Universal Health Care... what would this mean...

BlueRidgeHomeRN · Feb 9, 2008

i think we'd all get much farther in such discussions by emphasizing where we agree - that we want what's best for the most - and then respectfully pointing out the strengths of our own plans over another - as opposed to just pointing out how *wrong* , *stupid*, *foolish* , *naive*, etc the other person's plan is. and i'm saying this in regard to discussion both individual and social levels (eg in politics), not specifically in regard to any particular poster here.
:yeahthat: amen..can we get every single politician to read this, too! our primary is tuesday, and i'm watching dvd's because i can notsee my tv screen through all the mud and finger pointing.
to me, this argument makes much more sense than most i've heard (as opposed to warnings of dire consequences of uhc). i'd love to the see some suggestions about other approaches that could help reduce the threat of illness of leading to astronomical personal & societal costs. anyone want to start another thread?

count me in. a fair portion of the point i have been trying to make is that poor choices (diet, smoking, lack of excercise, uncontrolled diabetes) have a huge impact on healthcare dollars. people take awful care of themselves (in my basic belief, that is a choice) but then expect someone to fix their failing kidneys, blocked arteries, and copd at any expense to others, and are willing to seek legal redress if they don't feel they are getting "enough". a prime example is fl's repeal of its helmet law a few years ago--the bill was written so that adults who made this choice had to have a $1 million dollar health insurance bond. this part was never enacted. i have no problems with adults making choices, but do not feel that their subsequent $2.9 million bill for severe brain injury belongs to the public or the hospital system. their choice ends at my checkbook.

PedsED-RN · Feb 9, 2008

I'm all for universal health care on a very superficial level, it sounds good...but what is the point if patient outcomes are terrible?

As if outcomes are great for the people now who have no coverage, or get denied care due to inability to pay, or loose everything they own, including home, to pay off medical bills now that bankruptcy is no longer an option for med. bills.

This is an issue that gets me all worked up! I think there are many ways it can be executed wrong, but SOMETHING has got to change.

If people actually have the coverage and the means to seek preventative care, long term outcomes may improve, not to mention that ED's won't be used as clinics as much if they can go to an MD's office without getting turned away. Granted, there are many issues at hand to make it all work.

I will stop now, and spare you guys my rant :bugeyes:

Very interesting thoughts to read through though everyone!

jyoung1950 · Feb 10, 2008

in australia we have what you would call a universal health care system. every citizen of australia is eligible for free healthcare through hospitals and heavily subsidised healthcare with gp's - which is paid for by means of tax revenue. at present the administration of it is shared by the federal government and individual states, thus budgets and wages etc can differ from state to state. whilst its not perfect, it does ensure that everyone regardless of their financial situation has access to high quality healthcare. health issues are prioritised with the highest priorities being attended to first, and others go on waiting lists.
the beauty of our system i feel is that those who are not prepared to wait can elect to go 'private', which means skip the waiting periods and pay for the treatment themselves or through their insurance.
people who are on any form of government assistance also have what we call healthcare cards which can entitle them to free dental, optical and gp visits amongst other things.
yes there are many things that could be improved but no-one is ever turned away.
i only post this, to give those in the us an idea of what it could be like. i think the issues of waiting lists, wages and staff shortages are truly universal regardless of the healthcare system that is used.

healthcare is never "free" if it's supported for by tax revenues.

i have noticed that when posters write about their excellent healthcare system in canada, australia, france, etc., they often add that people can elect to buy private insurance in addition to what they receive (and pay for through tax deductions) from their government healthcare system.

why is there a necessity to buy private insurance if this government provided system is so much better than ours? what is the private insurance providing that the taxpayer funded healthcare isn't?

and if private is eliminating wait times, allowing more "elective" surgery and all, then doesn't it reveal that the folks who can't afford "private insurance" are missing something?

i appreciate any and all insight to this. please don't respond by informing me that our u.s. system isn't any better, has wait times, etcetera, etcetera as i am aware of our own problems. i want to know about your healthcare system.

if i, as a taxpayer and voter, am about to decide who to vote for regarding the u.s. healthcare issue and if, in fact, universal healthcare such as is found in the europeon countries and canada and australia is the way to go, i need to know what i am in for.

thanks so much!

mamabecky98 · Feb 10, 2008

I am from Canada and now live in the US I see both sides. To put it simply

If I can You and your Doctor decide what is best for your health. Whatever tx needs to be done is covered. There is no begging insurance CO. to cover the cost of a tx your doctor clearly says will benefit you or has any chance of improving you Quality of life. It is covered.

