Socialized medicine and nurses pay...

dnp2004 · Mar 17, 2009

Universal Healthcare, Socialized Medicine, I really don't care what you call it. I am personally against it. I have worked in Federal Access Hospitals ( these are rural hospitals that are maintained by the federal government) and the conditions were not good. First the pay was extremely low (with experience), they did not pay into SSI, or if you didn't have the 40 quarters necessary, you would lose all that you have paid into it.
I have talked with several nurses from Canada, and many nurses have to work more then 1 job to make enough money to pay their bills. I have researched the differences in the different models used and personally don't like any of them.
While it might work in the short term, what about the long term? Will we still have the number of physicians that we will need to care for the aging polulation? I have been in this industry since I was 19 years old and have seen many changes, some good and some not so good.
As nurses, we need to research this issue and come together as a group, to benefit our fellow nurses and to benefit our future patients.

I don't have any work experience in Federal Access Hospitals. Although I am a U.S. citizen that has worked in several nationalized health care systems over the past 40 years. This is my experience working in the industrialized countries that had advanced public health care systems:

I did not have to limit my patients access to healthcare because of their socio-economic status.
I did not order procedures based on cost.
Cost was never a concern when I wrote prescriptions either.
I was free from insurance company second- guessing and patient-provider interference/denials.
There was no medical bankruptcy. A sick person did not have to worry about the hospital taking their home away.
My pay was quite good.
Work conditions were good.
Licensing was 100% standardized throughout the countries I worked in. You could work anywherein the country you were licensed in as well as in other countries with reciprocating licensing agreements. No 50 certifications for 50 States. Which explains why I am licensed as a OB/GYN and as nurse depending of my location in the world. Long story!
Medical personnel could not be terminated simply because a facility administrator was having a bad day. Evidence and clear-cut protocols were the name of the game.
Even though I am an attorney as well a health care provider, I had no fear of patient lawsuits. They were extremely rare. Even when they did happen it was always the Patient vs. the Federal Government (Health Care System). Not the Patient vs. The Hospital or worse yet, The Patient vs. the individual health care provider!
Health care professionals did not have to carry individual Liability Insurance.
While we always tried to accommodate religious and culture differences, we weren't forced to disrupt the whole facility either.
When I was an administrator, I never was forced to discriminate against any my employees because of their race, nationality,gender, religion, or sexual preference. For example if a patient told me they refused to be taking care of by Black, Jewish, Polish, you fill in the blank, caretakers. I would tell them there request was impossible and would offer to immediately write up their discharge orders and to free up their bed if this was a problem. For me to to do otherwise was illegal and unethical. If they got nasty about it I would tell them to take the issue up with Parliament when they are in session next because they are the only ones who can change the laws.

Now I am not saying National Health Care is perfect. It has problems too. Though overall I think my experiences have been very positive with it.

Besides most of you already know that he U.S. already has national healthcare for senior citizens, military personnel, governmnet workers and the very poor. For those of you against national healthcare, what do you propose we do with these four groups who already have it? If you think we should keep them status quo, do you think it is wrong for other U.S. Citizens to want to be covered as well?

dnp2004 · Mar 17, 2009

I think we need to remember that lawsuits have completely gotten out of hand, as well, and need to be taken into consideration when deciding to go to a nationalized system. I agree we should try to take the profiteering out of medical care, but we'll have to overhaul the malpractice laws as well. I don't know much about Canada or Australia's systems, but I'm willing to be that it's a lot harder to sue healthcare providers in these countries, which really would be a blessing to this country, I think. The 'capitalism at all costs' mentality has gotten the US into the economic pickle we're currently in. It's time to look at other ways of doing things.

Amen to that! National Healthcare makes tort reform much easier because you can have one set of licensing standards, laws, rules and regulations to deal with instead of 50+.

Pediatric Critical Care Columnist · Mar 17, 2009

I think we need to remember that lawsuits have completely gotten out of hand, as well, and need to be taken into consideration when deciding to go to a nationalized system. I agree we should try to take the profiteering out of medical care, but we'll have to overhaul the malpractice laws as well. I don't know much about Canada or Australia's systems, but I'm willing to be that it's a lot harder to sue healthcare providers in these countries, which really would be a blessing to this country, I think. The 'capitalism at all costs' mentality has gotten the US into the economic pickle we're currently in. It's time to look at other ways of doing things.

