Specializes in Flight Nurse, Pedi CICU, IR, Adult CTICU.
A health care system is so much more than a hospital.
A healthcare system is much more than a dynamically calculated infant mortality rate, longevity calculation, and collection of stories about people who didn't get the services they felt they should have, but that doesn't keep people from talking about them constantly in the UHC discussion. And the reality is that hospital are an essential and key part of a healthcare system. It makes no sense to ignore or trivialize the role of hospitals and dismiss what has happened to Canadian Hospitals over the past 20 years.
I don't think anybody is suggesting that UHC automatically improves a health care system.
Are you serious? The arguments for UHC use lots of speculation and assumption in making it sound like changing to UHC is a no-brainer. Roughly quoting a line from a talented poster in this forum who was noting the absurdity in the arguments for UHC, "all our troubles will melt away like lemon drops." That's the way folks make it sound.
Any system must be run well in order for it to work well. The argument for UHC (well my argument anyway) is a moral one. I just think it is the right thing to do. I certainly don't see how UHC is detrimental or will ruin anything--but again that all hinges on how the laws are designed to support it.
Well, your argument is fatally flawed if morality is what it is based on. Some people find it immoral to conduct abortions, but the gov't allows it in spite of the moral objection. Some thing morally based restrictions on stem-cell research are improper legislation, but somehow controlling healthcare for moral reasons is acceptible? I don't need the gov't to legislation my personal moral behavior; I will help out those around me in need, and I don't need some corrupt gov't or special interest group to dictate my moral behavior. That is simply repulsive.
You are right - no competition. However competition is not the only motivation to seek out and offer new and better services to customers. Service improvements and better treatments come about through quality improvement programs and public accountability which I think are better motivators and lead to better outcomes anyway. Quality improvement programs and public accountability seek to find improvement because it is the right thing to do not because "we need more customers to make more money".
QI programs are not the creators of innovation. They will only use exisiting modalities to improve their services, they rarely create new ones. Outside of an incentivized system of competition and reward, there is LITTLE motivation to improve the system. And public accountability can be applied to private services who provide public services. A UHC system is not the only way to demand public accountability.
Government medical insurance plans will only pay for medically necessary care and will not pay for it outside of Canada if it is available in Canada but you still have a choice. Those people who choose to go outside of Canada are a very small minority. Please do not generalize this as a reflection of the entire population because it is not so.
What does this have to do with the discussion? This may be a residual issue from the failure to explain the "medical tourism" issue. But to expand on your comment, it doesn't make sense to say that the gov't severely restricts delivery modalities, but then to say they have a choice. The percentage of people leaving Canada for care is also irrelevant; very likely more would if they could afford to, and it does not mean that those who are not seeking care elsewhere are getting what they need or getting it in a timely manner.
One last thing I would like to inject into this discussion is that health insurance is not necessarily a part of UHC. Some countries have no insurance system for basic medical services and private insurers step in to cover items that are not included in the basic government system. It all depends on how the system is designed the concept of insurance is not mandatory. However, when public funds are used there has to be some type of limitation because the public money pot is not bottomless.
And this I've said. Now maybe if more people will understand this, they will realize the illogical flaw in constantly talking anectodally about care that was denied by private insurers.
The Canadian system is flawed- but that doesn't mean that the concept of UHC is not a good concept. Our government believes it has a moral obligation to provide health care services for Canadian Citizens and the Canadian population holds them accountable for that.
And I reply by saying...the US system is flawd, but that doesn't mean it's going to be improved by switching to another flawed system. And gov't's are becoming increasing less accountable to their population. An "accountable" gov't would not limit choices. It wouldn't force an exportation of care for their sickest patients. 15% of their population wouldn't report an inability to get a primary care provider.
I understand if you want to defend the Canadian system; I don't propose that it change at all. Understand, however, that every time the Canadian system is referenced and championed as a model for change, I will yet again point out the flaws in the system and share why such a program is a terrible idea for America.
You do pay for your own health care through your taxes - the government has to get the money from somewhere! Universal Health care does not mean FREE health care it means universal health care. Universal means that most people get most of the care they need most of the time regardless of their ability to pay or "pre-existing" conditions.
And in America, responsible behavior is free. Additionally, no one can be denied an evaluation and emergency care if needed, regardless of their ability to pay...it's law.
Two ingredients are necessary for the implementation of Universal Health Care in any country:
1. the belief in the obligation AND
2. the concept of public accountability
If you think that UHC will be a disaster in the US it is not because UHC is not a good idea it is because you think that both of these ingredients are missing in the American culture.
And from reading your posts on this forum I am inclined to agree.
First, both of these ingredients are not somehow unique to a UHC system. In America, we already hold our private enterprises publically accountable for the products they deliver, from the little tiny packets of sugar we put in our coffee, to the standards they use in building a 100+ story skyscraper in a population center.
