How Will Universal Health Care Change Nursing? - page 11

How will universal health care change the Nursing profession? Will we finally get ratios? Will our pay go up, or down? What about benefits? Will the quality of care improve, slide, or stay the... Read More

  1. by   nursecassia
    I am a Canadian Nurse, So I work in a publically funded hospital..I can tell you that there are shortfalls with this system, as well as great strides...In British Columbia where I am there are significant wait times for procedures, however people do not have to pay for these procedures...there are also wait times in hospitals, where I am depending on the day it can be anywhere from 2-12 hours...that being said there are always people that come in that should just be going to see a GP but because we have a shortage end up in our ER....we also dont have enough long term care beds so our beds fill up with people waiting for placement in a LTC facility..As an RN i make a good wage, I have great benefits...the support staff also make a good wage although they are considering hiring a private company to do things like housekeeping, dietary to cut costs...We do pay taxes, not as high as in the States by any means..the patient ratios where I am are less than desired and sometimes we have patients in hallways but as stressful as it gets sometimes the people you work with really band together to get the job done...we are sometimes 8-1 on night shifts, and for a team of 8 have an RN and LPN...The biggest thing is that people here dont stress about what will happen if they end up needing a doctor visit or hospital stay, we may pay in taxes but no one here ever has to lose their house, or take out huge loans for medical expenses...Whenever we travel to the states for even one day we always always get insurance..I think alot of you are brainwashed into thinking this private pay thing is a good system, sure if you can pay for it....We may have to wait longer for things but we dont have to end up wishing we were dead after accumulating so much debt.. I strongly believe public is the only fair and equitable way to go...health care shouldnt go to those that can afford it, enough said..I would never ever ever want to work in a system that promotes this. If you end up going public you will see the challenges, but you will also see so many of the benefits as well...People here are grateful of the care they recieve not stressed or resentful, they dont have high expectations because they arent paying house and home for it... SOrry if I sound like a US hater, I am not...I just really dislike this crap system you have now that does nothing but make major corporations richer and kick those that are down.
  2. by   nursecassia
    also, I am reading more and more of your posts and I am sick to my stomach...not for the horrific stories because those are to be expected from a private pay system but for those of you that really truly believe that a private system is the way to go I am saddened....Do you all realize how incredibly selfish this system is? Who are you, or any insurance company to value one persons life over anothers...If two people enter a hospital bleeding out, who is going to get care first? the insured or the uninsured...it is as simple as that...THIS IS MORALLY wrong!!! Those of you that think this system works are also those of you that either 1.) have a ton of money 2.) are a person that gets richer off of others....remember, everyone is only one step away from being in a slum ... things change in peoples lives fast..you may have health care today because you make the big bucks, but wait till you get in that unexpected car accident, cant work to pay the bills and end up at the bottom of the barrel...I stand firm on the fact that private pay is nothing but heirarchy making the rich richer and the poor poorer...publically funded is EQUAL and FAIR!! you may not like it cause you have to wait in line for someone ahead of you but I guess you would just have to suck up your ego and realize that indeed we are all humans and should be treated equally....NO system is perfect, they are all flawed but why would you want to choose the morally repugnant one?
  3. by   kinesjl
    Universal health insurance does not mean universal access to care. In practice, many countries promise universal coverage but ration care or have extremely long waiting lists for treatment.

    For example, at any given time, 750,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the NHS to cancel as many as 50,000 operations each year. In Canada, more than 800,000 patients are on waiting lists for medical procedures. The Canadian Supreme Court has found that many of these individuals suffer chronic pain and that some die awaiting treatment.

    The U.S. can increase coverage and access to care, improve quality and control costs without importing the problems of national health care.
    Those countries that have single-payer systems or systems heavily weighted toward government control are the most likely to face waiting lists, rationing, restrictions on the choice of physician and other barriers to care. Those countries with national health care systems that work better, such as France, the Netherlands and Switzerland, eschew centralized government control and incorporate market mechanisms such as competition, cost-consciousness, market prices and consumer choice.

