After posting the piece about Nurses traveling to Germany and reading the feedback. I would like to open up a debate on this BB about "Universal Health Care" or "Single Payor Systems"
In doing this I hope to learn more about each side of the issue. I do not want to turn this into a heated horrific debate that ends in belittling one another as some other charged topics have ended, but a genuine debate about the Pros and Cons of proposed "Universal Health Care or Single Payor systems" I believe we can all agree to debate and we can all learn things we might not otherwise have the time to research.
I am going to begin by placing an article that discusses the cons of Universal Health Care with some statistics, and if anyone is willing please come in and try to debate some of the key points this brings up. With stats not hyped up words or hot air. I am truly interested in seeing the different sides of this issue. This effects us all, and in order to make an informed decision we need to see "all" sides of the issue. Thanks in advance for participating.
Michele
I am going to have to post the article in several pieces because the bulletin board only will allow 3000 characters.So see the next posts.
It is important to qualify:::: Universal and government run are not necessarily the same thing. Also many countries with universal health care have private facilities as well, like in the UK or Australia.
Universal or government run systems do not cause a cap on wages. The government run systems do want to keep nurses' wages down, but so do for profit places in the US (just look at Tennet or anywhere else they close hospitals rather than negotiate with striking nurses). Negotiations determine wages in both places.
WASHINGTON - The Institute of Medicine (news - web sites) on Wednesday recommended for the first time that the government provide universal health insurance, attempting to spark an election-year debate on a decades-old problem that keeps getting worse.
The president and Congress should set 2010 as the deadline for providing coverage to all, according to the institute, part of the National Academy of Sciences (news - web sites), a private organization chartered by Congress to provide scientific advice to the government.
The report endorsed no proposal and provided no estimate of cost, except to say it would be expensive.
It said that rising costs, increasing numbers of uninsured and growing financial pressures on health care providers have created the right conditions for major reform at the federal level, a decade after Congress rejected President Clinton (news - web sites)'s proposed overhaul. The report was the last of six studies over three years that explored aspects of the lack of health insurance.
"I believe we're reaching the point where the system is unsustainable," said one of the report's authors, Dr. Arthur L. Kellermann of the Emory University School of Medicine in Atlanta.
Mary Sue Coleman, president of the University of Michigan and head of the committee that prepared the report, said the problem "is not going away. It will only get worse."
The Census Bureau (news - web sites) reported that 43.6 million people lacked health insurance at some point in 2002, compared with 39.8 million in 2000.
The study said that strong, bipartisan support is necessary for any proposal to move forward. The report got a boost former Republican Sen. Bob Dole, who praised the goal of universal coverage but said a partisan effort tied to one approach would be doomed to failure.
"If properly framed, the lack of coverage ... can be one of the big, big issues in this election," said Dole, who attended a news conference on the report.
Separately, a survey by two pollsters, a Republican and a Democrat, for the American Hospital Association found that a majority of Americans, including a majority of Republicans, are willing to pay higher taxes to "assure every American citizen receives health care coverage."
Yet reaction to the study showed the partisan divide that has marked the issue. Democrats were overwhelmingly supportive, while Republicans were skeptical.
Health and Human Services (news - web sites) Secretary Tommy Thompson said universal coverage by 2010 is "not realistic."
In a meeting with reporters this week, Thompson said, "I just don't think it's in the cards. I don't think that administratively or that legislatively it's feasible."
The Bush administration last year proposed spending up to $89 billion in health care tax credits to help those who do not have employer-based coverage. The Republican-led Congress took no action.
Thompson said the president would have more to say about the uninsured in next week's State of the Union address.
Senate Majority Leader Bill Frist of Tennessee said he was concerned that the report "may not focus enough on the reasons why health care costs continue to rise and how to pay for any reform."
Senate Democratic leader Tom Daschle of South Dakota said the lack of insurance is the leading domestic issue today. He said the report's goal could be met. "I think it's essential," he said.
The institute said the lack of health insurance was deadly, costly and a cause of insecurity even among the insured. Rejecting incremental expansions, it said only major reform at the federal level would make universal coverage a reality.
In previous reports, the institute has estimated that the lack of health insurance causes 18,000 unnecessary deaths in the United States and costs the nation $65 billion to $130 billion annually.
Layoffs and cutbacks in health benefits by employers have led even those with insurance to worry that they could lose it. Lack of adequate health insurance "creates insecurity for everyone, because losing that coverage tomorrow is so easy," the report said.
The Census Bureau said a decline in workplace-based coverage was the main reason for the increase in uninsured between 2001 and 2002.