Second, I remind you yet again that there is no need to take personal shots at me and imply what you believe to be the nature of my character. It's insulting, offensive, and serves no purpose in supporting your position.
Specializes in Flight Nurse, Pedi CICU, IR, Adult CTICU.
Maybe we could learn from the rest of the world , what we are as people is more than the value of our paycheck and what it can provide for ME , ME , ME !
My last contribution to this thread , H&S you generalise your Parochial views , via your facts to reflect a world view that is more complex than your facts encompass . I'm sorry but I should have realised it futile to debate
Honnête et Sérieux , when you attack the credibility of a nobel prize winner Sheesh . Pschitt ! none of us on this forum is worthy to share a thread with you . Good bye and good luck .
Of course it's futile to debate when the content of the debate quickly leaves the flawed assumptions and assertions, and resorts to attacking the character of the participants.
Not to mention that the methods and ideas used in favor of UHC are simply flawed and unsupported. It's not my fault if folks fail to properly qualify their position.
"Generalize my parochial views?" How does that even make sense? Are you going to say that someone like me who challenges a SINGLE PAYOR system is somehow more "narrow" in view than someone who believes that the only solution is to have the gov't take over? That is simply illogical...in more than one way.
I didn't "attack" the credibility of a Nobel Prize winner. I did, however, point out the flaw in qualifying someone's position just because they are a Nobel Prize winner. Again, Krugman is not an expert on healthcare policy. A critic...yet, but not an expert. He won his prize for his analysis of trade patterns; it had nothing to do with healthcare. Suddenly he's an expert in UHC? Is he any more credible than Edward Prescott who won the prize before Krugman and disagrees?
And yet again it saddens me to see people abandon their position when it's flaws have been revealed, and they resort to taking personal shots at the participants. What have I done so agregious except to disagree and present a differing point of view?
How are folks not embarrassed when they behave that way?
The VA system is not that great. Just talk to a few recent Vets that had to wait months for help with acute issues while the 60 y/o vet was able to get right in for his Viagra or other chronic issues. I see as much or more abuse of the VA system than in the regular system.
As far as the countries with supposedly better access to healthcare, look at the geographical size of the countries and how many hospitals and clinics are needed to fit so called "access to healthcare." There are many places in this country where you are hundreds of miles from any large city with a hospital. Are you saying the under UHC they will build large medical centers every 50 miles in the US to help increase access? With your VA example, there are many so called VA "hospitals" that offer little more than a primary care clinic and have to transfer people to other facilities.
I live in a city with world class medical facilities, I work hard in school and at my job, and my private health insurance doesn't offer offer me much choice at all. I don't get the primary health care provider that I want, I don't get to choose to have any sort of mental health care, and were I to purposefully or accidentally "chose" to get pregnant none of the prenatal care or birthing expenses would be covered. I'd have to apply for Medicaid or go into medical debt.
We ration health care in America big time, and most Americans don't have 'choice.' Insurance companies ration care for their members by making decisions about what they will cover, they also ration it by choosing who they will and will not enroll based on preexisting conditions. What good does this do us as patients? And what good does this do nurses? Nurse jobs are closing up, and it's not because people don't need nursing care anymore, it's because hospitals aren't making profit. Less nursing care is provided than is needed, so somehow, nursing care itself is being rationed. People aren't choosing to receive less nursing care now that there's a recession, it's what's being rationed to them by the private health care system.
I can't fathom what this has to do with American work ethic.
I'll be honest, I like the concept of a national healthcare plan, but what people are forgetting is the tax rate that these countries pay that have socialized medicine.
It's anywhere from over 30% to 60% per DOLLAR of earnings.
Specializes in Flight Nurse, Pedi CICU, IR, Adult CTICU.
I live in a city with world class medical facilities, I work hard in school and at my job, and my private health insurance doesn't offer offer me much choice at all. I don't get the primary health care provider that I want, I don't get to choose to have any sort of mental health care, and were I to purposefully or accidentally "chose" to get pregnant none of the prenatal care or birthing expenses would be covered. I'd have to apply for Medicaid or go into medical debt.
We ration health care in America big time, and most Americans don't have 'choice.' Insurance companies ration care for their members by making decisions about what they will cover, they also ration it by choosing who they will and will not enroll based on preexisting conditions. What good does this do us as patients? And what good does this do nurses? Nurse jobs are closing up, and it's not because people don't need nursing care anymore, it's because hospitals aren't making profit. Less nursing care is provided than is needed, so somehow, nursing care itself is being rationed. People aren't choosing to receive less nursing care now that there's a recession, it's what's being rationed to them by the private health care system.