Dr. visits are completely covered. This would definitely cut down on emergence wait rooms because people would go to there doctors for miner things, and also there would be preventive maintenance, so to speak

What UHC doesn't cover is unnecessary things like a private room (unless a health issue) or plastic surgery ( unless ur DR says u need it for mental health reasons) It also does not cover Dentist, prescriptions, eyeglasses, recently eye exams, things of that sort. but if you are on any type of Social assistance, unemployment etc. You will have coverage for those things up to a certain amount but it usually ends up being enough to sustain you. Also our tx's and prescriptions cost less then in the US

So the reason to buy extra insurance would be for things such as semi/private rooms, dental, prescriptions, plastic surgery but the insured use the same dr's the uninsured do so when it comes down to actually care of tx's it's all the same and the hospital emergencies and what else, go by need first not by insurance.

Canadians pay higher taxes then Americans do but I would pay it any day rather then have to deal with a high medical bill or BS insurance Company

I was 4 weeks pregnant when I first came to Nevada. No one would insure me they said because I had a pre-existing condition how ridiculous I had to fly back to Canada for Dr. visits then spend the last two months of my pregnancy there to have my baby. All this was much cheaper then paying for it in US. Thank u Canada!!!

fizz2Nurse · Feb 10, 2008

I am from Canada and now live in the US I see both sides. To put it simply
If I can You and your Doctor decide what is best for your health. Whatever tx needs to be done is covered. There is no begging insurance CO. to cover the cost of a tx your doctor clearly says will benefit you or has any chance of improving you Quality of life. It is covered.
Dr. visits are completely covered. This would definitely cut down on emergence wait rooms because people would go to there doctors for miner things, and also there would be preventive maintenance, so to speak
What UHC doesn't cover is unnecessary things like a private room (unless a health issue) or plastic surgery ( unless ur DR says u need it for mental health reasons) It also does not cover Dentist, prescriptions, eyeglasses, recently eye exams, things of that sort. but if you are on any type of Social assistance, unemployment etc. You will have coverage for those things up to a certain amount but it usually ends up being enough to sustain you. Also our tx's and prescriptions cost less then in the US
So the reason to buy extra insurance would be for things such as semi/private rooms, dental, prescriptions, plastic surgery but the insured use the same dr's the uninsured do so when it comes down to actually care of tx's it's all the same and the hospital emergencies and what else, go by need first not by insurance.
Canadians pay higher taxes then Americans do but I would pay it any day rather then have to deal with a high medical bill or BS insurance Company
I was 4 weeks pregnant when I first came to Nevada. No one would insure me they said because I had a pre-existing condition how ridiculous I had to fly back to Canada for Dr. visits then spend the last two months of my pregnancy there to have my baby. All this was much cheaper then paying for it in US. Thank u Canada!!!

First of all you are not being totally forthright about Canadian Insurance. There are plenty of things NOT covered by Canadian Insurance that are or can be covered by insurance plans here. Bariatric surgery for one. many health plans cover this option in the US or a portion of it where in Canada it is not part of the health plan. You make it sound like anything you and your doctor decide is covered. That is completely untrue.

Also the comments about being able to go to the doctor reducing waiting at the ER hasn't worked out so well has it? In Greater Toronto on an average night more than 50% (or according to statistics compiled by the Toronto Star last year 23 of 25) emergency rooms are closed or on divert due to overcrowding. Getting a doctor appointment is not so easy in Canada as practitioners commonly face huge wait lists.

One other thing: "You came to Nevada" as a guest or as a permanent resident? If you arrived as a permanent resident, you're saying you basically went against the rules of the Canadian System and ripped off their taxpayers by returning to Canada and using their system to fund your healthcare. You see thats one of the problems with so called "Universal healthcare" always the attitude that someone else should pay.

I would bet that it's a pretty sure thing you didn't inform the provincial government that you were terminating benefits before you moved to Nevada and then followed the three month waiting period to be covered once you were back in your home province.

In the USA many of us don't exercise the responsibility and the right we have of the options. Most people simply say, "I can't because insurance won't pay" but we always have the ability to buy better health plans or negotiate outside of what insurance offers.

Most Doc's accept VISA or cash and would be happy to. Consider Plastic Surgery where the actual cost adjusted for inflation has decreased even with new advanced techniques. That has a lot to do with the fact that those Surgeons have to negotiate directly with the payer.

No, many people don't have the ability to negotiate directly with physicians, which is why insurance exists. But you can still negotiate and choose different providers. In Canada, you CANNOT decide you don't like your local provider and use your insurance in another province. You simply are not covered. (Emergencies excepted of course) And yes someone will point out network rules etc for US coverage.

