I want to know what nurses think about socialized medicine.

HM2VikingRN, RN · Jul 26, 2009

Myths and memes about waiting times....

loriangel14, RN · Jul 26, 2009

Thank you for posting that, it was a very interesting read.

misswoosie · Jul 27, 2009

Just heard a horror story from Canada on a talk radio show. A woman's father needed a heart bypass at age of 59. He was denied by the medical board because he smoke and drank. The doctors gave him 5 years to live and sentenced him to die. At age 64, he began feeling unwell. Because docs only work 9-5,M-F there (according to this woman), his doctor was unavailable to him. His wife took him to the ER at 9pm on a Friday. At 10am Sat, the wife drove home for a blanket because he was cold. At 4am MONDAY morning, the man DIED in the same wheelchair he'd been sitting in for 55 HOURS having never been seen by a doctor. This woman was crying on air saying the Canadian health system killed her mother also... she was unable to elaborate on that death due to lack of time.
Universal care will result in rationing, longer waits in ERs than we have now and letting people die because their treatment may be deemed too costly. But hey, everyone will be covered... at least if you can find a doctor or be seen in an emergency.
I also read an article by a Canadian doctor who said his opinion on the Canadian Health system was changed when , as a medical student, he took a different route through the hospital by going though the ER... he said it was a war-zone that stank of urine and sweat. Some of the patients had been laying on cots in the halls for 5 DAYS. His goal in life was to make enough money to immigrate to the US so his children wouldn't have to grow up in the Canadian health system.
Even the prime minister of Sweden (I believe), had to wait 8 months until his turn to have a hip replacement.
As a college student, I had the opportunity to go to England for 4 months and study the health system there during a Community heath semester in my nursing program. I remember one elderly gentleman that I visited. He had a badly fractured patella. He was was on the waiting list to get his fracture fixed... surgery was scheduled for weeks out... meanwhile, he sat in his house at risk for all kinds of complications. In the US, he'd been operated on within 24 hrs, barring medical delays.
I can just see the problems that are going to happen. Patients and families expect immediate results and very timely service now... with private rooms, meals on demand and excellent nursing care. Everything is customer service driven. Imagine them being told they will have to wait weeks for their MRI or that they can take their elderly mother home with a broken bone while her wait on the list ticks down? Or maybe they'll be told that their loved one doesn't qualify for life-saving surgery... kind a bitter pill for those of us that have provided for our own needs for years to swallow. America is up for a rude awakening!
Yes, something needs to be done. But name one government program that isn't full of waste and run well? I don't want the government in charge of my healthcare. The insurance companys are starting to wake up and realizing if they don't do something about covering people at a lower cost they are toast. Obama's health plan will put them out of business....

Mmmm why does this ring true with me? Maybe because I work in the NHS in England.

We ar expected to provide "customer driven" care also, and have to deal with angry relatives.It doesn't help to say "well we only have 2 RNs for 30 patients" or "well there are no beds available in the hospital- that is why your ...... is lying on a trolley in the corridor "or "we haven't got any extra pillows"

People do wait up to 4 months after consultation with surgeon (and remember we have to be referrred by a PCP (gp)unless we pay privately-GPs are like gatekeepers to the NHS. But I take objection to having to pay for private care as I already pay NI contributions and my employer also pays an equal amount-so around 11% of my salary-$550 per month goes into the pot.This is how we can provide healthcare for everyone,because everyone that works pays into the pot and generally don't need to use it much until they are older.

It's fine to try and provide customer driven care when you have the resources and the back up, but very often we don't and are at the sharp end of the angry patients and relatives.Every department has a budget and GPs have to pay for hospital services out of their budget.If a PCP or hospital overspends then that amount is taken off their budget next year.

That said, I do believe that there does need to be some sort of rationing of procedures. Many surgeons would not do CABGs on people who continue to smoke and are obese, partly due to the increased risk of GA and also post op complications.People do need to take responsibilty for their health. Put it this way-if there was only money for 1 CABG op and there are 2 patients, one of whom has stopped smoking and lost weight and the other that contines to smoke and hasn't lost any weight, who would you chose to operate on? It's an ethical as well as financial decision.

fetch33 · Jul 27, 2009

Misswoosie,

Right now, as an RN, I am generally responsible for 4-9 patients, depending on if I am providing primary care or working with a LPN. So can I expect my patient ratios to go up as a cost-containment effort if nationalized health care goes into effect?... also, sounds like supplies are tightly controlled or limited. Must be frustrating to work in that environment.

