Socialised Medicine the myths and the facts

When considering whether or not America should adopt a Canadian style government funded health care system I am VERY concerned about the government control of and it's impeding of the physician and nurses plan of care for patients. For example, the care performed is ultimately limited to the resources available, resulting in patient prioritization and scheduling delays. As demand continues to increase over time resources will continue to decrease, remedied only by more taxation or an incremental decrease in care provided.

Saude,
Thanks for the info. I can see how it can be very disturbing to have terminally ill patients 'discarded'. I also know the greatest part of finances spent on healthcare for many patients are in the last year of life. This ties up limited resources on those whose chances of survival are extremely slim. I think that is unfortunate and it may come down to just that. Some countries already practice a form of this benefit vs. cost system. If a system only has so much money to provide health care, do we spend unlimited amounts on dialysis, ventilators, etc. only to have the patient die? This has always been a very delicate area and one much debated by clinical ethicist. My guess would be some day this type of decision will have to be made prior to admission. Living wills and durable power of attorney for health care matters have resolved some of these issues, but you can always have a family member who doesn't agree with the living will, etc.
This topic is probably best reserved for it's own thread.

It is not really a good way to compare by translating into dollars. In the UK your are paid in pounds. If you translate that into dollars, depending on the rate of exchange, it can look like a huge $$$ amount.

This is truly an informative site. Different backgrounds, different filters for perception , etc. But no matter what ,it is evident that there is a flaw of the deliverance of health care. We need to be practical and not much on idealistic....just do what is needed and makes sense. Maybe we should start as what is ethical in this area? Maybe start from there. Maybe this is the reason as to why we use the bible for our constitution and court rooms...we start with what is the right thing to do minus all the political , greed and manipulation of power and control and money that has infested our country and our health care , more than ever and getting worse now. Look around and see where we are now w/ our economy. I do not have to mention the ones responsible for this, and look where it got us. As people and citizens of this beautiful country, we need to get out from passive to assertive, and aggressive if need to. We need a change in our health care. Most specially , Nurses must be strong in this involvement and movement since the other health care professionals are too tangled in just making money!

I'm not sure I explained quite correctly. The preferences and better treatments apply to many other health conditions as well as the terminally ill. But that really wasn't the major point I was making anyway. My first point was do Americans really want the government telling Physicians and RN's who we can care for, when we can care for them, how we can care for them, and what care we can provide them? When considering whether or not America should adopt a Canadian style government funded health care system I am VERY concerned about the government control of and it's impeding of the physician and nurses plan of care for patients. For example, the care performed is ultimately limited to the resources available, resulting in patient prioritization and scheduling delays. As health care demand continues to increase over time resources will continue to decrease, remedied only by more taxation and or by incremental decreases in care provided. How is prioritization or delaying treatment, (and in the case of two tier systems that discriminate against the poor), any more ethical or moral than managed care which was my second point?

Well, as it stands now, insurance company flunkies who are primarily concerned with generating profits for the company are deciding what treatment physicians can provide. Is that any better? We would pay less in taxes for a non-profit, single-payor system than we are now paying in premiums to the private insurance companies, who siphon a big chunk of that money out of the system to pay for unnecessary administrative costs and outrageous executive salaries.

I am curious, when you say the patients with a low survival chance are 'discarded', what does this mean in actual practice?

Also I wonder how can care preformed EVER excede the resources available, except in a 'fairy tail' report prepared for management?
I was so shocked to read on that thread 'Used Nurse, Dirt Cheap', that LTC allows 1 RN for 100 patients in some States.
Just do the math; in a 12 hour shift, with a 30 minute lunch break, no bathroom break and no charting that is less that 7 minutes per patient, not counting the time to walk from room to room. As every nurse knows, one patient can take up your entire shift.

Of course this is LTC, and a lot of patients don't need a thing but help into and out of bed, and a little help dressing and with meals, the facility doesen't want, or need, RN'S, LPN'S, or even Medtechs for this kind of assistance, but still, what kind of robot can do a job like that, take responsibility for 100 patients, any or all of whom can sue you or try to have your licence, which you worked like a dog for, and spent years of your life getting, revolked?

You know if anything goes wrong, or a temperature or high or low B\P gets overlooked, or goes unaddressed, who gets the blame? Not the healthcare corporation that made the decision to staff like this. Send me to a combat zone anytime, it's a lot safer!

