Socialized Medicine....WHAT IF?

[unclebenny20]

Socialized Medicine...what will happen if Obama changes the US health care system like he says he will and turns it into socialized medicine or something similar? What will the ramifications be for us nurses?

[ZippyGBR, BSN, RN]

i heard wages wont be as high ....

why?

ironically the position the US of nursing not being billable per person at each skill level per hour will if anything reduce the downward pressure on wages that other professions might feel ... particularly in specialities where dotors are either 'overcharging' or undertaking tasks they coud be undertaken by other health professionals

[ZippyGBR, BSN, RN]

I do not think we will have a totally socialized system. I think we will have a hybrid of socialized and private.

show me a system which isn't to dsome degree a hybrid system ... especially for elective or 'cosmetic' procedures

[ZippyGBR, BSN, RN]

Without a doubt, anything subsidized by the Government will lead to the lowest wages they will get away with,

care to substantiate that , and the NHS is not really a fair comparator there due to the way it was set up with the majority of provider units being directly 'owned' by the NHS and if they aren't owned by the NHS (like many of the PFIs) are provided without clinical staff ...

other places in the world buy their services from private providers

it will also lead to poor access to health care and services,

there's none so blind, it amazes me that US health professinals continue withis line despite all the vidence that says huge tracts of the US population has poor access to health care

in the UK everyone who wants a family doctor has access to one - those who choose to abuse the ED for primary care are choosing to rather than being forced to ..

just have a little look at thre whole 18 weeks stuff in the NHS, plus of course the ?cancer and rapid access chest pain targets which predate 18 weeks and arefar ore rigourous

[ZippyGBR, BSN, RN]

Unless things have changed in most of the countries with socialized medicine, I remember reports from Canada, England and other European countries with this type of health care that scared the crap out of me. The biggest issue was the lack of physicians.

People died, waiting to see specialist. You had to be placed on a list to see a cardiologist or other specialist.

it's not a lack of ... it';s a contractural issue in some cases - some doctors actually want a life outside of work so regardless of how big and juicy the carrots dangled they don't do extra work onm top of their 40 whaterever hours a week of planned activities and their on - call commitments

cardiologists - look at the rapid access chest pain suff from the NHS as well as the 18 weeks stuff

sokme of these comments also forget that if something is truely clinically urgent the NHS just admits people to hospital and the GP can just do this ...

[ZippyGBR, BSN, RN]

They also save lots of money by providing far fewer costly tests to treat and diagnose illnesses, you'll see much less ct, mri, pet scans etc, Also once you hit a certain age you won't get treated for many things such as cancer that would cost much more than your life expectancy is worth, the ICU is another area that closes it's doors to you, happens in Europe

it's not just 'costly tests' , it's a case of agreed evidence base and in the case of CT scans in particular legislation ... what exactly is the point of irradiating someone if a USS provides adequate diagnostic information

do you need to run every concievable blood test every day or focus in on the appropriate use of the tests ?

this is aobut good CLINICAL practice as much as it is about cost control ... asking someone paid on a pure fee for service basis whether they would advocate the costliest procedure is going to get you one answer ...

there are no longer age bars in the EU for treatment or access to critical care, however there is a the 'clinical bar' of the patient's best interest and likelihood of survival ...

[getmeoutofhere]

care to substantiate that , and the NHS is not really a fair comparator there due to the way it was set up with the majority of provider units being directly 'owned' by the NHS and if they aren't owned by the NHS (like many of the PFIs) are provided without clinical staff ...

Not sure our pay can be levelled to that, the RCN been campaigning for decent pay for four decades. Any analysis could say it's down to the gender make up, the no or effectively no strike clause it's has as well as other reasons. if we copied nurses in ireland, Finland, sweden or even australia we just may find our pay approaching that of teachers?

there's none so blind, it amazes me that US health professinals continue withis line despite all the vidence that says huge tracts of the US population has poor access to health care

in the UK everyone who wants a family doctor has access to one - those who choose to abuse the ED for primary care are choosing to rather than being forced to ..

We have healthcare that covers us from craddle to grave, covers us for acute and chronic diseases something the US should be able be able to deliver given it's spent per person. Sure would look for someone to explain how they don't manage to?

[ZippyGBR, BSN, RN]

Not sure our pay can be levelled to that, the RCN been campaigning for decent pay for four decades. Any analysis could say it's down to the gender make up, the no or effectively no strike clause it's has as well as other reasons. if we copied nurses in ireland, Finland, sweden or even australia we just may find our pay approaching that of teachers?