Do you find families mad at the system or at you?

I work as an orthopedic nurse. We do thousands of elective total joint procedures a year. Are elective total joint procedures rationed by the government?

Is dialysis rationed by the government? I heard if you were over a certain age, you just didn't get dialysis and you died.

Is $550 the amount taken out for your health care or all taxes in general? I pay a lot less than that a month for health insurance for my whole family. Also, what are the pay caps for nurses? I have been a nurse for 23 years and make about $85K/year in a midwestern city. I could make a lot more if I was disciplined enough to work OT consistantly or worked on a coast.

misswoosie · Jul 27, 2009

Your argument is flawed for several reasons.
1. Anecdote is not fact. I bet if you asked me, I could find someone who attended the US ER and had to wait hours for a bed and died in the ER. I would bet my life savings that I could. EVERY system has flaws. Noone is denying that mistakes happen in any system, and sometime people fall through the cracks. That doesn't mean you should throw the baby out with the bathwater and ignore the whole idea of universal care.
2. If you want to go with anecdotes, I worked under mixed UHC/private HC for 10 years, and never heard of someone being refused treatment for anything other than medical reasons. Maybe someone wouldn't get a lung transplant if they kept smoking, but that's a universal standard, not financially-based rationing. There is no doubt that the public system has longer waits for elective surgery - so you're not precluded from having your own additional insurance to cover that.
3. NOONE is proposing that the US goes to a fully public system like Canada, or England. Noone! If you like your insurance, keep it and use at your discretion. For example, in Australia - if I attend the ER at a large public hospital, I would not use my private cover, because it's covered under UHC. If I busted my knee and needed an elective repair, I'd use my PHC to skip any line and choose my surgeon.
4. How is it that the argument of most people against UHC say "the government can't run anything, this will ruin the industry!" - have you LOOKED at the private insurers lately? They charge and receive ASTRONOMICAL fees that we all are paying for. Do you really consider that they are efficiently run?
It's illogical to compare apples with oranges.

How much do they pay towards UHC in Australia, and who pays?

elkpark · Jul 27, 2009

Is $550 the amount taken out for your health care or all taxes in general? I pay a lot less than that a month for health insurance for my whole family.

This is a type of comment we see posted here often. If you're referring to the amount that shows up on your paycheck stub as having been deducted for your insurance, in most cases that is only a portion of the monthly premium (typically a small portion) for the insurance, not the entire cost. Your HR department could tell you what the full cost of your insurance is, if you asked (if you're curious). I would be extremely surprised if you're getting family coverage for

Keep in mind, though, that the remainder of the insurance premium is also, basically, income that you've earned but never see, because your employer takes it "off the top" to pay for your insurance. Most people getting insurance through their employers have no idea what the insurance actually costs, because they've never asked.

misswoosie · Jul 27, 2009

Misswoosie,
Right now, as an RN, I am generally responsible for 4-9 patients, depending on if I am providing primary care or working with a LPN. So can I expect my patient ratios to go up as a cost-containment effort if nationalized health care goes into effect?... also, sounds like supplies are tightly controlled or limited. Must be frustrating to work in that environment.
Do you find families mad at the system or at you?
I work as an orthopedic nurse. We do thousands of elective total joint procedures a year. Are elective total joint procedures rationed by the government?
Is dialysis rationed by the government? I heard if you were over a certain age, you just didn't get dialysis and you died.
Is $550 the amount taken out for your health care or all taxes in general? I pay a lot less than that a month for health insurance for my whole family. Also, what are the pay caps for nurses? I have been a nurse for 23 years and make about $85K/year in a midwestern city. I could make a lot more if I was disciplined enough to work OT consistantly or worked on a coast.

Hi

I work as a Clinical lecturer practioner/ research nurse in acute stroke. So I co-ordinate 6 clinical trials, teach junior docs and qualified nurses from across the region which covers about 4,000 sq miles.I also assess suspected stroke patients in ED (as first point of contact with the stroke team) if our NP is away.