    Rising health care spending is not an uniquely American phenomenon. While other countries spend considerably less than the U.S. on health care both as a percentage of the gross domestic product and per capita, it is often because they begin with a lower base of expenditures. But their costs are still rising, leading to budget deficits, tax increases and/or benefit cuts. As the Wall Street Journal notes, "Europeans ... face steeper medical bills in the future in their cash-strapped governments." In short, there is no free lunch.

    Yet many naively think that if we simply expand coverage, cost control will take care of itself. If, as expected, health care reform costs $1 trillion to $1.5 trillion over the next 10 years, Americans should brace for massive tax increases — and not just for the wealthy. In fact, many of the tax increases being considered to pay for health reform — taxing employer-provided health benefits; soda and beer taxes; restricting or eliminating flexible spending accounts and health savings accounts; eliminating the deductibility of health expenses above 7.5 percent of adjusted gross income, etc. — fall heavily on the middle class.

    Moreover, current estimates probably understate the actual cost of health reform. The Urban Institute, for example, suggests the actual cost will be closer to $2 trillion, noting: "If all uninsured people were fully covered [in 2008], their medical spending would increase by $122.6 billion." If we assume that the cost of covering the uninsured will grow at the same rate the federal government assumes for all health spending growth (6.2 percent), then from 2010 through 2019 the cost of covering the uninsured would be $1.8 trillion.

    Furthermore, cost estimates for government programs have been wildly optimistic over the years, especially for health care. For example, when Medicare was instituted in 1965, it was estimated that the cost of Medicare Part A would be $9 billion by 1990. In actuality, it was $67 billion. Similarly, in 1987, Medicaid's special hospitals subsidy was projected to cost $100 million annually just five years later; it actually cost $11 billion, more than 100 times as much. And in 1988, when Medicare's home care benefit was established, the projected cost for 1993 was $4 billion, but the actual cost was $10 billion. If the current estimates are off by similar orders of magnitude, we would be enacting a new entitlement that could bury future generations under mountains of debt and taxes.

    Finally, the broad and growing trend in countries with national health care systems is to move away from centralized government control and to introduce more market-oriented features. As Richard Saltman and Josep Figueras of the World Health Organization explain, "The presumption of public primacy is being reassessed." The growth of the government share of health care spending in European countries, which had increased steadily from the end of World War II until the mid-1980s, has stopped, and in many countries, the private share has begun to increase, in some cases substantially.

    Other countries are loosening government controls and injecting market mechanisms, particularly cost-sharing by patients, market pricing of goods and services, and increased competition among insurers and providers. Pat Cox, former president of the European Parliament, said in a report to the European Commission, "[W]e should start to explore the power of the market as a way of achieving much better value for money."

    There is even evidence of a growing shift from public to private provision of health care. If many of the proposals in Congress would push us toward more of a European-style system, the trend in Europe is toward a system that looks more like the U.S.

    If there is a lesson that we can take from national health care systems around the world, it is not to follow the road to government-run national health care, but to increase consumer incentives and control. The U.S. can increase coverage and access to care, improve quality and control costs without importing the problems of national health care.
    Last edit by kinesjl on Jun 24, '09
  4. by   MaritesaRN
    Quote from kinesjl
    Universal health insurance does not mean universal access to care. In practice, many countries promise universal coverage but ration care or have extremely long waiting lists for treatment.

    For example, at any given time, 750,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the NHS to cancel as many as 50,000 operations each year. In Canada, more than 800,000 patients are on waiting lists for medical procedures. The Canadian Supreme Court has found that many of these individuals suffer chronic pain and that some die awaiting treatment.

    The U.S. can increase coverage and access to care, improve quality and control costs without importing the problems of national health care.
    Those countries that have single-payer systems or systems heavily weighted toward government control are the most likely to face waiting lists, rationing, restrictions on the choice of physician and other barriers to care. Those countries with national health care systems that work better, such as France, the Netherlands and Switzerland, eschew centralized government control and incorporate market mechanisms such as competition, cost-consciousness, market prices and consumer choice.

