Before we get into it, I'm going into first year nursing... but I'm not some young kid. I'm 34, married with a family, studied philosophy in my early 20's, and lived well below the poverty line for my entire life. I'm saying this to avoid any fallacious arguments stemming from status or authority.
Now that's out of the way...
Why is health care not a right?
It's not a right because it requires others to fund your health care costs. You do not have a right to the money of other people.
What about those in need of health care?
We all love helping people, and that's important. Which is why there are countless organizations, churches, synagogues, companies, online charitable organizations, and other opportunities for your access.
If health care is a right, it's immoral.
A socialist view of health care requires the theft of citizens money through taxation to fund your health care needs. Just because I need health care does not mean I can take money of others, even when done through governmental force.
What's the difference between access to things like fire services, and health care services? They're all services aren't they?
The difference is that citizens who pay for services should receive services. Taxation pays for fire services, people are therefore owed that service.Consider, outside of municipalities where services aren't paid for, firefighting is volunteer, or paid for out of pocket. At least that's how it works in Canada...
When is health care a right then?
When you pay for it, however, it's a contractual right. Not a human right. I'm owed the service because I paid for it, that's it.
Who's responsible to take care of me then?
You are. Crazy idea right?
Are there exceptions?
Obviously, those with zero capacity to care for themselves.
I suspect heading into a Canadian nursing program with my views will be an interesting experience.
What's odd is that I wasn't making it up, my friend actually flew to Florida for his shoulder because he was waiting too long. So it must not be pushed here, or there's a catch I'm missing? Why would people leave if they have privatized health care here?
The wait times for shoulder surgery may be longer for reasons such as; Ontario has small number of orthopedic surgeons that specialize in shoulders (US has ten times the population, has a greater number of specialists with expertise in niche areas), the best practice guidelines for the surgery may require at least a 6 month waiting time if the patient has had steroid injections into the shoulder.
The privatized health care is not for every type of diagnostic test, surgery, or health assessment. if you look up private medical clinics such as the Cleveland clinic (as Muno mentioned), as well as Medcentra (MRI), Shouldice (hernia centre) you will see the services that are offered and that they can be paid for privately.
I truly believe if the province is expected to pay to fix your elective surgery done out of country/province, you should be billed for it.
A knee replacement in Europe runs around $15K. Corneal transplants in the US, roughly $14K. Bariatrics and plastic surgeries in Mexico and the US are far cheaper.
IVF, bariatric, cosmetic surgeries (in most cases) are wants not needs and Universal Healthcare was not intended to cover these item.
Yes, Bariatric surgeries improves quality of life, increases life expectancy, reduces the possibility of Diabetes, but most obesity is self inflicted. People paid for those calories but expect the province to pick up the cost of fixing it. Personally, I feel the province should pay for gym memberships and Weight Watchers for bariatric patients and only do the surgery when a weight loss programme has been started. Most bariatric clinics require some sort of weight loss prior to surgery. But there needs to be good psych support.
Most provinces don't pay for IVF itself but are required to pick up the costs of the complications. Some women don't do well with the preparation treatments and then there are the costs of the multiple births and resulting NICU costs. Parenthood isn't a right. But that's a whole other kettle of fish.
Cosmetic surgeries? Breast implants? Porifice reductions (well, if there are skin infections in the hanging folds, yes, it should be covered) There will always be cosmetic surgeries that should be covered, burn patients come to mind. "I don't like my nose", no that shouldn't be covered but if you know what to say you will get it covered.
Corneal thinning is not unknown after LASIK type procedures. The patient pays for LASIK but the province fixes the problems down the road. People need to see, you only get issued with one set of eyes.
So, yes, I think if you pay for a procedure to be done privately you should be billed to fix whatever goes wrong.
This buisness of morbidly obese people "just needing access to gym memberships and motivation" is insensitive to bariatrics that may be reading, and does not reflect a competent nursing view. You do not have RN next to you name so I am only informing, not casting blame, so that you can be a better nurse. Morbidly obese pts have to face an uphill battle to get bariatric surgery covered. Many have had other illnesses, like Cushings, that caused the obesity. If they do get approved for Bari surgery, it's because it's a life saving measure. Bariatrics cannot be blamed solely for their weight, as the influences that our society has on obesity is clearly established. The perspective that a culture is responsible for influencing it's members and greatly contributes to their health is basic principle of human development, and one that is supposed to guide our care as nurses. And it's proven that obesity is greatly linked to American culture. Therefore, we do have some social responsibility to save an obese person through the very risky bariatric surgery. As well, the patient will cost us less in the long run because he/she will have less complications.
