Socialized Medicine....WHAT IF?

loriangel14, RN · Nov 15, 2008

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

Yes, and that is sad.

lamazeteacher · Nov 16, 2008

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

That does not happen in Canada. My brother-in-law there, was 76 when he had a knee replacement (soon after it was indicated). My sister has also received all the tests and care she needs, at 79 years of age.

There is a special hospital in Toronto for newly diagnosed and latent cancer patients, which provides all the chemo and radiation anyone thinks is indicated, with no age restricti9ons.

I'm on Medicare here in the USA, and I know tests have been witheld from me when a chest X-ray indicated mt heart was enlarged, and my aorta "tortuous". My doctor said, "Oh, they made a mistake" (reading the x-ray). It is worrisome.

Remember that the costs of medical care are highest in top executive positions, in company run hospitals and insurance companies. The ones that say they're "non profit" are the worst. They just distribute the "cream" (profits) among the CEOs and other top executives, heads of departments (Vice Presidents), etc.

When there is "universal care" (please don't call that socialized, it isn't!), the money goes to staff: doctors, nurses, techs, etc. who get the competitive rate of pay, for medical equipment and medications. In Canada, doctors have a high class living standard, but resent being less rich than doctors in the USA, so they bad mouth their system. Right now they're trying to get insurance approved in government for fees above that which they are now paid. So do nurses get that chance? Noooooo.

However, doctors in Canada went to medical school knowing that money wasn't their chief objective. Doctors in the USA, until very recently started medical school with the objective of making millions from their practises (and they have). That involves a lot of ethical issues still unresolved.

Government agencies will be responsible only for handling costs (not making policies for it), in "Universal Care". Medical personnel: doctors, nurses, department heads will be in charge of determining medical charges and wage deduction amounts, using realistic figures, without the cost of decorative hospital lobbies, plush doctors' offices and executives' custom luxurious furniture and high salaries.

With the tax revenue (5%) charged those who whose income is above $250,000 (not small business owners by any stretch of "Joe the plumber" or anyone else's imagination). Just think of the census, take 5% of the population (high earners), multiplied by 5% of the $50,000 to $500,000, for the amount above $250,000 that 5% of the population makes - then you'll get the amount of funds over the wage deductions for average wage earners that will be available for health care (it's less than insurance companies charge now). Now isn't that better?

Socialism is about all the money earned by an entire population being witheld from the individuals who earn it, and payments are made by a central office where that is done, for everyone's food, housing, clothing, untilities, necessities, spending allowances, furniture, entertainment, and medical care. The only place on this planet where that is practised with impunity, is on Kibbutzim (plural for Kibbutz) in Israel. Those who live in those communal type of groups (not many and a small % of Israel's population), volunteer to be in that kind of environment (no one pressures them to be there), and they do work that best suits them.

Most of us in the USA and elsewhere want some autonomy and wouldn't be interested in that lifestyle. :yeah:

THAT Nurse., BSN, MSN, DNP, RN, APRN · Nov 16, 2008

With the tax revenue (5%) charged those who whose income is above $250,000 (not small business owners by any stretch of "Joe the plumber" or anyone else's imagination). Just think of the census, take 5% of the population (high earners), multiplied by 5% of the $50,000 to $500,000, for the amount above $250,000 that 5% of the population makes - then you'll get the amount of funds over the wage deductions for average wage earners that will be available for health care (it's less than insurance companies charge now). Now isn't that better?

Oh yes, because America was made great by taxing someone else and taking their money (whether we think they deserve it or not) and using it for our own benefit.

getmeoutofhere · Nov 17, 2008

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

In theory but in practice you hear of the senior nurses being downgraded, especially since DoH fouled up on GP and consultant payrises

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 ...

Public symapthy doesn't pay the bills. Irish nurses are more than happy to give it up for a decent payrises and i'd be happy to have a payscale in line with teachers for starters!

Avg. salary for nurses 25k, starting salary for teachers for 25k correct as of april 2008.

We should learn form the unionised hospitals in the US, now that is one thing i'd happily import over!

getmeoutofhere · Nov 17, 2008

http://www.theaustralian.news.com.au/story/0,25197,24652940-5017906,00.html

THE television images were graphic. Thousands of people were waiting patiently in a dusty field to see doctors and dentists and specialists working in the open air or under makeshift tarps.