You're quite correct about that. In Canada the award in a wrongful death suit is usually no more than $100,000 for an adult and between $10,000 and $40,000 for children. The families who sued over the pediatric cardiac surgery deaths fiasco in Manitoba in 1994 were awarded $10,000 each. Fewer than 10% of potential medical malpractice cases are ever filed and of those, only about 1/5 proceed to trial. Out-of-pocket costs to the plaintiff are astronomical with no guarantee of damages at the end. We inquired into the feasibility of filing a suit over a medical misadventure suffered by our son 20 years ago that left him totally dependent on others and were told that although there was a good possibility we had a case, there was virtually no possibility of recouping any of the approximately $100,000 in legal fees we'd have to pay as the case progressed. Contingency as seen in the US does not exist here, so the costs would've been on a pay-as-we-went basis. We don't have that kind of cash lying around so the notion died a rapid death. In general, Canadians are less litigious than our neighbours to the south.

madwife2002, BSN, RN · Mar 17, 2009

I had visitors this week from the UK and we discussed at great length the remarkable changes which are occuring in the health service in the UK. One such thing is the reduction in the waiting lists for planned surgeries to days and weeks. The GP goes on line and finds where the pt can have surgery on days suitable for the pt and can book it there and then. No more waiting for an appt to come through you know when and where immediatly.

Nurses are working with health authorities to prevent numerous re admissions known as the revolving door, by maintaining these pts in the community. Great things can be learnt from other countries of how to manage care.

We had a pt readmitted today dehyrated because she was frightened to drink because she didnt know where to buy 'thicken up" as the pharmacies dont stock it round here!!!!The pt has to phone or go on line to order.

I still dont earn what I earn't in the UK and i have been here 4 yrs. I miss the vacation time but I love living here

Honnête et Sérieux · Mar 20, 2009

People think it's about some of us simply not wanting a "socialize" healthcare system.

The reality is that Americans won't tolerate this kind of system no matter what label you put on it.

madwife2002, BSN, RN · Mar 21, 2009

People think it's about some of us simply not wanting a "socialize" healthcare system.
The reality is that Americans won't tolerate this kind of system no matter what label you put on it.

That is so true and such a horrendous story, thanks for sharing.

elkpark · Mar 21, 2009

People think it's about some of us simply not wanting a "socialize" healthcare system.
The reality is that Americans won't tolerate this kind of system no matter what label you put on it.

There are plenty of healthcare horror stories within the US, also. Our paying much more for healthcare than any other industrialized nation is no guarantee that we're getting "better" care. I surveyed hospitals for my state for several years, which included investigating complaints and unusual/suspicious deaths, and saw plenty of terrible situations.

RN4MERCY · Mar 21, 2009

There are plenty of healthcare horror stories within the US, also. Our paying much more for healthcare than any other industrialized nation is no guarantee that we're getting "better" care. I surveyed hospitals for my state for several years, which included investigating complaints and unusual/suspicious deaths, and saw plenty of terrible situations.

And that's why we need to remain involved in our government as an engaged citizenry and hold our legislators accountable.

It's not acceptable, when making social service cuts, that the first thing to go after care for the poor, seniors, children, and women are budgets for public healthcare enforcement agency personnel. The privatization of health care and capitulating to insurers is one of the most heinous examples where the lack of transparency has killed people by the hundreds of thousands. Their weapons of destruction are exclusions, recissions, delays, co-pays, deductibles, and denials. When they get caught fraudulently cheating they write it off as the cost of doing business. Why are we allowing them to ration health care in this country and rip us off by making ungodly profits while they do it? We need to "civilize" medicine and access to health care in this country by passing HR 676.

And beware the framers of the debate who may be trying to suggest that "nurses pay" is somehow responsible for the high cost of health care in this country...a very devious attack on workers by corporate interests. The current system works for them: avoid sick people and, if they happen to get in the door, make a profit by not hiring enough RNs to care for them. :banghead:

Honnête et Sérieux · Mar 22, 2009

There are plenty of healthcare horror stories within the US, also. Our paying much more for healthcare than any other industrialized nation is no guarantee that we're getting "better" care. I surveyed hospitals for my state for several years, which included investigating complaints and unusual/suspicious deaths, and saw plenty of terrible situations.

When you investigate "compaints," all you will see is the negative. Generally adequate or superior care is not 'reported.'

The reality is that healthcare delivery in socialized systems is no better than it is here, no matter what some WHO survey may try to tell convince us.