The following is from the
'Neue Post' a very popular magazine, that's been around a long time and is published in Germany. It is kind of like a cross between 'People' and 'Good Houskeeping'.
I want to add this because I know that my above post has the very real possibility of turing this discussion into a gripe session about staffing and that was not my intention. (I can get carried away, just like anybody, with my personal peeves!)
People under a 'Universal Health Care System' have questions just like any body else, and this was an attempt to answer some questions readers had. (Jenny, I may need your help!)

Neue Post 25 February 2009
'These are Your Rights as a Patient'.

1. Can my Doctor refuse to take me as a patient because his\ her (I will use 'he' for both) practice is full?
Unfortunatly, yes. Just like you, as a patient, have a right to choose a doctor, the doctor has a right to choose his patients, even if he is the only specialist near you. If you are handicapped, and cannot get around easily (Germany is full of little villages) you can call the Association of Doctors for the Insurances (Kassenärztlichen Vereinigung) and they will try to try to get the doctor to accept you.

2. Do I have the right to a paticular medicine?
No. The doctor is given the room to decide on the therapy, and the Apotheker can choose to give you a less expensive medicine. If you don't wnat this to happen, ask your doctor to cross out 'the same' on the RX.

3. Is the Doctor allowed to treat Private insurance patients before me?
No, they cannot, even if some doctors will tell you they must see 'private insurance' patients first.Complain if that happens to you. If nothing helps, change your doctor!

4. Can I get a Second Opinion?
Of course! Especially by a difficult diagnoses a second opinion can be sensible and helpful. That may not make the doctor treating you happy, when you ask him to send you to another specialist (Überweisung), but he has to do this and you do not have to pay any more for this second opinion.

5. The doctor only has five minutes of time for me. Is that OK?
Not really, but the law did not write for an exact time for the visit. However, every doctor is (verpflichtet) supposed to inform the patient about diagnosises and therapies. Even when it sounds like thy are talking Greek (Fach-Chinesisch) to you, ask until you understand.
It will help if you write your questions down befor you go into see the doctor.

6. I forgot my insurance card. Can the doctor send me away?
The important thing between a doctor and a patient is trust. If the doctor trusts you he will treat you whether or not you have your card with you. He does not have to however. He con send you away. You are supposed to renew your insurance card once a Quarter (year). (Einmal pro Quartal müssen Sie die Versichertenkarte vor legen.)

7. I sat in the watting room 1 and 1\2 hour. That is too long, isn't it?
Yes, that is too long, when you have an appointment. You should ask why. You must accept 30 minutes of waiting time. However, emergencies come first, by law.

8. Am I allowed to look at my Personel Medical file?
Yes. You can see your file and make copies. The doctor can charge you 50 euro cent per copy. The doctor does not have to had over his personal notes. If you have a medical power of attorney they also have the right to see your medical file, and get copies at their own cost.

9. The first appointment I could get is in four weeks. Is that normal?
That depends on your complaint. If you have severe pain, or an emergency, your doctor must see you as soon as possible. If it is routine visit, it can be normal to have to wait four weeks for an appointment.

10. Why does the Apotheke not take my Rx?
Probably because it is no longer good. (gültig). A 'red' colored Rx has to be filled in one month. A 'private insurance' patient has three months for this Rx. A 'yellow' colored (Betäubungsmittle-Rezept) Rx. must be filled in one week. A 'green' Rx does not have a time limit.

11. I am still weak. Can the hospital discharge me anyway?
Whether or not a patient stays in the hospital is a decision for the doctor. If you feel you are being discharged too early you should discuss this with the doctor. (in Vorgehen Ruhe besprechen).

12. If I am a victum of a medical mistake in my treatment, who can help me?
I am sorry I don't know how to translate this because the legal system in Germany is a little different and I don't know legal terms in English either.
(Rechtsschutzversicherung, or if you don't have that, eine Schlichtungstelle, eine Patienteninititive oder Ihre Krankenkasse)

Some places for more Information and Addresses are:
Unabhängige Patientenberatung Deutschland (UPD)
www.upd-online.de

Patientenintitiative e.V.
www.patienteninitiative.de

Verbraucherzentrale Bundesverband e.V.
www.vzbv.de


So, there you have it. Now that system doesn't sound so bad does it?
And this is Germany. France is supposed to have a the best, Holland and Belgum are up there to. All of these systems are rated above the US by the WHO.
One of the first things you notice when you get off a plane from the US here are all the healty old peole walking around.
Now how come these countries, some of them not as big as some States in the US can manage to provide health care to their citizens and the US cannot?
I am telling you, there is something wrong with this picture!

