Please provide insight into nationalized health care.

5cats · Mar 9, 2009

Every system has it's problems, but I think everybody deserves basic care and emergency care. But what's the definition of both? And who's paying for it and who's not?

Here in UK I think there's so much abuse around of our healthcare system, it's unbelievable, just because you don't have to pay for it, it's being paid via taxes. And what you can get is enourmous. So apparantly that's also not really the right way to go, even if the intention (to give everybody the care he needs) is fantastic.

5cats

HouTx, BSN, MSN, EdD · Mar 9, 2009

I'm not going to wade in on the "nationalized health" debate, but I do want to defent the VA system.

You daughter's experience was awful, but I am thinking that this may be a facility-specific issue. My 86 yo father has been a VA patient since his retirement at age 68. In all this time, his care has never been delayed or compromised. Our VA facility here in Houston is extremely well organized - 100% paperless - and highly efficient. And - no, I don't work for them.

1Tulip · Mar 9, 2009

I'm not going to wade in on the "nationalized health" debate, but I do want to defent the VA system.
You daughter's experience was awful, but I am thinking that this may be a facility-specific issue. My 86 yo father has been a VA patient since his retirement at age 68. In all this time, his care has never been delayed or compromised. Our VA facility here in Houston is extremely well organized - 100% paperless - and highly efficient. And - no, I don't work for them.

You may be right. Our facility will get a big increase in their budget and build offices for more bureaucrats. Meanwhile their MRI machine has been down for over a year. Maybe in Houston there are more eyes on what's going on, more vocal veterans who won't put up with shoddy treatment. I don't know who should be held accountable for the state our hospital is in. (The population of our town/burbs/near-by towns together is probably under 500,000 people. Way teenier than Houston.)

It's a heated debate. I don't know about Britain, but here the arguments get really hot, so I don't want to make this to be a Red State/Blue State kind of post. You know... I just want to know if when I'm 75 and come down with breast cancer, (God forbid) will I get shuffled to the side, or given cheaper treatment because my productive years are behind me and it wouldn't "pay off" in government calculus to give me the expensive chemo drugs.

I guess if you strip the politics away, Americans (folks like me and I think I'm pretty average) want to get good health care, when they want it, at an affordable price. That's about it.

I thought a nurse who lives with a system like that, as a patient a professional and a tax payer, could provide information and opinion we don't get over here. The discussion here is just so heated... both sides have vilified each other and no one is genuinely asking and listening.

allnurses Guide · Mar 9, 2009

It's a heated debate. I don't know about Britain, but here the arguments get really hot, so I don't want to make this to be a Red State/Blue State kind of post. You know... I just want to know if when I'm 75 and come down with breast cancer, (God forbid) will I get shuffled to the side, or given cheaper treatment because my productive years are behind me and it wouldn't "pay off" in government calculus to give me the expensive chemo drugs.
.

There are lots of myths about national health care from what I read in some of the healthcare reform posts, one being that once you get to a certain age you are no longer treated. In the scenario you describe, you would be treated like any other patient, treatment would be based on your co-morbitities and the progression of the disease. If aggressive treatment is in your best interest (in the opinion of your doctors) then you would be treated. It is not up to the government to dictate individual treatment options it's down to the treating physician and they couldn't give a toss about how much it costs.

it may help if you ask more specific questions, there are lots of things I would change about the health service but I definitely wouldn't want a system where you are only able to access healthcare if you can afford it. I'm a great believer in healthcare for all, I don't mind paying national insurance to fund it either.

1Tulip · Mar 9, 2009

Thank you. that is very helpful. I know we are getting facts about national health care that are "spun" to fit a narrative.

Some of the negative things that are mentioned: (and apologies, we're talking about politicians here, OK? Not sure how your political campaigns are done, but ours are rarely civil. Here goes...

"You're going to have to wait for (insert number here) months to get an MRI and even longer for elective surgery."

I've already mentioned "we have medicines that citizens in the UK can't access".

"It's sinking the British economy" (Who can tell what's sinking economies around the world... this may not be answerable.)

"People have no 'skin in the game', no reason to have good life habits because they don't have economic consequences of seeing a doctor or being a patient in the hospital.