Some of the patients had advanced cancer, some untreated diabetes. Most were seriously unwell. Some had arrived the previous evening, waiting all night just to make sure they were seen.
A long line waited to have their rotten teeth pulled. A close-up shot showed the dentist tossing an extracted tooth into a plastic bucket. It was almost full of teeth.
The images looked like foreign aid being delivered to a refugee camp somewhere in Africa. But they were taken in the US state of Virginia, where British adventurer turned philanthropist Stan Brock offers free health treatments once a year to some of the 47million Americans who do not have health insurance and can't afford care.
They were a reminder of why we should cling to our public health system for all we are worth.

ZippyGBR, BSN, RN · Nov 17, 2008

In theory but in practice you hear of the senior nurses being downgraded, especially since DoH fouled up on GP and consultant payrises

the 30 k staff nurse is practice - i work with them , maybe this year or next i will be one of them (assuming i don't get back to band 6)- top 3 or 4 increments of band 5 earning 24 - 26 k basic , working a rotating shift pattern

all too often the 'down grading' of posts was an assumption based on Fudged Whitley grading equalling the AFC band people would get ...

i say above 'get back' to band 6 as i was graded as a band 6 as a What was E grade staff Nurse - this well and truely threw those holding the purse strings ... cue rapid 'staffing reassessment' redeployments and so on to move the cost of meeting these salaries and capping them off

we've seen Specialists or people such as bed /site nurse managers getting 'downgraded' because their AFC job description and evaluation didn't score enough in the correct things - it's easy as a ward manager / senior sister to get a seven you have a reasonably large delegated budget .... but the G graded 'site manager' or 'night practitioner' doesn't necessarily and unless they are truely an advanced practice nurse - which often they aren't really - their practitioning onsists of 'house officer' type jobs unless the trust has fully taken on board hospital at night and adequately educated these staff tobe able to function fully as practitioners

Public symapthy doesn't pay the bills. Irish nurses are more than happy to give it up for a decent payrises and i'd be happy to have a payscale in line with teachers for starters!
Avg. salary for nurses 25k, starting salary for teachers for 25k correct as of april 2008.

as previously discussed Teachers get NO additional allowances, teachers are expected to work additional hours over and above their contracted you must be on the site hours ... don't forget all qualified teachers are expected to take charge of their area ( i.e. deliver teaching to their classes) from minute 1 of day 1 of their career - where in well managed trusts Junior RNs don't take charge of a clinical area for months to years on wards and years on critical care areas or departments

the main problem with AFC was that regions and the DoH let trusts pull some of the stunts trusts have pulled ...

Chico David, BSN, RN · Nov 18, 2008

I must say that for those of us in the US, the discussion of internal politics in the British system is pretty much Greek - or Cockney, which is the next best thing for being incomprehensible.

Just cruising again through some of the comments, it's interesting to see some of the ignorance and relatively sloppy use of terminology. Hope we do better in applying terms correctly in clinical practice than we do in politics and health policy.

Here's a glossary, per my understanding of some of the common language:

(with a few editorial comments included)

Socialized medicine: a system under which a government agency provides the care and doctors and nurses are employed by the government. The only western countries with such systems to my knowledge are Great Britain and Spain. We have a small example in our Veterans Hospitals. No one is proposing extending such a system to the general public in the US, and likely no US politician ever will.

Single Payer: a system under which the government is the sole insurer, but not in the business of providing actual care, or at least not the main provider of care. Canada is the best known example. There are also countries in which non-profit private insurers act under strict regulation. These are not strictly single payer in the pure sense, but they look and act like single payer to the patient and the provider. Everyone is covered under a single set of rules, a single set of billing forms, etc. countries with some variation of this include France, Germany and Switzerland among others. SB 840 in California last year and HR 676 in congress are single payer proposals in the US. Our Medicare is a truncated single payer system, in that its beneficiaries are only partly covered.

