Socialized Medicine the myths and the facts

[madwife2002]

The first and the most obvious concern is the cost to the patient and their family, we all know how devastating an illness can be for patients and their family many times I have witnessed the despair when a diagnoses meant further treatment which insurances question and in some cases wont cover. I have seen patients needing costly drugs to keep them alive and being unable to afford them, causing repeated admissions to repair the damage so called none compliance has caused. The first question in none compliance is were the pts actually refusing to take their medication or was it simply they could not afford to buy their medication because they don't have enough money and other bills need to be paid first? If the real reason is the cost then surely it would be more simple of we provided these medications at a more effective price or that all medications cost $5 no matter what they had? Outrageous I hear you shout but the cost of the repeated admission is far more costly than by helping prevent a repeat admission, by providing medicine they can afford.

How about blood tests could these not be done in the doctors office before the pt leaves for home and forgets to go and have a blood draw, or simply cannot get to the lab to have them drawn. I have personally waited in doctors office hours (and paid for the privilege) then been sent to the lab, miles away to sit and wait for blood work to be done. Why could the doctors not employ somebody to be at the office to draw blood on patients?

We should be looking at improving preventative medicine rather than patch it up and see.

Many times I have seen patients discharged with a new diagnoses of diabetes, no follow up at home can be organised because in my city nothing exists to assist these people. There should be a diabetic home nurse who monitors these patients in their own home-rationale, this would again help prevent admissions for diabetic complications, and none compliance.

So you wonder what has this got to do with socialized medicine. Well, in the UK if you have...

• Children
• Over 60 for women and over 65 for men
• Diabetes
• Asthma
• Thyroid problems, etc...

...then you get all your medicines for free.

There are in place specialized RN's who focus is on preventative care in the community. There are telephone help lines which anybody can utilize for free.

Maternity care is free a midwife will be assigned to you for the duration of your pregnancy and up to 6 weeks later. The cost of the birth-nothing no matter how you deliver.

I have been asked what kind of care do you receive in a socialized medicine country and I ask them, I am a product of socialized medicine you tell me how my care differs from nurses who have paid outrageous amounts of money to train as a nurse?

Of course even in the UK you can have private care if you chose to pay, this is an advantage if you need hip replacements, knee replacements, eye surgeries-other wise you may have to wait. There are initiatives in place to reduce waiting times for surgeries in the NHS and I hear that dr's can now book surgeries from their office at hospitals all over the UK which helps reduce waiting times, plus hospitals get fined if they don't meet their quota.

I agree MRI's and CT's are not as freely available, but again initiatives are in place to improve the waiting times. Emergency care no different all patients will receive emergency care.

Poor conditions yes there are poor hospitals and there are excellent hospitals, no different to Phoenix AZ.

Questions??

[Jstand]

And I have a bridge for sale...

There are some republicans at a town hall meeting that already bought a few of them. You might want to see if they are interested.

[GM2RN]

There are some republicans at a town hall meeting that already bought a few of them. You might want to see if they are interested.

That's ok, the libs already beat them to it.

[lamazeteacher]

Post # 347 by "alwaystiredmommy"

"Can you provide some examples of what else it is that you think they might do to even pay them 80% of what a doctor makes? Furthermore, do you really think they would be qualified and able to do the job?"

I have to begin this with a story:

When my son (who is now 36) was 16, I took him to a new doctor for his yearly checkup (an internist) rather than his pediatrician. Making conversation, the doctor asked what my son thought he'd like to do as a vocation.

Being a "people pleaser" sort of kid when around adults, my son lowered his voice considerably and said, "I've been thinking of medicine". Well he'd certainly never shown that incliniation with me! I jerked my head and ears up, and the doctor replied, "Oh, there's no money in it any more......don't do it".

Needless to say, I never took him to that highly recommended doc again.

I did have a conversation with my son regarding the truth. I asked him if he wanted to make a lot of money, and he said, "Yeah". So I suggested that he go directly for that by taking business courses in college, not camophlage that goal in a white coat. "Doctors", I said "should make taking care of people who are sick or in danger of becoming sick, their priority".

Becoming preoccupied by hidden agendae (megabucks) has diverted most doctors today from any concern they may once have had in people's wellbeing. It has warped their ethics, made them even more "holier than thou", and confused patients to the extent that they can't trust many doctors' decisions.

I was booked for knee replacement surgery a few years ago, due to severe knee pain. However the office where I saw the orthopedic guy to whom I'd been referred, couldn't find my X-rays. "That doesn't matter", said that erstwhile caregiver. I said, "I'd like to see how I do with PT first".

Then I found out that the doc retired the week following the cancelled surgery date he'd given me. the head of PT recommended a knee strap, and I have lived painlessly ever after (well, at least 3 years). Altruism went out the door, when doctors decided they were worth more than the average person, by virtue of having worked hard to get into med school and for very little money for a few years afterward.