I don't necessarily think government-run health care is the best idea.......if there's any way a thing can be made impossibly complex, government will find it! But we MUST get the for-profit insurance industry OUT of health care........this is, IMO, the root of all evil where medical services are concerned. Health care stopped being about "caring" when it became a business, and when you've got insurance-company CEOs who've never spent a day in medical school making millions of dollars a year deciding who should and should not receive care, something is very, very wrong.
I agree that we must get the private for-profit insurance companies out!!! I think we need a UNIVERSAL health care system. How many times have we seen nurses on this BB say that they are uninsured or can't afford their employer's insurance? How many uninsured pts. do you see everyday? How many kids and low-income people are without coverage, and how many more are set to lose coverage with the impending budget crises throughout the country??? something has to be done, and private insurance IS NOT the answer.
One of the articles posted talked about canada's approx. 16 wk. wait for elective surgeries. Well, they are ELECTIVE, aren't they? Sometimes we have waits that long here, depending on the surgery. Of course medically necessary surgeries should receive priority.
I've also heard about an "access to care" problem that can be created by universal health care. To that I say, we already have an access to care problem under the current system. We have too many people who are uninsured or underinsured or scared to go to the hospital/dr's office because of the costs. Wasn't there an article on here recently about people being arrested for not paying their medical bills?? Americans already have an access to care problem. Many of us can't afford proper care, or drugs. Healthcare is just too expensive, even with insurance. Many of the insurance policies I have seen lately cost more than they are worth, and God forbid you get sick, because you will definately incur a HUGE out of pocket expense before the insurance kicks in.
This is a subject very near and dear to my heart. I for one will ALWAYS support a universal health care system.
Thanks for the articles and opinions and input! It is great.
What is the difference between "government-run" healthcare and "universal healthcare" ? I assumed these were the same thing. If the government did not run "universal healthcare" then who would?
What about the notion mentioned in the first article about ingenuity and invention? What about the idea that we are motivated by money? We sure are movitated by money, as RN's, come contract time, aren't we? If in a universal healthcare Doctors and nurses make what a bus driver makes, then where is the incentive? Where is the incentive for pharmaceutical companies to invent new drugs to treat cancer and autoimmune disease and HIV and come up with new antibiotics or anti-virals or new vaccines. Has Canada been inventive? Have government run universal healthcare systems displayed ingenuity? When one in 8 of us females develop breast cancer, do we want there to be a newly developed treatment, so that we can survive to raise our children?
I am looking for answers for these types of questions. It seems that they are not out there. Even the Harvard study does not show the cons of universal healthcare. The only thing they discuss is a 16 weeks wait for elective surgery. Well, if you need a simply lap chole for gallstones, that is elective surgery. You could be fine and just need the lap chole, right? If you are required to wait 4 months or 16 weeks for an elective lap chole, and a gall stone becomes logded in your common bile duct, and you then develop pancreatitis and need TPN and lipids and IV pain medication before you can even have your surgery, that ends up being far more costly, doesn't it? I am sure a mastectomy is an elective surgery. Do you want to wait 4 months to have the cancer cut out of your breast? Most surgeries are elective, even we patients know and feel that they are not elective. The only surgery that is not elective is emergency or trauma patients. Where are the people to question that aspect?
And, paperwork that physicians and nurses do is not soley for administration, is it? Why do nurses chart for hours on five patients? Is it to prevent law suits and cover your butt, or is it simply wasted administration? How would universal care prevent the need for doctors and nurses to thoroughly chart on each and every patient?
And, what about law suits? Who would be sued in malpratice and who would pay in universal healthcare? Would the taxpayers pay for malpractice suits? Could a patient sue the government (TAX PAYERS) as well?
Where is patient choice in universal care? What are your options and choices versus government run universal care? We think we are limited now by HMO's, I have a feeling we aint seen nothin' yet, until we have the government telling us what hosptials to use etc.
What are patient to nurse ratios in a universal care system, and what EXACTLY are the wages for say an RN who has worked full time for 5 years in our current system, versus an RN who has worked full time for the same lenghth of time under universal care. These are also things that we need to consider that NOBODY seems to mention or discuss in any of the articles. I want to see figures: EXAMPLE UNiversal care RN makes $26.50 per hour and a RN in US current system makes $28.00 per hour. I want wage hours for comparsion. Do UNiversal care RN's get overtime pay? Do universal care RN's get paid hourly or on salary with no overtime pay?
I sometimes feel that nurses are so brain-washed by the democratic party of the US. They walk along like mindless sheep following the pro abortion, pro DFL agenda and just incessantly chant the mantra that the DFL'ers tell them to believe: Universal care, government run healthcare, and they do not submit any of the above questions.
