By design, a monopoly produces a different kind of worker. Unwilling to have their wages capped and freedoms restricted, the best inevitably leave. Mediocrity, unfortunately, gives rise to fewer malcontents and thus is a prerequisite for stability in the system. Put it this way: if a socialized system wants to survive, it must expunge the most driven and gifted from its midst. When wages, moreover, are tied to a negotiated deal with labour, rather than, in the case of a competitive market, to the individual physician's performance, the position of the mediocre practitioner is further reinforced.
Would you suggest that on average, the nurses in the Canadian socialized system make more than nurses in the more privatized American system? If so, I would like to understand, given the nursing shortage in both countries, why there is a remarkably higher percentage of Canadian RN's crossing the border to work? What is the incentive driving this process?
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I would suggest that comparisons like "on average" are useless because the devil is always in the details. There are a ton of reasons why Canadian nurses come here. Some for the money, but note where they are going. It's to specific states. We get A TON of southern nurses taking travel contracts out here too for the same reason (even in their unsocialized system, they can make more money in California). Some come for the opportunities (the US have 10 times the population and a lot more places to work and go to school). Some come for the adventure.
If nursing in the US was SO much better than nursing in Canada why don't all nurses from Canada come here? It's pretty easy for them to do. Yet, most Canadian nurses will never work down here. Many that do eventually go back home because things like family, cost of living, maternity benefits, vacation time, working conditions, holidays, cost of living, etc. all have to be factored into their decision. We were never as short staffed in Toronto as I've been down here, we don't even have to rely on travel nurses to run our unit.
And if wages are only a function of supply, demand, cost of living, and negotiation, why are all Ontario nurses paid the same regardless of where they work? Isn't the cost of living much higher in Toronto compared to the rest of the province?.
Because the province has one union and the union negotiates the one contract. The cost of living comparisons which influence wages are between provinces (Ontario is more expensive to live in overall than Newfoundland for instance so nurses there get paid more).
Privately run hospitals have a GREATER incentive to keep costs down; they don't have the privilege of asking for more money from the gov't if they perform poorly. They also have other incentive; to provide services to as many people as possible in order to improve revenue. A socialized system does not have that incentive.
It's obvious to me that you've never worked in Canada if that's what you think. People in Canada feel ENTITLED to healthcare. If you aren't doing your job at your hospital, expect a BIG ruckus. Efficiency is demanded.
Private hospitals like you said have a greater incentive to keep costs down. Know what the biggest operating cost a hospital has is don't ya? Nursing wages.
Here's what I'm saying; you can change the system, but you will never change the cost of living. I believe at the end of the day that socializing the American system will result in lower wages for nurses, and they will have an even lower purchasing power because the cost of living will not change. So I ask, do you actually believe that changing the system will improve nursing wages?
And here's what your friends back in Canada cannot afford on their Canadian wage, and it's the ability to live in California.
You believe it will result in lower wages for nurses. OK, I understand why you'd be fearful then.
I don't. I've been around long enough and in enough places to know that won't happen. Even in a socialized system like in Canada, the government has to negotiate a contract with nurses. It's no different from what CNA does with its employer hospitals in California.
BTW, my friends in Canada make about the same as a staff nurse here. They could afford it. They just choose not to leave, no matter how hard I try to convince them to come down. They visit and that's enough for them. They actually can't understand why I haven't moved home yet to start a "real life".
It's obvious to me that you've never worked in Canada if that's what you think. People in Canada feel ENTITLED to healthcare. If you aren't doing your job at your hospital, expect a BIG ruckus. Efficiency is demanded.
Private hospitals like you said have a greater incentive to keep costs down. Know what the biggest operating cost a hospital has is don't ya? Nursing wages.
Specializes in Cardiac Surg, IR, Peds ICU, Emergency.
Single payer is NOT socialized medicine. The provider stays independent. Private physicians, clinics, hospitals, PT, chiropractic, dentists, optometry, skilled nursing stay the same.
The government will not run the hospitals, clinics, or others.
The county facilities and Beverly Hills hospitals will be paid paid by a single payer. No more hospitals going to the government to get money for indigent care.
We are a great country. Let us get better!
Singler payer is socialized in that it is socialized financing, and changing to any kind of socialized system will definitely affect any provider who receives these reimbursements.
We can get better, but the issues must first be properly identified and addressed with intellectual honesty.
Specializes in Cardiac Surg, IR, Peds ICU, Emergency.