Backlash against their fellow human beings as a result of abusive instructors' demeaning ways; and having an expanded sense of self worth, having completed their personal gauntlet, drove them straight into the insurance companies' and pharmacological manufactirers' arms. Together they plotted to gain great wealth, in colusion with each other in an "I'll scratch your back if you'll scratch mine" way.

Psychotherapy will definitely be necessary when their income is reduced to Medicare levels, and their objectives are redefined, but do you think they'll avail themselves of same? Mental health is going to receive the same emphasis in the reformed health care......

They'll only be happier when those suffering from conditions caused by inadequate medical care, and choose to sue their physician for that, are compensated less. Then they'll expect their premiums for malpractise insurance to decrease, but those companies know good bait on their lines, so they won't do that.

Then medical schools will have fewer applicants, and more of them will be interested in treating human frailities. We will have gone full circle into an era of the possibility of finding kindly, communicative doctors who listen to patients and nurses...... Perhaps those docs will do as a friend of mine has, posat a sign in their waiting rooms (that will be less luxuriously furnished) saying:

"I have no malpractise insurance. Being your physician is an honor I appreciate, and I will do everything I possibly can to give you expert medical care that is current, with you on the team of health care providers you choose.

I have very few assets and 4 children heading for university."

[Jstand]

everyone wants to cut doctor's salaries because they make far more than enough to reward the level of their work.

i'm sorry but what do you know about their level of work? do you have any idea what someone has to go through to become a doctor? years and years of no salary, 32 hour shifts, time away from their families, etc, etc. people fail to notice the many years student doctors put into the health system for free (plus the years of residency).

i know plenty about their level of work. why would you assume that i don't? what basis do you have to question it? you are the one who has absolutely no idea about other professionals' level or work, time away from family, years and years of low salary, etc. that isn't confined to medical professionals. they are not the only ones in the world that make sacrifices.

let's not act as though doctors work harder than anyone else who makes comparable money.

...but do those that make comparable money have someone's life in their hands? probably not.

that simply isn't true. if the only reason that the "best and brightest" go into medicine is for the money, perhaps we should find someone else to do it for other reasons.

i'm sorry but i personally would want the best and the brightest to be my doctor. and let's not kid ourselves, most people care about their salary. and if you say you don't you are lying.

depends on how you define the best and the brightest. if they are crooks, i could care less about having the best and the brightest.

you also assume that these "best and brightest" have other choices that would pay them a fraction of what they would make even under lowered reimbursement schedules. can you provide some examples of what else it is that you think they might do to even pay them 80% of what a doctor makes? furthermore, do you really think they would be qualified and able to do the job?

first of all i am not implying that doctors will leave the industry to do something else (although that does happen). i am saying people will just not chose it at all. they will go into other industries completely. also these "lower reimbursement schedules" are making it so hospitals are actually losing money on some surgeries. i know this because i work for a huge top 5 hospital. and another thing... how much do you think doctor's make? everyone seems to think they are all millionaires or something. true there are a few that make alot of money but many of them make less than 150k. a nurse can easily make 100k, do you want to cut their salary as well?

that really doesn't happen because they don't have similar opportunities out there. they won't go into other industries completely because they can't earn as much even after reimbursments get cut. if you really think that is true, then offer me at least one example. i know how much doctors make. it doesn't matter if it is millionaire or not, it is a larger salary than 90% of the population makes. and sure, if a registered nurse makes 100k a year, i am fine with cutting their salary as well. you should be careful about thinking that you really understand the economics of the situation just because you "work for a huge top 5 hospital". that doesn't mean that you are able to access the information to make that statement. when is the last time that you actually looked at a set of financials for that top 5 hospital? do you really think that you would understand them if you did? i doubt it. i also highly doubt that you have any idea how much the hospital makes on a surgery. furthermore you wouldn't understand the cost data if they were served up to you on a platter. the bottom line is that what the hospital makes on a surgery has no bearing on what doctor's salaries are or should be.

[Ginger's Mom, MSN, RN]

As a mother of a medical school student who will be in so much debt ( more than the average mortgage) I understand how difficult it is to be a doctor.

To be an intern she has to pay for the application fee, the testing is much more expensive than nurses. She has a masters degree in Clinical research so becoming a doc isn't about money.

To be fair all medical students should have the government pay for the majority of medical school.

[Jstand]

As a mother of a medical school student who will be in so much debt ( more than the average mortgage) I understand how difficult it is to be a doctor.

To be an intern she has to pay for the application fee, the testing is much more expensive than nurses. She has a masters degree in Clinical research so becoming a doc isn't about money.

To be fair all medical students should have the government pay for the majority of medical school.