I submit: Look at Medicaid and Medicare and then ask yourself if you want the government overseeing all of your medical care and determining what is best for you!
Please, keep the information and opinions coming. It needs to be discussed.
ATLANTA - Taxpayers foot the doctor's bill for more than half of obesity-related medical costs, which reached a total of $75 billion in 2003, according to a new study.
The public pays about $39 billion a year - or about $175 per person - for obesity through Medicare and Medicaid programs, which cover sicknesses caused by obesity including type 2 diabetes, cardiovascular disease, several types of cancer and gallbladder disease.
The study, to be published Friday in the journal Obesity Research, evaluates state-by-state expenditures related to weight problems. The research was done by the nonprofit group RTI International and the Centers for Disease Control and Prevention.
"Obesity has become a crucial health problem for our nation, and these findings show that the medical costs alone reflect the significance of the challenge," said Tommy Thompson, secretary for the Department of Health and Human Services. "Of course, the ultimate cost to Americans is measured in chronic disease and early death."
States spend about one-twentieth of their medical costs on obesity - from a low of 4 percent in Arizona to a high of 6.7 percent in Alaska.
California spends the most on health care for the obese, $7.7 billion, and Wyoming spends the least, $87 million.
"We have a lot of taxpayers financing the costs of overweight and obesity for those in public sector health plans," said Eric Finkelstein, a health economist with RTI International who conducted the study. "That provides justification for governments to find cost-effective strategies to reduce the burdens of obesity."
About 64 percent of adults in the United States are either overweight or obese, according to the CDC's 1999-2000 National Health and Nutrition Examination Survey.
Physicians are seeing more and more people having health problems because they're overweight or obese, said Dr. Denise Bruner, chair of the board of the American Society of Bariatric Physicians.
"This is one of the major health epidemics we're looking at in America," she said. "I truly see this as a very grave problem for which we in the public need to certainly be pro-active in terms of taking charge of our health."
Obesity should be treated and prevented more aggressively through public health programs to encourage healthy diets and exercise, said Michael Jacobson, executive director of the Center for Science in the Public Interest, a nonprofit health advocacy group.
"It would certainly make for happier lives, and also save medical expenses," he said. "A healthy population would save taxpayers a huge amount of money."
Question:
What ethical responsibility do taxpayers have to healthcare problems related to lifestyle choice??
Universal healthcare will cause all taxpayers to pay for all of the lifestyle choices of other people, even if you exercise eat right, do not smoke, and take care of yourself......
mjlrn, I think that it's much more than a problem of insurance companies alone feeding at the trough. But agree with you that this is an important chunk of the problem.
As for about a government run health care system? The government runs the military already, and this has hardly helped control costs. Nor has it helped make the military available only for wise use.
Never the less, a government mandated single payer system is a must to move us forward against the tide of deteriorating and totally corrupted US system of delivery of medical care. Neither the Democrats nor the Republicans have what it takes to reform this mess, so we are certainly doomed short term to yet worse to come, IMO. I would like to see a Movement to picket the hospitals.
NurseHardee
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mjlrn...
I don't necessarily think government-run health care is the best idea.......if there's any way a thing can be made impossibly complex, government will find it! But we MUST get the for-profit insurance industry OUT of health care........this is, IMO, the root of all evil where medical services are concerned. Health care stopped being about "caring" when it became a business, and when you've got insurance-company CEOs who've never spent a day in medical school making millions of dollars a year deciding who should and should not receive care, something is very, very wrong.
Specializes in LTC, assisted living, med-surg, psych.
If I were in charge, I would have my universal health care system administered by an independent entity made up of doctors, nurses, and other providers, as well as financial managers and ordinary citizens. This organization would be funded by, and accountable to, the federal government, and yes, there would HAVE to be some rationing of services........but the bureaucrats wouldn't be the ones deciding that. This way, EVERYONE would have access to basic and intermediate-level health care services; these would include birth control, heart and kidney transplants, chiropractic care, and bariatric surgery. However, I would NOT expect universal coverage to pay for cosmetic surgeries, so-called alternative therapies, or those which are considered experimental.........those who want these services and can afford to pay for them should do so.
Of course, there are a billion things that could go wrong with such a system, and I'm sure there are those who will gladly point them out. But we have to start somewhere, and getting the insurance industry out of health care would be a helluva start. For them, there's always auto, life, fire, flood, and disaster insurance to keep them going.....leave health care to the people who KNOW health care!!