(Again... these are the politicians' lines...) "If Britain and Canada have such wonderful health care, why are their rich citizens coming here for their heart surgeries?"

"There are fewer and fewer people willing to become RN's and MD's to work in the national system and the hospitals are going to third world countries for nurses and physicians" (But then... so do we, and ours are really excellent.)

This is a longish list and I'm sure that both sides on our health care controversy will come up with lots more "information" that they'll use to move the debate their way. Please take up any of them or all. I just appreciate you're real life experience.

BTW: Once (when I still had money) I visited the UK. I started having problems with asthma. The B&B owner told me to go around the corner to a clinic (and I had trouble finding it because it wasn't all steel and glass with a big sign in front!) and speak to the M.D. Wow! I probably waited all of 15 minutes and I got a prescription in a snap. She was really nice I had to buy the inhalers of course, but so what...

MandaAnda · Mar 9, 2009

As an American who has lived in the UK throughout her 20s, I think the NHS is great on the whole. I've done my nurse training here (I do happen to like the American way of training nurses better though). I like the autonomy that a lot of nurses have here.

I certainly don't mind paying towards the NHS through my taxes (makes it nice that I never "see" the money in the first place), although I do get frustrated that people who *choose not to work* get to benefit what my tax money goes towards (I don't mean stay at home mums, but I feel that it's easy to sponge off the UK benefits system).

Overall, I think the care is pretty good. Working in paediatrics, I actually think too many kids get admitted to hospital for things that can be cared for in the community. My personal experience of waiting lists hasn't been bad. I had to have all four wisdom teeth out under GA, and it was only a three month wait or so.

I don't think the NHS has facilities that are as sparkly new and high tech/cutting edge as the US sometimes, but it's not that high on my worry list. I think my main irritants with the NHS are that it's not standardised (you'd think it would be, but every Trust has different products for the same thing, different policies, etc.) and that the NHS must haemorrhage money treating those who aren't eligible (we have NHS cards if we're eligible for treatment on the NHS, and I really think that people should have to product that at the point of care).

allnurses Guide · Mar 9, 2009

Thank you. that is very helpful. I know we are getting facts about national health care that are "spun" to fit a narrative.
Some of the negative things that are mentioned: (and apologies, we're talking about politicians here, OK? Not sure how your political campaigns are done, but ours are rarely civil. Here goes...
"You're going to have to wait for (insert number here) months to get an MRI and even longer for elective surgery."

In the UK we now have some very strict government targets that we have to meet for elective non urgent work, this is an 18 week referral to treatment time. The days of long waits for elective surgery is long gone. This time is even less for urgent surgery.

My one complaint would be that we all work extremely hard to get these patients dates to come in for treatment, optimising and making sure they are fit for surgery and then because our social care in the community is lacking there isn't enough capacity in our hospitals to accommodate them, therefore they are cancelled.

I've already mentioned "we have medicines that citizens in the UK can't access".

Not sure, I know there has been some controversy surrounding some of the cancer treatments that have not been approved by the National Institute of Clinical Excellence, however this is not government driven it is evaluated on the best use of resources, so the expensive drugs that have limited proven effectiveness may not been approved for use. To the patients that they are denied it may be the only hope for prolonged life, however these drugs are few and the decisions are made by clinicians

"It's sinking the British economy" (Who can tell what's sinking economies around the world... this may not be answerable.)
"People have no 'skin in the game', no reason to have good life habits because they don't have economic consequences of seeing a doctor or being a patient in the hospital.
From what I have read (and I haven't experienced any other system than the UK this is my impression from this site) health promotion and chronic disease management is very good in the UK, the GP's get insentives for managing these patients effectively and many of our departments have very active health education and promotion units.
(Again... these are the politicians' lines...) "If Britain and Canada have such wonderful health care, why are their rich citizens coming here for their heart surgeries?"
I am not sure they are, if they are rich then they could afford private healthcare in the UK, I have yet to see statistics to support the comments that rich Brits are flocking to the US for treatment.
"There are fewer and fewer people willing to become RN's and MD's to work in the national system and the hospitals are going to third world countries for nurses and physicians" (But then... so do we, and ours are really excellent.)
We haven't aggressivley recruited from overseas for many years now, we have waiting lists for entry to medical and nursing school and our new grads often struggle to find work.
If I may add my own experience into this, I injured my knee quite badly 2 years ago, I was seen in the emergency unit within an hour and given emergency treatment, then followed up in a fracture clinic the following week where I was referred to physio. I had a physio appointment withint 2 weeks, and got first class treatment. Unfortuntely this treatment was not enough, there had been too much damage to underlying tissue and I had to have surgery, from the date booked it took just over 2 months for me to get a date for surgery, it was my own choice to delay this for another 2 months. I continued with physio and followups with the surgeon and again needed more surgery. Within 2 month of this I will have a date for surgery in the next few weeks.
I have recieved first class treatment thoughout this experience.