As far as cosmetic surgery, this was an area that I have worked in and have experience that backs the following. Private pay is better for elective plastic surgery. If you are paying for a cosmetic procedure via insurance, it's because you have a severe deformity, breast removal from cancer, or disfigurement from accident. You are never going to pay for lipo or boob jobs through any insurance otherwise. In fact, the practice I worked at didn't even take insurance at all, for any reason, and this is pretty typical. It's better for the doctor, and patients generally do not want something like a nose job done by someone that they aren't paying directly. The fact that they pay means they are entitled to a specific standard rather than have to deal with possible aesthetic dissatisfaction that coincides with a need based service.
Most importantly to clarify for other nursing students who may be reading:knee and hip replacements are definitely something to be covered by insurance as this leads directly to disability. Your perspective was "obesity is the fault of the obese" for that issue. However, knee and hip issues are almost inevitable, for everyone, yet you still believe that it shouldn't be paid for? This is not a healthy nursing view. A hip fracture often means impending death for the elderly because of the amount of disability that comes with it. As well, hip replacements are high risk. And they are not just handed out casually by surgeons. Similarly, knee replacements are not offered until last resort, and other measures are taken to save the knee.
But ultimately, it is the DOCTOR'S responsibility to determine if a procedure is necessary, and then insurance confirms it. It is never the publics decision. Ever. Even NURSES. That way over steps our bounds. If you are unhappy that MEDICINE determined these procedures are necessary, the MEDICINE must make that change. No one else has the authority to make medical decisions for others, and necessity is a MEDICAL decision. Absolutely nobody.
You don't understand why universal healthcare was set up, do you?
Hips fractures are emergent and performed STAT in my province. Electives usually within 6-9 months. Pay to jump the queue, have complication? You get treated as an emergency and the province pays.
You'd be surprised at what employment extended insurance pays for in Canada.
Can you explain why American insurance companies can veto, delay American doctors decisions on care?
I'm not why that is the case ALL of the times in your country, but SOME of the time it's done here because the patient has a major artery involved in the fracture. That is in fact a life saving measure. The other case is severe pain, as a broken hip is often such severely painful experience that for the sake of ethics it must be addressed quickly. We do not just let our patients suffer 10/10 pain because they cannot afford a medical procedure. There are plenty of times (especially if a person is very old) that the surgeon will not recommend surgery, and the person will just have the broken hip and be bed bound.
If doctors are performing unecessary procedure/non-emergency procedures emergently, than that's something that should be taken care of internally. This is why evidence based practice is important! Medicine needs to assess and ammendment these issues, because they are the medical professionals. Allowing govt to get involved in these decisions opens the door to terrible things: politicians influencing major medical decisions.
There is supposed to be what is considered a "check and balance" for government to make "play fair and nicely" decisions over medicine for the sake of regulating it, but in most cases they overstep their bounds and interfere. Medicine is in fact supposed to be almost completely self governing. If you talk to any physician, they will probably have something to say about government making decisions on medicine that they have no authority to make. Which is why health care should be clearly established as a right (which it is through many legal documents such as EMTALA). Note that "healthcare is a right" is different from "who is financially responsible for paying healthcare", which OP refuses to observe or acknowledge. It's very different, and the difference needs to be noted as it can cause a great deal of harm to willingly give up our "right to healthcare"
Also, it's not the patient's fault they have complications. You say that if they want the complications for some reason? I mean complications come with surgery often, it's just a fact,. We do not just ignore patients and let them suffer because they have complications. Your issue is that the surgery is elective? You say that as if it's a luxury, like cosmetic surgery. People don't just have major hip surgery to upgrade or get superpowers. It's because they really need it, and doctors recommend it after exhausting other options. The need is the same, it's just that the Emergent needs to be dealt with today, while elective means that they can wait till the Emergent patients are done first. Often these people are partially disabled, and have chronic pain.
Uh. Yeah, that's what "giving them up" would be. Forfeiting them by contract.
Letting laws be passed that say "healthcare is not a right" is how you do that.