I have a Ba, advanced diploma in clinical research, teaching certificate and specialist ICU nursing qualification.I have been qualified for 26 years and earn $53,000 -BUT remember our COL is high.I am at the top of my band.

My total deductions from my paycheck each month (12 pays per year) is around $1580-this includes half of the NI $550 deduction (rest is paid my employer, but still going into the pot),income tax,pension and car parking.

I come out with about $2800 per calendar month.

Only place that pays higher to NHS nurses is London-where they get a 20% uplift, but COL in London is about 1 and a half to twice that of most other citites-hence loads of private agency staff in London.

Our acute/rehab (post thrombolyis patients, all acute strokes admitted to hospital, all rehab patients unless suitable for home rehab)has 30 mixed sex beds

4 single sex six bedded bays.

4 one bedded rooms (no bathrooms) for very sick or infected pts

2 bathrooms and 2 toilets for the whole ward.

Everything is in short supply and carefull monitored. The ward managers have budgets. they get one non clinical day per month-rest of time they have a caseload of patients.

We don't have equiv of LPNs anymore-their training was phased out in the 80s I think- there may still be some enrolled nurses but most converted to Rns.

Only other nursing staff are health care assistants.

May be 3 RNs and 4 healthcares on early shift but only ever 2RNs and 1 or 2 healthcares on nights.

NHS saves millions of pounds every year through unpaid overtime-staying late for an hour or so is expected if ward is busy or you have a new patient. It isn't acceptable to claim unless you work a whole shift as overtime. AND we have unions!

As forjoint replacements-they are rationed in the way that someone who has a pre-existing condition (other than OA) that means they would still be moderately disabled even after a joint replacement, would not get one.Age alone wouldn't be a deciding factor.

Wouldn't be offered a joint replacement until they met certain criteria related to pain, ROM at the joint etc, not exactly sure.I think this is partially because they know the artificial joints have a limited life span-so don't want to do it too soon, plus also I beleive shoulders are mainly done for pain-rather than improved ROM.But ortho is not my field by any means.

A neighbor of mine is 70- he has really bad RA and has had ops on hands/feet/wrists and is on treatment (? Gold or some other IV ).I noticed he was dragging his leg the other day and when I asked he said he needs an ankle replacement for OA. It took 4 weeks to be seen by a surgeon after seeing his GP and now he has to wait maybe 18 weeks for the op.

Orthopaedics is big money here as hospitals get paid extra money for getting the waiting list down -it's called waiting list inititaive, but think it might be just for hips and knees.

I don't think people appreciate how bad it can be here until they are patients, then they are often shocked at what we put up with.But then if they aren't happy with care then they take it out on the nearest person and don't really care why.

It has changed so much in the last 15-20 years since we became more financially controlled and they brought in managers and accountants.Unfortunately they seem to make cuts in nursing/support services etc first.Never seems to be management or Allied Health proffs eg pharmacists,physios.

Often there will be more physios and more pharmacists on the ward than RNs!

We are driven by government set targets-don't meet those and you lose your star rating and money.

Take for example the target that no one spends longer than 4 hours in ED, unless they need to be there. This was to try to ensure people got treated promptly and sent home or to wards as appropriately. Severe punishment if you don't meet the target. So what happens is that during a bed crisis (every day over the winter flu season) they will send patients to any ward that has a bed just to meet the target.So a stroke patient goes to a surgical ward or vice versa.

The whole idea of the target was to improve patient care, but because the target has to be measurable, they just look at the numbers and that's it. So then the targets for stroke patients to be admitted directly to the stroke ward are affected.

AnnieOK · Jul 27, 2009

Just joined this site this morning and have spent most of the time since reading this thread. I wanted to know what other "in-the-trenches" RN's around the country thought about this. After reading most of the replies, I wanted to add only a few points that I think are important for all of us to remember, regardless of which side of this we come down on.

There was some discussion about what the Founders would think of government-provided health care, and what the Constitution says and doesn't say. I know that there's a large contingent of Americans who don't hold the Constitution in high regard, or deem it to be of any "importance or relevance" any longer. To these people I would only say, whether you think the Constitution is "outdated" or not, it is the basic law and foundation of this country. All our laws and policies are supposed to be constitutional. This is for your protection, and the protection of the liberty you take for granted. When you state that you don't hold it in high (or any) regard, you are saying that the foundation for all laws and the guarantee of basic individual rights is of no importance. The Constitution protects all of us, whether we think so or not.