Universal systems in some countries are government run, in others they are simply government funded and monitored. In Canada, the provincial governments divide their provinces up into health authorities which are managed by docs and beaurocrats, same as in the US. The provincial government decides how to fund each area according to need, but it isn't the government micromanaging. There are universal systems, like in the UK I believe, which have both public facilities and private facilities. Standards are still monitored by the government (like they are in the US), but there are private facilities for people who have the supplemental insurance, which compete with public ones in a way.
As far as ingenuity... Canada has a long history of that (as do many other countries)! Where do you think scientists discovered insulin and changed the lives of millions of diabetics? My hospital raises litterally hundreds of millions of dollars for research (I think it was 170 million over three years of fundraising). Drug and technology companies still have a motive to develop new products because we still purchase the drugs and technologies we use (our unit is looking at buying over 60 $40 000 isolettes for the NICU). Drug companies' patents here still allow them to make a handsome profit.
As far as pay scales.... Doctors and nurses in universal systems are not paid less than bus drivers:). This is another common misconception in the US. Nurses in some parts of the US make more than in Canada and in other parts make less. Average doctor salaries in Canada are lower than in the US, but that's because we have fewer specialists and more GPs, and GPs always make less money. Specialists here are compensated less outright, but the fact that their overhead is so much less means that a lot of docs actually do just as well here. malpractice insurance is MUCH less, we have a single payer system so there is less paperwork to spend on and doctors and hospitals here never have to worry about getting stiffed by patients who can't pay. I know a lot of Americans are scared of the term universal because they think it means they will have to pay for the people who can't, but really, you do now anyways. The costs for you to get medical care are so expensive partly because it has to absord the cost of non-payors who declare bankruptcy.
As far as lawsuits... there seem to be a lot less here, and I don't know why. Doctors and nurses still have their own malpractice insurance (mine is covered by the hospital and the union, like it was when I worked in the US).
As far as elective surgeries: they are just that. A mastectomy is classified as urgent, not elective. We have elective, urgent and emergency. An urgent surgery is one that will cause health problems if not treated fairly quickly, like a mastectomy. An emergency is obviously one that would cause injury or death if not treated immediately. That's why people aren't questionning that aspect. Again, studies have shown that people may wait longer here for certain procedures, but it doesn't have a negative effect on their long term health. And for all the talk about waitlists, I have never known anyone who has had trouble getting treatment when it was needed. Are there horror stories about indivdual cases where things have gone wrong in Canada? Of course, just like in the US. But you have to look at the big picture. Is it the norm? No. There has even been research showing that women in Canada from low socioeconomic groups do better when they get ovarian cancer compared to women in the US and the reason was access to care. I would rather have to wait a week or two as opposed to not getting a surgery I needed cause I didn't have the money. I promise I will find the name of the book that references all the studies you seem interested in.
As far as patient choice, trust me, it is MUCH more limited in the US unless you have signifigantly more money that I did:). Having lived and worked in both countries, I know that Americans think Canadians have no control over their care or who they choose as a care provider, but that just isn't true. I think it's because Americans think the government manages healthcare, when in reality they fund and monitor it, but the system is run by the people who work in it (administrators, doctors, etc). I chose my doctor and when he wants me to get certain tests, I get them done. When I have had health issues, we have discussed the options and then made a decision together. The government does not determine my care, my doctor and I do. When I lived in the US, I had to have a doctor that was a part of the HMO list, and it was a struggle to get the HMO to approve things the doctor wanted done. I wound up paying out of pocket more than once. And the most ridiculous part was, I was only covered in a certain geographical area! If I went on vacation to Florida, I wasn't covered at all!
OK, I am getting long winded, but I'll keep going.....
Patient ratios in the US and Canada are similar, but I generally get a better deal in Canada which could be because I work in larger urban settings. In L&D it was rare for me to get 2 women in active labor, something that was routine when I was in washinton. In the NICU I look after 2 or 3 babies (only look after 3 if none are vented). Med surg in my hospital only uses RNs and they have 4-5 patients on days. I have worked with LPNs on med surg and generally the RN-LPN team would have 8 or 9 patients, though I have seen up to 12 in one hospital. Just like in the US, it does vary between hospitals depending on their size (a hospital in NYC may have more resources than one out in the boonies). I do not have to float, ever. I get an hourly wage and am paid OT (time and a half) for anything extra as are all nurses (we get a pretty good benefit package as well). We have no mandatory OT like some places in the US because it is against our labor laws. Wage scales vary by province. In Ontario, a new grad starts around $23 an hour + shift diffs (so figure $18 American). The top of the payscale for staff nurses is reached at 9 years and is about 32-34+ diffs (though agency nurses make much more). In BC the range is from 25-33 or something. Each province has a nursing union which negotiates wages. If you go to a provincial union website you will get links to the payscale. In ontario, it's the ontario nurses association. In BC it is the British Columbia Nurses' Union (http://www.bcnu.org I think). You'll have to google a bit:) It's hard to give a real comparison because cost of living is a big factor and Canada is a BIG country. Nurses in San Fransisco will make a large hourly wage, but it's so expensive that a nurse in Arkansas making a much lower wage may live better.