I would suggest that comparisons like "on average" are useless because the devil is always in the details. There are a ton of reasons why Canadian nurses come here. Some for the money, but note where they are going. It's to specific states. We get A TON of southern nurses taking travel contracts out here too for the same reason (even in their unsocialized system, they can make more money in California). Some come for the opportunities (the US have 10 times the population and a lot more places to work and go to school). Some come for the adventure.
But these southern nurses (of which I am one), are not going to Canada. And the population note is very relevant, which is why I made it before. The US population is huge compared to Canada; roughly 10 times larger. One could then reasonably speculate that if nursing were more profitable and pleasing in Canada, you would expect the flow of US nurses to Canada to be about 10 times larger than the flow in the opposite direction, but such is not the case. In fact, in 1995, about 1/4 of all new grad Canadian nurses went to the US. This is the number that specifically chose the US and didn't choose another socialized system. In 1993-94, it was 40%. This number has dropped significantly, but in the late ninties, 22% of international applicants were from Canada.
Comparatively, of all of the international nurses working in Canada, less than 7% of INTERNATIONAL nurses came from the US, and it definitely wasn't either a percentage, or a number even coming close to the number and percentage of Canadian immigrants. And you can't claim that it's because there aren't any jobs, because Canada is experiencing a nursing crisis as well, and is importing them from the Phillipines, India, and the UK in much larger numbers than nurses are crossing from the south.
If nursing in the US was SO much better than nursing in Canada why don't all nurses from Canada come here? It's pretty easy for them to do. Yet, most Canadian nurses will never work down here. Many that do eventually go back home because things like family, cost of living, maternity benefits, vacation time, working conditions, holidays, cost of living, etc. all have to be factored into their decision. We were never as short staffed in Toronto as I've been down here, we don't even have to rely on travel nurses to run our unit.
Well, looking at the numbers, it does appear that US nursing is for more appealing to a huge percentage of Canadian RN's. You don't need 100% immigration to make that distinction.
Because the province has one union and the union negotiates the one contract. The cost of living comparisons which influence wages are between provinces (Ontario is more expensive to live in overall than Newfoundland for instance so nurses there get paid more).
But this does not support previous claims made regarding COL. That was my point, and it appears that folks are now bouncing from one side to another regarding the influence of COL. First, it was important in defining wages, but then it's standard province wide and negotiated by the union. I just ask that you'd decide. My point was, and still is, that when it comes to comparing wages, it matters not what the purchasing power is based on local market conditions, unless you are willing to suggest that a socialized system will pay RN's MORE in Oakland, Ca (or in your city), than the current system pays them. The rationale for that is something I would be interested in reading.
It's obvious to me that you've never worked in Canada if that's what you think. People in Canada feel ENTITLED to healthcare. If you aren't doing your job at your hospital, expect a BIG ruckus. Efficiency is demanded. Private hospitals like you said have a greater incentive to keep costs down. Know what the biggest operating cost a hospital has is don't ya? Nursing wages.
Nope, never worked in a Canadian hospital, and have no desire to work in a socialized system, here or abroad. I've been in many hospitals in socialized settings, and have never observed conditions under which I would be willing to work. And please don't distort the point on efficiency; the use of nursing wages is no more a factor in a privatized system vs. a socialized system. The difference is that if a private system underperforms, they have to adjust their behavior to operate more efficiently. A hospital in a socialized system underperforms, they make a case for needing more money, which in no way cultivates incentives for improving efficiency.
Specializes in Cardiac Surg, IR, Peds ICU, Emergency.
I never said socialization of medicine changes the cost of living in an area. I am saying it's an important thing to consider when comparing who makes more. You can't say "Nurses in California make more money than nurses in Canada, so their wage is better" unless you consider the impact their cost of living has on the purchasing power of their wage.
I most definitely can say that Calif nurses have a better wage. What is more important to point out, however, is that while the cost of living will not change because of socialization, there is no evidence that socializing the system will improve wages for those same nurses who will have to face the same economic challenges.
Meanwhile, what I'm reading is that a nurse in Hornell, NY will make the same amount of money as a nurse in Manhattan. This will destroy the hospitals in NYC.