The government does already pay for the vast majority of their education. Furthermore, they don't graduate with a larger debt proportionate to their starting salary that most students do. Why on earth would we pay more of their debt? Just so that they can make even more money? It is astounding to hear medical students cry about this. Other professionals don't complain about it. Why do we hear so much of this from doctors? They get a more than fair deal.

[ballerinagirl]

THis is an interesting discussion, and I believe it brings out the pros and cons of the "socialized" system. My question is this:

If the government now provides health care (or pays for it), what do you do if:

1) a woman is pregnant, and tests show that the child is severely deformed and will most likely need care for most of their lives. This is expensive.

In a system w/ socialized medicine, what priority will be placed on coverage for this baby.

Some people may think that she should terminate the pregnancy, but if we all think this way, we are missing the entire point that 1) many times, these so called abnormalities diagnosed in the womb somehow fix themselves or end up not to be true. 2) some women firmly believe that terminating a pregnancy is wrong -- what then?

When resources are limited, there are people who will encourage that this life (and yes, it is a life, contrary to what some people believe) will be "selectively terminated". As rare as it may seem, it could potentially happen.

2) another scenario -- what if an elderly person would like to have some kind of surgery, but the surgery is expensive...would the system then tell that person that he/she can't have it becuase the benefits are few and the cost is high?

3) If everyone has to go to a GP (like they do inthe UK), what do you do if you can't get past the GP, or if they won't refer you to a specialist? Example: if you break a bone, it can be set and casted, but, if you cast it the wrong way, or do something bad because a GP is not an orthopedist, what would happen then? Do you still have the option of going to a specialist at your own expense or are you S.O.L. because nobody will refer you? I'm sorry, but I've been to a few "primary care doctors" who can't navigate out of a paper bag, I'm wondering how they got through med school. (but that's another issue).

While I am not against the fact that people should have health coverage so that it doesn't bankrupt them, I am not sure I am comfortable w/ so called "experts" defining algorithms and expecting everyone to live by them, and making it hard for people to get the correct care because it might be a tad expensive. (Translation -- Kaiser does that now don't they?)

I am not pleased w/ the direction of health care -- I think we will eventually find that this utopia of providing access to everyone might eventually backfire, as it does in many cases. But of course, it sounds fabulous to hear that anyone can go to a doctor and get medicine for their illness...what are we going to do when the insurance companies decide that it's no longer profitable, so they will just get out and leave everything up to the government...

All the promises that "your insurance will NOT be affected", and "you'll continue to receive your insurance" is bogus because we all know that if an employer says -- I can't afford to provide health insurance to my workers, there goes that plan and unfortunately, we will all be stuck w/ the government's plan, which frankly, probably won't be all that wonderful.

But it sure sounds good -- can't argue w/ that. Let's revisit this plan in 2014 or maybe 2018.

[dlatimer]

Ballerinagirl,

You make some very valid assertions. Undoubtedly these are are questions that will have to be answered in the future. The way I understand the health care reform bill recently passed as law in the US is that it is not perfect. Of course changes will have to be made. In order to have a healthy, secure workforce affordable health care is essential. The cost of health care is exploding and the options available for extending life is growing daily. Where do you draw the line? In the mean time costs need to be contained. If nothing was done to prevent the increasing cost it would surpass 20% of GDP in just a few decades. Economists tell us that is unsustainable. We will be unable to function in the world if this happens. The insurance companies make money by wagering on your health. When your costs exceed your investment - you cut your losses, or cancel the policy of the insured. Therefore, the insurance companies have to be taken out of the equation, but they will not go silently into the dark night.

[lamazeteacher]

I believe that the Catholic Church has a greater obligation to pay the way for a disabled person's entire life, as that was brought to fruition usually, due to their decrees.

Most of the Christian population isn't Catholic, but if they were raised in that Church the guilt suffered by even the thought of having an abortion, is tremendous. So they don't have an amniocentesis. I'm sure the Church is happy about that decision, as the procedure could endanger a fetus, especially one whose life is held "by a thread". Again, they're responsible in that scenario, so they should pay for any tragic repercussions.

[Ginger's Mom, MSN, RN]

The government does already pay for the vast majority of their education. Furthermore, they don't graduate with a larger debt proportionate to their starting salary that most students do. Why on earth would we pay more of their debt? Just so that they can make even more money? It is astounding to hear medical students cry about this. Other professionals don't complain about it. Why do we hear so much of this from doctors? They get a more than fair deal.

The Medical School my daughter goes to gets (zero federal dollars), I have a son getting his Master's Degree, he is going to a state university, gets paid a TA position and graduating with 1/10th of the debt my daughter has. I know what I paid for my masters degree.

PGY pay is less than a nurse makes. The process of getting into medical school is so much harder than going to graduate school, you have to pay for each primary and secondary application. If you get an interview you have to pay all the costs. My son had his room and board covered for his interview and no secondary applications .