cariad · Mar 11, 2009

as a brit, who has now been in the us for 5 years, we misunderstood how the american health care system worked, we foolishly thought that we had health insurance so when we had to access the treatment after a car crash we didnt know what the bills were that arrived daily from all sorts of medical providers, we werent aware that even with health cover , we still had to pay part of the bills. i ask my american co-workers how the system works, and even they dont understand it. i work in the hospital and my dh still has medical problems, as an outsider it looks to me that there is plenty of socialised medicine here, in az its called achss, which is for people with nothing or not very much money, medicare for the elderly and of course insurance companies that control the american health system...the only difference i see, is that when i lived in the uk, i paid for my free medical care through payments taken from my wages, over here, i pay for my medical care through payments that go to a private health company, any profits they make go into someones pocket, any money that is paid in the uk goes into the health system. there is good and bad both sides of the atlantic, but speaking from experience my ex- just had open heart surgery in the uk, after going to the er, he was admitted, had the surgery 3 weeks later, of which time he remained in the hospital, he is now home going through cardiac rehabilitation, and has no money worries as there is no cost involved, he lives in wales and doesnt pay for any prescriptions and while he is off work he gets sick pay from his company. compared to the treatment for my dh's cardiac problems, we may have had next day treatment, but then the bills arrive and when he has no income he has the worry about paying for them, plus the high cost of our monthly prescriptions, and as sharrie says, its not the government who makes decisions about health care its the staff who work for them, much the same people who make the decisions over here.

1Tulip · Mar 11, 2009

You folks have really provided some good information. I do think we're getting distorted images about your system.

Our system has some real problems. The political furor has arisen because there are (according to the Democrat party) "45 million uninsured Americans". Well, yeah... about 13 - 15 of these Americans aren't Americans. They're here illegally. (On my unit about 10% of my patients speak no English and have no familly members who can.) Most of the other Americans finance their middle class life-style by not paying for health insurance. They've made a choice. Buy a brand new recreational vehicle, or pay health premiums... hmm... guess which one they choose?

About half the patients on the neuroscience unit where I work are uninsured. Because these people get first rate care and don't pay for it, I pay for it through my state taxes (if they are qualified to be put on Medicaid) or by huge hospital bills if I have to be admitted.

It's frustrating. Does the UK have anything like our Departments of Motor Vehicles? It's a running joke that no matter what state you live in, you have to deal with this immensely tedious, inefficient bureaucracy. That's what Americans fear our health care would be like if we become a single payer system.

cariad · Mar 12, 2009

in the uk everyone who works pays towards their health care even if they choose to go and get private treatment and choose to pay for that. so if the americans had a health system where you paid out of what you earned, towards your health care, then all workers would pay, there would be no choice. my point is that those of us who do work and pay health benefits in the usa, the profit from that goes into the companies pockets, the profits from what you pay from your wages in the uk, go back into the health care system. the uk has the same problems as the usa people who dont work, dont pay into the system but still get the treatment for free. the only people who suffer in the usa are the workers who do pay and then still get stung after the treatment, with medical bills. in the uk you still get the same treatment without the medical bills, and please ask someone in the uk what rate of tax they pay, as usually americans think that everybody pays 40% or more,,,,the real rate is 23%, but then it may even differ from that as i am not in the uk anymore.

Silverdragon102, BSN · Mar 12, 2009

National Insurance contributions on average is 23% but does vary depending on how much you earn and whether employed or self employed.