Socialized Medicine/Nursing

Julie, RN · Jun 11, 2000

Oooh! What a great question!

My father-in-law lives in England and has expressed to us that he has to wait quite a while for tx. I also watched a cable documentary on how ER's function in the UK, the health care providers were frustrated b/c people were showing up in the ER for anything and everything-not just emergencies (in order to meet their perceived health care needs quicker). On the other hand, I feel health care in the USA is too expensive and many uninsured are not getting good treatment-preventive medicine is really lacking in this group (b/c they often only show up to a hospital when it's too late).

Every system has it's faults, so what is the remedy????

Cheers!

Julie M.

AHarri66, BSN, RN · Jun 11, 2000

I think you're exactly right about government infringement into industry (including medicine) and personal lives/property leading us towards socialism. When more regulations, taxes, and laws are enacted it has the effect of driving prices up and quality of product down. Couple that with an overly litigious society, and we're all in trouble! The cost of health insurance and medical care as a whole has increased greatly since the times of fee-for-service; wage regulation, tax-funded insurance programs, and the need for high coverage malpractice insurance for medical professionals have all had a large part in this. Of course, this was all done in the name of improving the quality of life for everyone, but in actuality it has only served to push goods and services even further out of reach for people as a whole. This trend has effected all areas of life in the US, and is a far cry from what our Founding Fathers had in mind when they spoke of a 'limited government.' This becomes more clear if you realize that a tax of approximately 8% would fund a Constitutionally mandated government, but we are now taxed an average of 45% (including 'hidden' taxes.) Think of how much more people could afford if they were allowed to spend their *own* money how *they* see fit--not how Uncle Sam dictates.

Regards,

Angela

PPL, BSN, RN · Jun 12, 2000

Exactly! Thanks for posting. I hope to hear directly from the UK and Canadian nurses too. What are they taking home AFTER taxes, what conditions, staffing ratios, etc? Also, I wonder what their fellow physicians are feeling about their system? I worked at one facility in the US where canadian doctors came for treatment, now why is that? I wonder! Hey, I love this site! Smiles and best to all!

barry · Jun 14, 2000

Why dont you ask your question in the newsgroup sci.med.nursing or uk.sci.med.nursing there apear to be many more worldwide nurses on these newsgroups they may however be tired of the topic.By the way almost every country in Western Europe and Australia and New Zealand (if you know where that is) have what you would refer to as socialised medicine with a greater or lesser degree of private medicine. Where I grew up socialism was not a dirty word and I strongly support our public health system.

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bunky, BSN, RN · Jun 14, 2000

What a GREAT topic! I am Canadian, and came down to the States to work because one of the drawbacks of socialized medicine is that it suffers the pangs of a poor economy just like everything else. The differences between the two systems are incredible. In any system you will find abusers, people who run to the ER for non-emergency tx. Here you have a lot of medicare and medicaide people who do this because it's free and they can set their own time to come in. But the biggest difference that I see is the overall level of health in the country. Why? Because with socialized medicine people don't have to let their wallets dictate their health. People go to the doctor earlier and prevent complications. This makes compliance easier too as they can go for follow up care even though they may be feeling better. This is especially important prenataly! Do you know that the US has a higher infant mortality rate than some so-called third world countries?!

And talk about waste! I worked in a long term care place that had a medicare unit. When pt's meds were dc'd we had to destroy them! Perfectly good meds were wasted once a month! I also worked on a pedi unit, where I swear we saw every kid who had ever vomitted in that town, and if the kids came in with a fever, the diagnosis was always R/O sepsis and involved a lumbar puncture. I see elderly people admitted for debridement of decubitus (and I've never seen so many decubitus as I have here by the way) then while they are there, lets just do an EGD and colonoscopy on them even though they are like 90 and if we happen to find a hiatal hernia what in the world are we gonna do about it? I see lots of expensive blood cultures being done just because someone has a fever post op, and I see a lot of CT scans done for CYA reasons. I think the biggest shock to me is the number of end stage alzheimers, and CVA people on tube feeds to prolong a life that is basically just an existance and we are merely prolonging their death. Never say never here for fear of a lawsuit perhaps? I see doctors having a very hard time finding specialists to take a patient, even a baby, simply because they don't have insurance.