Your post only illustrates how people want both sides of the fence. You want great healthcare but you don't want to pay.

allnurses Guide · Feb 10, 2008

Why is there a necessity to buy private insurance if this government provided system is so much better than ours? What is the private insurance providing that the taxpayer funded healthcare isn't?
And if private is eliminating wait times, allowing more "elective" surgery and all, then doesn't it reveal that the folks who can't afford "private insurance" are missing something?

I have been reading this debate with a great deal of interest and I am not sure that there is any perfect system. All have thier pros and cons and I am certainly not qualified to judge other heathcare systems as I haven't expereinced them. I can only give a UK perspective in answer to your questions. Private insurance is available and some people do opt for that but the vast majority do not, they stay with the NHS.

The waiting lists are much better than is being reported here, I believe ZippyGBR quoted the government targets that we HAVE to achieve otherwise we are given financial penalties. That is 18 weeks for elective surgery (it is much shorter for cancer targets) and there is a 4 hour limit on an emergency unit wait. Access to GPs is good if it is urgent for things less serious then you may have to wait for a week or so.

In Wales we get all medication free but dental and optical stuff is paid for.

I am currently awaiting treatment within this system for an injury sustained last year. I had excellent emergency care and followup with physiotherapy. Rapid access to clinics and assessment by a surgeon and I was put on the waiting list in September, I made a choice to defer until the end of January as I was going on holiday and last week was offered a date for surgery in March, as patient choice I refused this as it is not a good time and have been guarenteed a date for surgery in May.

This is just my example of my experience but it may help to answer your question.

Edit: just to add it that again as already mentioned here the waiting times are irrelevent if you have a clinical emergency or urgency as this is treated at the time of presentation

HM2VikingRN, RN · Feb 10, 2008

There is very little difference in waiting times between the US and Canada.

Jolie, BSN · Feb 10, 2008

[quote=HM2Viking;2653489

There is very little difference in waiting times between the US and Canada.

Is a 25% difference insignificant to you?

According to your graph, 47% of Americans were able to receive same-day or next-day services, while only 36% of Canadians were seen the same or next day.

Almost 25% more Americans than Canadians were seen within a day of requesting services. That is not "very little difference".

pickledpepperRN · Feb 10, 2008

Is a 25% difference insignificant to you?
According to your graph, 47% of Americans were able to receive same-day or next-day services, while only 36% of Canadians were seen the same or next day.
Almost 25% more Americans than Canadians were seen within a day of requesting services. That is not "very little difference".

Um, tell me if I'm wrong. It seems to me the difference between 47% and 36% is an 11% difference.

In both countries less than half of the people can see a doctor.

Does the US figure include the uninsured?

How does Canada care for people needing mental health care?

Jolie, BSN · Feb 10, 2008

Um, tell me if I'm wrong. It seems to me the difference between 47% and 36% is an 11% difference.

To simplify the problem, allow me to use the figures 48% and 36%.

If I am 48 years old, and you are 36 years old, I am 12 years older than you, but my age is actually 25% greater than yours.

In Viking's example, 48 Americans were seen within a day, and 36 Canadians. That is a difference of 12 people, which constitutes a 25% difference in the number of people seen within each system.

HM2VikingRN, RN · Feb 10, 2008

I actually don't advocate for adopting a Canadian style system. I think we would be far better served by looking at the countries that do better on average across quality dimensions for ideas on how to i,prove our system. THis means looking at the countries to our left on the graph as well as those in the following graphic.

While many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions. Based on these patient and physician reports, the U.S. could improve the delivery, coordination, and equity of the health care system by drawing from best practices both within the U.S. and around the world.
Citation
K. Davis, C. Schoen, S. C. Schoenbaum, M. M. Doty, A. L. Holmgren, J. L. Kriss, and K. K. Shea, Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, May 2007

whaley · Feb 11, 2008

What an intersting debate. I work in England, but have always been quite interested in the US health system as it always seemed quite elitist. At the beginning of this debate some people were worried about how it would affect their pay and the pt/nursing ratio. Well in the NHS in England, nurses in the private sector don't get paid much more than NHS nurses. However the pt/nurse ratio can be quite high, I often have 15 patients to look after. I don't know what it's like in the US, but I do work on quite an underfunded ward, so it's not usually that high.

At the moment our government is trying to reduce the number of pts that need to be in hospital, so it putting more money into the community rather than hospitals, so people with chronic diseases can be treated and managed better, and therefore in theory need less hospital admissions.

The NHS does have to be careful with resources, for example certain drugs like cancer drugs aren't available to everyone, which has recently caused quite a lot of controversy.

The perfect sysytem would be that everyone could have free health care and there would be no money issues or waiting lists, however that's not going to happen, but I do believe that everyone has a right to good quality free health care.