6 ms·

Health Care is not like building roads. I live in Quebec, Canada and the healthcare here is among the worst in the civilized world. Also - it's illegal to pay

Health Care is not like building roads. I live in Quebec, Canada and the healthcare here is among the worst in the civilized world. Also - it's illegal to pay a doctor to fix you. Canada is the only place in the world where it's illegal to pay someone to cure you of something. It's basically communist. The American system is untenable, but 'single payer' is not the solution. Successful countries that do it are tiny. Sweden is smaller than Los Angeles. Swtizerland does it at the cantonal level, which on average is 800 000 citizens. Can you imagine your entire hospital and insurance system being in blocks of 800 000? Maybe at the state level, subsidies, regulating drug prices etc. etc. - but full-on national level 'single payer' would be a huge disaster, beyond contemplation. Also in many single payer systems - the guy who snuck across the border illegally gets the exact same healthcare as you, working professional, paid a million in taxes, dutiful citizen etc.. I think there should be coverage for everyone, but single-payer is not the path.

icebraining 10y ago
Not a word about the UK's NHS?
jomamaxx 10y ago
You can vote me down if you want, but I live in a system where I cannot get a doctor. And it's illegal to pay for one. I' forced by the government, to use local clinics where they don't have my records, I don't have a relationship with the doctor, they can't make longer term prognosis, and frankly, the care is sub-par. I once had an ailment that was difficult to diagnose, the doctors at the clinics, used to seeing people for coughs and colds could give a shit. I ended up having to pay a few grand for an American entity operating barely within the bounds of legality in Canada (the Cleveland Clinic). I can assure you that it's a pretty desperate feeling when you are locked out of the system. Notre Dame Hospital in Montreal is lined with people in beds in the hallways, broken chairs, broken, leaking water fountains in the waiting room, broken / discarded beds in the waiting room - I thought I was in Cuba. The doctor was actually nice but the facilities were crazy. A well run McDonald's has more visible operating efficiency. It's far from optimal.
- dalke 10y ago
  I think you might be downvoted because your complaint is not an intrinsic problem with single payer systems, nor is it common in those systems. I could turn around and point to poor people from rural communities in the US, who can't afford healthcare, and depend on free mobile clinics like http://abcnews.go.com/Health/mobile-free-clinic-brings-health-care-uss-underserved/story?id=20016498 http://abcnews.go.com/Health/mobile-free-clinic-brings-healt... . BTW, Cuba appears to have a significantly better system than what you describe. Cuba also trains doctors for other countries, including people from the US. Medical training in the US is so expensive that people who want to be doctors for the poor can't afford the loans. See http://www.pbs.org/newshour/rundown/cuba-offers-poor-med-students-a-free-ride/ http://www.pbs.org/newshour/rundown/cuba-offers-poor-med-stu... .
  - jomamaxx 10y ago
    "uba appears to have a significantly better system than what you describe." Cuba has no money. They pay their doctors roughly $10/week. Do you think Cuba can afford all of the drugs, diagnostic equipment, software and services that are required to make a highly functional modern Medical system? Of course not. I made a reference to Cuba out of sarcasm - there is no defending the Cuban system, other than to say that they can provide adequate 'very basic coverage' to it's citizens, which is good. They pay their doctors literally less than the cost of many common and important therapeutic drugs. It's an economic non-sequitur.
    - dalke 10y ago
      For your "sarcastic" comment, you happened to pick one of the developing countries known for doing well with limited resources, with child mortality and longevity rates comparable to the US. A country which, btw, is also promoting medical tourism. Which includes Canadians going there - http://www.nytimes.com/2015/02/18/world/americas/americans-may-see-appeal-of-medical-tourism-in-cuba.html http://www.nytimes.com/2015/02/18/world/americas/americans-m... . Perhaps you could go there for treatment? Though from http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-12-417 http://bmchealthservres.biomedcentral.com/articles/10.1186/1... it looks like more Canadians go to India. (The US isn't on the list because Canadians don't think of that as international travel.)
dalke 10y ago
Health care also isn't like writing software. I know how to write software. I don't know how to select health care plans, and I when I had my own US company I was always afraid that I had made the wrong choice. > "Can you imagine your entire hospital and insurance system being in blocks of 800 000" I now live in Sweden, so I'm not unfamiliar with how single payer works in a country of 9 million people. Do note that it's not so isolated as you think. If I were to travel to France, and fall ill, I am entitled to any medical treatment that a resident would receive. This includes Switzerland, so your statement isn't quite a match to how the system works. And let me say that it's a big relief to not worry about those details anymore. With our first kid on the way, I didn't have to wonder if my insurance would cover everything, or if I was feeding into the cost machine that has caused the price of giving birth to triple over the last 20 years in the US. > "Successful countries that do it are tiny" icebraining pointed out the 63 million people living in the UK with its NHS. Even in the US, there are about 9 million people in the VA system and 55 million people in the Medicare system. Is there some fundamental reason which explains why Medicare cannot scale by a factor of 6? > "the guy who snuck across the border illegally gets the exact same healthcare as you" First, in the US everyone, no matter their immigration status, has the right to emergency care. See http://www.medscape.com/viewarticle/590328 http://www.medscape.com/viewarticle/590328 for how the ethics are clear. So you end up with pregnant women coming to ER to give birth, which is expensive. And you have people coming to ER for things that could have been handled at a clinic more cheaply, and before any complications might have come up. To make things more complicated, how does this hypothetical border crosser live in the US without a job? Because if he had a job enough to live on, then either the US employer is paying under the table, or he has a falsely acquired SSN and is paying into Medicare, even if he can't use it. The same works for universal healthcare - the money comes from payroll tax/automatic salary deductions, so even if someone snuck across the border, as long as they have a job they are paying for healthcare. Second, people visiting (say) France from a country outside Europe are not covered under the French system. They are supposed to pay. Indeed, they do pay. Medical tourism is a thing. People will travel to France for treatment, and they pay for the treatment. It is not free to all comers. When my then-girlfriend visited me in Sweden for a couple of weeks, she needed an emergency root canal. She had to pay, and she did, even though she isn't a dutiful Swedish citizen. But sure, there are people who are in the country but aren't eligible for health care and can't afford to pay or refuse to pay. There are two options 1) treat them, 2) don't treat them and wait until they appear in the ER once the problem gets more serious. (Option 3 is let them die, but I'm not inhumane enough to want that.) Which is why the following happened in Spain. "Under a reform that came into place in September 2012, foreigners without residency papers lost their national health cards which allowed them free treatment in local public health clinics." Then in 2015, "Spain's conservative government said ... it would restore free healthcare for illegal immigrants, overturning a controversial decision taken three years ago." - https://www.thelocal.es/20150331/spain-to-restore-free-health-care-for-illegal-immigrants https://www.thelocal.es/20150331/spain-to-restore-free-healt... And they did it to take the load off of expensive ER care, which even the non-single-payer US does.