There was also some references to various "media" outlets and websites as sources of unbiased information. One mentioned was mediamatters.org. I would only like to point out that this is a branch of the group of liberal groups funded by George Soros, an ardent opponent of Republicans, conservative thinking, and traditional American values based on free market principles. I understand the difficulty in finding truly unbiased sources of information; it's very hard. I'm not saying that the poster who referred to mediamatters was wrong in what she said, just would like for all to know that it is not an unbiased source.

I think it is the cost of health care in this country that is the problem, not access. I've been a nurse in an NICU for three decades and have never---not one time---seen a medical decision about a baby's treatment depend on whether the family had insurance or not. Never.

The access is there, but the cost is high. One solution in my opinion, would be to start with tort reform. JMHO.

I know for me, I know that we need some new solutions to the problem of the high cost. But I don't want the Democrat's plan because I don't want the government involved in my personal and private health care. Again, that's just me. I value my liberty and individual freedom and my privacy. I believe I would lose some, or all, of that with the type of health care plan currently being discussed. JMHO.

Crash_Cart · Jul 28, 2009

.
The access is there, but the cost is high. One solution in my opinion, would be to start with tort reform. JMHO.
I know for me, I know that we need some new solutions to the problem of the high cost. But I don't want the Democrat's plan because I don't want the government involved in my personal and private health care. Again, that's just me. I value my liberty and individual freedom and my privacy. I believe I would lose some, or all, of that with the type of health care plan currently being discussed. JMHO.

The high costs have been perpetuated in an upward spiral over the years by the big drug pushers and the private health insurance industry. That's why a $10 Aspirin on the hospital bill doesn't cost $10 over the border in other countries which already have an established Universal Health care system in place. Keep in mind the "current" high costs for health care in the U.S are created by "for profit" entities and naturally they want everything to be as expensive as possible.

However, in a public funded taxpayer system, the costs are placed under the microscope of the public taxpayer. Let's call it "public accountability" for public tax dollars spent if you will. You can't have public accountability with a private health insurance or for profit drug companies. That is the problem.

In fact, if you use Google, you can quickly find out that a Universal Health Care system will serve to actually "lower" the costs associated with providing health care services to the public.

For example:

http://healthcare.change.org/blog/view/cbo_admits_very_quietly_that_hr_3200_will_reduce_costs

I don't think many people really understand that.

But I would rather fork my private health insurance dollars over to a public system instead because they won't deny coverage, it will not be tied to an employer and the system will guarantee heath care to every American and they will do so with public accountability involved.

No inflated costs, no pre existing condition or out of pocket and co pay nonsense. Just straight care for straight tax dollars. Makes sense to me.

My Best.

AnnieOK · Jul 28, 2009

In fact, if you use Google, you can quickly find out that a Universal Health Care system will serve to actually "lower" the costs associated with providing health care services to the public.
For example:
http://healthcare.change.org/blog/vi...l_reduce_costs

Ah, yes, change.org. With respect, I do not consider that website to be at all unbiased. It's purpose is only to push the Democratic plan. The blogger has worked for Obama since during the primaries, and is currently affiliated with SEIU, which has ties to ACORN. I suggest visiting the Heritage Foundation, or Investor's Business Daily, both of which have presented thorough, detailed discussions of this plan, good points and bad. I don't have their links handy, but a Google search will take you there.

FWIW, I do look at what both sides are presenting, and know that the truth lies somewhere in between. But I suspect it lies closer to what the Heritage Foundation and IBD offer, than a blog written by an Obama worker.

Nice night, all.

wowza · Jul 28, 2009

The high costs have been perpetuated in an upward spiral over the years by the big drug pushers and the private health insurance industry. That's why a $10 Aspirin on the hospital bill doesn't cost $10 over the border in other countries which already have an established Universal Health care system in place. Keep in mind the "current" high costs for health care in the U.S are created by "for profit" entities and naturally they want everything to be as expensive as possible.
However, in a public funded taxpayer system, the costs are placed under the microscope of the public taxpayer. Let's call it "public accountability" for public tax dollars spent if you will. You can't have public accountability with a private health insurance or for profit drug companies. That is the problem.
http://healthcare.change.org/blog/view/cbo_admits_very_quietly_that_hr_3200_will_reduce_costs

The high costs you are talking about (like the $10 Aspirin) have nothing to do with insurance or drug companies.