As far as people all paying for health choices of others.... This is actually a good thing. It means that EVERYONE has to pay into the healthcare system through their taxes. In the US, you do it indirectly (that article was American right?). Someone can go without insurance, then show up with an MI and the hospital has to treat him, even though he will never pay for any of it. Then those of us who do carry insurance wonder why it is so expensive! It's cause we have to pay for that MI guy's care one way or another!
In Canada, people who make bad lifestyle choices are not free to avoid contributing to their healthcare. The other thing is, insurance companies in the US can refuse to cover people with certain conditions, so even if they want to pay for insurance, they can't. The best way to run a system is to have low and high risk people in your pool. One of the reasons the medicaid system is so shabby is because it only takes the high risk, no paying people. We pay more in taxes in Canada, but I actually take home about the same percentage of my pay here, because in Washington I had to pay for my insurance.
I think it's a little ironic you would say that people are brainwashed into thinking that universal healthcare is good. It has been my experience that people in the US are brainwashed into thinking it's bad, based on misconceptions. Canada's system may be completely wrong for the US, but there are a lot of universal systems to look at for ideas. The Canadian system certainly is far from perfect, and we can also look to other countries for inspiration.
"Universal Health Care, what the United States can learn from the Canadian experience". Authors are Armstrong, Armstrong and Fagan.
Every American and Canadian should read this book before they make up their minds about which system they prefer for themselves and for their country. It is a great book which deals with all the questions kitkat mentions and more, all supported with research, facts and figures. I swear, if you read it with an open mind, you can't help but be educated about the pros AND cons of our systems in the US and Canada. If you want to know what I think is the biggest con to the Canadian system, it's that it is too vulnerable to politics. One government can introduce an innovative fabulous program, but if it takes 10 years to complete and the new government doesn't like it in 5 years..... The biggest con in the US is that we spend more money than Canada, but 40 million people have no insurance if they get sick. And I hate the notion of customer and not patients which seems to be more and more common in the US (and is gaining ground in Canada).
I love the book because it is about the big picture. Too often, Canadians and Americans hear about individual horror stories and think those represent the norm. Do some Canadians get poor medical care sometimes? Yeah. But can you honestly say that's different from the US? Not with a straight face I bet;)
you are right on the money. I was getting ready to write a long response to some of the other comments until I got to yours, and you said everything I was going to.
Well, thanks elkpark. I am tired of typing now, but I do think it's important to dispell the myths Americans have about our system. Now we just need a few Brits and Aussies to tell us the answers to those questions in their system:)
Thanks so much for your thoughtful reply. I do greatly appreciate it. Yours is the first reply that does not soley contain rhetoric.
The US is so divided politically. We have a conservative Republican viewpoint, and a liberal Democrat viewpoint. Republicans being mostly anti-universal healthcare with Demoncrats being mostly pro-universal healthcare. My viewpoint has been affected by pro-disability advocates, that are actually notoriously liberal left-wing Democrats. However, even they are carefully watching universal healthcare and are concerned about it's effect on disabled Americans. There are multiple claims of denied access to disabled citizens under universal healthcare. They are thought of as a waste of money. And, in the US a lap chole is elective, even though serious life-threatening complications can result if not treated surgically with removal of the gallbladder.
The mantra of all of our Nurse Unions and college professors is the chanting of we must have a national universal healthcare system, and that it IS the only answer. However, all they spew is rhetoric as well. They offer no studies, no proof, no effect on RN's, no effect on staffing or patient care. They just chant the mantra and I am easily tiring of rhetoric without proof.
If you would, suffer me a bit longer and read the next post of an article that I found and comment.
fergus51
6,620 Posts
It is important to qualify:::: Universal and government run are not necessarily the same thing. Also many countries with universal health care have private facilities as well, like in the UK or Australia.
Universal or government run systems do not cause a cap on wages. The government run systems do want to keep nurses' wages down, but so do for profit places in the US (just look at Tennet or anywhere else they close hospitals rather than negotiate with striking nurses). Negotiations determine wages in both places.