Universal healthcare: This is a deliberately vague, catch-all term, which can mean any of the above, but in the current US healthcare debate, it is usually meant to describe a sort of hodgepodge system in which a combination of private insurance and existing government programs, more regulation on private insurance, mandates on employers to provide insurance, mandates on individuals to buy insurance and subsidies for those who can't afford it is patched together in the hope it will get everyone covered. Examples are Mass Care in Massachusetts, the Obama plan, the Clinton and Edwards plans earlier this year and various others. Been tried a number of times in various places, has never worked and never will but keeps coming back up from politicians who see the need to get people covered but fear a fight with the big insurance companies.

And I suppose I might as well throw this one in too:

Republican Health Plan: You're on your own. Don't get sick.

lamazeteacher · Nov 18, 2008

Oh yes, because America was made great by taxing someone else and taking their money (whether we think they deserve it or not) and using it for our own benefit.

It seems tro me that health care benefits more people than one individual, when the top 5% of the population's who earn above $250,000, have 5% of their overage taxed.......

Is there another reason you are upset by others benefiting by getting health care from which they would otherwise be excluded , preventing costly complications of their illnesses and possibly surgery (amputations for uncontrolled diabetics who haven't gone for care of an infection due to their inability to pay for it)?

Coming from Canada, in 1963 to the USA, I am constantly amazed by the prevailing attitude I've noticed which seems to be, "What is mine is mine, what is yours is mine, and I couldn't care less about anyone else no matter how desperate their circumstances are. Canada has had Universal, single party payer health care for the past 45 years. The only lack they suffer, is the lack of glitzy 5 star hotel lobby-like appearance in their hospitals and medical offices.

The pluses for those residing in countries that share their resources with each other (e.g. health care), is the reassurance that they won't lose their homes, automobiles, college education funds for their children, etc. if they become ill for a lengthy period. They also get up to date care, with medical equipment that is "state of the art" - yet not all the hospitals have the same costly pieces of diagnostic equipment - so those who reside in the rural areas need to come to large towns or cities for that. (However public transportation is much more advanced than ours, so family members don't have to take a day off their work, to get sick relatives to city facilities for testing or equipment for diagnosing less common illnesses).

There are fewer physicians in rural areas, which is where it takes longer to get a primary care provider. Nowadays, MD residents fresh from their training aren't guaranteed the location of their choice to practise medicine. They may have to go to smaller communities first, where they're needed. Since education is subsidized by the government, the agency funding medical student(s) may dictate where they go.

From personal experience after I received an Ontario government "bursary" for my postgraduate nursing education in Canada, I had promised to work for one year in Public Health wherever they sent me. When I achieved my degree in Public Health, I found that I would lose my US citizenship, due to an ammendment of the law allowing it for children of an American (my mom) who were born outside the USA. That ammendment said that I had to live in the US for 5 years, between the ages of 14 and 28. I found that out the year I was 23!

So the Ontario government that had funded my education allowed me to work in Windsor, Ontario, Canada (to fulfil my obligation) while living in Detroit, MI (across the bridge from Windsor, Ont.). (I'd need to be a US citizen to work in a Public Health agency in the USA, which I planned to do for a few years.) The only kink in that was my family's purchase of a car for me, in Detroit. The Royal Canadian Mounted Police sent 2 enormously tall gentlemen to the office who took me out of a meeting, to tell me that I could not drive an American car on Canadian business. I could only drive it to the office and take public transportation to make home visits and do the school nursing that was my job. Live and learn!

What I'm saying in this long post, is that countries other than the US provide more empathy and opportunities for education and health care for their population; and we should learn from their example. :yeah:

loriangel14, RN · Nov 18, 2008

I agree with you that the big gap in thinking in this issue seems to be the American mentality that they only care if they are covered and are not concerned with anyone else. If Joe down the street gets sick and loses everything -so what? I am glad that my taxes go towards paying for healthcare for others that are not as fortunate. As a struggling single mom I have always been glad that I can get the medical attention my children need and know I won't lose my home or savings if something catastrophic happens. As a Canadian I believe that healthcare should be accessible to all and while I know our system is not perfect I wouldn't trade it for anything else.

getmeoutofhere · Nov 20, 2008

I
Here's a glossary, per my understanding of some of the common language:
(with a few editorial comments included)
Socialized medicine: a system under which a government agency provides the care and doctors and nurses are employed by the government. The only western countries with such systems to my knowledge are Great Britain and Spain. We have a small example in our Veterans Hospitals. No one is proposing extending such a system to the general public in the US, and likely no US politician ever will.