The $10 Aspirin has to do with hospitals trying to stay afloat despite the gov't policies. Policies like EMTALA force ERs to treat pts and make the hospital absorb the cost. These costs are often enormous for inner city hospitals making them have to over charge for other things to make up the costs.

No drug company has an interest in Aspirin. It is cheap as dirt. Thus it has nothing to do with drug pushers or private health insurance. Furthermore, being under public scrutiny would change nothing. The costs would have to be paid somehow or the hospital would go bankrupt (like Georgetown in DC did in the 90s or Hanhemann in Philly did around 2000).

Currently it is genereally those without insurance that get the brunt of these out-of-whack charges because the insurance companies have negotiated these costs down. So in this instance

As to HR 3200 here's the quotation that the article quoted:

"H.R. 3200, as introduced, would already be on track to achieve tens of billions of dollars in Medicare savings each year, primarily as a result of provisions that would reduce payments to Medicare providers"

As the underlined portion states, their savings are coming straight out of the pockets of those who are providing the services. Doctors are already not accepting new medicare patients and they currently lose money each time they see a medicare patient- not make less money, actually lose money; the costs outweight the reimbursement. If reimbursement decreases even further you will see doctors actively dropping their CURRENT medicare patients. A health insurance is no good if no one accepts it.

Still inner city hospitals will be forced to accept medicare because they have no other option. So, while they already bear the brunt of provisions like EMTALA, they will be forced to accept even less money from medicare. Furthermore, gov't money given to these hospitals is getting cut under the current plan too (by >100 billion dollars). The hospital I work at takes care of 1/2 of the indigent patients in the STATE and in addition to medicare gets 130 million dollars a year to offset the cost of taking care of the indigent pts. Cutting not only medicare but also the money given to the hospital on top of that will work in the exact opposite direction Obama wants it to- patient care will suffer and people will be left without care.

But no one in the media talks about these implications... wonder why...

Ah, yes, change.org. With respect, I do not consider that website to be at all unbiased. It's purpose is only to push the Democratic plan. The blogger has worked for Obama since during the primaries, and is currently affiliated with SEIU, which has ties to ACORN. I suggest visiting the Heritage Foundation, or Investor's Business Daily, both of which have presented thorough, detailed discussions of this plan, good points and bad. I don't have their links handy, but a Google search will take you there.
FWIW, I do look at what both sides are presenting, and know that the truth lies somewhere in between. But I suspect it lies closer to what the Heritage Foundation and IBD offer, than a blog written by an Obama worker.
Nice night, all.

Heritage foundation was created, as it states in their mission statement, to further conservative ideas. This is not exactly unbiased. In reality, there no such thing as unbiased journalism any more.

Rebel Yell · Jul 28, 2009

We already have "socialized medicine" here in the U.S. in the forms of Medicaid, Medicare, VA and in a different form, the HMO's. That is a start to your comparison. I don't believe there is a simple answer to this. I have been without insurance and needed health care, and fell between the cracks. I found that working out a payment plan with the hospital and doctor worked out well.

But what I personally think, is that I do not want the government involved any more than it already is. This country is broke, trillions of dollars in debt, and this will bring us further to our knees. This is not what I want to leave for my children. America, wake up to the bigger picture. This is a power and money grab. Why are they rushing it?

Health care is not a right, it is a responsibility. But it is also our responsibility as Americans to help those out in need. I know a lot of people will be angered with me saying that. But when does it stop? Do I pay for your car insurance, your house insurance next? We can't pay for everything, and be the country we were supposed to be. We need to FIRST fix the problems with our current system, and maybe even dismantle some of it (good God! What?). Second, build it back up learning from the mistakes of the past.

Government beauracracy is not the answer. There are other options out there, but none are being reported. Here are the two main bills: HR 676, HR 3200. Check them out for yourselves at http://thomas.loc.gov/ and at http://www.congress.org/congressorg/home/, and click on "legislation". Be informed, not from just what you hear on the news and through heresay, but through your own research. Then, make your own informed decision.