Don't know if I agree entirely. Laws can only be passed to recognize or protect human rights, they can also instantiate positive rights. However, it would require mutual consent to "give them up", and that would require you ever having them in the first place. I get what you're saying though, we'll have to agree to disagree on it being something you ever had to begin with.
I see you have edited your original post. You called me out for not having "RN" behind my name.
So let me enlighten you. I have a BA, and completed PN course of two years (the requirement in Canada) which was the old RN programme before the BScN became entry level for Canadian RNs. I also hold advanced certifications in three specialty areas, completing the same course work and exams as the RNs in the class.
I notice that you have never told us what education you have. I mean for all we know you could be a very qualified office manager.
I've worked in bariatrics and several other areas. I have colleagues in the Bariatric programme that do the initial assessments for candidate suitability. In 15 years of acute care, I've never had a bariatric patient that had Cushings. They've had multiple co-morbidities ranging from being bed bound, diabetic, and abuse survivors. Heck, by the BMA chart, I'm considered obese, but would never go the bariatric route.
Post op complications? Well, let's see, you fly into a country, have surgery and leave as soon as possible to avoid hotel fees, etc , because you want it done as cheaply as possible. No physio and barely a post op exam. I truly feel that the patient should pay the costs. I remember well one case that went to India, lived with relatives in the countryside to save money and brought home a truly nasty infection, the wound was weeping on the flight home and went straight to emergency. Why not have it looked at locally before the flight? Well, Canada's health care is free! That's what the family told emerg.
So, please feel free to enlighten us to your qualifications to be taking part in this discussion? At least the OP was polite enough to admit he's just starting as a nursing student.
What if I wanted to pay for an MRI tomorrow though, and shoulder surgery in the fastest possible time? The reason I'm asking is my friend recently flew to Florida to have this done because he got tired of waiting. Have you also heard of people flying to the US to get faster care, or would you say that's not very common in your experience?
You are so ignorant of healthcare systems and how they work. Instead of spending time on pointless arguments, spend your time studying healthcare organizations and economics. In a national health insurance system like Canada's or Great Britain's, certain types of healthcare are rationed by waiting time. In the U.S., because we do not have universal healthcare, care is rationed by pricing and insurance. This is because no country has infinite healthcare resources. Yes, some Canadians fly to the US for procedures. Some Americans fly to Singapore because some procedures are cheaper there. Both systems use rationing, but different types of rationing. From a moral perspective, most of us believe universal healthcare is more equitable, as all human lives are worth the same.
You are so ignorant of healthcare systems and how they work. Instead of spending time on pointless arguments, spend your time studying healthcare organizations and economics. In a national health insurance system like Canada's or Great Britain's, certain types of healthcare are rationed by waiting time. In the U.S., because we do not have universal healthcare, care is rationed by pricing and insurance. This is because no country has infinite healthcare resources. Yes, some Canadians fly to the US for procedures. Some Americans fly to Singapore because some procedures are cheaper there. Both systems use rationing, but different types of rationing. From a moral perspective, most of us believe universal healthcare is more equitable, as all human lives are worth the same.
Shibaowner, my arguments were in regards to the nature of rights, and socialized health care. There is tons of stuff I don't know, in health care and otherwise. I'm not opposed to learning, if you have information, fill me in.
So in a two tier system like Canada, some here are saying privatized health care is offered for already insured services. Does that mean I can pay to queue jump? If so, do you feel that's immoral?
While wiki is a terrible source to use (I know), it states:
"Six of Canada's ten provinces used to ban private insurance for publicly insured services to inhibit queue jumping and so preserve fairness in the health care system. In a complex legal decision in 2005, the Supreme Court of Canada ruled that in some circumstances, such bans can be illegal if the waiting period was unduly long."
It is not unusual for wealthy Canadians to want a two tier system and many Canadians argue against allowing any privatization as it may be a slippery slope to full privatization. However, that hasn't proved to be the case in Ontario, as there have been private clinics for many years, for example Shouldice hernia surgery clinic opened 1945, Rudd endoscopy opened in 1969, Medcentra MRI opened in 2004 and we are nowhere near to becoming fully privatized in Ontario and likely never will be.
The physicians who work in private clinics often work in the public hospitals as well, and the overhead costs for their private clinics are very expensive. There is not enough private cash patients to fully support private clinics and OHIP only pays the set fees for services that they would pay the physician if they were doing the procedure in a publicly funded hospital. Most physicians are not going to be interested in private clinics because they will not be making more money after they pay for their overhead costs and staffing.