    Rising health care spending is not an uniquely American phenomenon. While other countries spend considerably less than the U.S. on health care both as a percentage of the gross domestic product and per capita, it is often because they begin with a lower base of expenditures. But their costs are still rising, leading to budget deficits, tax increases and/or benefit cuts. As the Wall Street Journal notes, "Europeans ... face steeper medical bills in the future in their cash-strapped governments." In short, there is no free lunch.

    Yet many naively think that if we simply expand coverage, cost control will take care of itself. If, as expected, health care reform costs $1 trillion to $1.5 trillion over the next 10 years, Americans should brace for massive tax increases-and not just for the wealthy. In fact, many of the tax increases being considered to pay for health reform-taxing employer-provided health benefits; soda and beer taxes; restricting or eliminating flexible spending accounts and health savings accounts; eliminating the deductibility of health expenses above 7.5 percent of adjusted gross income, etc.-fall heavily on the middle class.

    Moreover, current estimates probably understate the actual cost of health reform. The Urban Institute, for example, suggests the actual cost will be closer to $2 trillion, noting: "If all uninsured people were fully covered [in 2008], their medical spending would increase by $122.6 billion." If we assume that the cost of covering the uninsured will grow at the same rate the federal government assumes for all health spending growth (6.2 percent), then from 2010 through 2019 the cost of covering the uninsured would be $1.8 trillion.

    Furthermore, cost estimates for government programs have been wildly optimistic over the years, especially for health care. For example, when Medicare was instituted in 1965, it was estimated that the cost of Medicare Part A would be $9 billion by 1990. In actuality, it was $67 billion. Similarly, in 1987, Medicaid's special hospitals subsidy was projected to cost $100 million annually just five years later; it actually cost $11 billion, more than 100 times as much. And in 1988, when Medicare's home care benefit was established, the projected cost for 1993 was $4 billion, but the actual cost was $10 billion. If the current estimates are off by similar orders of magnitude, we would be enacting a new entitlement that could bury future generations under mountains of debt and taxes.

    Finally, the broad and growing trend in countries with national health care systems is to move away from centralized government control and to introduce more market-oriented features. As Richard Saltman and Josep Figueras of the World Health Organization explain, "The presumption of public primacy is being reassessed." The growth of the government share of health care spending in European countries, which had increased steadily from the end of World War II until the mid-1980s, has stopped, and in many countries, the private share has begun to increase, in some cases substantially.

    Other countries are loosening government controls and injecting market mechanisms, particularly cost-sharing by patients, market pricing of goods and services, and increased competition among insurers and providers. Pat Cox, former president of the European Parliament, said in a report to the European Commission, "[W]e should start to explore the power of the market as a way of achieving much better value for money."

    There is even evidence of a growing shift from public to private provision of health care. If many of the proposals in Congress would push us toward more of a European-style system, the trend in Europe is toward a system that looks more like the U.S.

    If there is a lesson that we can take from national health care systems around the world, it is not to follow the road to government-run national health care, but to increase consumer incentives and control. The U.S. can increase coverage and access to care, improve quality and control costs without importing the problems of national health care.
    You are very knowledgeable, and in fact quite specific as to what entails in the new proposed health coverage. We need to get on and start it , then work the details and specifics as we encounter them down the road.... this way we deal w/ the actual problems as we go through the process and not before , otherwise we will not get anything done at all.
  5. by   tazzyjo
    Although I haven't had time to read all the in's and out's of the proposed "universal healthcare" I have worked in both the US and Canadian systems and have seen both sides of the coin so to speak.