There's a huge overall difference in the attitudes of the patients too. I see a lot of patients, paying or not, feeling like they are at a restaurant or a hotel and demanding services that people in a socialized system gladly attempt to do for themselves, and threatening lawsuits that people in a socialized setting wouldn't dream of doing. Even in nursing homes, we used to get swamped at Christmas time with gifts from relatives who were grateful! Here because it's all for profit, they understaff, and people don't get the care that they need, so families complain and even when those same families get top level priority because the administrator is afraid of them calling the state in, they will want more from you and never once say thank you for anything.Why, because they feel like they are paying for this directly and they are damned well gonna get every penny's worth. When people aren't paying directly yet they are getting a service, they are much more apprecitative of that service as they view it that you are doing something for them. Even the families helped out a lot more than here too!

As for the Canadian doctors going to the US for tx, I guess it's because they don't have to wait for anything. With socialized medicine we do have to wait for some things but in an emergency you have priority, not because you have money to pay for it! And we get Americans trying to sneak into our hospitals too just like you get Mexicans here in the border towns.

From a nursing standpoint how does it compare? Well, you don't have agencies breathing down your neck to see a bunch of paperwork. Despite what you think, there is a LOT less paperwork in the socialized system. They are looking more for the results, not documentation done in triplicate. The emphasis is not nearly so much CYA stuff like you find here. There is more time to do all the nursey nurse comfort care that we learned in school, like post-op baths so you don't see people with betadine on their belly 4 days after surgery. And as for your salary being taxed higher, yes, it is but when you stop to consider that on top of your tax here you are also paying top dollar for some really crappy health insurance, I feel that it evens out. Our benefits are far superior too. When an employer there advertises great benefit packages, they mean it! We get 12 stat holidays a year as opposed to 5 here, with time and a half, sometimes double time for working those holidays, we get dental benefits that pay for almost everything, even 50% for braces, our drug plan benefits sometimes are so good that you only pay 35 cents for your prescription no matter what it is or what it costs. Our higher taxes there show in the condition of our streets too which are much better lit at night and there are sidewalks on both sides of the street. And all of the other benefits we get, like baby bonus for each child once a month you get a cheque depending on your income, and it can really add up for a low income family! Also, I never saw a doctors bill in my life until I came here. And do you know that services provided in Canada at least are cheaper than here too! It's true, while at home I went to see my old family doctor and it cost me half the price to pay out of my pocket to see him than it did to see my doctor in the states, even though I had health insurance, there is still the deductable and copayment. And one of the nicest benefits is that after you have a baby, you get almost a year off with like 66% of your income and you can even split some of that time with the father.

There is good and bad in every system, but overall I'd take the well run socialized system over this one any day! This one just seems out of control and driven by greed as opposed to need.

[This message has been edited by bunky (edited June 14, 2000).]

PPL, BSN, RN · Jun 15, 2000

Ok Bunky, you've offered me much to read and to think about! It does sound like you prefer your system overall, but I'm not too clear on why you came to the states to practice? By the way, I've enjoyed your other posts and wish you were working along side of me. Barry, can you tell me why you are so supportive of your system, and do you agree with most and/or all of what Bunky has told us? Thanks to all posters!