Cheaper...yes. They don't allow their attorneys to run rampant across the country making millions of dollars in medical malpractice like John Edwards did, driving up the cost of insurance, and driving physicians to practice more costly defensive medicine. They don't attempt rescusitation on neonates as early as we do...simply discarding the fetus in a non-statistical way if it is born before a certain age or below a certain weight (at which we would attempt to rescuscitate)...and then claim better infant mortality rates.

And if our care isn't better, it makes me wonder why politicians from countries which are ranked "higher" than ours in healthcare delivery (Canada, Italy), came to the US for healthcare. If Cuba supposedly has a better system, then why did Castro have to import a surgeon to operate on him? If they supposedly have a better infant mortality rate, why doesn't Canada send their surplus high-risk obstetrical patients to Cuba instead of the US? (in 2008, just TWO of the 13 provinces/territories sent over 100 of their high risk babies to the US). Not healthy obstetrics...their high risk OB's.

People have been too easily convinced that our healthcare system is a complete wreck, and that they want it to look like someone elses wreck.

Healthcare is a personal choice, a result of the decisions we make about ourselves, how we behave, what we eat, and where we spend OUR MONEY...and it amazes me that people want to make it a function of the gov't.

http://www.telegraph.co.uk/health/healthnews/5029626/Hospital-scandal-missed-warnings.html

And before someone accuses me of cherry-picking information, I'd just like to share that for these 'incidental' links I shared so far, all I did to find them was go to UK Google News and click on one of the first stories that pops up in the health section.

dnp2004 · Mar 23, 2009

when you investigate "compaints," all you will see is the negative. generally adequate or superior care is not 'reported.'

the reality is that healthcare delivery in socialized systems is no better than it is here, no matter what some who survey may try to tell convince us.

the systems used in various countries are quite different from each other. btw, i know i must sound like a broken record but i have to say it again. the united states currently has socialized systems for tens of millions of people. since it is in fact socialized medicine would you be in favor of eliminating those programs? i will list them at the end of this posting.

universal healthcare systems are very different from each other. as a matter of fact in some countries you can opt out of them and purchase your own insurance. would you approve of that?

cheaper...yes. they don't allow their attorneys to run rampant across the country making millions of dollars in medical malpractice like john edwards did, driving up the cost of insurance, and driving physicians to practice more costly defensive medicine. they don't attempt rescusitation on neonates as early as we do...simply discarding the fetus in a non-statistical way if it is born before a certain age or below a certain weight (at which we would attempt to rescuscitate)...and then claim better infant mortality rates.

i agree that we need "common sense" tort reform. the lawsuits are out of control.

as an ob/gyn i can tell you from experience that the primary reason the infant mortality rates are so high in the united states is because of the complete lack of care uninsured/underinsured pregnant women are receiving. many of my patients work over 50 hours a week up to the time of delivery and yet they cannot obtain the insurance they need. they maybe working several part time jobs, hence they are not eligible. do you know how much an individual has to pay for decent family insurance coverage? yearly deductible limits? how much medicine costs? what happens if you have a preexisting condition? i have tried to help my patients receive insurance. it is a real mess!

and if our care isn't better, it makes me wonder why politicians from countries which are ranked "higher" than ours in healthcare delivery (canada, italy), came to the us for healthcare.

politicians want the best healthcare they can receive and many of them realize how great the u.s. system can be. you have to remember something, a country is typically ranked higher than the united states because their medical coverage maybe better for the majority of their population. that being said politicians are in a class of their own. think about the following:

-politicians typically don't have to pay for their family coverage.

-politicians are covered for life.

-politicians don't have insurance gatekeepers trying to deny their claims and second guessing treatments.

-politicians don't pay for prescriptions nor do they have to worry about a particular medication being on an approved list.

-even if the treatment is highly experimental, a politician has 100% coverage. $400,000.00 transplant, no problem!

-politicians are given private rooms.

-politicians pick and choose their medical staff.

-politicians choose their dieticians and chefs that can make "medically-compliant" meals for them.

-politicians have themselves, family, medical equipment, personnel and medicine flown anywhere without regards to cost.

-politicians don't have to worry about decreased income due to sickness. they are paid 100% of their salaries even if they are incapacitated.