Howabout we get the terminology right for the systems used in Europe?

We have two systems, the "Beveridge" system (loosely used to refer to tax based systems), and the "Bismarckian" which is based around a plethora of competing insurance organisations independent of health service suppliers.

The Bismarckian generates more resources but the admin consumes more resources than the Beveridge model. It also said to deliver better results but our government disputes this?

I would dispute the belief that the UK is a socialized system.

FYI

http://en.wikipedia.org/wiki/Health_care_in_the_United_Kingdom

http://en.wikipedia.org/wiki/Universal_health_care#United_Kingdom

http://en.wikipedia.org/wiki/National_health_insurance

As you'll read, people have a choice of going with private sector if they have insurance. Also, since day one of the NHS, the first port of call to access heathcare are GPs, doctors who are private sector contractors. And the foundation hospitals have,in theory, a degree of self-control that just wouldn't be possible in a truly socialised system.

Hope this helps.

Chico David, BSN, RN · Nov 20, 2008

I'm not an expert by any means, especially in the details of the British system. My main concern was the many comments in this thread that conflate all forms of government involvement in healthcare and make no distinctions among the various proposals. Just for example, no one in the incoming administration has proposed anything that could even remotely be called "socialized" but if one listens to many conservative politicians that's what one would think.

On the other side, many "liberal" politicians are trying to sell "universal healthcare" plans that are mostly about forcing people to buy private insurance - when we know that in America, having insurance does not mean having access to the care you need.

lamazeteacher · Nov 20, 2008

Wikipedia has a reputation of inaccuracy, which tends to make my think it's unreliable. Granted, wikipedia keeps up to date descriptions, but users really have to check that they are correct. I use established dictionaries (in print) to verify the meaning of words.

That said, I must take issue with your acceptance of Wikipedia's rendition of the meaning of "socialized medicine". President-elect Barack Obama hasn't issued any statements regarding "nationalized" health care, and from his book that he published outlining his platform, before his election as President-elect of the USA, he intends to keep insurance companies running the program (so as not to "reinvent the wheel"), with increased monitoring and outside direction; and decreased salaries at the top.

Now that it seems Senator Tom Dashle will be heading the Health and Human Services Department, he will oputline his strategy soon (I hope). In no spoken or written statement has President - elect Obama said that the US government will determine policy or pay care givers. It is my understanding that any government involvement is restricted to a "cashier" role, simply taking in monies and paying out fees as directed by Senator Dashle's people. These "people" will be medical professionals, not clerks given hard and fast rules.

President-elect Obama has indicated his wish to have Mental Health on an equal basis (payment wise), with Physical Health. Halleluyah!! Since the mind drives the body, it seems that doing otherwise has been counter productive.

As always, in the USA we like to be unique and better than any other country's similar programs. So look toward a better health care program, and better newborn morbidity and mortality stats (as well as all others, but it's the newborns who keep us near third world country examples). Nations with more generous health care wellness enhancement (illness prevention) programs show us up all the time. Canada withdrew food products with saturated and uinsaturated fats from the shelves of their markets, as the care of resulting CHD is expensive.

They also jumped on mandatory seatbelt requirements and "stop smoking" recommendations (with incentives/perks for those who stopped), as soon as it was proven that costly illness resulted from those behaviors. Curiously, given Americans' way of thinking, Canadian citizens never resented those who eschued seat belts; and smoked, as causing more of their tax money to be spent on health care, nor did they support those unwise choices. The "blame game" seems to stop at their border.

Scare tactics, calling oponents' plans ugly names like "socialized" are for campaigning, not actualities. The poster of the unquoted remark (which I deleted, but to which I wanted to respond) seems to think that renovation of our health system means we will adopt another country's (failing) program.

Let's be part of the solution, and post things that work about healthcare programs elsewhere! :yeah: