How Will Universal Health Care Change Nursing?

Saúde · Jun 25, 2009

UK, France , Holland??? Please... these are among some of the most expensive countries to live in BECAUSE OF THEIR SOCIALIST IDEALS.

kinesjl · Jun 25, 2009

None of us has health insurance, really. If you develop a long-term condition such as heart disease or cancer, and if you then lose your job or are divorced, you can lose your health insurance. You now have a preexisting condition, and insurance will be enormously expensive—if it's available at all.

Free markets can solve this problem, and provide life-long, portable health security, while enhancing consumer choice and competition. "Health-status insurance" is the key. If you are diagnosed with a long-term, expensive condition, a health-status insurance policy will give you the resources to pay higher medical insurance premiums. Health-status insurance covers the risk of premium reclassification, just as medical insurance covers the risk of medical expenses.

With health-status insurance, you can always obtain medical insurance, no matter how sick you get, with no change in out-of-pocket costs. With health-status insurance, medical insurers would be allowed to charge sick people more than healthy people, and to compete intensely for all customers. People would have complete freedom to change jobs, move, or change medical insurers. Rigorous competition would allow us to obtain better medical care at lower cost.

Most regulations and policy proposals aimed at improving long-term insurance—including those advanced by President Obama— limit competition and consumer choice by banning risk-based premiums, forcing insurers to take all comers, strengthening employer-based or other forced pooling mechanisms, or introducing national health insurance. These will, as they have everywhere they've been tried, lead to skyrocketing health costs and rationed care.

The individual health insurance market is already moving in the direction of health-status insurance. To let health-status insurance emerge fully, we must remove the legal and regulatory pressure to provide employer-based group insurance over individual insurance and remove regulations limiting risk-based pricing and competition among health insurers.

Saúde · Jun 25, 2009

The increases we see today in our health care system IS NOT the result of a free market. It's the result of FAILED government policies that have DESTROYED our health care market. ANYONE DISAGREE??? And your remedy to this is more and more government... That's a true definition of INSANITY!

talaxandra · Jun 25, 2009

i've said some of this before but as opponents to uhc seem to ignore experiences of members from uhc countries unless they're bad, here i go again.

objection: some people can afford insurance but prefer to buy cigarettes/alcohol/other less important consumables - why should i pay for them?

response: the australian version of uhc is funded through a 1.5% income tax; if you earn over a$50,000 (individual) or $100,00 (family) and choose not to pay for private health insurance you are also liable for an additional 1% levy. this means that if you can afford insurance and don't your contribution to the public health care system increases

objection: wages will go down and workload will increase

response: salaries may go down but i would imagine that nurses working in a country with uhc have more money to spend, because insurance is both optional and cheaper (see below). victoria had the first nurse/patient ratios in the world, despite having uhc. we don't have untrained staff doing nursing work, we don't mop floors or clear linen, and we don't act as ward clerks.

objection: taxes will go up

response: according to a comprehensive 2006 report comparing australia's tax rates with both oecd-10 (australia, canada, ireland, japan, the netherlands, new zealand, spain, switzerland, the united kingdom and the united states) and oecd-30-countries,

the report shows that australia is a low-tax country. australia's overall tax burden (31.6 per cent), measured as the tax to gdp ratio, is the eighth lowest of the 30‑member oecd. australia's mix between direct and indirect taxation is in line with other oecd countries, although the composition differs. for example, australia's indirect tax mix differs through a lower reliance on value-added and sales taxes, and a relatively higher reliance on property and transaction taxes, further, australia does not levy any wealth, estate, inheritance or gift taxes. [source]

it is true that australia's overall tax rate is higher than that of the us. however, as the authors point out,

one of the reasons the united states has a higher taxation revenue per capita than australia, but a lower taxation revenue as a proportion of gdp, is because it produces more gdp per person than does australia... the higher productivity and higher income of the united states give it greater capacity to raise more taxes than australia, while still potentially leaving its citizens with more disposable income than is the case for australia.[ibid]

private health insurance in a uhc country: private health insurance is considerably lower here than it seems to be in the us. for example, the most expensive cover i could find for a family, (including reproductive assistance and major dental) cost around $au300 ($us245) a month. you could get pretty much the same coverage for maybe $50/month less.

there's still a thriving private health insurance industry here, in no small part because the insured get a tax break on two fronts - reimbursement of some of their costs and a exemption from the surcharge levy (and additional 1% tax). there's also a perception, from those who work outside the system, that care is better in the private sector; those of us working in health care generally believe that the private system is prettier and great for minor elective problems, but the public sector is where the sick people and the expertise are.

medicare has no lifetime cap. i never have to worry that i'll lose my home if i have a stroke, get cancer or am involved in a serious accident, even if i lose my job or am unemployable.

kinesjl · Jun 25, 2009

The failing Massachusetts experiment, like the failed Clinton health plan of 1994, relies on coercion, mandates, price controls, and government rationing. If comprehensive health-care reform happens in 2009, it will follow suit — and perhaps go even farther, by creating a new socialized health-insurance program as an option for Americans under age 65. Tens of millions of Americans would lose their current health insurance and could also lose their current doctors, President Obama's reassurances notwithstanding. Since there aren't enough Americans earning more than $250,000 to finance the estimated $1.7 trillion price tag, reform would mean higher taxes for the middle class, violating another promise Obama made during the presidential campaign. Worst of all, these reforms would — through government rationing and the sclerosis that government brings to health-care delivery — reduce the quality of medical care and cost many lives.

Universal coverage is impossible without coercion; that's why the leading Democratic proposals would force Americans to obtain health insurance, either on their own or through an employer. Those who do not obtain the prescribed level of coverage would pay a fine. Those who do not pay the fine would go to jail. During the 2008 primaries, Hillary Clinton attacked Obama's plan for not being coercive enough: She proposed to compel all Americans to purchase coverage with a so-called individual mandate. Obama criticized this mandate, claiming that Clinton would "have the government force uninsured people to buy insurance, even if they can't afford it" — but in reality, his plan was scarcely less coercive. He proposed an individual mandate for children's coverage — don't worry, only the parents would face jail time — and an employer mandate that would compel employers to provide "meaningful" coverage to their workers.

Whatever coercive power an employer mandate lacks because it exempts small businesses, part-time workers, and the unemployed, it more than makes up for in other ways. Obama's National Economic Council chairman, Larry Summers, once wrote that employer mandates "are like public programs financed by benefit taxes": They can increase unemployment, work against the very people they purport to help (i.e., low-wage workers and the sick), and "fuel the growth of government because their costs are relatively invisible." Economists Kate Baicker of Harvard and Helen Levy of Michigan estimate that, by effectively increasing the minimum wage, an employer mandate could kill 315,000 low-wage jobs. Unlike the hundreds of thousands of jobs lost to the current recession, those jobs would not return: The mandate would continue to eliminate jobs as long as the growth of health-insurance costs outpaces that of low-wage workers' productivity.

Since employers finance health benefits by reducing wages, it is practically irrelevant whether a government enacts an individual mandate, an employer mandate, or both. One way or another, the cost of any mandate comes out of the worker's hide. Politicians such as Obama tend to prefer an employer mandate, however, for the reason Summers suggests: Employer mandates hide the implicit "mandate tax" in the form of reduced wages, where workers are less likely to notice it.

During the campaign, Obama vaguely defined "meaningful" coverage as being at least as good as what members of Congress get. That standard could end up forcing half of all those with private health insurance (roughly 100 million people) and all of the uninsured (an estimated 46 million) to get a more comprehensive plan, whether they value the added coverage or not. Whatever the meaning of "meaningful" is, the mandate tax would grow over time as a result of "mandate creep." As they have done at the state level, patient advocates and providers will demand that Congress mandate lower deductibles and coinsurance, as well as coverage of particular services. Since the 1970s, states have gradually enacted nearly 2,000 laws requiring consumers to purchase specific types of coverage. The Congressional Budget Office (CBO) estimates that such laws increase premiums by an average of about 3 percent: less in states with few mandated benefits (such as Idaho: 13 mandated benefits) and more in states with many (Maryland: 63).

Massachusetts already had 40 such laws by the time Mitt Romney enacted an individual and employer mandate in 2006. After that, mandate creep accelerated. Bureaucrats and lobbyists imposed coverage for prescription drugs, preventive care, orthotics, prosthetics, dependent students, and domestic partners. They imposed other costly restrictions, including limits on cost-sharing such as maximum deductibles (no higher than $2,000 for individuals and $4,000 for families), a ban on per-illness or per-year caps on total benefits, and a ban on coverage providing a "fixed dollar amount per day or stay in the hospital."

The result is absurd: There's zero evidence that anything beyond a basic health plan actually improves health outcomes, yet the individual and employer mandates gradually make coverage less affordable by outlawing the leaner, less expensive plans. (If Congress enacts these mandates, we can say goodbye to health savings accounts as we know them.)

As a result, insurance premiums are rising rapidly in Massachusetts, as are the subsidies required to help residents — including families of four earning up to $66,000 — comply. Government spending has far outpaced projections, with the total cost of reform reaching $1.9 billion last year. Tax increases on tobacco, hospitals, insurers, and employers have failed to stanch the bleeding. Combined public and private health spending has grown an estimated 66 percent faster than it would have without the reforms. The true believers in universal coverage are so committed to this disaster that they spin the cost overruns as evidence of success. Of course, cost overruns are a success if your goal is simply to boost health-care spending. That's why the health-insurance lobby and physicians' groups such as the American Medical Association support an individual mandate, which opens the spigot by forcing more people to purchase more of their services. One insurer-funded study practically celebrates how the Massachusetts reforms hide the runaway spending by dispersing the burden across higher premiums, higher taxes, and lower wages.

The biggest sticking point has been whether to create a new socialized health-insurance program. While many Democrats fear that a new government program would jeopardize health reform's chances for passage, Obama and Baucus want such a program to be an "option" for those under age 65, within the context of a new federally regulated market that Obama calls a "National Health Insurance Exchange." House Speaker Nancy Pelosi and four House caucuses representing more than 100 Democrats have stated that a "public-plan choice," modeled on Medicare, is the sine qua non of reform. Sixteen Democratic senators have signed a letter signaling their support.

Not even the 1993 Clinton reforms envisioned so radical a step. One analysis by the Lewin Group, a prominent health-care-policy firm, estimated that Obama's campaign plan would move 48 million Americans into a new government-run plan — essentially doubling the Medicare rolls. Lewin subsequently estimated that if Congress used Medicare's payment rates and opened the new program to everyone, it could pull 120 million Americans out of private insurance — more than half of the private market — and boost the government rolls by an even larger number. Two-thirds of Americans would depend on government for their health care, compared with just over one-quarter today.

That would strike a historic blow against even the possibility of limited government. Medicare and Medicaid are the reason that the size of the federal budget will double from 20 percent to 40 percent of GDP within 80 years. Medicare's unfunded liabilities are in the neighborhood of $80 trillion. The CBO estimates that all income-tax rates would have nearly to double by mid-century (top rate: 66 percent), and increase by nearly 150 percent by 2082 (top rate: 88 percent), just to pay for existing federal programs. If Congress creates a new government health program instead of reforming the ones we've got, tax increases will be inevitable and painful: The CBO estimates that by 2050, economic output could be 20 percent lower than if government remained at its current share of GDP. And tax cuts will be a pipe dream: In 1995 and 1996, Bill Clinton showed that the most effective strategy for defeating tax cuts is to paint them as a threat to voters' health care. If two-thirds of Americans come to depend on government for their health care, whether through a new program or through subsidized "private" coverage, we can forget about limiting government within our lifetimes.

Despite Medicare and Medicaid's failure to contain health-care costs, the Left claims that one more government program ought to do the trick. Their main strategy, which they seldom admit, is explicit government rationing. Thus the $1 billion in the stimulus bill for "comparative effectiveness" research — which would help government bureaucrats decide, e.g., whether Mom's next round of chemo (in the words of a draft committee report on the stimulus bill) "will no longer be prescribed." Massachusetts has created a commission to help the government develop a "common payment methodology across all public and private payers," including the use of "evidence-based purchasing strategies" — code for explicit government rationing.

Unlike Britons, though, Americans won't allow government bureaucrats to make their medical decisions. Neither will doctors, drugmakers, and device manufacturers, who don't like federal agencies questioning the value of their services. That's why Congress, at the behest of the industries, has repeatedly defunded agencies that produce industry-offending research. Even if a new comparative-effectiveness effort were to survive, the CBO estimates that after ten years it would reduce federal health spending by "less than one one-hundredth of 1 percent." When explicit rationing fails, the government will turn to its old standby: implicit rationing, typically via price controls.

