluing other UHC systems. Universal Healthcare will be here. Will be up to the best and brightest to design a system worth of our discussions...

In the UK we have a hoard of human resource policy and procedures to deal with poor performers, this covers all staff including medical staff and nurses, and I have to be honest they can be really useful to me as a manager to help me support failing staff with training, education and mentorship, however I have at times felt that they also tie my hands when I have someone who is not capable of doing their job.

It is difficult, and at time frustrating because these staff are redeployed to other areas, where more often than not they continue to perform badly, but they do get plenty of opportunity to improve so there is a great deal of job protection.

It is very difficult to fire anyone working in the NHS, it does happen but it's not easy, even if they are clearly a poor performer

[Honnête et Sérieux]

I think this is a really valid concern, in the UK we are now getting increased litigation and the cost to the NHS is astronomical, from what I have read this is a far bigger issue in the US.

For years in the UK government organisations had something called Crown Immunity, which meant we were not able to be sued or prosecuted. Clearly not a good thing, but when this was lifted the increasing cost to the organisations has taken funds from much needed services.

With the US litigation culture, I would worry that there would be no way such a system could support that financial burden there would need to be some way of dealing with that. Not sure that there is an answer to that, my personal opinion is that in the UK more and more people are acting like it is their right to sue, even if it is a recognised complication that has been explained at consent.

These fears, I believe, are spot on.

The problem in the US is that the very political types who advocate for UHC also generally oppose tort reform.

This is why I've said in the past (possibly in other threads), that their own ideologies are in contradiction or incompatible.

[Elvish, BSN, DNP, RN, NP]

The problem in the US is that the very political types who advocate for UHC also generally oppose tort reform.

UHC -

Tort reform - also

[hillarypeace2006]

From my own personal experience with National Healthcare in Austria, I encountered an OB who I felt was less than competent and it was well known, however, he was never asked to step down from his post of head of the department. Instead pts through word of mouth were told to avoid him. My concern especially in the US is that these types will have no problem getting and retaining contracts to provide care, and like with current medicaid programs foreign trained physicians will hold the majority of the contracts While the rest will become "private" providers.

I think that yes we have to look at tort reform, but responsible tort reform. I don't think it unreasonable for peoeple to expect monetary remedy for actions of gross negligence. On the bright side if the govt serves as the offending party instead of the invidual physician, there would be probably be an overall cost reduction because of over the top medical malpractice.

My husband, a surgeon is finding that it will be very difficult to practice solely because of malpractice rates alone. This is becoming a harsh reality for people who specialize.

[leadesign]

patients that do doctors in other nations.

...is now available for a limited time on dvd

[Hekate]

from my own personal experience with national healthcare in austria, i encountered an ob who i felt was less than competent and it was well known, however, he was never asked to step down from his post of head of the department. instead pts through word of mouth were told to avoid him. my concern especially in the us is that these types will have no problem getting and retaining contracts to provide care, and like with current medicaid programs foreign trained physicians will hold the majority of the contracts while the rest will become "private" providers.

i think that yes we have to look at tort reform, but responsible tort reform. i don't think it unreasonable for people to expect monetary remedy for actions of gross negligence. on the bright side if the govt serves as the offending party instead of the invidual physician, there would be probably be an overall cost reduction because of over the top medical malpractice.

my husband, a surgeon is finding that it will be very difficult to practice solely because of malpractice rates alone. this is becoming a harsh reality for people who specialize.

i think that what you have encountered with this ob head of dept is something we all experience regardless of the health system in place (unfortunately) .

i have worked with the head of trauma for 2 years and this surgeon was known for making the most horrible mistakes! when patients have asked me if he was good, i tried to make tons of compliments about another surgeon that i knew was good without bashing the head of trauma in the hope to steer patients away from his incompetent hands.

i often wondered why he was still in place~ not only was he a bad surgeon~ but he also had the worse character and working with him meant being regularly insulted, yelled at, not to mention trying to tie the loose ends after him.

i was told that the reason he remained in his job was because a) no one else wanted to be the head of trauma (too much trouble, paper work, calls etc) and b) because he was on every possible board (general surgery, trauma, ems, political boards, hospital boards etc..) and therefore was so embedded in the social and professional network that nobody felt safe to point out his short comings. to my knowledge, several law suits were made against him, but again, his position within the political, medical and social network of this community protected and defended him to ever be judged guilty!

and this is happening in our us sue-happy system.....:barf01::lol_hitti

[talaxandra]

My concern especially in the US is that these types will have no problem getting and retaining contracts to provide care, and like with current medicaid programs foreign trained physicians will hold the majority of the contracts While the rest will become "private" providers.

All the consultants I know who work privately (either medical or surgical) also work within the public health care system. While I'm sure they exist, I'm not aware of many consultants for whom this is not the case.

While there are certainly cases of unsafe practitioners not being removed early (Jayant Patel being the most notable example), I believe this has much more to do with protective culture than the source of funding.

I hgree with those of you who've mentioned litigation as a significant contributor to US healthcare cost. I have idemnity insurance ($2M) as part of my union membership, along with free legal advice and representation, but I doubt I'll need the former and anticipate that the only use I'll have for the latter would be employment- rather than litigation-related - in twenty years of clinical practice nobody I know (nursing or medical) has been individually sued. I don't mean taken to court, I mean any kind of overture of legal action. Even the threat "I'll sue!" is rare.

This doesn't mean, as someone claimed ages ago on this thread, that patients who've been harmed are unable to sue but the cases I've heard of where patients claimed against the hospital as an entity were settled out of court (always legitimate claims, like the patient with diabetic neuropathy who received significant burns from a hot pack placed directly agaisnt her ankle).

[hillarypeace2006]

All the consultants I know who work privately (either medical or surgical) also work within the public health care system. While I'm sure they exist, I'm not aware of many consultants for whom this is not the case.

While there are certainly cases of unsafe practitioners not being removed early (Jayant Patel being the most notable example), I believe this has much more to do with protective culture than the source of funding.

I hgree with those of you who've mentioned litigation as a significant contributor to US healthcare cost. I have idemnity insurance ($2M) as part of my union membership, along with free legal advice and representation, but I doubt I'll need the former and anticipate that the only use I'll have for the latter would be employment- rather than litigation-related - in twenty years of clinical practice nobody I know (nursing or medical) has been individually sued. I don't mean taken to court, I mean any kind of overture of legal action. Even the threat "I'll sue!" is rare.

This doesn't mean, as someone claimed ages ago on this thread, that patients who've been harmed are unable to sue but the cases I've heard of where patients claimed against the hospital as an entity were settled out of court (always legitimate claims, like the patient with diabetic neuropathy who received significant burns from a hot pack placed directly agaisnt her ankle).

Thanks for the information. Americans are quite litigious not so much out of greed but because of the corporate structure of 95% of what we do in our everyday lives. Accountability is a real issue here and that has historically been the best method for taking folks to task.

[StNeotser, ASN, RN]

My problem with the US health system is that most of us of working age are contributing the hard earned dollars to health care. However, it's most likely that we will use the most health care dollars within five years of our deaths. So, we are contributing to private industry all our working lives (providing we have no pre-existing conditions - what losers those people are!), then taking from the taxpayer when we are retired. Nice.