This is a reply I posted to another American who had specific questions about our system, I hope you find it helpful.
Universal systems in some countries are government run, in others they are simply government funded and monitored. In Canada, the provincial governments divide their provinces up into health authorities which are managed by docs and beaurocrats, same as in the US. The provincial government decides how to fund each area according to need, but it isn't the government micromanaging. There are universal systems, like in the UK I believe, which have both public facilities and private facilities. Standards are still monitored by the government (like they are in the US), but there are private facilities for people who have the supplemental insurance, which compete with public ones in a way.
As far as ingenuity... Canada has a long history of that (as do many other countries)! Where do you think scientists discovered insulin and changed the lives of millions of diabetics? My hospital raises litterally hundreds of millions of dollars for research (I think it was 170 million over three years of fundraising). Drug and technology companies still have a motive to develop new products because we still purchase the drugs and technologies we use (our unit is looking at buying over 60 $40 000 isolettes for the NICU). Drug companies' patents here still allow them to make a handsome profit.
As far as pay scales.... Doctors and nurses in universal systems are not paid less than bus drivers. This is another common misconception in the US. Nurses in some parts of the US make more than in Canada and in other parts make less. Average doctor salaries in Canada are lower than in the US, but that's because we have fewer specialists and more GPs, and GPs always make less money. Specialists here are compensated less outright, but the fact that their overhead is so much less means that a lot of docs actually do just as well or better here. Malpractice insurance is MUCH less, we have a single payer system so there is less paperwork to spend on and doctors and hospitals here never have to worry about getting stiffed by patients who can't pay. I know a lot of Americans are scared of the term universal because they think it means they will have to pay for the people who can't, but really, you do now anyways. The costs for you to get medical care are so expensive partly because it has to absord the cost of non-payors who declare bankruptcy.
As far as lawsuits... there seem to be a lot less here, and I don't know why. Doctors and nurses still have their own malpractice insurance (mine is covered by the hospital and the union, like it was when I worked in the US).
As far as elective surgeries: they are just that. A mastectomy is classified as urgent, not elective. We have elective, urgent and emergency. An urgent surgery is one that will cause health problems if not treated fairly quickly, like a mastectomy. An emergency is obviously one that would cause injury or death if not treated immediately. That's why people aren't questionning that aspect. Again, studies have shown that people may wait longer here for certain procedures, but it doesn't have a negative effect on their long term health. And for all the talk about waitlists, I have never known anyone who has had trouble getting treatment when it was needed. Are there horror stories about indivdual cases where things have gone wrong in Canada? Of course, just like in the US. But you have to look at the big picture. Is it the norm? No. There has even been research showing that women in Canada from low socioeconomic groups do better when they get ovarian cancer compared to women in the US and the reason was access to care. I would rather have to wait a week or two as opposed to not getting a surgery I needed cause I didn't have the money. I promise I will find the name of the book that references all the studies you seem interested in.
As far as patient choice, trust me, it is MUCH more limited in the US unless you have signifigantly more money that I did. Having lived and worked in both countries, I know that Americans think Canadians have no control over their care or who they choose as a care provider, but that just isn't true. I think it's because Americans think the government manages healthcare, when in reality they fund and monitor it, but the system is run by the people who work in it (administrators, doctors, etc). I chose my doctor and when he wants me to get certain tests, I get them done. When I have had health issues, we have discussed the options and then made a decision together. The government does not determine my care, my doctor and I do. When I lived in the US, I had to have a doctor that was a part of the HMO list, and it was a struggle to get the HMO to approve things the doctor wanted done. I wound up paying out of pocket more than once. And the most ridiculous part was, I was only covered in a certain geographical area! If I went on vacation to Florida, I wasn't covered at all!
OK, I am getting long winded, but I'll keep going.....
Patient ratios in the US and Canada are similar, but I generally get a better deal in Canada which could be because I work in larger urban settings. In L&D it was rare for me to get 2 women in active labor, something that was routine when I was in washinton. In the NICU I look after 2 or 3 babies (only look after 3 if none are vented). Med surg in my hospital only uses RNs and they have 4-5 patients on days. I have worked with LPNs on med surg and generally the RN-LPN team would have 8 or 9 patients, though I have seen up to 12 in one hospital. Just like in the US, it does vary between hospitals depending on their size (a hospital in NYC may have more resources than one out in the boonies). I do not have to float, ever. I get an hourly wage and am paid OT (time and a half) for anything extra as are all nurses (we get a pretty good benefit package as well). We have no mandatory OT like some places in the US because it is against our labor laws. Wage scales vary by province. In Ontario, a new grad starts around $23 an hour + shift diffs (so figure $18 American). The top of the payscale for staff nurses is reached at 9 years and is about 32-34+ diffs (though agency nurses make much more). In BC the range is from 25-33 or something. Each province has a nursing union which negotiates wages. If you go to a provincial union website you will get links to the payscale. In ontario, it's the ontario nurses association. In BC it is the British Columbia Nurses' Union (
www.bcnu.org I think). You'll have to google a bit It's hard to give a real comparison because cost of living is a big factor and Canada is a BIG country. Nurses in San Fransisco will make a large hourly wage, but it's so expensive that a nurse in Arkansas making a much lower wage may live better.
As far as people all paying for health choices of others.... This is actually a good thing. It means that EVERYONE has to pay into the healthcare system through their taxes. In the US, you do it indirectly (that article was American right?). Someone can go without insurance, then show up with an MI and the hospital has to treat him, even though he will never pay for any of it. Then those of us who do carry insurance wonder why it is so expensive! It's cause we have to pay for that MI guy's care one way or another!
In Canada, people who make bad lifestyle choices are not free to avoid contributing to their healthcare. The other thing is, insurance companies in the US can refuse to cover people with certain conditions, so even if they want to pay for insurance, they can't. The best way to run a system is to have low and high risk people in your pool. One of the reasons the medicaid system is so shabby is because it only takes the high risk, no paying people. We pay more in taxes in Canada, but I actually take home about the same percentage of my pay here, because in Washington I had to pay for my insurance.
I think it's a little ironic you would say that people are brainwashed into thinking that universal healthcare is good. It has been my experience that people in the US are brainwashed into thinking it's bad, based on misconceptions. Canada's system may be completely wrong for the US, but there are a lot of universal systems to look at for ideas. The Canadian system certainly is far from perfect, and we can also look to other countries for inspiration.
I want to know what nurses think about socialized medicine.
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