Universal Health Coverage?

Nurses General Nursing

Published

This topic came up last night in our seminar. Again, we struggle and struggle with this concept.

I often times look at Medicare and how they handle things such as coverage, reimbursment, etc. As it is, they only pay 30cents on the dollar, are slow to reimburse, most often clinics and hospitals struggle financially and often times have to write off alot of procedures d/t Medicare. I sometimes see Medicare as a reflection of what universal health coverage would be; not enough money and care down to the least common denominator. Canada, our neighbor, is also struggling as there isn't enough money to care for all of their citizens. What is everyone else's opinion on this? What IS the answer?

Here is a poem I came across that I thought I would share:

Taken from the International Conference in Medicine held in February 2001:

Draped in Disquise

Cries for medical care equal to Canada or Great Britain is fair

Everyone's much better there, so why not us? We want their care

NO, they say, it isn't so

Don't give up what you have for the lesser care within our society

Am I to believe it's a disguise? A mask claiming to be better for you or me;

confusion, disorder split in two which shall we choose?

One bringing change, or another bearing mediocrity

Our lives are too precious to be bound by the arms of bureaucracy.

Other nations have tried and failed leaving only discontent and disparity

Look forward to what can be.

Not their past except it's history.

Lest the burning desire of what we lust becomes the aftermath of only dust.

If we turn our backs and pretend not to see, no more will we the envy be, and the failures of others becomes our destiny.

Learn from their failure, for left unexplored creates another worse than before.

By Linda Tofanelli

Fergus,

Sounds like a good book and I will get a copy and read it.

I think after reading some of the earlier posts, I have been working nights and was a conference too this week, there is alot of misconceptions about nursing in Canada.

However, I think now my focus will be for a change in location that focuses on other parts of Canada, the UK or even down under.

My eyes where really opened when I read the "would this pt be one to one in your ICU". Now that thread is worth reading for any Canadian considering the States, esp if they are an ICU RN.

Mattsmom

Salaries for RN's in Canada are easily accessible. For instance, I work in Ontario and the web site for our union is ONA the Ontario Nurses Association. The new contract, which was recently signed, gives the top RN's 31.45 an hour, plus benefits. If you want to work part time the rate is 38.14 an hour ( now that is with in lieu of benefits). Our benefits include sick time, vac time, dental, long term disability, vision care, ect.

There is of course night shift, weekend shift premiums on top of these hourly wage rates and they range from 1.30 to 1.50 an hour or so.

J.

Have just read alll of the posts and I see that abuse of ER services seems to be universal. It would seem to me that having an NP running an urgent care clinic in every ER would take care of the people that all ready think it's a clinic. It was tried at our ER and worked well. Unfortunately the NP was a nursing instructor and had to go back to teaching in the fall, and the slot has not been filled year round.

I am really glad you guys are going to look into the book. It is excellent:)

On a side note, I also learned today the NP business is getting attended to here. Looks like we NPs will be allowed to practice independantly here, not just in rural areas that can't afford a doctor, pretty soon. They are currently working out the competencies and legalities

And mattsmom, our union website is http://www.bcnu.org I believe. The salary info is available there. Our BON website, http://www.rnabc.bc.ca also has links to other unions across the country. Currently the best paid nurses are in Ontario (where JMP is), Alberta and BC (where I am).

JMP, I think that is the biggest difference between the American health care system and ours. The gap between a good hospital and a bad one is huge!!!

Fergus, thanks for the book. I believe that will come in handy. I am going to have to be doing some research and really make sure I know what I am talking about. I decided to put my money where my mouth is and contacted the state democratic party for the state of Michigan and had an extensive conversation with the gentleman that turfs people who want to help to various areas. We talked about the nursing shortage, managed care and universal care. He invited me to participate in helping form the healthcare platform for the democratic party in the state. I was excited! I don't know if anything I can bring to the table will ever make a difference but I am at least willing to try.

So I have a great deal of learning to do to make sure I have all my ducks in a row. Any help appreciated.

Here are some other books that are good:

"Health Care: Opposing View Points" by James D. Torr

Has short essays on various health care topics.