Agenda for Change created a previously unthought of position - one where the ordinary staff nurse could earn 30k GBP without overtime, it also removed the artifical pay depressing effect of whitely D grade - which some HAs and trusts used to suppress wages quite effectively

Striking is a double edged sword - look at the damage the most recent fire strike did to the public perception of firefighters in the UK , no longer heroes with soot stained faces but greedy grabbers who get paid to sleep ...

one thing to remember with teachers pay is that do not get any additional allowances - where NHS staff get unsocial hours pay, another factor is teachers salaries do not reflect the amount of ime spent outside the working day doing work - where extra hours for Nurses represent bank wages if not overtime ...

[Katie82, RN]

We MUST stop universal healthcare in its tracks. Now!!!!!!!!!!

I believe there must be a middle of the road compromise. I am hoping for the "hybrid" that another poster mentioned. I will keep my private insurance. I have studied (in school) the socialized systems in a variety of other countries, and they are not the feel-good healthcare for all most proponants of UHC see them to be. I worked with a British nurse who decided to stay in this country because at home, she made less than the CNAs in our hospital did. I am watching the Mass. health insurance plan with great interest, but it will be a few years before real outcomes are known. Most of the opposition there seems to come from folks who do not want to be forced to pay a premium, those who had access but went without insurance because they had other uses for the cost of the premiums. UHC will not be free, to the patient or the taxpayer, and it will be much more restrictive than private insurance. My guess is that most folks with private insurance will keep it.

[Katie82, RN]

why?

ironically the position the US of nursing not being billable per person at each skill level per hour will if anything reduce the downward pressure on wages that other professions might feel ...

Nursing is a billable resource in a round-about way. Cost of labor, which is one of the biggest costs for a hospital, is factored into the "Cost per day room and board" charge. What will happen to this charge under UHC is anybody's guess. It is a fact that Medicare and Medicaid pays less for room and board than private insurance. Many hospitals struggle to make ends meet because they care for high concentrations of M&M patients. THis does not even address the cost of caring for the uninsured, who rarely pay their bills. HHS does offer a little relief to those hospitals that see large numbers of uninsured, but it is pitifully little. What will happen if the Gov't is paying the entire bill? My guess is that wages will be reduced.

[ZippyGBR, BSN, RN]

Nursing is a billable resource in a round-about way. Cost of labor, which is one of the biggest costs for a hospital, is factored into the "Cost per day room and board" charge. What will happen to this charge under UHC is anybody's guess. It is a fact that Medicare and Medicaid pays less for room and board than private insurance. Many hospitals struggle to make ends meet because they care for high concentrations of M&M patients. THis does not even address the cost of caring for the uninsured, who rarely pay their bills. HHS does offer a little relief to those hospitals that see large numbers of uninsured, but it is pitifully little. What will happen if the Gov't is paying the entire bill? My guess is that wages will be reduced.

well stop worriying about the 'losses' from those who don't pay any / all their bills ... suddenly you aren't factoring that in anymore - as you'll get a per patient bed day rate for each occupied bed (and probably an enhanced rate for critical care beds occupied by clinically appropriate patients) - what's your current 'can't pay , won't pay' percentage ...

you may find target lengths of stay - but i'm quite sure the insurers have that as well

also if the system allows top-ups and there's still a hybrid system for certain types of work there's opportunities to bill for premium rooms ... even the NHS has the facility for people to ask for single room and be charged for it ... it works in some facilities which have decent numbers of single rooms it doesn't elsewhere, and in new builds it'ds by the by as they are 50 % single rooms anyway

my point was there will be less pressure to justify every billable hour etc which other groups may find and may find increased pressure to use assistants etc ( thinking PT and OT in particualr here, but also radiologist instead of radiographer for certain tests)

[lindarn]

I have Tricare medical insurance because my husband is (now) retired Air force. Tricare has been fine. I had big knee surgery several years ago, was kept over night in the hospital, and all I paid out of pocket to the hospital was $85.00.

I get all of our prescriptions free at the base hospital. If they do not carry it, or I choose to have it filled at Rite Aid pharmacy close to where I live, we pay $9 for a prescription medication, regardless of what it costs, and $3 for a generic.

There is no reason that we cannot put all of our over-60-year old, citizens on Medicare, and under 60-years old on a form of Tricare. The infrastructure is already there. Use it to insure all citizens as Universal Health Care. It does work.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[HM2VikingRN, RN]

The care you receive is not according to what's in your wallet. My daughter was born weighing one and a half pounds and spent 16 weeks in the hospital. My cost? just the gas money to drive to the hospital every day. She received the best care possible, no treatment or procedure was ever questioned or with held and I didn't have to file for bankrupcy. I cannot imagine having to get permission from someone at an insurance company to get the care you need.

The US rations care based on ability to pay not need.