But these southern nurses (of which I am one), are not going to Canada. And the population note is very relevant, which is why I made it before. The US population is huge compared to Canada; roughly 10 times larger. One could then reasonably speculate that if nursing were more profitable and pleasing in Canada, you would expect the flow of US nurses to Canada to be about 10 times larger than the flow in the opposite direction, but such is not the case. In fact, in 1995, about 1/4 of all new grad Canadian nurses went to the US. This is the number that specifically chose the US and didn't choose another socialized system. In 1993-94, it was 40%. This number has dropped significantly, but in the late ninties, 22% of international applicants were from Canada.
Comparatively, of all of the international nurses working in Canada, less than 7% of INTERNATIONAL nurses came from the US, and it definitely wasn't either a percentage, or a number even coming close to the number and percentage of Canadian immigrants. And you can't claim that it's because there aren't any jobs, because Canada is experiencing a nursing crisis as well, and is importing them from the Phillipines, India, and the UK in much larger numbers than nurses are crossing from the south.
Well, looking at the numbers, it does appear that US nursing is for more appealing to a huge percentage of Canadian RN's. You don't need 100% immigration to make that distinction.
But this does not support previous claims made regarding COL. That was my point, and it appears that folks are now bouncing from one side to another regarding the influence of COL. First, it was important in defining wages, but then it's standard province wide and negotiated by the union. I just ask that you'd decide. My point was, and still is, that when it comes to comparing wages, it matters not what the purchasing power is based on local market conditions, unless you are willing to suggest that a socialized system will pay RN's MORE in Oakland, Ca (or in your city), than the current system pays them. The rationale for that is something I would be interested in reading.
Nope, never worked in a Canadian hospital, and have no desire to work in a socialized system, here or abroad. I've been in many hospitals in socialized settings, and have never observed conditions under which I would be willing to work. And please don't distort the point on efficiency; the use of nursing wages is no more a factor in a privatized system vs. a socialized system. The difference is that if a private system underperforms, they have to adjust their behavior to operate more efficiently. A hospital in a socialized system underperforms, they make a case for needing more money, which in no way cultivates incentives for improving efficiency.
There are some serious flaws in your logic. You could not reasonably expect there to be 10 times the number of US nurses going to Canada because the population of US is bigger. There are fewer nursing jobs in Canada so those nurses would have nowhere to go to, would they? US nurses seem to just leave nursing altogether instead.
In 1995, a lot of Canadian nurses did go to the US. That was because there were no jobs in Canada. We were cutting nursing jobs. I was interested in nursing at the time and strongly discouraged from pursuing it because I'd be unlikely to find work when I graduated. No shortage, no jobs for new grads, they had to go elsewhere. 2007 is a very different time. The nurses that did leave chose the US because it's close to Canada and easy to go to, not because they wanted a for profit medical system. At the time a lot of them didn't even need to take the NCLEX. I seriously wonder how many Canadian nurses you know if that's what you think. If your latest figures are from 12 years ago, then I don't really find them too relevant. They might as well be from 1960 because that's about how much has remained the same since then.
We do take nurses from the Philippines and the UK and India. Do you maybe think there is a reason they chose Canada? They could go to the US too, you realize. Could it be that that working in a for profit medical system isn't their only concern?
I don't even know what you're talking about regarding cost of living anymore. Here is my stance for clarity's sake. Cost of living influences wages (in Canada this is done province to province). Cost of living is important in determining whether a wage is good or not. The wage is negotiated by the union, yes, and influenced by cost of living in each province, yes. Yes, in a socialized system a nurse would make more in Oakland Ca, than they would in Little Rock Ark.
On the last point, you just prove your lack of personal work experience. Those of us who have worked in those systems know things aren't wasted. When the money funding hospitals comes from taxes, people do not put up with pouring unlimited amounts of money into the system. Canada spends less per capita on health care than the US does. If you were right and we didn't care about efficiency because we could just get more money from the government then it would be the opposite.
I most definitely can say that Calif nurses have a better wage. .
Some do on a simple dollar per dollar comparison, some don't. New grads at my hospital start at $27 an hour. New grads in BC are pretty close to the same. At the end of the day, they are going to be a lot better off financially up there than down here.
Specializes in Cardiac Surg, IR, Peds ICU, Emergency.
There are some serious flaws in your logic. You could not reasonably expect there to be 10 times the number of US nurses going to Canada because the population of US is bigger. There are fewer nursing jobs in Canada so those nurses would have nowhere to go to, would they? US nurses seem to just leave nursing altogether instead.