I can't fathom what this has to do with American work ethic.
Because it is said time-and-time again, I feel it's important to point out that in systems where the gov't is making the decisions, people don't alternately have choices that privately-insured people don't. THe gov't rations care, and decides what they will cover.
Going to any of the 'traditional' UHC systems does not somehow solve these problems.
And given the comments about the operations and reimbursements about hospitals, I just wanted to point out that the facility where I work has 'held' the annual COL raises, and is only hiring for certain departments. One of the reasons cited was because our "gov't payor" population has increased...meaning, the number of patients admitted under socially funded programs has increased, and the number admitted under private insurance has decreased...resulting in LOWER reimbursements for our hospital. For that reason, I don't see how expanding socialized programs is going to do anything but hurt us more.
And here is a representative problem with the socialized programs...we receive patients from other facilities who underwent procedures prior to arriving at our hospital. They are admitted to us once they meet criteria (by MEDICAL standards...i.e. resolved head bleed) to come to us for specialized surgery. Once we are done with the surgery, we CANNOT discharge them back to their home hospital until they fully recover because the idiots at Medicare would rather pay one big check to the more expensive hospital instead of cutting two checks for two hospitals...and actually saving the taxpayer a lot of money, and saving the parents a lot of grief. It's been explained to them time and time again, and they can't figure out this simple issue. For that reason, I don't have any faith in giving them the whole enchilada.
ETA: The choices I have with my private insurance are overwhelming, and include stuff that I would gamble on if my private insurer didn't offer it. They actually paid for half of my Invisalign, cover 100% for new lenses every year, and the list of physicians in my book was so long, that I just picked through it until I found an internist who was educated at an IVY League school, and I requested him...approved. And when my physicians office screwed up and sent my lab samples to the wrong processor, my insurer sent the physician a letter that said not only were they refusing to pay, but that since he was an approved provider, he was not allowed to send me a bill either.
I bet I could also get cheaper insurance elsewhere, but this is as important to me as housing, transportation, and leisure...all of which I pay FAR MORE for than I do health insurance.
Because it is said time-and-time again, I feel it's important to point out that in systems where the gov't is making the decisions, people don't alternately have choices that privately-insured people don't. THe gov't rations care, and decides what they will cover.
People under UHC have much more alternatives than privately insured pts. The government does not pick and choose what they will cover or what they won't on a case by case basis. You do not have to wait for a procedure to be approved first or ask what provider is allowed or covered. things that are not covered are usually cosmetic but if it is medically needed it is covered. The government funds the system but they don't make the administration and care decisions.
Specializes in Flight Nurse, Pedi CICU, IR, Adult CTICU.
People under UHC have much more alternatives than privately insured pts. The government does not pick and choose what they will cover or what they won't on a case by case basis. You do not have to wait for a procedure to be approved first or ask what provider is allowed or covered. things that are not covered are usually cosmetic but if it is medically needed it is covered. The government funds the system but they don't make the administration and care decisions.
This is a sorely innaccurate misgeneralization.
My insurance company does not pick and choose on a case by case basis.
And the last thing someone from a universalized country can do is be critical of 'waiting' in the US system...waiting is a huge notorious problem in UHC countries.
Finding an approved provider is not a problem...providers want paid, and they will strive to become approved providers. Alleging that finding an approved provider is a problem with the system is disingenuous.
And it is completely inaccurate to say that the gov't does not make the administration and care decisions. Their system does not issue blank checks; they who pay the bills make the decisions...I don't see how people can believe that it functions any other way. It's as illogical as saying that the gov't pays for the roadways, but someone else decides where they are built.
My insurance company does not pick and choose on a case by case basis.
you must have some spectacular health insurance then. not everyone with insurance is so fortunate.
my insurance company (which sucks, and i'm paying for COBRA since i'm in waiting at my new job) denied almost all of my pulmonary testing (not medically necessary), hospital stay for status asthmaticus (didn't meet deductible and out of pocket) and allergy shots (not covered in plan) and would only pay for the prednisone weans.
Unfortunately, I can't cut much from my transit expenses, since they are mostly limited to new tubes for my bike when one goes flat. I share a small apartment in a not-so-posh neighborhood. I eat a lot of rice and beans. Trust me, I'd love to have comprehensive health insurance like you, health care is a huge priority for me too - that's why I want to be a nurse :) But on what could I cut back? My weekly spa appointment? (just kidding!) More like my tuition. But anyway...
