Calif RN disagrees with CNA in many ways. Am I alone?

fergus51 · Feb 11, 2006

I'm from Canada and I liked it. The only thing I've ever had to pay out of pocket for was meds. I didn't pay 50% taxes either. I paid about the same as I pay in California. Just FYI.

mobilsurgrn · Feb 12, 2006

Fergus, as a person who lived in Canada, how would an all-access system make a difference in ED visits? Would people avail themselves to clinics or primary care physicians because it was free? Do Canadians, as a rule, take more respsonsibilty for preventative care? I a Canadian has a URI or the flu can they get in to see a physician in a reasonable amount of time?

I ask these questions because it seems now that if I get sick I can't get an appointment with my primary care doc for several days. By then, I am either well or really sick..

We hear all of the horror stories about Canada, England, others, but you have first hand experience. Can Americans, who are comparably unhealthy, make this work?

fergus51 · Feb 12, 2006

Fergus, as a person who lived in Canada, how would an all-access system make a difference in ED visits? Would people avail themselves to clinics or primary care physicians because it was free? Do Canadians, as a rule, take more respsonsibilty for preventative care? I a Canadian has a URI or the flu can they get in to see a physician in a reasonable amount of time?
I ask these questions because it seems now that if I get sick I can't get an appointment with my primary care doc for several days. By then, I am either well or really sick..
We hear all of the horror stories about Canada, England, others, but you have first hand experience. Can Americans, who are comparably unhealthy, make this work?

I've said many times that I don't think a Canadian style system will work in America. It won't. Ever. I wouldn't advocate it because it's pointless.

There are places where it's hard to get a family doctor in Canada so you have people relying on walk in clinics or hospitals. Smaller towns in particular have trouble attracting new docs, so EDs are misused there at times too. I come from a town of about 75000 people, always had a family doc, could generally get in within a day or two and when I couldn't, could just go to one of the half dozen walk in clinics in town. My wait time is actually a lot longer in the US. I've known I need to get my gallbladder out for a few weeks now, but because of the money I'm going to have to try to tough it out for a few months before scheduling the surgery. I don't know whether we focus more on preventative care in Canada... that seems to be underfunded and underdiscussed just like here. The system has its own problems, I just usually add my experience when people post things I have found to be completely untrue (like you can't pick your doctor in Canada, the government decides your treatment, health care is rationned, they don't have new technologies, etc).

SFCardiacRN · Feb 13, 2006

I just usually add my experience when people post things I have found to be completely untrue (like you can't pick your doctor in Canada, the government decides your treatment, health care is rationned, they don't have new technologies, etc).

http://www.ncpa.org/ba/ba104.html I've never sought treatment in Canada but this is what we keep hearing in the states.

mark hamel · Feb 13, 2006

A link to a far right think tank in Texas, get real :uhoh3:

fergus51 · Feb 13, 2006

http://www.ncpa.org/ba/ba104.html I've never sought treatment in Canada but this is what we keep hearing in the states.

Exactly, that's why I feel the need to post on occasion. That article screams of spin.

Like it says this many Canadians are waiting for surgery or treatment. Well, what kind of treatment? Are they like my mother who had to wait for a minor foot operation done only really for cosmetic reasons (didn't affect her quality of life at all mind you)? Do the wait times impact patient outcomes (that's the biggie)? Plus they talk about things like the wait between seeing a GP and having surgery. Well, that's fine, but was surgery the first treatment tried? If I go to my OB/Gyn and have endometriosis, he may recommend medications and try them before surgery. So my wait time seems really long, but it's really that I've been trying for a non-surgical cure first. They also like to focus on provinces like PEI which have about the population of Wyoming, so I don't know how representative they are of the entire country. They talk about Canadians receiving treatment in the US, but always ignore the specifics like the actual percentage of Canadians who seek treatment in the US which is amazingly small and whether they sought treatment there, or just wound up getting sick while in the US and needing it then. I was really surprised at the assertion that racial minorities go to the back of the line for health care... I've never seen race listed under patient info. I was also surprised at the assertion that Canadians docs worry about the budget. I see that here, never saw it there. I could go on and on about that article, but suffice it to say it's propaganda.

That particular article is so bad that they don't even get the population number right. The last time our population was what they quoted was around 1985. Canada has over 31 million people as of 2001's census and our population is currently estimated to be over 32 million (http://www40.statcan.ca/l01/cst01/demo03.htm). That big of a disparity alone is enough to tell me their other figures are suspect.

mobilsurgrn · Feb 14, 2006

Exactly, that's why I feel the need to post on occasion. That article screams of spin.

It is nothing but spin and it was published over 10 years ago.

But take the issue out of political context. The proposed legislation is rediculous. It is unsustainable and would never pass a means test. The bill's sponsor claims that the U.S. could provide the current model- every bell, whistle and stop, to all U.S. residents, not citizens but residents, by curbing costs through paperwork reduction, national contracts for drugs, elimination of all for-profit entities, renegotiated provider agreements and a modest payroll tax. The bill states that all existing for-profit properties would be purchased by the government.

According to The American Hospital Directory, there are 1257 U.S.for-profit facilities with an average net present value of $30 million. So we would start out with a repurchase bill of $37 billion dollars. Then, regional government agencies would systematically "right-size" each community, closing hospitals and mothballing a good portion of the money spent to purchase the for-profits. Competition would end and with it so would many best practice pursuits. I don't advocate much of the current and past overspending due to competition but ending competition alltogether would be catastrophic.

So here comes another proposed program that would land in the laps of the working middle class and gives honest, caring liberals, like myself, a bad name.

If the CNA wants to put this stuff out as "what's best for patients" they must do some research, understand the implications and be responsible about telling all sides of the story. They have not done that- yet. It sounds good, it sounds right, and it's something that they can chastize opponents for not supporting.

fergus51 · Feb 14, 2006

I do have to say best practice pursuits aren't dependent on competition for money. The best hospital that I have experienced in that regard was in Canada (most research, most likely to support evidence based practice, all RN staff, good equipment, encouraged increasing education in staff, etc).

To me, I think the best solution for America would be some sort of mandatory insurance system coupled with insurance regulation.

mobilsurgrn · Feb 14, 2006

I don't think it's directly about money. I think recognition may go away in a one-payor model. I completely agree that a mandatory insurance model would be a good first step and I would not complain about paying a fair share for others to have it.

pickledpepperRN · Feb 14, 2006

Is this the legislation being discussed?

Medicare For All

H.R. 676: The Conyers Bill

Brief Summary of Legislation

http://www.healthcare-now.org/printsummarytest.html

http://www.healthcare-now.org/singlepayer.php?sid=4&subid=24

Healthcare-NOW!

http://www.healthcare-now.org/hr676.php?sid=4&subid=16

The United States National Health Insurance Act establishes an American-styled national insurance program.

The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and cost effective health care services regardless of ones employment, income, or health care status.

fergus51 · Feb 14, 2006

I don't think it's directly about money. I think recognition may go away in a one-payor model.

:chuckle Trust me, it doesn't. I worked at the two busiest hospitals in Canada as far as L&D/NICU were concerned and the competition was fierce! The nurses were always sure their hospital was the best. In Toronto, there were 3 NICUs within a mile of so of eachother and of course, mine was the best:chuckle (I'm sure nurses at the other places thought theirs was better, but our staff would have argued on that;)).

mobilsurgrn · Feb 14, 2006

OK, I'll have to trust your experience on that...