You most definitely can expect that the number of immigrants to at least reflect the population ratio, but it doesn't. Instead, what we see is a country with a remarkably smaller population sending both a immensly higher PERCENTAGE and a higher actual number of immigrants across the border when they are in fact facing a nursing shortage crisis.
In 1995, a lot of Canadian nurses did go to the US. That was because there were no jobs in Canada. We were cutting nursing jobs. I was interested in nursing at the time and strongly discouraged from pursuing it because I'd be unlikely to find work when I graduated. No shortage, no jobs for new grads, they had to go elsewhere. 2007 is a very different time. The nurses that did leave chose the US because it's close to Canada and easy to go to, not because they wanted a for profit medical system. At the time a lot of them didn't even need to take the NCLEX. I seriously wonder how many Canadian nurses you know if that's what you think. If your latest figures are from 12 years ago, then I don't really find them too relevant. They might as well be from 1960 because that's about how much has remained the same since then.
2007 is definitely a very different time, a time where Canada is facing a shortage, but the nurses are still leaving for the US in disproportionate numbers, and saying that they picked the US because of proximatey and ease is ridiculous, because Canada is just as close and easy for an American, but it's not happening to the extent we see coming in.
Here's what has remained the same; NAFTA, which opened the doors for Canadians nurses to enter the US, and the shortage has increased on both sides of the border. How many Canadian nurses do I need to know? There are several in our unit; one is a good friend and while her husband (an employee for a Canadian tractor company) wants to return to ONTARIO, she dreads the thought of returning to nursing in Canada and they've chosen to stay.
We do take nurses from the Philippines and the UK and India. Do you maybe think there is a reason they chose Canada? They could go to the US too, you realize. Could it be that that working in a for profit medical system isn't their only concern?
Many of them do come to the US; my point had absolutely nothing to do with a comparison of Filipina/Indian nurses coming to the US or Canada, but that in spite of the opportunities for immigrant nurses in Canada, you were getting a much higher percentage from the Philippines and India instead of from across the 'close and convenient' border.
I don't even know what you're talking about regarding cost of living anymore. Here is my stance for clarity's sake. Cost of living influences wages (in Canada this is done province to province). Cost of living is important in determining whether a wage is good or not.
I figured as much; I'm not sure why. I'll try to break it down. I pointed out the obvious; an RN in a given region (i.e. the one selected by one of the forum members), will make a lot more than an RN in another given region, i.e. Toronto. Someone else pointed out that the cost of living in Calif. was higher. I pointed out again the obvious; it doesn't matter, because the cost of living is the same in Calif. or Toronto no matter what kind of health system is being used. In this case, you can only measure actual wages, and the cost of living is not relevant to the discussion. It's definitely relevant to some economic discussions, but not this one.
On the last point, you just prove your lack of personal work experience. Those of us who have worked in those systems know things aren't wasted. When the money funding hospitals comes from taxes, people do not put up with pouring unlimited amounts of money into the system. Canada spends less per capita on health care than the US does. If you were right and we didn't care about efficiency because we could just get more money from the government then it would be the opposite.
There is no need to get personal. And it's more than just about 'waste.' It's also about availability of services and timely access to available services, both of which are big problems in Canada (also a problem here, but not resolvable with any socialization). And regarding your last comment; that is exactly what the author was saying, and what I was saying. If you underperform in a socialized system, you can blame it on a lack of money and resources and ask for more, whereas a privatized system has more incentive to operate efficiently...and also has more motivation for innovation and improvement.
I'm not getting personal. I just think if you'd worked in the system you were talking about, your opinion would not be what it is. Even if it was, it would certainly hold a lot more water with me. Those of us who have worked there know from experience that we can't just ask for more money, that the drive for efficiency is FIERCE.
My last comment has nothing to do with blaming underperformance on a lack of money because there is no underperformance IMO. Outcomes in Canada are good. It points out that Canada spends less money, not more, and runs a more efficient health system. If it was underperforming, you'd think the mortality and morbidity rates in Canada would be much higher than the US. They aren't.
That's the problem with labeling an entire system a failure when it has worked well for decades. There is a reason you don't see a lot of Canadians advocating we switch over to the American style health care system despite the fact that the Canadian system definitely has some problems. It's because they know that the US system does too and there is no reason for us to exchange one set of problems for the other. Both countries are better off focusing on how to improve their own systems.
Specializes in Cardiac Surg, IR, Peds ICU, Emergency.