    In Canada it's great that EVERYONE has access to healthcare for little or no cost depending on which province they live in. But this system also leads to abuse of the healthcare system by some patients. It is hard to find a PCP in Canada as the government regulates where new docs can start up a practice and if a doc does start up a practice you can be sure he will have a full contingent of patients within a month. So then the ER becomes the fall place for many people without PCP's. There are walk in clinics that operate on a first come first serve basis, but people have become demanding and think that they deserve immediate service (as in the US) even if their problem is minor (i.e. a patient showed up at a "new" hospital thinking it needed to be seen by a physician for a zit (can we system abuse)). Universal healthcare should ensure fair and equal access for all, but does need monitoring and limits set to some degree. Limiting where doctors can work only leads to further healthcare industry problems, incentives to work in rural areas would be a more sound alternative than forcing new docs out to the rural area and still paying them the same.

    Medications, although expensive can vary from place to place. I've bought a particular medicationin someplaces for as little as $40 and as much as $300+ (just to note the most expensive place was in Canada and not the US). All were "generic" so there is no explaining the differences. Costing would be something that would have to be between government and drug companies (and we all know who will be forced to give in).

    I am sure insurance companies will fight this change tooth and nail as they will be forced to give up plenty of money and autonomy, same as the drug companies who may be forced to take longer to recoup their expenses in R&D. For profit hospitals may also oppose I would think as it may become a lost leader for them???

    There has to be a happy medium between what now exists and what has been done in many other countries for years at the expense of tax payers.

  6. by   MAISY, RN-ER
    And yet with all those Canadians waiting, they spend 50% of what we do and have better outcomes and live longer!

    Maybe if we spent what we do now, but changed the system to primary care and chronic illness maitenance- we'd exceed everyone globally! Do you think everyone can keep focus on the sick people, not themselves?

    Don't buy into the AMA, they are greedy with each other-PMD make 20% of a specialist's salary, do you honestly think the specialist wants to take a pay cut?

    Don't buy into the insurance companies free market crap-they are and have been turning profits on our backs for decades!

    Don't buy into the pharmaceuticals or any other big business that has encouraged discriminatory behavior over the past few decades. They didn't and don't give a rats behind unless you have the dollars in hand!

    I am not set on one plan, or way of doing something. All I am saying is we need a change, implement it slowly, reevaluate and modify. BUT DO IT! :wink2:

    M
  7. by   Heogog53
    At one very sad point in my life, I collapsed and was unable to work for over five yearsstarting in about 1998. I was the one with the higher salary, so my family was in big trouble from that point on. I was on medical disability offered by my company; it was pretty good coverage, too. However, my then spouse wasn't very good at money at all, and I wasn't really competent to make good choices. Instead of contacting a lawyer or simply saying , "NO" to settling, we were up to our necks in debt and the money sounded pretty good. Now that I look back, the disability company got off lightly. We mistakenly hoped that the money would allow us to pay off everyone and get us back on an even keel. Not so. I applied for SSDI, was denied once and then found someone to help me have a sucessful appeal. At that time, Fibromyalgia was NOT considered a "true illness", so despite having expert doctors, who evaluated all my records and stated that I had had it for years and was getting worse, the second appeal lost. Next, I had to go to the SSA's chosen doctor, who turned out to be a psychiatrist, a very wealthy one who'd contributed heavily to the building of a symphony hall, then had a fit because it wasn't named after him...finally it was...His office was a very leather chairs with the brass nails and dark wood furniture, and lovely Oriental rugs. None of my docs had offices like that, so I made a comment, admiring it. He asked me to come in to his official office and then we talked for about an hour and a half. I was wearing overalls, a t-shirt, running shoes and my hair was very short(normal for me). No make up, no jewelry.
    About a month later, his report came in; for making that comment about his office, I was seen as "trying to maniplulate the doctor by "getting close to him", and my clothing was interpreted as "very male, lacking feminity", implying that I was a lesbian, and in his opinion, my depression and fibromyalgia were not the slightest bit an impairment to working. As you can imagine, I was first flabbergasted and then angry beyond belief. I faxed a copy of the report to my FM/shrink and my counselor, as well as called them. My FM doc said, "Oh yeah, he's a rubber stamp for SSA" and proceeded to write a scathing rebuttal, as did my counselor. Why I was sent to shrink in the first place for an FM eval was beyond me. Finally, my case was heard and I finally got awarded SSDI. As I worked as an RN for a very long time, my disability income was higher than a lot of others i knew. I got 1100 a month plus had to pay my Medicare out of it. Plus if you make TOO much income from SSDI, it's taxable. After a year, I got Medicare- this was before prescription costs were covered at all. At the time, my husband was working and did have insurance, which paid for my scrips. However, I'd usually picked out the best health insurance plan offered by IBM, and we hadn't needed to change it in five years. It was being discontinued, so I tried really hard to make sense of the blurbs, couldn't and my spouse picked out a BRAND NEW in our area HMO. Almost no doctors in the area had signed onto it yet, so everyone but my FP doc was OUT OF NETWORK. Our health care costs, based on that one horrible year when I really was ill and needed good coverage ended up costing us over 30k in one year. That was in addition to the other health care costs we were still trying to pay out of pocket. I needed to have an orthpedic surgery on both knees but was told that we had to come up with our expected co-pay of 1,200 out of pocket before they would even schedule me for elective procedures.

