Universal Healthcare Questions

[NeuroNP]

OK, I'm an American and I just read "Nursing:Against the Odds" by Suzanne Gordon. In it, she makes a strong push for Universal Healthcare, claiming that not only will it help people, but actually make it better for nurses as well.

I remember being on vacation in Canada back when Clinton was first trying this and talking to a Canadian who told me that your system isn't all that great and we would be good to be wary of it. I can't, however, remember his reasoning. I've of course heard about waiting lists, rationing and Canadians who come to the states for healthcare, but most sources aren't without political bias.

I realize that a lot (if not all) responses to this will not be without political bias either, but I'd like to hear from Aussies and New Zealanders (and Brits and Canadians for that matter) what your take on this is. Is your system a good one? Would it work in the US? What are the downsides? Upsides?

Particularly if there's anyone who's experienced the US and Austrailan/New Zealand systems, a compare/contrast would be nice.

Thanks!

Bryan

[gwenith, BSN, RN]

I don't think what we have here can truly be called a univeral health care system.

Not everything is free.

Hospitals are free and there are waiting lists for ELECTIVE surgery and procedures. Take angiograms for example - here in my town the waiting list for NON-urgent angiograms (patient stable - no further bouts of angina etc) is about 10 weeks. For urgent angio's - well next ten minutes)

Definitely there is more assessment related to risk factors. If you are 95, a heavy smoker and have severe vascular disease you will probably NOT be considered a candidate for bypass surgery.

BUT, and here is where we differ from some "universal healthcare" schemes, we have a private health system surviving alongside the public system. Everyone has the option of either taking out health insurance and going private or relying on the public health system. This takes a LOT of pressure off of the public system but it is by no means perfect.

We do not have fully free pharmacuetical support - BUT most drugs are subsidized under the PBS.

There are some ways in which public health care is better - for a start the goverement has a greater interest in public health campaigns - anti-smoking is VERY strong here and backed by increasingly tough laws discouraging smoking. When the goverement has to pay for something it starts getting very interested in stopping that something happening.

In a way having a large percentage of nurses employed by the goverment gives you a little bit of bargaining that is not there normally. It adds politiical pressure to the bargaining table - at least at present.

[fergus51]

The US already has universal healthcare to a point (you can't be turned away in an emergency), we just don't require universal contributions to the system (you don't have to have insurance). I have said again and again, if I get sick I'd rather be back in Canada. I can deal with elective wait times a lot better than losing my life savings. I've lived and worked in both countries and honestly don't see a difference in the hospital care provided, the difference I see is in how it is paid for.

Oh, and a Canadian style or Australian style system will NEVER work in the US. Never, never, never. You could never overcome the bad pr.

[Grace Oz]

The medicare system we have here in Oz is funded by taxpayers. We all pay a medicare levy once our income reaches a certain level, (don't remember what that is, sorry). We pay this levy regardless of whether or not we also belong to a private health insurance company.

There was a scare campaign by the government a few years ago whereby they tried to cajole people into joining private health funds. It was reasonably successful. Many people joined private funds. Only to discover, they still had enormous 'gap' payments to pay out on top of what the health fund rebated! And then, there's not always a bed available in private hospitals either! Sometimes, which private hospital you can be admitted to, depends entirely on whether or not your health fund has a contract with that hospital! Not only, but also.... only if your doctor has practising rights for a particular hospital, can you be admitted there. This is just a small insight into the private hospital system here in Oz.

I'm old enough to remember when Australia had one of, if not THE best, health care systems in the world. Like most things, that's changed and the respective governments have chopped and changed things in such a way as to make what we once had, unrecognisable.

Still, no-one who is ill ever gets turned away from a public hospital.

They might not get the treatment they really need, but they will be seen by...someone!

Yes! I'm being sarcastic! But that's another story for another day!

[talaxandra]

Hi Bryan,

As gwenith said, we have a two-tier system. Public health care is available to all citizens of Australia and countries with which we have a reciprocal relationship (Italy, New Zealand, the Republic of Ireland, Finland, Norway, Malta, the Netherlands, Sweden and the United Kingdom - this allows restricted, not full, access to Medicare). It includes treatment for acccidents and emergencies, including the whole cost of hospitalisation, casualty presentation and out-patients; ante- and post-natal care; PBS-subsidised prescription medication; free eye checks; and rebates for medical fees and services (which are the majority but not all of the charged fee).

Private insurance has always been an option, but in recent years the Federal government has made a strong push toward increased uptake - this includes a 30% rebate of fees, an additional Medicare tax of 1% for income earners over $50.000 pa, and increased fees for people who join after the age of thirty.

For those who take out private health insurance there's a significantly shorter waiting period for elective procedures, more choice about specialists and surgeons, and cosmetic pluses like private rooms, tastier meals etc. Depending on the level of insurance, there can also be hefty 'gap' fees.

For those who can't afford to go private, things are tighter than they used to be. There are fewer bulk billing GPs (where the Medicare rebate is the whole medical fee), which means people are taking longer before seeing a doctor. I've also noticed an increase in patients running out of medication in the last two years, perhaps a result of the increase in the PBS cap. That's where prescriptions are filled free of charge after an eligible individual or family have spent $874.90 in a year ($239.20 for concession card holders).

For political reasons I chose to pay the extra levy and not pay for private health insurance. That costs me more a year than a 'save tax' option would (very cheap, very low coverage insurance, aimed at avoiding the levy and allowing you to avoid the penaltie of over-thirty joining). I'm in good health, and if I become ill will end up in a public hospital. For emergency situations I'd rather be here (at my acute, tertiary public hospital) than somewhere pretty and private. Two years ago I had elective surgery at a private hospital - it cost several thousand, but I'm still ahead :)

Coming from the Australian system my sister (who's moved to the UK) is still having touble coming to terms with the British version of universal health care, which seems to have less choice, fewer services, of less good quality, and more heavily utilised.

For more information, check out http://www.health.gov.au/internet/wcms/publishing.nsf/Content/Healthcare+systems-1

PS How cool - while researching I discovered that you can register as an organ donor (or a NOT donor) online: http://www.medicareaustralia.gov.au/yourhealth/lodge_your_request/aodr_register.htm And now I'm registered!