Government already controls the prices for roughly half of all health-care spending. Medicare sets somewhere close to a million different prices. In Medicaid, the states do the same. The leading Democratic proposals would vastly expand government's role as price setter, primarily by moving tens of millions of patients into price-controlling government programs. Indeed, many reformers want a new government program to use the very prices Medicare does. Obama, Baucus, Wyden, and others seek to control private health-insurance premiums as well.

A government-controlled price is almost never right. Price controls are responsible for both the current surplus of specialists (because prices are too high) and the shortage of primary-care physicians (because prices are too low). Medicare and Medicaid price controls are generally not binding on private payers, though they do influence overall supply. That's one reason, for example, many Massachusetts residents — particularly those newly insured under the Romney plan — are facing long waits for primary care.

Price controls enable a veiled form of government rationing: If government sets the prices low enough, many doctors won't participate, which creates non-price barriers to access. States set Medicaid's prices so low that nearly half of all doctors limit the number of Medicaid patients they will accept. Some 20 to 30 percent refuse all Medicaid patients. Medicaid patients often travel hours to find a participating provider.

That is not to say that price controls are an effective tool for reducing spending. When government sets prices too high — as with specialty care, agricultural price supports, and 20th-century airline regulation — spending may rise. Government can ratchet prices downward, yet providers know more than regulators about their actual costs and are difficult to monitor. Northwestern University economist Leemore Dafny thus finds that hospitals are "quite sophisticated" in their "strategies" for gaming Medicare's price controls. Physicians likewise push back by increasing quantity and substituting higher-priced services (e.g., CT scans rather than X-rays). Even setting prices too low can sometimes cause spending to rise: In 2007, Maryland's low Medicaid price controls kept Deamonte Driver from seeing a dentist for his toothache. (Only one in six Maryland dentists accepts Medicaid patients.) The infection in Driver's abscessed tooth, which could have been treated with a simple extraction, spread to his brain. That led to $250,000 of medical services, including two unsuccessful brain surgeries. Price controls do not contain costs so much as pretend that certain costs don't exist — like the loss of Deamonte Driver, who died at age 12, as the Washington Post put it, "for want of a dentist."

If anything, Medicare errs on the side of providing too much access to care. One-third of Medicare patients looking for a new primary-care physician have difficulty finding one, but that amounts to just 2 percent of enrollees. That cannot last, particularly if Congress creates a new government program. Given the cost pressures facing these programs, Medicare and any new program will start to look more like Medicaid. There will be more Deamonte Drivers.

Price controls even allow politicians to rob producers. Wharton professor Mark Pauly notes that the government's "raw bargaining power . . . can permit [it] to be inefficient . . . and actually incur higher true costs than other competitors, and to cover up those inefficiencies by the transfers extracted from providers." The Lewin Group estimates that if Congress moves 130 million Americans into a new government program, physicians and hospitals would see their net incomes fall by roughly $70 billion in 2010. That pay cut, which works out to about $47,000 per physician, may just correct existing overpayments. But what about the next $47,000 cut?

Price controls on insurance premiums create another form of implicit rationing. Premium caps, which Massachusetts governor Deval Patrick is currently threatening to impose, force private insurers to manage care more tightly — i.e., to deny coverage for more services. Rating restrictions prevent insurers from pricing health insurance according to a purchaser's risk. According to Harvard economist and Obama adviser David Cutler, rating restrictions unleash adverse selection, which drives comprehensive health plans from the market. That rations care by forcing many consumers to accept less coverage than they would prefer. Rating restrictions also encourage insurers to avoid the sickest patients or skimp on their care — another form of implicit rationing.

If those dynamics sound familiar, there's a reason. Congress already imposes a loose form of rating restriction on most of the market by prohibiting employers from charging different employees different premiums. Some 20 states already impose rating restrictions on health insurance sold to individuals.

When the Left claims that government programs do a better job of containing costs than private insurance, what they mean is that government does a better job of hiding costs — such as the monetary and non-monetary costs it imposes on patients and providers. Pacific Research Institute economist Ben Zycher points out that the taxes required to run Medicare destroy economic activity, making that program's administrative costs "between four and five times [those] of private health insurance."