    I ended up in the ER three times on one year, and finally, the last time I was there, I saw one of my docs go by and told the nurses that HE"S MY DOC. Thank God I did, because he took one look at me with an FUO of 104 and a belly as big as a triplet pregnancy and admitted me for testing. I had surgery on a semi-emergent basis- not a katy bar the door emergency, but I had to have the surgery or I would have died.
    After two days of testing and one night of screaming in pain, he wanted to do a laparscopic look. It turned into five hours of surgery and loosing my reproductive organs, finally having a diagnosis of peritonitis, a lot more antibiotics and one out of body experience. I started to get better...and then my colon stopped working ten months later.
    My husband had lost his job at that time, due to a recession in the early 2000's. I had my colon removed, went home, took the recommended meds, including imodium to slow down the passage of anything through my newly shortened bowel and ended up back in the hospital for another ten days, having developed a paralytic ileus and had thrown a blood clot to my spleen. Having no colon, I was terrified about the ileus. T'any rate, everything got better and I was sent on my way. The first surgery bill was paid almost in full by medicare, the rest picked up by our health insurance, but the second one was all on the government.
    At that time, my medications per month cost more than my SSDI check could cover. One of us is on unemployment, the other on SSDI, scrips not covered and the bills were piling up.....
    I lost my house, I ended up bankrupt with a credit rating of zero and had to scrap together enough money to pay my bankruptcy lawyer.........
    I did however, rent an apartment before the mortgage company took the house back, or I have no idea how I would have found a place to live. No family on either side, no friends who could possibly take us in, no nothing. Everything was gone with the exceptions of our old cars, some family albums, etc.
    In 2003, I was finally able to get a nursing job in an OR. I couldn't believe that anyone would hire me to do my old job. Since then, I've paid back my counselor and docs as much as I could of their bills excused in bankruptcy, gotten anything I missed that went into collections paid off, and gotten back on my feet.
    But the cost to my self-esteem, my family's welfare, and the loss of a house I put some of my inheritance money into as a down payment; that cost is inestimatable.

    During that itme, I was unable to cook, clean, grocery shop, take proper care of my children, etc. If some one had told me that I might have been able to get a home health worker to help me with ADL's, life would have been marginally better...

    But that's what happens when at the ripe old age of 47 I became unable to take care of myself. I could have used some of the French system's help at cleaning the house, doing laundry, taking the kids here and there, helping me get to doc appointments, and the Canandian system of not having to loose my life by taking my house and sense of self away. I was no longer ME, RN, mom, life partner, etc. I was a chronically ill patient with a supposedly non existant disease that almost killed me. That what the US health care system did for me.

    I support a system that does not ruin you. I support a system that tells you what you are entitled to as an ill person, one that helps you along and not one that makes the incredibly ill jump through hoops that even intelligent people don't understand- and they are well!

