Most countries with universal healthcare don't have "socialized medicine." The UK has a socialized system, with public insurance and public healthcare providers. But only a third of hospitals are publicly owned/managed, and even there most doctors are private practitioners. And in the Netherlands and Switzerland, both the insurance and hospitals are private.
Changing "who pays" won't solve anything in the U.S. system, which is obvious because if that mattered Medicare and Medicaid would be a dramatically better system than private insurance. What's different in all those countries is higher supply of medical providers, lower compensation for medical providers,[1] and aggressive price controls not just for drugs, but for all procedures.
[1] It's notable that in the U.S., being a nurse or even a nursing assistant is a great middle class job for non-college educated people. In the U.K., where nurses are public employees, nurses are literally on strike right now because of their extremely low wages.
Many countries don't have price controls, but do have purchasing controls. The two are very different. Price controls you say you can't sell something for more than x. Purchasing controls is saying we won't pay double for something that works 1% better.
My opinion is that in the US there's basically no purchasing controls.
In the main I agree with this sentiment, but you're being reflexive here, which gets you into trouble. The movement towards BSN degrees follows a significant amount of research showing that BSN degrees correlate with superior patient outcomes. You wouldn't call a degree credentialing requirement for an MD "an elite war on the working class", nor would you visit a doctor without a degree. You're happy to throw a little culture war barb at nursing credentials because: you don't respect the profession. It is much, much harder than it looks. Its biggest problem is that it has a stupid name; they should be called "associate physicians".
You can reasonably disagree with state statutes requiring BSNs for RN licensure! But you can't pretend that the notion is risible, the way you have here. It is not.
You’ve whiffed it. Lots of people in my extended family are nurses or nursing-adjacent. Some have degrees and some don’t. I think it’s a really important job and it’s really good that elite gatekeepers haven’t gotten to nursing yet. I also think you shouldn’t need a college degree to be a programmer or a lawyer and probably not a doctor either. All of those jobs could be done by people with focused applied education, rather than theoretical academic education.
My view is pretty much exactly the opposite of what you suggest: I think few jobs including mine, justify the time and expense of a theoretical university education. Cancer researchers and civil or nuclear engineers, sure. But we shouldn’t use college degrees as barriers to keep “the proles” out of large segments of the workforce.
Lots of people in most extended families are nurses or nursing-adjacent, Rayiner. It's an extremely popular career. I'm Irish Catholic, which is the "my father is from a village in Bangladesh"-equivalent mic drop of "being related to lots of nurses".
As I said, that's not what we're doing: we have empirical data that says that additional training improves patient outcomes. If you truly believe that doctors shouldn't require degree credentialing, there's not much more for us to discuss.
At any rate, I just jumped in here to point out that nursing is not in fact a reliable pathway to a solid middle class career that doesn't require a college degree. All nurses have some kind of degree, most have 4-year college degrees, and in 10 years it's likely that all of them will.
It makes a lot of sense to me that nurses would generally have degrees. It does not make sense to me that sales account managers, HR professionals (the fastest growing white collar profession in the US), marketing communications specialists, bookkeepers, and project managers are required to have degrees. You saw the newly-elected Democratic governor of Pennsylvania run on the issue of eliminating degree requirements for public positions in his state; I'm optimistic we'll see a movement pressuring corporations to adopt similar rules, since they're fundamentally unjust and also serve to increase prices.
I assume in almost all professions more education correlates with better employees but I imagine most of that value is selection bias as opposed to causative.
Here’s a hub of links, though TBF there’s so much money at stake that my starting position is skeptical, even discounting rayiner’s concerns about elite institutional capture. Especially without a corresponding analysis of costs (maybe that’s here?)
I found a bunch of different studies some showed an effect some didn't. But all the ones I found linked the % of nurses with BSNs to outcomes which has two sources of possible confounds, the nurse level and the hospital level.
Maybe you've seen better studies than I could find that convinced you of this but all the studies I could find looked like bad science.
Everything positive in the world correlates with increased education level. Even lifespan. People with a BA live 3-4 years longer than without. But I'm under no impression that if we extended mandatory schooling to the age of 22 the average lifespan in the US would shoot up 3 years.
This is the problem in a nutshell. Sure, BSN provide better care. However, they don't provide better care than the number of regular nurses you could pay with the same money.
The US has an obsession with maximizing outcomes per clinician or per drug. It gives no or very little thought to outcomes per Healthcare dollars spent.
Nurses in the U.S. sometimes go on strike. Nurses in the U.K. sometimes go on strike. Neither group goes on strike because their employer is a government. People go on strike due to working conditions and pay; not because their employer is a government. I don’t see how your comment has anything to do with the point I made in my comment that you responded to.
In 2020 the U.S. median wage was $20,000 per year greater than the UK. What does this have to do with the points I made?
The person you were replying to wasn't saying they're on strike because of government employment. They were saying the government pays badly, illustrated by an ongoing national strike happening right now.
I didn't bother addressing this before because I thought I'd salvage what I could from your previous comment, and ignore the non sequitur-ridden majority of it.
What was the point of rayiner saying that the nurses striking in the UK are public employees? How is that relevant to the point they tried to make?
That comment that rayiner made is the non-sequitor since there are lots of examples of non government enterprises that underpay their workers and said workers going on strike. That comment doesn’t pertain to the greater point they attempted to make.
They are wrong too in their belief that all those countries have a greater supply of medical workers.
Rayiner is wrong regarding Medicare. Rayiner does not know what they are talking about on this issue.
I assume it's that any job that needs a vast number of employees is going to struggle to pay well. The government employing all nurses is a good example of that.
Anyway, you seem to have a personal issue with that comment, and you don't need me for this conversation, so I'll leave you to it.
Changing "who pays" won't solve anything in the U.S. system, which is obvious because if that mattered Medicare and Medicaid would be a dramatically better system than private insurance. What's different in all those countries is higher supply of medical providers, lower compensation for medical providers,[1] and aggressive price controls not just for drugs, but for all procedures.
[1] It's notable that in the U.S., being a nurse or even a nursing assistant is a great middle class job for non-college educated people. In the U.K., where nurses are public employees, nurses are literally on strike right now because of their extremely low wages.