"Betrayal of Trust: The Collapse of Global Public Health"

by Laurie Garrett

Chapter 4 has history of U.S. system.

Specializes in LDRP; Education.

Some interesting Emergency Room statistics:

In 1998, for all US Emergency Rooms, there was an estimated 100.4 million visits to the ED that year.

Of that 100.4, 19% were considered emergent, in where care needed to be delivered within 15 minutes or less.

31% were urgent, where care was needed within 15-30 minutes.

This comes from Sultz, H & Young, K. (2001) Health Care USA: Understanding Its Organization and Delivery , 3rd ed.

Oops, it was FEGAN, not Fagan as the third author.

God, I hope the United States never goes socialist health care.

Take England for example. A cancer patient has to wait half a year for treatment. George Harrison didn't stick around in England to take care of his cancer. He was treated in the US.

Canadians who can afford it come down to the US to have their health problems treated.

My sister works for the Intestinal Disease Foundation and she received a call from a woman from Canada for information on the symptoms she had and my sister suggested she visit a gastrologist. The woman said she had a few months before and because of the health care, she could only visit him once a year.

Oh well.

Originally posted by Stargazer

Prior to April 15th, there was a long thread on another (fairly international) board I post to regarding taxes. Some of the Americans whingeing (isn't that a great word? Brit-speak for whining) about their high taxes were practically laughed off the board--and then informed by their non-American counterparts that paying, say, 14 - 20% or so, on average, of one's income doesn't constitute "high" taxes anywhere else in the world but the US.

Are you referring to all the taxes we pay or just Federal Withholding?

If it's just Federal, when we calculate our taxes, we need to remember State income tax, Social Security, Medicare, sales taxes, real estate, personal property, local income taxes, and all those tiny little taxes added to our utility bills. Have I missed any taxes?

Originally posted by mattsmom81

Forgive me if someone has mentioned these points already.

I have a group of British girlfriends who came to the US in the 70's during the 'nurse invasion' brought on by the shortage then. They all became citizens here, eventually raising families, because in Britain, their salary is little more than minimum wage under national healthcare. They tell me they could not support themselves independently on their salaries in Britain! Are US nurses willing to take such a cut in pay should we go to a similar system? I sure can't see US docs taking ANY pay cut, so you know we would....!!

With the current move towards BSN as mimimum, who will go into a 4 year program to make little more than minimum wage?

I remember the last healthcare plan....and Hilary's famous quote about a main problem in our healthcare system being the 'overpaid handmaidens' in nursing.....but how quickly some forget.

Good points you raise. From what I am seeing on these threads is that the nursing profession wants respect, less stress on the job (i.e, a normal work week), more money, etc. and then wants the government to take over health care.

I'm sorry, but where is it written that we have a right to health care? Where is it written that we have a right to education?

Life is not fair - not in this imperfect world. And I'm still reluctant to have Big Brother doll out my pills and medical care. The road to Hell is paved with good intentions.

The Washington Post

August 11, 2001

"Burton's German Trip Protested"

By Juliet Eilperin

"Rep. Dan Burton (R-Ind.), chairman of the House Government Reform Committee, arranged for an unusual government-paid trip to Frankfurt and Bonn this week to investigate the German postal system. He is also visiting his wife, who is receiving medical care in Frankfurt, according to the congressman's aides."

http://www.washingtonpost.com/wp-dy...-2001Aug10.html

There are very serious problems with our health care system, especially in access and coverage in a system that is infamous for wasting our abundant resources. Our national policies continue to favor the entrepreneurial elements in the health care system while continuing to neglect the unmet needs of the people. Unfortunately, the rhetoric continues to drive the displacement

of our national priorities, as if the unmet needs were merely a nebulous construct, rather than real needs of real people.

Now, to the difficult part of this message. We need to look at the

actions of Rep. Burton, a man who is now deeply and intimately involved with the real needs of a real person. This overriding issue makes it impossible to fault his actions. He is making the best decisions he can in a very difficult, trying situation. He has walked away from "the best health care system in the world" and gone to another country that offers some of the best care available. He has walked away from "the most advanced research and technology" to another nation that likewise has advanced research and technology. With FEHBP coverage, he has his choice of any care within the limitations of his plan, but he elects to go to a country that happens to assure that care is covered and accessible for essentially everyone, with virtually no restrictions on providers. At home, he continues to work with elements in our society that want to keep government out of our health care. Yet he accepts a government funded health plan, and even is not above accepting government transportation for a combined personal and quasi-government-business trip. Apparently Rep. Burton does want the government involved in health care when it is providing him and his loved ones with access and coverage.