The greatest danger of the Democrats' reform plans, however, lies in the fact that they would hamper and cut short thousands of lives by preventing markets from improving quality.Though America produces more new medical technologies than any other country, the way we deliver medical care is often backward and dangerous. We lack basic conveniences present in other sectors of the economy, such as accessible electronic records. Doctors too often do not coordinate the services they provide to a shared patient. The number of medical errors is frightening — an estimated 181,000 severe errors per year in hospitals alone, resulting in up to five times as many deaths as result from a lack of health insurance. And, yes, we lack crucial comparative-effectiveness research about which treatments work better than others.

Each of these failures can be laid at the feet of government, specifically Medicare. The reason has to do with the difference between two ways of paying providers. Prepayment (also known as "capitation") is a payment system in which providers receive a fixed budget to care for a defined patient population. It encourages providers to invest in electronic medical records (EMRs), care coordination, error reduction, and comparative-effectiveness research. Kaiser Permanente, a prepaid health plan, leads the industry in these areas precisely because prepayment allows the Permanente Medical Group to keep any money it saves — by, for example, using EMRs to avoid duplicative tests or medical errors.

Medicare's "fee for service" payment system, on the other hand, pays providers an additional fee for each additional service or hospital admission. That actually penalizes providers that try to improve those dimensions of quality. EMRs help avoid duplicative CT scans by saving and making accessible the results of previous scans. But Medicare will pay for a second scan. And a third. And a fourth. So a provider that invests in EMRs is not only out the cost of the computer system, but also receives fewer payments from Medicare.

The story with medical errors is similar, but more horrifying. If a medical error injures a patient who then requires additional services, Medicare will pay not just for the services that injured the patient but also for the follow-up services. That's right: Medicare pays providers more when they injure patients. Again, if providers invest in error-reduction technologies, they are not only out that initial investment, but Medicare penalizes them with fewer payments.

Rather than allow a level playing field for all payment systems, so that competition forces them all to improve, government tips the scales toward fee-for-service. Medicare is the largest purchaser of medical services in the U.S., and it operates largely on a fee-for-service basis. According to former Medicare chief Thomas Scully, "in many markets Medicare and Medicaid comprise over 65 percent of the payments to hospitals, and more than 80 percent in some physician specialties." No wonder a recent New England Journal of Medicine study found that only 1.5 percent of non-federal hospitals use a comprehensive EMR system. Name any quality innovation that might save money by avoiding unnecessary services — EMRs, bar-code scanners for prescription drugs, surgery checklists. Medicare blocks them all. The Left bemoans the resulting quality problems, yet is desperately trying to subject even more of the market to the very stagnation Medicare introduces. Massachusetts, with its commission to develop a single payment system for its entire health-care sector, is diving head first into the cement. It makes no difference if government chooses a different payment system than Medicare's. The problem isn't the particular payment system, but the lack of competition from other systems.

Surgeon and scholar Atul Gawande writes: "When we've made a science of performance . . . thousands of lives have been saved. Indeed the scientific effort to improve performance in medicine . . . can arguably save more lives . . . than research on the genome, stem-cell therapy, cancer vaccines, and all the other laboratory work we hear about in the news. . . . Nowhere, though, have governments recognized this." Medicare has spent four decades and billions of dollars penalizing providers who try to save those lives, or develop the tools necessary to do so.

We don't need to go to Canada to find horror stories about government-run health care. One hundred thousand deaths each year from medical errors should be frightening enough. Before the great health-care debate of 2009 is over, some Democrats and even some Republicans will reassure us that we can reach universal coverage without creating a new government entitlement if only we mandate "personal responsibility" the way Massachusetts did. If Massachusetts has taught us anything, it is that individual and employer mandates are a new government program. They effectively socialize health care by compelling participation in the marketplace, dictating what consumers purchase and at what price, eliminating both economical and comprehensive health plans, and raising taxes. Massachusetts shows that mandates lead ultimately to government rationing by granting government even more power to decide how providers will be paid and how they will practice medicine.

The health care debate is not just about the freedom to make one's own medical decisions. It is about life and death. If we insist on a dynamic and competitive market, health care will be better, cheaper, safer, and more secure. If we go in the direction of new government programs, mandates, and price controls, we will see higher costs, more medical errors, more uncoordinated care, and more lives lost because people with government "insurance" nevertheless couldn't find a doctor who would treat them.