Private plans make just as many absurd choices, if not more, than Medicare and Medicaid about what they will cover. From how few days one may spend in the hospital, or in which hospital, after surgery, to what drugs we can take for all of our conditions, private insurance execs are making these decisions for us ("We'll pay for your kidney transplant but not the drugs you need to take after" a friend of mine just heard). It's great that your plan covers your orthodontics, but do you really think they'd be eager to cover you at all if you were not an employment based consumer and had an expensive pre-existing condition? While it would be great to think that they were doing the best job possible because they are regulated by our free market choices, Anthem, Aetna, Wellpoint... etc have become so big, and work so well together, that they are able to impose their choices upon us. In how many towns in this country is there just one company who insures at least half the residents? The HMO that I grew up in was just gobbled up by one of those big guys. There are too few players who have too much power to call this a free health care market.
Anthem, in my case, could in a position to make some of the most important decisions of my life for me, but I don't get to vote for their execs. At least in a National Health Care plan the regulators would be accountable to us and our votes.
Health care is such an important part of our lives, the decisions about how its regulated should be made out in the open by people we elect, not behind closed doors by people we don't know.
Specializes in Flight Nurse, Pedi CICU, IR, Adult CTICU.
you must have some spectacular health insurance then. not everyone with insurance is so fortunate.
my insurance company (which sucks, and i'm paying for COBRA since i'm in waiting at my new job) denied almost all of my pulmonary testing (not medically necessary), hospital stay for status asthmaticus (didn't meet deductible and out of pocket) and allergy shots (not covered in plan) and would only pay for the prednisone weans.
Actually, my insurance is pretty good...I spend a little extra for it, but like I said, it's because it's important to me, and I still spend less than I do on transportation, and far less than I spend on leisure and shelter, and on some unessentials.
But what you can't assume is that those things would automatically be covered under a UHC plan.
Honnête et Sérieux , when you attack the credibility of a nobel prize winner Sheesh . Pschitt ! none of us on this forum is worthy to share a thread with you . Good bye and good luck .
Honnête et Sérieux
283 Posts
A healthcare system is much more than a dynamically calculated infant mortality rate, longevity calculation, and collection of stories about people who didn't get the services they felt they should have, but that doesn't keep people from talking about them constantly in the UHC discussion. And the reality is that hospital are an essential and key part of a healthcare system. It makes no sense to ignore or trivialize the role of hospitals and dismiss what has happened to Canadian Hospitals over the past 20 years.
Are you serious? The arguments for UHC use lots of speculation and assumption in making it sound like changing to UHC is a no-brainer. Roughly quoting a line from a talented poster in this forum who was noting the absurdity in the arguments for UHC, "all our troubles will melt away like lemon drops." That's the way folks make it sound.
Well, your argument is fatally flawed if morality is what it is based on. Some people find it immoral to conduct abortions, but the gov't allows it in spite of the moral objection. Some thing morally based restrictions on stem-cell research are improper legislation, but somehow controlling healthcare for moral reasons is acceptible? I don't need the gov't to legislation my personal moral behavior; I will help out those around me in need, and I don't need some corrupt gov't or special interest group to dictate my moral behavior. That is simply repulsive.
QI programs are not the creators of innovation. They will only use exisiting modalities to improve their services, they rarely create new ones. Outside of an incentivized system of competition and reward, there is LITTLE motivation to improve the system. And public accountability can be applied to private services who provide public services. A UHC system is not the only way to demand public accountability.
What does this have to do with the discussion? This may be a residual issue from the failure to explain the "medical tourism" issue. But to expand on your comment, it doesn't make sense to say that the gov't severely restricts delivery modalities, but then to say they have a choice. The percentage of people leaving Canada for care is also irrelevant; very likely more would if they could afford to, and it does not mean that those who are not seeking care elsewhere are getting what they need or getting it in a timely manner.
And this I've said. Now maybe if more people will understand this, they will realize the illogical flaw in constantly talking anectodally about care that was denied by private insurers.
And I reply by saying...the US system is flawd, but that doesn't mean it's going to be improved by switching to another flawed system. And gov't's are becoming increasing less accountable to their population. An "accountable" gov't would not limit choices. It wouldn't force an exportation of care for their sickest patients. 15% of their population wouldn't report an inability to get a primary care provider.
I understand if you want to defend the Canadian system; I don't propose that it change at all. Understand, however, that every time the Canadian system is referenced and championed as a model for change, I will yet again point out the flaws in the system and share why such a program is a terrible idea for America.
And in America, responsible behavior is free. Additionally, no one can be denied an evaluation and emergency care if needed, regardless of their ability to pay...it's law.
First, both of these ingredients are not somehow unique to a UHC system. In America, we already hold our private enterprises publically accountable for the products they deliver, from the little tiny packets of sugar we put in our coffee, to the standards they use in building a 100+ story skyscraper in a population center.
Second, I remind you yet again that there is no need to take personal shots at me and imply what you believe to be the nature of my character. It's insulting, offensive, and serves no purpose in supporting your position.
Stick to the topic.