Mary H. · Jun 15, 2000

This is a really interesting topic. I wonder what legal protections and limits on liability are written into the Canadian or other socialized system. Also, our society is different than the other countries, particularly with regard to us not being able to deal with death very well. Bunky, when you compare the societies and legal protections, how do you visualize a system similar to Canada's working here?

bunky, BSN, RN · Jun 15, 2000

Hi PPL. The reason that I came here is simply financial. When I graduated in 1995 and I started job hunting we were in the midst of an economic recession. I'd send out resume's all over the place and all that the hospitals there had were the odd casual positions and not open to new grads. When I started checking around, I found that the seniority lists for the full time employees after multiple lay-offs went as far back as 20 years at one major hospital. Meaning that all the full time nurses left had been there for at least 20 years or they had been layed-off. Everything is unionized so seniority really counts there. In my class there were about 55 of us. Out of that 55, I'd estimate that 10 of us left for the US and it was in order to gain experience, and to work full time. I must add here that when I went to school, I'd say that at least 60% of the students in that entire college were mature students who had been working in other fields but returned to school when the manufacturing industries started laying off people and these people who had only highschool diplomas found themselves without any hope of competing in the job market. It was very depressing because jobs that our fathers held and raised families on, and that my generation banked on and enjoyed for several years, were all of a sudden gone and we were caught with mortgages and debts based on that decent income which was no more. The people that stayed in Canada had an extremely hard time getting a job in nursing and are only now working full time. Meanwhile those of us that left got full time jobs right off the bat.

Now the tables have turned drastically. Now there is a nursing shortage going on there because all of those older full time nurses are retiring, and in earlier response to the poor job situation the nursing schools had cut way back on admissions and were not cranking out RN's like they had before. So now I get recruitment notices from Canadian hospitals asking us to come home and you know what, I am considering it.

As far as the US society and legal limitations? I think it is a situation which has been created due to fear of being sued. And I also think that this idea of suing is a direct result of asking people to pay a fortune for healthcare. When people are having liens put on their homes to pay off thousands of dollars in medical bills, they will look for any reason to recomp some of that money.

As for attitudes about death and dying? I wonder about this all the time. I wonder if it isn't more of a cultural thing, at least in the region and the culture I am working with. It seems that the people who were well off and saw the doctor regularly during their life don't wind up with g-tubes, and their families seem to accept their imminent death without trying to prolong their suffering. Maybe it is lack of knowledge that makes some so unwilling to say no heroics and it may even be partly influenced by guilt at not having had their relative seen by a doctor regularly. It is something that I see all the time and often wonder about. And you do have a mini socialized system here already in the military and it seems to be working alright there.

And you sound very interesting too in your other posts and I'd glady work beside you too

only we may never get our work done because we'd be talking too much. Ha! Ha!

[This message has been edited by bunky (edited June 15, 2000).]

PPL, BSN, RN · Jun 16, 2000

Hi Bunky and other posters. I am also wondering about the level of inovative freedom, R&D, etc., in the socialized systems. I am aware of the much lower prices of pharmacuticles in Canada, but isn't this because much of the R&D cost is on the backs of US citizens? Also, we ARE paying a fortune for health care, but are you saying that isn't the case in Canada, but to me it seems it is, it's just in the form of taxes. So how is that any less and/or better? One problem is that we ALL want the very best available healthcare, but no one wants it to come out of THEIR pocket. I see this alot. To me, it's the Zero Sum Concept, there's NO FREE LUNCH, so it comes out of employer's/employee's pockets for employer subsidized insurance, taxes, federal and state funding and the redistribution of tax monies, private insurance/private out of pocket, and then charity, which of course is NEVER really free, but is reflected in the cost of premiums and taxes to the above groups. I was very interested that you say the Canadian system has much less documentation, CYA, etc. I got the impression that you feel you're much more free to actually nurse there. Why is this the case? I would have thought with government oversight, it would be the opposite. I think the government oversight here in the US and all the accrediting bodies, etc., are a HUGE burden on the management and ESPECIALLY the folks in the trenches! Who is dealing with all the paper shuffling in Canada then? By the by Bunky, my oldest son's lifelong nic is Bunky, so when I discuss these topics with my hubby, I now refer to you as Nurse Bunky, for his convenience! Thanks posters and smiles for one and all!

bunky, BSN, RN · Jun 16, 2000

PPL guess where insulin was first developed? Guess who found the gene for CF? We do have a great deal of R&D going on for a country that has only 27 million.