Are you intimately involved with a medical student ( I mean to have access to their bills like I have ? ). I have quoted my sources could you share your sources since I find them very different from what my family has experienced.

[lamazeteacher]

What I'm reading indicates that it takes too much money, like paying to get into med school (for applications) and then borrowing money to pay for tuition, expensive books, housing and food, etc. etc. for med school....... and that is that why doctors have to charge excessive amounts of money for their services, once they complete their studies? By "obscene", I mean millions/year. It's like a reward for all the anxiety, etc. for enduring and succeeding in their quest.

I hear a lot more anger expressed by doctors, toward patients and anyone in favor of relieving the financial suffering of patients. Have other physician's defense against lawsuits scared them so much that they see all patients as likely plaintiffs against them?

Have doctors become inured to the ruination of patients' lives, due to their, hospitals' and insurance companies' compounding of physical and emotional pain with economic disaster, as a result of their illness(es)? Why have doctors not become advocates for patients who along with their family members, have become poverty stricken, by becoming part of the solution, rather than being oppositional?

By saying, "Oh well" and doing nothing, doctors become part of the problem, colluding with the hospitals, insurance companies, DME and pharmaceutical companies that make incredible profits. The costs of medicines they prescribe, they say are unknown to them. Why haven't they looked into patient complaints about that? Canadian doctors did, and the medical system began there, due to their initial efforts. U.S, doctors looked the other way, when a law was passed through pharmaceutical company lobbyists' proclamagtions of support, that alllowed VA hospitals to negotiate medication prices, but specifically stated that insurance companies and anyone else could not do that!

They have to have seen that their indulgences and those of the others with whom they allied themselves, perpetuated greater injustice, and would come back to bite them. Yet they whine and cower about changes that ultimately were made by the government, when the experience of serious illness (most of which has roots other than non-compliance) became horrendous for their patients. Doesn't "First do no harm" have ramifications in those circumstances?

[talaxandra]

If the government now provides health care (or pays for it), what do you do if:

1) a woman is pregnant, and tests show that the child is severely deformed and will most likely need care for most of their lives. This is expensive. In a system w/ socialized medicine, what priority will be placed on coverage for this baby. When resources are limited, there are people who will encourage that this life (and yes, it is a life, contrary to what some people believe) will be "selectively terminated". As rare as it may seem, it could potentially happen.

This isn't aimed at the poster I'm responding to but really? This kind of response drives me nuts - the idea that universal health care will result in some hideous slippery slope end product is pure scare mongering. Every Western country except the US has universal health care. While they're all different, and the program you (may) end up with will no doubt be different again, none of them has anything like enforced termination of potentially disabled babies. Though termination's an option, genetic counsellors are not allowed to influence the decisions of parents, even when explicitly asked.

That's not to say that support for parents is everything it could be - my godson is significantly affected by autism (admittedly not a condition currently detectable in utero) and though his education costs are state covered and his mother receives a tiny payment toward his care, at the moment knowing what will happen when he a) nages out of school, and b) is unable to be cared for by his family is still unknown.

But medical costs? Wholly covered - CF, cerebral palsy, microencephaly...

2) another scenario -- what if an elderly person would like to have some kind of surgery, but the surgery is expensive...would the system then tell that person that he/she can't have it becuase the benefits are few and the cost is high?

"Would like" some surgery? Well that's going to depend on the kind of surgery and the need. Cosmetic surgery isn't covered, but pretty much everything else is. There are certainly waiting lists, but decisions about eligibility for surgery are made by the surgeon and anaesthetist not the government - if the patient is likely to have a good outcome then age isn't really an issue.

That's not to say you can have whatever you want - there was recently a high profile case here of a young woman who was rejected for a second liver transplant (original liver failure related to drug use, transplanted liver failed due to a return to heroin), but the WA government bowed to pressure and paid for a living-related partial liver transplant; she died today.

3) If everyone has to go to a GP (like they do inthe UK), what do you do if you can't get past the GP, or if they won't refer you to a specialist? Example: if you break a bone, it can be set and casted, but, if you cast it the wrong way, or do something bad because a GP is not an orthopedist, what would happen then? Do you still have the option of going to a specialist at your own expense or are you S.O.L. because nobody will refer you?

I've never heard of a GP refusing to write a referral, but I guess you could see another GP if that happened. IN Australia you're not limited to seeing one GP. Everyone I know who's fractured something has gone to ED for x-rays and casting, including me.

If you're happy to pay to go private that's certainly an option here, and prices are considerably lower than they seem to be in the US. I had a surgically-assisted maxillary expansion, which is a wholly elective procedure (ie not a Medicare funded procedure); I needed volume expanders post op and spent the night - including anaesthetic and surgical fees it was around $3,000 all up. Although not a Medicare procedure, because I spent over the annual threshold on medical expenses that year I got money back at the end of the financial year.