Here in Australia, when having a prescription filled out, we are offered a choice of a cheaper brand of medication. However it is entirely our choice whether to accept that or not. It's up to the individual which one to have, cheaper V's more expensive. Being a Medicare only ( ie; uninsured) patient does not exclude one from having a choice. You just pay more if you choose the more expensive product.

In Brazil, where you are, with 80% of the people relying on the government health care system, and no money coming into it, and the other 20% of the people who work and have health insurance getting funded care, there can be no comparison with the Canadian system, where at least 90% of the people are employed and contributing to the health care system. That money doesn't go to pay for ultra luxurious lobbies in hospitals, conference rooms, expensive office furniture and decorated doctors' offices, or the extra equipment that each hospital in the USA has, in order to compete with the others.

From what I've learned from my Brazillian neighbors, their insurance funded healthcare in Brazil is good, and they go back there for the less expensive procedures and treatments; and dental care that is too expensive here. Since he owns his scientific and medical equipment business that has offices there and in several states in the USA, emergency treatment would be provided for them here, using their insurance company here. They say the care given unemployed, poor people is awful. Their attitude about it is the same as yours.

Since I'm from Canada, still have many family members and friends there, I know that the health care system there is financially handled by government, and medical decisions are made mostly by physicians (who are very jealous of the inflated incomes of their American counterparts). Everybody gets good care! The long wait times you hear about is propaganda put out here by the AMA, unless it happens in far off rural communities, where there are few doctors and less hospitals. Of course there are people here, and there who don't accept responsibility for making their appointments in a timely manner, and then blame it on the system.

In big cities there, the wait for procedures is the same as it is here, and emergency surgery is done as quickly. In fact, patients stay at rehab facilities after surgeries, to have the PT they need and monitoring. That means that equipment which is rented to each hospital discharged patient for use in their homes here, is shared in the rehab. facility, which saves the money that's spent on the higher number of the same equipment here. Also, the physical therapists can work with more than one patient at a time, which makes their care for a shorter time min the home as it's done here, especially including travel time. It's a waste of money.

Now I'm all for home health caring for patients so they spend less time in hospitals and that spares them from nosocomial infections (sometimes), but surgical things like joint replacements, have a better recovery rate when done in a rehab. facility, away from the "superbugs". Let me tell you, though, those facilities aren't fancy, and rooms are semiprivate no matter who you are - that saves money.

There's also a difference in the character of most Canadians. Traditionally people there hate to be "on the dole" (an old fashioned term), and want to be up and working ASAP after an illness. Malingering is unusual, as is the erroneous concept that when it's free, people see their doctors more often. They also have little sense of the system as being given to undeserving undesirables, who purposely don't work, due to lack of caring for themselves or the people whose income tax pays for their care. Taxes there are higher, but when you realize that the interest on mortgages is not tax deductable there, as it is here, and much fewer tax credits are given, that explains it more than thinking it's higher due to health care. Compared to the amounts paid here to insurance companies, the amount of each working person's income tax that goes toward health care in Canada, is less!

My sister worked as a detective in Canada, who investigated suspicious health cases for Equifax (the very company that reports credit here). She found that many of the people who dragged out the time for their recovery from an illness, were immigrants or people whose nature, as she put it, is "less than honest" - very frowned upon and certainly not considered "smart".

I remember another neighbor I had long ago, who worked as a "steward" (flight attendant) on international flights. He had an accident with a meal cart, and wasn't badly injured (had full range of motion and strength of all extremities and his back), but he was off duty for a year. He rented equipment while "off sick" to grade his property, riding around on it, until he went begrudgingly back to work, when his "leave" ran out. No one came to check on him!

I guess we're OK with that here, because it wasn't money from our paychecks to the government that paid for his time and health care, but it was from the employees of the airline for which he worked. The airline just ran it as a "business expense" which was tax deductable......