MaritesaRN · Jun 25, 2009

UK, France , Holland??? Please... these are among some of the most expensive countries to live in BECAUSE OF THEIR SOCIALIST IDEALS.

Oh, I see, the conversation shifted to socialism -- this is not the issue. Let us research and study what works and what does not work in a system. All I am saying is to find alternatives , changes that will allow our health system to accomodate every citizen for healthcare ! The current one is not working! Employers now are going for the PPO instead of the HMO-------although the preventatives are 100% payable, I still have to pay 20% of that. think how much I will have to pay for a thousands of dollars surgery? .........I can not afford the 20% , and I am insured !!!!!! :cry:

Saúde · Jun 25, 2009

The HMO Act of 1973 required most all businesses to offer their employees HMO coverages, and allowed businesses, BUT NOT INDIVIDUALS, to deduct the cost of health insurance premiums from their taxes each year. Why not allow individuals the same deductions???

Our Government never blames itself for the problems created by their bad laws. Instead, they tell us more Government, in the form of universal coverage, is the answer. How can anyone with 1/2 a brain say more Government is the the logical answer when our Government is already involved in 2/3 of all health care spending, through Medicare, Medicaid, HMO, and other programs.

If you look back in history there was a time when the American health care system was the envy of the entire world. America had the best doctors, the best hospitals, patients received the best care, the care was affordable, and thousands of private charities provided health care services for the poor.Most Americans paid cash for basic services, and had insurance only for major illnesses and accidents. This meant both doctors and patients had an incentive to keep costs to a minimum because the patient was directly responsible for payment, rather than an HMO or government program.

The REMEDY to fixing our health care mess IS NOT socialized medical care and more government involvement. But rather a system that encourages everyone (doctors, hospitals, patients, and drug companies) to keep costs down. As long as somebody else is paying the bill, the bill will be too high.

dtp232323 · Jun 25, 2009

I am no expert on the Canadian system, but I did spend 10 hours in an ER chatting with nurses, receptionist and aides. They had one doctor who drove 45 KM (about 100 miles) from his home to reach the hospital and they were happy to have the one. The equipment (computers included) appeared to be over 20 years old. There was no soap in the room or restrooms. It seems there was only one size gloves available. The admitting lady told me they were very close to having to close their doors due to lack of funding. The nurse seemed embarssed after scotch taping my arm ID band to hold in it place. I shouldn't have told her ours (in the states) had to be cut off with scissors. I asked what locals did when they were ill. They said the GP's accepted a certain number of patients and other people did without. This is not what I would like to become accustomed to.

I fell down 20 stairs, fractured a bone in my elbow (I had no idea if there were internal injuries) and chose to fly back to the state to use more modern facilities with soap, better lighting and probably a more rested staff. I also did not want to bring staph with me from Canada. I was so happy to go to my local ER and wait 2 hours. At least I knew there would be a CT, MRI, or ultrasound available if needed.

We do need to fix our system. I don't think government control is the way to do so.

MaritesaRN · Jun 25, 2009

The HMO Act of 1973 required most all businesses to offer their employees HMO coverages, and allowed businesses, BUT NOT INDIVIDUALS, to deduct the cost of health insurance premiums from their taxes each year. Why not allow individuals the same deductions???
Our Government never blames itself for the problems created by their bad laws. Instead, they tell us more Government, in the form of universal coverage, is the answer. How can anyone with 1/2 a brain say more Government is the the logical answer when our Government is already involved in 2/3 of all health care spending, through Medicare, Medicaid, HMO, and other programs.
If you look back in history there was a time when the American health care system was the envy of the entire world. America had the best doctors, the best hospitals, patients received the best care, the care was affordable, and thousands of private charities provided health care services for the poor.Most Americans paid cash for basic services, and had insurance only for major illnesses and accidents. This meant both doctors and patients had an incentive to keep costs to a minimum because the patient was directly responsible for payment, rather than an HMO or government program.
The REMEDY to fixing our health care mess IS NOT socialized medical care and more government involvement. But rather a system that encourages everyone (doctors, hospitals, patients, and drug companies) to keep costs down. As long as somebody else is paying the bill, the bill will be too high.