-politicians that leave office are typically paid a very decent salary for life.

after reading the above i think it is quite obvious the rest of the population is not eligible for this type of coverage. it is multi-tiered system that we have in the u.s. with those in the lower and middle socioeconomic strata being an uninsured/underinsured population in the tens of millions.

if cuba supposedly has a better system, then why did castro have to import a surgeon to operate on him?

castro is a politician that can afford the best. besides, an outside surgeon is less likely to try to kill him. he has many enemies.

if they supposedly have a better infant mortality rate, why doesn't canada send their surplus high-risk obstetrical patients to cuba instead of the us? (in 2008, just two of the 13 provinces/territories sent over 100 of their high risk babies to the us). not healthy obstetrics...their high risk ob's.

this policy is wise for canada . contractingto the u.s. means there is less staff to hire and less expensive equipment to buy. they found that in bordering communities they could save millions by using u.s. facilities that can absorb the surplus high risk cases. as far as sending patients to cuba, well the u.s. is much closer to canada than cuba. also the u.s. is better for handling high-risk pregnancies.

people have been too easily convinced that our healthcare system is a complete wreck, and that they want it to look like someone elses wreck.

honnête et sérieux are you insured? if you just whip out your insurance card and receive the best care, than the system works for you. if you are not insured and can't receive insurance, i suppose the system might seem like a wreck. of all of the universal systems you examined do you think all of them are worse than the u.s. system? what would you do about the uninsured/underinsured? healthcare is a personal choice, a result of the decisions we make about ourselves, how we behave, what we eat, and where we spend our money...and it amazes me that people want to make it a function of the gov't.

assuming one is eligible and can pay for medical coverage of course. even if you can pay; the insurance company may not pay for a certain procedure, they may not pay for the medicine your doctor recommends. if you are really sick i suppose the only choice you have is to pay out-of-pocket for the $400,000.00 transplant.

since you believe healthcare choices should not be a function of government, do you want to eliminate the following healthcare related systems that are a function of government for:

u.s. military personnel
veterans administration
medicare
medicaid
government employees
all state based medical benefits systems
hospital certification
medical personnel licensing
usda food inspection programs
fda approval for medication.
federal and state regulation of health insurance companies

dnp2004

madwife2002, BSN, RN · Mar 23, 2009

I would also like to put my :twocents: in. You dont see people in socialised medicine countries lying in the street dying for the want of medical care contra to popular belief. Some of the finest research around is done in countries with socialised medicine.

What you do see here is people almost dead coming to the ER for treatment just before it is too late but then having to stay days longer than anticipated because the illness is too far gone-People are frightened of how much money they will have to pay to come to the hospital-and this happens all the time not occasionally.

Honnête et Sérieux · Mar 23, 2009

A well-written response. Thanks.

I must share, some of the items are oversimplified, and I'm not sure how they can support an expansion of UHC or socialized care.

The systems used in various countries are quite different from each other.

True, but that doesn't stop advocates of a socialized/UHC system from routinely generalizing these systems as examples by which we should model ourselves. For that reason, it doesn't make sense to then dilute my reference to other countries when I use them as an example.

The United States currently has socialized systems for tens of millions of people. Since it is in fact socialized medicine would you be in favor of eliminating those programs?

I never said that, but I'm certainly not in favor of expanding them. As American experiments in expanding the socializing or "universalization" of our healthcare have shown, they fail even in small models.

Of course I would "opt out" of a socialized system and pay for my own, but the advocates of choice would not, and cannot reasonably offer that option, ironically truly denying me 'true choice.' While I would prefer to keep my own coverage, and pay for it myself, someone will still be needed to pay for any expansion of the socialized systems. I hardly think that those of us who "opt out" would be permitted to "opt out" of footing the bill for everyone else.

I agree that we need "common sense" tort reform. The lawsuits are out of control.

So true. Unfortunately, those who typically advocate for a universalization/socialization of our system are the same ones who impede tort reform. I can't believe they don't realize that their own ideologies are in conflict with themselves. The reality is that significant tort reform would have just as much impact on improving our current system as it would a socialized system. We don't need to change the health-care delivery model, we need to get rid of our litigious insanity.

As an OB/GYN I can tell you from experience that the primary reason the infant mortality rates are so high in the United States is because of the complete lack of care uninsured/underinsured pregnant women are receiving.

For perspective, please understand if I don't apply your personal experience as being a definitive description as to the cause of an issue. I agree that a lack of prenatal care has an impact on our infant mortality rates, but I submit this; one of the reasons our infant mortality rate APPEARS to be so high is because of the various ways that the world calculates infant mortality rates; you acknowledged that different socialized systems operate differently. They also measure themselves differently. We attempt to rescuscitate newborns at times as small as 23 weeks gestation, we keep them alive for extended period of time, and if they die, we count them into our mortality statistics. Whereas, I challenge you to show me that countries using a socialized system who addresses neonates the same. More often, they will not count infants born before a certain week (i.e. 27 weeks...which we would include), or born under a certain length or weight. The reality is that the statistics are not calculated uniformly across the systems. A uniform measurement would likely show substantial changes in the 'rankings,' but countries are ideologically driven to both maintain their system and criticize the rankings if they don't 'flow' in their favor. Even the WHO had to change their 1995 rankings (in 2002), when critics revealed the illogical and flawed methodology. France, previously number one, was angry to be dropped to number five.