    I'm a tax payer and I work at a State hospital. I serve the under or not at all insured in a larger number than most hospitals and I support those people by paying my taxes and paying more for my health insurance coverage. We take care of the indigent, citizen or not, the paying insured customer(thank God we do have some of those), and somehow, I can't understand turning away anyone.....and as a regional hospital, we frequently see people who come from too far away to commute, people who need places to stay, places to eat while their loved one, a lot of them children, are cared for.

    Our system isn't perfect, our choices in health insurance are getting worse, now the insurance companies is making the obese employees take the lower paying plan- they have no choice in this, as a punishment for being obese, because the obese, cost more to take care of. We suffer with our family deductibles of 2000 bucks a year before the 80/20 kicks in or even the 70/30.....

    I don't see any drop in illness related bankruptcy stopping any time soon....or forclosures, either. Does anyone else?
  8. by   MaritesaRN
    Quote from tazzyjo
    Although I haven't had time to read all the in's and out's of the proposed "universal healthcare" I have worked in both the US and Canadian systems and have seen both sides of the coin so to speak.

    In Canada it's great that EVERYONE has access to healthcare for little or no cost depending on which province they live in. But this system also leads to abuse of the healthcare system by some patients. It is hard to find a PCP in Canada as the government regulates where new docs can start up a practice and if a doc does start up a practice you can be sure he will have a full contingent of patients within a month. So then the ER becomes the fall place for many people without PCP's. There are walk in clinics that operate on a first come first serve basis, but people have become demanding and think that they deserve immediate service (as in the US) even if their problem is minor (i.e. a patient showed up at a "new" hospital thinking it needed to be seen by a physician for a zit (can we system abuse)). Universal healthcare should ensure fair and equal access for all, but does need monitoring and limits set to some degree. Limiting where doctors can work only leads to further healthcare industry problems, incentives to work in rural areas would be a more sound alternative than forcing new docs out to the rural area and still paying them the same.

    Medications, although expensive can vary from place to place. I've bought a particular medicationin someplaces for as little as $40 and as much as $300+ (just to note the most expensive place was in Canada and not the US). All were "generic" so there is no explaining the differences. Costing would be something that would have to be between government and drug companies (and we all know who will be forced to give in).

    I am sure insurance companies will fight this change tooth and nail as they will be forced to give up plenty of money and autonomy, same as the drug companies who may be forced to take longer to recoup their expenses in R&D. For profit hospitals may also oppose I would think as it may become a lost leader for them???

    There has to be a happy medium between what now exists and what has been done in many other countries for years at the expense of tax payers.



    I am sure there will be some issues that needs to be worked out in any system ----that is why we need independent regulators--watchdogs! A PCP appointment should be included in the persons assigned insurance first day since this PCP will be the center of the patients treatment. We will take some processess form the HMO that was workable (case mgmt. is a must to direct patients care efficiently and cost effectively---but not for profit for the private insurance ...this saved money will go back into the main insurance pot, instead of some HMO company pot --of which is more profit geared than, appropriate and ifficient health care. Yup , it is not going to be smooth sailing....but you know what ? the health system that we are in right now is so bad , and profit motivated ---bad ethics and karma all the way !!!!!
  9. by   rnnowalways
    Quote from kinesjl
    Universal health insurance does not mean universal access to care. In practice, many countries promise universal coverage but ration care or have extremely long waiting lists for treatment.

    For example, at any given time, 750,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the NHS to cancel as many as 50,000 operations each year. In Canada, more than 800,000 patients are on waiting lists for medical procedures. The Canadian Supreme Court has found that many of these individuals suffer chronic pain and that some die awaiting treatment.