I can't really explain WHY there's less paperwork despite government involvement either, but it is quite true I promise you. I can give you a good example of it though. I was involved with a state inspection of a nursing home here and in Canada we also had them. In Canada, they looked at the overall health of the residents, decubs, safety issues, privacy issues, satisfaction of the residents etc. Here, the inspector wrote out an entire page of deficiencies about a basket of personal care items that the CNA's were using! It was ridiculous and nit picking to the 100th degree! They looked at all of the other stuff too but their focus is too broad to see the overall picture and money is then having to be spent on "stuff" instead of "staff", and many times it is unnecessary stuff.

And there is more time for actual nursing care because the documentation is sensible, and your not documenting to prove that you actually saw Joe Blow every two hours because you're worried that Joe Blow's family is going to sue your ass off. You get to spend more time with Joe Blow instead of just writing that you saw him sleeping every two hours and Joe Blow isn't watching that clock to ensure that he's getting his hard earned money's worth out of you! When something isn't coming directly out of their pockets, they aren't getting a bill in the mail for it, then people are a lot less suspicious of you.

I think that the government here is preoccupied with looking for fraud and rightfully so because there are huge profits to be made in this business.

And as for the higher taxes, yes it's true they're higher. But think about the money you have to spend on really lousy health insurance here, and then the deductable, and it seems that they're always finding a reason NOT to pay for something. By and large your property taxes are higher here too. Our electricity is cheaper and so is our phone and cable. You get taxed here it's just not as noticeable. And the hospitals don't just rely on tax money there. They've become really innovative on ways to make money. You know the State lotteries here? In Canada part of the provincial lottery procedes go to hospitals. And there is a really neat idea that's getting popular there that I don't see here yet but think it'd catch on like wildfire if they tried it? They are opening up franchises in the hospitals such as one of our best kept secrets which I am hesitant to reveal here ha! ha! Tim Horton's! It's a donut/coffee chain that makes the worlds BEST plain old cup of coffee! They are putting them into hospitals because they are like a sure fire money maker. Some of the childrens hospitals now have McDonalds in them and the hospitals are the owners of these businesses and get the profits. To me, this just seems so damned business savy! And you may be interested to know that the united nations has voted Canada the best place to live in the world again in part because of the socialized approach. US politicians do study our healthcare system as well and have been working on ways to implement something like it. It is similar to the military system that is in place here now, only no one person gets priority treatment in Canada as is the case with active duty VS retired military. It goes by need.

I know I am sounding like a commie and will shut up now. I just see such a huge tax base here to build on and it seems like such a better solution than is currently in place here. The higher infant mortality rate here than in a country like Zimbabwe should be a wake up call.

PPL, BSN, RN · Jun 16, 2000

Yes, give me a cup of plain old(well not old) coffee every time! Down with Starbucks; and bring on Tim Horton's! You're right about taxes in the US, but believe me, they can try to hide'em, but many of us are well aware! As far as the lotto, I just see it as another tax. State says ya can't gamble. State says buy a lotto ticket if ya wanna gamble, meanwhile, they're smashing all the cherry machines in the clubs. Of course, the lotto coffers begin to grow, because as we all know, the odds of winning are horrendous! The state becomes richer and more powerful, while the average Joe Blow(remember him?) has no say in how the "funds" are distributed. Little by little, we become more and more dependent and beholden, not to mention grateful, to our wonderful nanny(read state). Now, back to nursing. Your example re the nursing home inspections and money spent for stuff, not staff is right on! And there IS a great deal of fraud, I agree, but fraud is a government mandate. By that I mean that when the state begins to dictate how much a business can profit, sets up increasingly more regulatory laws, preventing the business from prospering, because it's too costly to meet the regs, then SOMETHING has to give(zero sum again) and here in America, business WILL prosper, even if it has to sneak around, while the nanny is asleep. No Bunky, you don't strike me as a die hard Commie, but don't ever forget from whence that huge tax base you speak of comes. It comes from you and me! The people! Lord, I'm flyin' my flag now! LOL! Thanks Bunky. I suspect you're gonna be missed here if ya go back to Canada.