Politicians want the best healthcare they can receive and many of them realize how great the U.S. system can be. You have to remember something, a country is typically ranked higher than the United States because their medical coverage maybe better for the majority of their population.

Thanks for making my point. Our system is awesome. So awesome that leaders from countries that boast of their higher rankings come to the us. BTW, not just leaders, but citizens as well. And if you are using the "majority" position, then I fail to see the argument for expanding socialist health programs here.

Castro is a politician that can afford the best. Besides, an outside surgeon is less likely to try to kill him. He has many enemies.

Are you really standing by that idea? Is that what Castro said? And if Cuba produces such a high-quality health system, it makes no sense that a surgeon had to be imported for a relatively uncomplicated procedure. I don't believe for a minute that Castro was any more or less in danger from an imported surgeon than an exported surgeon, and if he is so afraid of his populace, it makes no sense then to suggest that he is providing them a health-care experience that is superior to ours.

This policy is wise for Canada . Contractingto the U.S. means there is less staff to hire and less expensive equipment to buy. They found that in bordering communities they could save millions by using U.S. facilities that can absorb the surplus high risk cases. As far as sending patients to Cuba, well the U.S. is much closer to Canada than Cuba. Also the U.S. is better for handling high-risk pregnancies.

Better for handling high risk pregnancies, but oddly our infant mortality rates are higher. Stating the obvious...this makes NO SENSE.

Maybe fiscally wise for Canada, but a complete slap in the face to people who have to leave the country, leave their families behind, and endure some of the most challenging times of their life away from home in the name of saving a buck. That's just the tip of what is wrong with the idea.

Additionally, it's the SICKEST neonates that are coming to the US, gaining automatic citizenship when being born here (ethically wrong), and impacting OUR statistics, not Canada's...who then claim better mortality rates. Using such logic, we could simply export all our garbage to an Alberta landfill and then claim that we have a cleaner homeland. Furthermore, it looks like a supporting argument for outsourcing our healthcare beyond the borders; where are we going to send our patients to so we can save a buck? And will Americans tolerate it? The reality is that the Canadian system (which some think we should strive to emulate), makes it work specifically because they are able to access our system.

are you insured? If you just whip out your insurance card and receive the best care, than the system works for you.

Yes, I'm insured, and please understand that the context of your question is offensive. No, I don't "just whip out" my insurance card and receive the best care. I lifted myself out of a lower-middle-class upbringing, positioned myself to obtain an education and a job, and I work full-time so that I can obtain healthcare coverage as a part of my compensation package. I submit a certain amount of premium to fund this plan, and pay certain copays and for additional items that I prefer over the quite reasonably acceptable alternatives that I chose to pass over.

I don't indulge in an unhealthy diet, and I don't live on the couch in front of the TV or a computer.

All these things are things I do to preserve my health, and are not simply the function of "whipping out" an insurance card...and I do these things independently of any gov't providing it to me.

Even if you can pay; the insurance company may not pay for a certain procedure, they may not pay for the medicine your doctor recommends.

And again I repeat myself; this is not a valid supporting position FOR a gov't plan. Just because we make it a UHC/socialized system, it doesn't suddenly mean all these things that the "insurance company" wouldn't pay for would suddenly be 'covered' or 'payed for' by a UHC/socialized system. Since people keep making comparisons to other 'socialized' countries, I need to share something that they may have forgotten; UHC/Socialized systems deny care as well.

In closing, your list is not an accurate representation of a socialized system or socialized services. US military personnel (including me, a veteran), gave something to this country. The military produces something, and the VHA provides a service to people who have made a significant contribution. If you want to make a UHC system that makes it's dependents eligible by way of a four (or more) year commitment to serving their country in some way, then I might get on board. I hardly think that's what anyone is proposing.

Government employees are employees. Not government dependents. Same with licensing; the only people licenses are those who made the sacrifice to achieve (AND maintain) the licensure.

And I'm not following you regarding the USDA and FDA; they aren't making anything. The private sector is the one 'producing,' while the gov't is simply making them follow some rules. Now if the USDA and the FDA were actually making our food and drugs, you might have a point.

Good discussion.