    The U.S. can increase coverage and access to care, improve quality and control costs without importing the problems of national health care.
    Those countries that have single-payer systems or systems heavily weighted toward government control are the most likely to face waiting lists, rationing, restrictions on the choice of physician and other barriers to care. Those countries with national health care systems that work better, such as France, the Netherlands and Switzerland, eschew centralized government control and incorporate market mechanisms such as competition, cost-consciousness, market prices and consumer choice.

    Rising health care spending is not an uniquely American phenomenon. While other countries spend considerably less than the U.S. on health care both as a percentage of the gross domestic product and per capita, it is often because they begin with a lower base of expenditures. But their costs are still rising, leading to budget deficits, tax increases and/or benefit cuts. As the Wall Street Journal notes, "Europeans ... face steeper medical bills in the future in their cash-strapped governments." In short, there is no free lunch.

    Yet many naively think that if we simply expand coverage, cost control will take care of itself. If, as expected, health care reform costs $1 trillion to $1.5 trillion over the next 10 years, Americans should brace for massive tax increases-and not just for the wealthy. In fact, many of the tax increases being considered to pay for health reform-taxing employer-provided health benefits; soda and beer taxes; restricting or eliminating flexible spending accounts and health savings accounts; eliminating the deductibility of health expenses above 7.5 percent of adjusted gross income, etc.-fall heavily on the middle class.

    Moreover, current estimates probably understate the actual cost of health reform. The Urban Institute, for example, suggests the actual cost will be closer to $2 trillion, noting: "If all uninsured people were fully covered [in 2008], their medical spending would increase by $122.6 billion." If we assume that the cost of covering the uninsured will grow at the same rate the federal government assumes for all health spending growth (6.2 percent), then from 2010 through 2019 the cost of covering the uninsured would be $1.8 trillion.

    Furthermore, cost estimates for government programs have been wildly optimistic over the years, especially for health care. For example, when Medicare was instituted in 1965, it was estimated that the cost of Medicare Part A would be $9 billion by 1990. In actuality, it was $67 billion. Similarly, in 1987, Medicaid's special hospitals subsidy was projected to cost $100 million annually just five years later; it actually cost $11 billion, more than 100 times as much. And in 1988, when Medicare's home care benefit was established, the projected cost for 1993 was $4 billion, but the actual cost was $10 billion. If the current estimates are off by similar orders of magnitude, we would be enacting a new entitlement that could bury future generations under mountains of debt and taxes.

    Finally, the broad and growing trend in countries with national health care systems is to move away from centralized government control and to introduce more market-oriented features. As Richard Saltman and Josep Figueras of the World Health Organization explain, "The presumption of public primacy is being reassessed." The growth of the government share of health care spending in European countries, which had increased steadily from the end of World War II until the mid-1980s, has stopped, and in many countries, the private share has begun to increase, in some cases substantially.

    Other countries are loosening government controls and injecting market mechanisms, particularly cost-sharing by patients, market pricing of goods and services, and increased competition among insurers and providers. Pat Cox, former president of the European Parliament, said in a report to the European Commission, "[W]e should start to explore the power of the market as a way of achieving much better value for money."

    There is even evidence of a growing shift from public to private provision of health care. If many of the proposals in Congress would push us toward more of a European-style system, the trend in Europe is toward a system that looks more like the U.S.

    If there is a lesson that we can take from national health care systems around the world, it is not to follow the road to government-run national health care, but to increase consumer incentives and control. The U.S. can increase coverage and access to care, improve quality and control costs without importing the problems of national health care.
    I absolutely agree. Whoever proposes that universal government -run healthcare is the way - are you willing to give a most personal choice about your health, most critical decisions, ones that make a difference between a life and death for you or your loved ones to a big goverment? And pay for it with constantly increasing taxes? Medicare is the closest example of it in US, and as per our lawmakers it is about to run out of money. Governments can not be and never were good at running anything without bankrupting us and future generations.
    I want to make my own choices. Choices I will not have with a single - payer system. It scares me to death to think that we will be treated like sheep. It is utterly unamerican. We are the only country which up to now advocated a freedom of choice. Are we betraying ourselves? Whatever the right solution is, IT IS DEFINITELY NOT THE GOV't RUN system which already proved to be inadequate in othe rcountries which have it. Isn't it ironic that as other countries are turning away from it, we are moving full - speed ahead towards the cliff?
  10. by   FireStarterRN
    I believe that universal health care should be guaranteed for the basics, with individuals having the option to supplement as they see fit. Employers could continue to offer supplemental insurance benefits as incentives to workers, but everyone in America would have at least basic health coverage, without frills.