Real people have real needs. None of our needs are met by rhetoric. In health care, they are met partly by our own personal efforts. But clearly most of us by ourselves can never assure that we can meet the financial demands of catastrophic illness, nor the public health protections that can be provided only on a population basis, nor the assurance that the health care infrastructure will be there when we need it, nor the assurance that our resources will not be frittered by Wall Street and by the technological and pharmaceutical firms that have their own priorities which they have placed higher than the public good. Real people with real needs can expect those needs to be met only with a combination of personal effort balanced with a public effort that places reality above rhetoric.

Health Affairs May/June 2002

Phantoms In The Snow: Canadians' Use Of Health Care Services In The United States

Surprisingly few Canadians travel to the United States for health

care, despite the persistence of the myth.

by Steven J. Katz, Karen Cardiff, Marina Pascali, Morris L. Barer, and Robert G. Evans

A tip without an iceberg?

This study was undertaken to quantify the nature and extent of use by Canadians of medical services provided in the United States. It is frequently claimed, by critics of single-payer public health insurance on both sides of the border, that such use is large and that it reflects Canadian patients' dissatisfaction with their inadequate health care system.

All of the evidence we have, however, indicates that the anecdotal reports of Medicare refugees from Canada are not the tip of a southbound iceberg but a small number of scattered cubes. The cross-border flow of care-seeking patients appears to be very small.

Our telephone survey of likely U.S. providers of wait-listed services such as advanced imaging and eye procedures strongly suggested that very few Canadians sought care for these services south of the border. Relative to the large volume of these procedures provided to Canadians within adjacent provinces, the numbers are almost undetectable. Hospital administrative data from states bordering Canadian population

centers reinforce this picture. State inpatient discharge data show that most Canadian admissions to these hospitals were unrelated to waiting time or to leading-edge-technology scenarios commonly associated with cross- border care-seeking arguments. The vast majority of services provided to Canadians were emergency or urgent care, presumably coincidental with travel to the United States for other purposes. They were clearly unrelated either to advanced technologies or to waiting times north of the border. This is consistent with the findings from our previous study in Ontario of provincial plan records of reimbursement for out-of-country use of care. Additional findings

from the current study showed that a small amount of cross-order use was related to proximal services, primarily in rural or remote areas where provincial payers have made arrangements to reimburse nearby U.S. providers.

Finally, information from a sample of "America's Best

Hospitals" revealed very few Canadians being seen for the magnet referral services they provide.

These findings from U.S. data are supported by responses to a large population-based health survey, the NPHS, in Canada undertaken during our study period (1996). As noted above, 0.5 percent of respondents indicated that they had received health care in the United States in the prior year, but only 0.11 percent (20 of 18,000 respondents) said that they had gone there for the purpose of obtaining any type of health care, whether or not covered by the public plans.

Despite the evidence presented in our study, the Canadian

border-crossing claims will probably persist. The tension between

payers and providers is real, inevitable, and permanent, and claims that serve the interests of either party will continue to be

independent of the evidentiary base. Debates over health policy furnish a number of examples of these "zombies"-ideas that, on logic or evidence, are intellectually dead-that can never be laid to rest because they are useful to some powerful interests. The phantom hordes of Canadian medical refugees are likely to remain among them.

http://www.healthaffairs.org/freecontent/v21n3/s6.htm

Comment: This excellent study refutes the false generalizations that have been extrapolated from the embellished anecdotes of Canadian medical refugees in the United States. Debates on health care policy should be based on the best factual information available regardless of whether or not those facts support individual ideological viewpoints. This important study should be downloaded and made readily available to refute those that insist that single payer approaches should be

dismissed immediately without further consideration merely because of the fictional massive medical migration from Canada into the United States.

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