There is another alternative ...... the Coop sytem-----supposedly everybody patient, doctors, hospitals and drug companies share the responsibility......maybe this will be a motivation since everybody's pockets will be affected.

Also the "patients " have changed ....elderly people live longer with chronic diseases. Bottom line I do no think there is a sure thing of a system ..... It is an ongoing process and will evolutionize through time. :nurse:

But no matter what we need to change what we have now. It is not viable in the long run. Nobody should be worrying if they should buy food or medicine ? It is getting to that point, you know. Change we need--- YES WE CAN!

Fiona59 · Jun 25, 2009

I am no expert on the Canadian system, but I did spend 10 hours in an ER chatting with nurses, receptionist and aides. They had one doctor who drove 45 KM (about 100 miles) from his home to reach the hospital and they were happy to have the one. The equipment (computers included) appeared to be over 20 years old. There was no soap in the room or restrooms. It seems there was only one size gloves available. The admitting lady told me they were very close to having to close their doors due to lack of funding. The nurse seemed embarssed after scotch taping my arm ID band to hold in it place. I shouldn't have told her ours (in the states) had to be cut off with scissors. I asked what locals did when they were ill. They said the GP's accepted a certain number of patients and other people did without. This is not what I would like to become accustomed to.
I fell down 20 stairs, fractured a bone in my elbow (I had no idea if there were internal injuries) and chose to fly back to the state to use more modern facilities with soap, better lighting and probably a more rested staff. I also did not want to bring staph with me from Canada. I was so happy to go to my local ER and wait 2 hours. At least I knew there would be a CT, MRI, or ultrasound available if needed.
We do need to fix our system. I don't think government control is the way to do so.

Want to tell us which major urban centre this happened in???

StNeotser, ASN, RN · Jun 25, 2009

All I can really tell is this after wading through this very long debate

On personal experience: As a UK citizen and an American naturalized citizen who moved here for a marriage (now defunct) and am still required to stay here until my child reaches the age of 18;

I didn't mind private healthcare insurers ten years ago before they decided to put up there premiums well over inflation so they could boast to shareholder "this years profits are 40% over last years profits" x 10 in a row.

On Sunday some Insurance Chick wanted thirty minutes of my time to sell me all kinds of accident insurance, cancer insurance and disability insurance. She wasn't high. Despite all the health care premiums and taxes I pay, they want me to pay this too.

If I ever get cancer, I'm going home. Period.

There.

All you "for American citizens only" idiots in this thread I'm sure that will please you immensely that I've paid ten years of faxes and then become a burden and had to leave.

For all the UK citizens who haven't had my taxes (except what I'm paying on a small estate my Grandma left me basically a field nobody will let us build on but if we sell it to a big developer then we're fine - see the world really does revolve around money) I'm terribly sorry.

If theres one thing I hope will be eradicated in Universal medicine (it won't be socialized - Americans did you ever notice the FSTE or the DAX being part of the Eastern Bloc?) is the "customer service" aspect. I don't mind family members being involved at all, but I have just had the nastiest family member of my life come into the med room thinking she was "damned well entitled" to go through the med fridge and going through MARS when the nurse wasn't around. She was accusing and holding the facility accountable for her mothers decline a 93 yr old with long history of CHF. We weren't allowed to give this patient anything but tylenol for pain, because her mother had been a "moaner" for some 30 years about pain. Yet the minute this patient was discharged suddenly adult protection services were called against the daughter. Yet when she was a "customer" no cops or family services were called. What's up with that? Is there a reason nurses get messed up through moral distress?

Saúde · Jun 26, 2009

Quote from the Canadian Nurses Association. "The federal government’s financial contribution to the health system must increase in exchange for assurances that pan-Canadian objectives regarding reduced waiting times and a broadening of the continuum of care will be met."

So is there a problem with excessive waiting times for treatments or not??? All I here from those on this website is that it's propaganda, cohorts, or lies. Either the CNA is lying or those on this website are lying. Which is it???

It's quite hilarious when they use words like, "federal government's financial contribution". Translation - more and more and more taxes from the PEOPLE... One thing we can be certain of about Canada's health care system is that it's always going to be hungry and will need to be fed more and more on a regular basis to survive or it'll soon look similar to Brazil's health care system. Take care.