    So, if you lose your job at least you'd have something. If you want more posh coverage with more choices, then work hard as you would for any luxury.
  11. by   johnnybravo8802
    What do you guys think will happen if everyone has access to healthcare? The answer is that we will be more overworked. Ever since I started nursing school in 1992, all I've heard is about nurses being overworked and underpaid. With this reform, I foresee it getting much worse. I am already rolling my eyes at 3/4 of the people being admitted now-they don't need to be in the hospital wasting my time doing an admit packet that takes 30 minutes. I want to work on people who are actually sick. Hospitals are about money now and will admit anyone they think they can get money out of and it will be worse with univ. healthcare. Five years ago, I could glide through a 12 hr. shift and we would get 2-3 admits but now we literally admit 10 before lunch. Sometimes I'm admitting 2 at one time and that's ridiculous!!! It's already an assembly line and I don't want to make it worse.
  12. by   MAISY, RN-ER
    This is very timely as I write continue to write a healthcare paper about disparities in healthcare and how access to primary care would eliminate much of the cost experienced by hospitals. Just one study I am working on states 2 in 5 AA are hypertensive, as a disparaged population primary care is limited. If their BP was controlled it would reduce the CVA and cardiac emergencies by 17%-19%. Think of the money involved with a stroke, rehab and disability-that's a bucket of money that would be saved and applied elsewhere.

    There are so many stats, and so many problems that may be alleviated with preventive care. The money needs to be kept at the base for all, right now it's all spent at the tip of the pyramid on only a few for catastrophic care.

    There are ways to do this, we just have to start.
    M
  13. by   Fiona59
    Quote from tazzyjo

    In Canada it's great that EVERYONE has access to healthcare for little or no cost depending on which province they live in. But this system also leads to abuse of the healthcare system by some patients. It is hard to find a PCP in Canada as the government regulates where new docs can start up a practice and if a doc does start up a practice you can be sure he will have a full contingent of patients within a month. So then the ER becomes the fall place for many people without PCP's. There are walk in clinics that operate on a first come first serve basis, but people have become demanding and think that they deserve immediate service (as in the US) even if their problem is minor (i.e. a patient showed up at a "new" hospital thinking it needed to be seen by a physician for a zit (can we system abuse)). Universal healthcare should ensure fair and equal access for all, but does need monitoring and limits set to some degree. Limiting where doctors can work only leads to further healthcare industry problems, incentives to work in rural areas would be a more sound alternative than forcing new docs out to the rural area and still paying them the same.

    Medications, although expensive can vary from place to place. I've bought a particular medicationin someplaces for as little as $40 and as much as $300+ (just to note the most expensive place was in Canada and not the US). All were "generic" so there is no explaining the differences. Costing would be something that would have to be between government and drug companies (and we all know who will be forced to give in).

    The provincial government in my province doesn't tell a new GP where he/she can set up office. They offer incentives to practice in rural/northern areas.

    The cost of drugs vary pharmacy to pharmacy, as does the prescription filing fee. So, if it is corporate greed, boycott the offending drugstore chain. The majority of people know this and shop around. Most full time workers carry "extended health benefits" from their employers or Blue Cross and claim back between 70 and 100% of their medication costs. Prescription drugs, lenses, braces, etc, are covered and what balance left outstanding is tax deductible as is the insurance premiums on these plans.

    You never hear of a Canadian filing for medical bankruptcy.

    Now back to how UHC could affect nurses. In the US, you might see a national standarization of wages for nurses.

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