I'm not getting personal. I just think if you'd worked in the system you were talking about, your opinion would not be what it is. Even if it was, it would certainly hold a lot more water with me. Those of us who have worked there know from experience that we can't just ask for more money, that the drive for efficiency is FIERCE.
My last comment has nothing to do with blaming underperformance on a lack of money because there is no underperformance IMO. Outcomes in Canada are good. It points out that Canada spends less money, not more, and runs a more efficient health system. If it was underperforming, you'd think the mortality and morbidity rates in Canada would be much higher than the US. They aren't.
That's the problem with labeling an entire system a failure when it has worked well for decades. There is a reason you don't see a lot of Canadians advocating we switch over to the American style health care system despite the fact that the Canadian system definitely has some problems. It's because they know that the US system does too and there is no reason for us to exchange one set of problems for the other. Both countries are better off focusing on how to improve their own systems.
You see, that's the beauty of science and evidence-based-medicine; it's not supposed to reflect the impressions seeded from our individual experiences, but from the data. And I'm not basing my position on opinion, but on the data. The nursing migration rates, wait times, and wages are no opinions.
Yes, outcomes in Canada are good, but are not necessarily a reflection of the health care system. The primary benchmark often cited is life expectancy, which is 2-3 years better in Canada. This is more a reflection of lifestyle decisions (i.e. preventative care) than the results of Canadian acute care, and in fact, the lowest mortalities in Canada are in disease processes most affected by primary care or prevention as oppossed to those disease processes that are treated in the hospital.
I've long aknowledged that socialized systems have higher quality prevention themes, but that prevention is no mystery to Americans; too many simply choose to ignore it.
I believe that US general mortalities would improve if people would simply drive to the gym instead of Burger Hut, but we can't make them. I also believe that Canadian mortalities would deteriorate if the US adopted a more socialized system, because it would tighten the current access that Canada has to US healthcare.
You're cherry picking the data that supports your view and then saying that makes it fact and not opinion. That isn't impartial reasoning. That's Micheal Moore style editorializing.
Also, (ignoring the fact that you have no proof that lifestyle choices or preventative care are good but hospital care is bad in Canada) why would you think preventative care isn't a part of the health care system worth considering when comparing two countries? Preventative care is what allows us to detect all those illnesses that are treated in hospitals EARLY when outcomes to treatment are the best. I would rather find breast cancer early and only need a lumpectomy than late when I'd need a mastectomy and radiation or chemo. If it keeps me alive longer, I don't really care where I was treated.
The myth of the Canadian hordes crossing the border for healthcare is about as meaningful as the myth of millions of Americans lacking any healthcare access at all.
I swear, I have the exact opposite conversations with Canadians about health care down here. It never fails to surprise me that people read a few articles that support their preconceived views and then become 100% convinced about systems they've never worked in or been treated in. One of my Canadian nursing colleagues does it, and I've learned it doesn't matter what the reality is, her mind is made up (she thinks EVERYTHING down here is worse than "back home"). I think that's the case here and I accept that and will let it alone. It's been an interesting conversation though, thanks:) I am glad you're happy with the US system, and we both agree that it doesn't need to adopt the Canadian one.
fergus51
6,620 Posts
I would suggest that comparisons like "on average" are useless because the devil is always in the details. There are a ton of reasons why Canadian nurses come here. Some for the money, but note where they are going. It's to specific states. We get A TON of southern nurses taking travel contracts out here too for the same reason (even in their unsocialized system, they can make more money in California). Some come for the opportunities (the US have 10 times the population and a lot more places to work and go to school). Some come for the adventure.
If nursing in the US was SO much better than nursing in Canada why don't all nurses from Canada come here? It's pretty easy for them to do. Yet, most Canadian nurses will never work down here. Many that do eventually go back home because things like family, cost of living, maternity benefits, vacation time, working conditions, holidays, cost of living, etc. all have to be factored into their decision. We were never as short staffed in Toronto as I've been down here, we don't even have to rely on travel nurses to run our unit.
Because the province has one union and the union negotiates the one contract. The cost of living comparisons which influence wages are between provinces (Ontario is more expensive to live in overall than Newfoundland for instance so nurses there get paid more).
It's obvious to me that you've never worked in Canada if that's what you think. People in Canada feel ENTITLED to healthcare. If you aren't doing your job at your hospital, expect a BIG ruckus. Efficiency is demanded.
Private hospitals like you said have a greater incentive to keep costs down. Know what the biggest operating cost a hospital has is don't ya? Nursing wages.