As a conservative with libertarian leanings I USED to think that a single payer...

fergus51 · Feb 12, 2004

I don't think the demand for nurses increases in a single payer system (and that is not the same thing as a universal system, which is what you seem to be talking about). Many provinces have less nurses per capita than many states. Single payer doesn't mean more use necessarily, it often means use at a better time (earlier). The fact that people here can get preventative or early care for free could keep them out of the hospital. By contrast, if you delay going to the doctor until it is extremely serious, you could wind up in ICU for days on end. I saw this in L&D in the US on a fairly regular basis. I would have women come in with no prenatal care and they would have gestational diabetes, PIH, etc that could have been controlled if it had been caught early but because it was left for so long the health consequences were very serious to both mom and baby (and let me tell you, NICU care is expensive and employs a LOT of people). In Canada, it is extremely rare for me to see a woman who hasn't received prenatal care, unless she is homeless or drug addicted or in an abusive relationship

Roland · Feb 12, 2004

Are there any obvious downsides for those in medical professions? Some NP's and CRNA's are concerned that they might take pay cuts. However, it sounds like Canada's issues with NP's and CRNA's are NOT related to your health care system. Having seen both systems in action what (if any) benefits are intrinsic to the US model.

fergus51 · Feb 12, 2004

There are definitely opportunities to make more money in the US if you are willing to work as a travel nurse or a CRNA (we have neither in Canada, though I don't know about other countries like the UK or Australia). There is definitely more leeway to negotiate a higher salary in the US if you are willing. I know some hospitals pay their employees more than the one down the street, which is a good thing if you work at the higher paying place. Canadian hospitals generally can't compete with their American counterparts when it comes to the goodies like signing bonuses. But a lot of American hospitals can't afford to offer those things either, and I am more concerned about work environment and a good wage than a bonus.... I think the biggest difference between Canada and the US is that in the US the hospitals go from state of the art AMAZING hotel like places to dives I wouldn't want my dog in. If you are able to work at the hotel like hospital, you'll do very well financially but if you are working at a lesser place you can be treated horribly. There are differences between hospitals in rural and urban areas in Canada, but the wages and working conditions don't vary as much. In fact the wages often don't vary at all. So, a nurse in Toronto makes the same as a nurse in a rural (cheap) town. Good for the rural nurse, not good for the nurse in Toronto. There are a lot of considerations when it comes to wages....I think the wages here have more to do with the union than with the fact that we are in a universal single payer system. I don't see any reason why there would be pay cuts if there were a single payer system in the US.

ktwlpn, LPN · Feb 12, 2004

! This increased demand on the system would probably mean that nurses would have to be paid higher wages in order to avert a truly critical shortage.

:rotfl: like that will EVER happen...

Roland · Feb 12, 2004

Maybe the unions in Canada could consider seperate "regional" negociations with pay tied to some sort of more local cost of living index. The advantage of unions is that everyone gets paid the same (with the same experience level) of course that is also a disadvantage. However, like you said that is a seperate question from the single payer system.

Personally, I think we need to "go back" to a system where almost everyone "pays their own way" for medical care. In fact, I would PROHIBIT employer paid health insurence EXCEPT for major medical with significant deductions (maybe around $2,000 or so). I would also create seperate STATE SUPPORTED medical facilities that would provide both primary and acute care. To attend one of these facilities you would have to meet certain criteria similar, but more leniant than Medicaid is today. Same thing for prescription drugs and the elderly. I would provide prescription drug coverage ONLY to those individuals who had incomes below about 150% of poverty or who could prove extraordinary costs. Of course this system would have draw backs as well (liberals would be quick to accuse this approach of being a two tiered level of care). However, in a free society the weathy are always going to have more, (and better) of everything. The beauty of capitalism and freedom is the opportunity to achieve a very high lifestyle, unfortunately the freedom to succeed contains by necessity the opportunity for failure. We've at least come to the point where almost everyone agrees that there should be some sort of "safety net". Ultimately, I think that the economic productivity and technological advances of a free society make life better for almost everyone.

