I want to know what nurses think about socialized medicine. - page 16

I'm doing a report on Socialized medicine and dont know much about how people feel about it as I live in Idaho.What are any of you Canadian nurses feelings about it? Good or Bad?... Read More

  1. by   HM2VikingRN
    http://www.thelancet.com/journals/la...137-9/fulltext

    I am reading the article as we speak. The principles being discussed have already been operationalized to a great degree in our health care system.





    Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles (table 2): youngest-first, prognosis, save the most lives, lottery, and instrumental value.5 As such, it prioritises younger people who have not yet lived a complete life and will be unlikely to do so without aid. Many thinkers have accepted complete lives as the appropriate focus of distributive justice: “individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate.”1, 75, 76 Although there are important differences between these thinkers, they share a core commitment to consider entire lives rather than events or episodes, which is also the defining feature of the complete lives system.


    Having an ethical framework to allocate resources is not a bad thing. Part of the problems we have in our health care system can be directly attributed to the have it all mentality. We have to be honest and accept that we will have some rationing of care based on clinical need instead of ability to pay. (18000 people a year are dying in the US d/t inability to pay for needed care.) No one will have a zero priority for care under the complete lives system.

    y
    contrast, the complete lives system combines four morally relevant principles: youngest-first, prognosis, lottery, and saving the most lives. In pandemic situations, it also allocates scarce interventions to people instrumental in realising these four principles. Importantly, it is not an algorithm, but a framework that expresses widely affirmed values: priority to the worst-off, maximising benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.
    This is not a framework for denying care it is a framework to extend care to more people rather than fewer....
  2. by   HM2VikingRN
    http://www.thelancet.com/journals/la...137-9/fulltext

    I am reading the article as we speak. The principles being discussed have already been operationalized to a great degree in our health care system.





    Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles (table 2): youngest-first, prognosis, save the most lives, lottery, and instrumental value.5 As such, it prioritises younger people who have not yet lived a complete life and will be unlikely to do so without aid. Many thinkers have accepted complete lives as the appropriate focus of distributive justice: "individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate."1, 75, 76 Although there are important differences between these thinkers, they share a core commitment to consider entire lives rather than events or episodes, which is also the defining feature of the complete lives system.


    Having an ethical framework to allocate resources is not a bad thing. Part of the problems we have in our health care system can be directly attributed to the have it all mentality. We have to be honest and accept that we will have some rationing of care based on clinical need instead of ability to pay. (18000 people a year are dying in the US d/t inability to pay for needed care.) No one will have a zero priority for care under the complete lives system.

    y
    contrast, the complete lives system combines four morally relevant principles: youngest-first, prognosis, lottery, and saving the most lives. In pandemic situations, it also allocates scarce interventions to people instrumental in realising these four principles. Importantly, it is not an algorithm, but a framework that expresses widely affirmed values: priority to the worst-off, maximising benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.
    This is not a framework for denying care it is a framework to extend care to more people rather than fewer....
  3. by   fetch33
    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....
  4. by   HM2VikingRN
    Quote from fetch33
    Just heard a horror story from Canada on a talk radio show.
    ....
    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....
    1. Don't believe anything you hear on talk radio.....

    I can think of numerous programs that run well and efficiently....

    SS-less than 3 cents per thousand for administrative costs....(VS 2% for your 401 k)
    Medicare-3 % overhead vs 25% for "efficient" private markets.....

    Markets can't cure health care....
  5. by   HM2VikingRN
  6. by   fetch33
    Quote from HM2Viking
    1. Don't believe anything you hear on talk radio.....

    I can think of numerous programs that run well and efficiently....

    SS-less than 3 cents per thousand for administrative costs....(VS 2% for your 401 k)
    Medicare-3 % overhead vs 25% for "efficient" private markets.....

    Markets can't cure health care....

    http://www.msnbc.msn.com/id/22184921 about medicare fraud

    From http://www.hhs.gov/stopmedicarefraud/ :

    Most health care providers are doing the right thing and providing care with integrity. But sadly, due to the illegal actions of a small but active group of heath care fraud perpetrators, billions of dollars are stolen from taxpayers each year. Medicare fraud schemes have grown bolder and more elaborate, resulting in billions of dollars in false billings and fraud schemes which are robbing Medicare and Medicaid blind and leaving our most vulnerable citizens at risk.

    http://www.oregonlive.com/news/index..._social_s.html :
    Cheaters cost Social Security billions

    by Bryan Denson and Brent Walth, The Oregonian Saturday December 06, 2008, 8:36 PM


    The Social Security Administration has fallen behind in reviewing the medical conditions of 1.7 million Americans on its disability rolls, potentially paying up to $11 billion in benefits to people who are no longer disabled.
    The agency's failure to tackle those pending disability reviews allows tens of thousands of undeserving people to bleed government funds that Americans count on when they become too sick or injured to work, The Oregonian found in an ongoing investigation of Social Security.
  7. by   ghillbert
    Quote from fetch33
    Just heard a horror story from Canada on a talk radio show. ...
    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.
    Last edit by ghillbert on Jul 26, '09 : Reason: typo
  8. by   loriangel14
    Very well said.
  9. by   HM2VikingRN
    Quote from fetch33
    http://www.msnbc.msn.com/id/22184921 about medicare fraud

    From http://www.hhs.gov/stopmedicarefraud/ :

    Most health care providers are doing the right thing and providing care with integrity. But sadly, due to the illegal actions of a small but active group of heath care fraud perpetrators, billions of dollars are stolen from taxpayers each year. Medicare fraud schemes have grown bolder and more elaborate, resulting in billions of dollars in false billings and fraud schemes which are robbing Medicare and Medicaid blind and leaving our most vulnerable citizens at risk.

    http://www.oregonlive.com/news/index..._social_s.html :
    Cheaters cost Social Security billions

    by Bryan Denson and Brent Walth, The Oregonian Saturday December 06, 2008, 8:36 PM


    The Social Security Administration has fallen behind in reviewing the medical conditions of 1.7 million Americans on its disability rolls, potentially paying up to $11 billion in benefits to people who are no longer disabled.
    The agency's failure to tackle those pending disability reviews allows tens of thousands of undeserving people to bleed government funds that Americans count on when they become too sick or injured to work, The Oregonian found in an ongoing investigation of Social Security.
    The fraudulent Medicare billers are usually caught (and they tend to rip off all payers).......I am quite certain that private disability insurers have waste fraud and abuse problems.


    In my original post I was addressing efficiency of payment and administration not loss prevention functions. I was also addressing SS function as a payer of funds for retirement not in its disability insurance function....(Although in the article the SS managers acknowledge that they have a backlog of cases to adjudicate but they also are attempting to address a backlog in initial applications for benefits.) Its a case where the problems are already recognized and the system is trying to fix itself. Its hardly inefficent or venal when problems are being addressed.
    Last edit by HM2VikingRN on Jul 26, '09
  10. by   HM2VikingRN
  11. by   loriangel14
    Thank you for posting that, it was a very interesting read.
  12. by   misswoosie
    Quote from fetch33
    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.
  13. by   fetch33
    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.
    Last edit by fetch33 on Jul 27, '09

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