Debating this is not changing anyone's mind. Nurses must embrace nursing ethics and values in order to provide compassionate and appropriate care. In addition, in order to get through nursing school, nurses must be able to relate care measures to nursing ethics and values. A nurse that does not believe healthcare is a right is going to have trouble with this.
What are nursing values? I'm going to quote some sources, and I have provided the links:
"Nurses as one of the health service providers and members in health system who are responsible for giving care to the clients and patients based on ethical issues.[1] They need ethical knowledge to conduct their appropriate function to manage situations and to give safe and proper legal and ethical care in today's changing world.[2] With regard to practical care, they always try to answer the question of What can I do?,†whereas they should try to answer what is essential to be done for the patients in the context of ethical principles.[3] Ethics seek the best way of taking care of the patients as well as the best nursing function.[4]
Nurses are responsible for their clinical function, and their main responsibility is to take care of the clients and patients who deserve appropriate and safe care.[5] They act based on the values they have selected. These values form a framework to evaluate their activities influencing their goals, strategies, and function.[6] These values can also be counted as a resource for nurses' conduct toward clinical ethical competency and their confrontation with contemporary ethical concerns. Values conduct human life priorities and form the world we live in. They act as one of the most basic parts of human life. Ethical values are inseparable components of the society and, as a result, nursing profession."
Discovery of basic values and reaching an agreement on clinical ethical values are essential with regard to constant changes in nurses' social class and role.[9] Nurses' awareness of their values and the effect of these values on their behavior is a core part of humanistic nursing care.[10] They need to tailor their function to the value system and cultural beliefs of their service recipients.[11] Values originate from cultural environment, social groups, religion, lived experiences, and the past. Social, cultural, religious, political, and economic considerations influence individuals and their value system,[6] and ultimately, health, education, social strategies, and patients' care. Numerous documents have been prepared in nursing texts and literature concerning these values and clarification of their traits.
The search yielded 10 nursing ethical values: Human dignity, privacy, justice, autonomy in decision making, precision and accuracy in caring, commitment, human relationship, sympathy, honesty, and individual and professional competency."
"Core nursing values essential to baccalaureate education include human dignity, integrity, autonomy, altruism, and social justice. The caring professional nurse integrates these values in clinical practice."
Let's look at some nursing school mission statements:
Johns Hopkins: "The mission of the Johns Hopkins University School of Nursing is to improve the health of individuals and diverse communities locally and globally through leadership and excellence in nursing education, research, practice, and service."
Univ of Penn: "Our mission is to make a significant impact on health by advancing science, promoting equity, demonstrating practice excellence, and preparing leaders in the discipline of nursing."
Duke: "We believe that optimal health does not preclude the existence of illness; health and illness exist on parallel continuums such that even people with chronic or debilitating illness may experience optimal levels of health through adaptation. We believe that all humans, from infants to the oldest of age, have a capacity to adapt to health and illness challenges whether they arise from environmental or genetic origins. Nursing's role is to assess, support adaptation, or intervene when the appropriate ability does not exist within the individual or group. Because health is an innate characteristic of humans, we believe that high quality health care is a human right. We believe that nursing has a moral responsibility to the common good and an obligation to social justice and equitable access to culturally sensitive, high quality care for all human beings. Nurses also are responsible for helping to reduce health disparities and reaching out to those, locally or abroad, who are vulnerable."
It will be very difficult for a nurse to get through a BSN or MSN program without embracing these values. In addition, it does not seem that a personal philosophy antithetical to these values will result in the current definition of good nursing practice.
dishes, BSN, RN
3,950 Posts
The wait times for shoulder surgery may be longer for reasons such as; Ontario has small number of orthopedic surgeons that specialize in shoulders (US has ten times the population, has a greater number of specialists with expertise in niche areas), the best practice guidelines for the surgery may require at least a 6 month waiting time if the patient has had steroid injections into the shoulder.
The privatized health care is not for every type of diagnostic test, surgery, or health assessment. if you look up private medical clinics such as the Cleveland clinic (as Muno mentioned), as well as Medcentra (MRI), Shouldice (hernia centre) you will see the services that are offered and that they can be paid for privately.