As a relatively "poor" person in America (our income is about 15K per year for a family of three as students), I still think that I have it better than "middle class" people in much of the rest of the world. I certainly have it better than "middle class" people did several hundred years ago. My water is clean (relatively anyways, it's not going to kill me in the short term), I have plenty to eat, and my house isn't cold (except when I turn the oil furnace off because it runs about $300.00 per month). Thus, I believe that if technologies such as AI, and nanotechnology, continue to advance that people two hundred years from now will have it better than me. Since, I believe that a free economic system best promotes such an advancement, that is what I advocate.

fergus51 · Feb 12, 2004

prohibiting employer paid plans would just result in people not getting care. I feel bad saying it, but I think there are too few people willing to save thousands of dollars in case they get sick. Benefits are an important part of a job. I'll give up benefits if my wages increase to the point where I don't need them anymore, but I don't see that happening.

ktwlpn, LPN · Feb 12, 2004

prohibiting employer paid plans would just result in people not getting care. I feel bad saying it, but I think there are too few people willing to save thousands of dollars in case they get sick. Benefits are an important part of a job. I'll give up benefits if my wages increase to the point where I don't need them anymore, but I don't see that happening.

Many people in this country are simply unable to save money because they need everything they have just to live(older folks on fixed incomes come to mind) Think what would happen if we had possibly millions of people in this country forgoing medical care-wouldn't we see a resurrgence of communicable diseases that have been erradicated through vaccination? What about people suffering with chronic diseases or cancers? We should just get the treatment we can pay for? What happens when we can not afford morphine and we are dying in pain? The current system is really flawed-no argument there-but to deny care to anyone will bring trouble to all...

fergus51 · Feb 12, 2004

Believe me, you're preaching to the choir on that one. I don't believe anyone should be denied medical care, and I think that everyone should have to contribute to the costs.

Roland · Feb 13, 2004

We basically have a system where "anyone" can get medical care now. Unfortunately, it's just not in a very organized way. Consider that I developed a severe L-3/S-1 herniation in October, with secondary symptoms including loss of perineal sensation, and sciatica. Even though I didn't have health insurence, and couldn't pay cash the hospital didn't hesitate to run an MRI to rule out cauda equina syndrome. The end result is that I racked up two thousand in medical bills that I'm now paying at the rate of $20.00 per month (which will negatively impact my credit). However, I DID get treatment despite not haveing a "life threatening condition". Actually, I got a diagnosis rather than treatment. My perineal sensation returned but I still can't feel the little toe on my left foot.

The point is that there are many hospitals (usually those which have religious missions) that will treat you without regard to ability to pay (of course they still want to COLLECT from you if they can).

fergus51 · Feb 13, 2004

And if they can't collect, I wind up paying for it. Or if it is too much for you, you get to declare bankruptcy..... Lovely....

gwenith, BSN, RN · Feb 13, 2004

Why not look into the system we use???

We pay a percentage of tax (forgive me but I can't remember exactly how much and one of the reasons is PAYE system of tax - my employer pays tax for me and I just get to claim back what I can - if you don't have it in your hand in the first place you never miss it)

Paying a percentage means that the rich AUTOMATICALLY pay more in relation to health insurance (yeah they screamed:rolleyes: ) We also have the option to take out private health insurance - at whatever level we like. I.E. I could opt to "extras only" which means dental and optical and some frilly bits or I could have full health cover and go private all the way.

Not everything is free - increasingly visits to the GP (LMO) are not free you have to pay over and above what the government rebate is (except for pensioners) but I do not see this as neccessarily a "bad thing" as it does prune out those who go to the doctor once a week almost as a "social" visit. There are advantages and disadvantages - if you are interested in more information I have posted quite a few links in the Australasian forum.

But, I still believe that the greatest hinderance to making health care "universal" in the USA is the hidden cost of litigation. We are starting to see that here and it worries us. We do not want our health care costs to "blow out" just because the legal fraternity see it as a nice fat never ending gravy train.