icebraining 10y ago

Not a word about the UK's NHS?

jomamaxx 10y ago

You can vote me down if you want, but I live in a system where I cannot get a doctor. And it's illegal to pay for one. I' forced by the government, to use local clinics where they don't have my records, I don't have a relationship with the doctor, they can't make longer term prognosis, and frankly, the care is sub-par. I once had an ailment that was difficult to diagnose, the doctors at the clinics, used to seeing people for coughs and colds could give a shit. I ended up having to pay a few grand for an American entity operating barely within the bounds of legality in Canada (the Cleveland Clinic). I can assure you that it's a pretty desperate feeling when you are locked out of the system. Notre Dame Hospital in Montreal is lined with people in beds in the hallways, broken chairs, broken, leaking water fountains in the waiting room, broken / discarded beds in the waiting room - I thought I was in Cuba. The doctor was actually nice but the facilities were crazy. A well run McDonald's has more visible operating efficiency. It's far from optimal.

dalke 10y ago
I think you might be downvoted because your complaint is not an intrinsic problem with single payer systems, nor is it common in those systems. I could turn around and point to poor people from rural communities in the US, who can't afford healthcare, and depend on free mobile clinics like http://abcnews.go.com/Health/mobile-free-clinic-brings-health-care-uss-underserved/story?id=20016498 http://abcnews.go.com/Health/mobile-free-clinic-brings-healt... . BTW, Cuba appears to have a significantly better system than what you describe. Cuba also trains doctors for other countries, including people from the US. Medical training in the US is so expensive that people who want to be doctors for the poor can't afford the loans. See http://www.pbs.org/newshour/rundown/cuba-offers-poor-med-students-a-free-ride/ http://www.pbs.org/newshour/rundown/cuba-offers-poor-med-stu... .
- jomamaxx 10y ago
  "uba appears to have a significantly better system than what you describe." Cuba has no money. They pay their doctors roughly $10/week. Do you think Cuba can afford all of the drugs, diagnostic equipment, software and services that are required to make a highly functional modern Medical system? Of course not. I made a reference to Cuba out of sarcasm - there is no defending the Cuban system, other than to say that they can provide adequate 'very basic coverage' to it's citizens, which is good. They pay their doctors literally less than the cost of many common and important therapeutic drugs. It's an economic non-sequitur.
  - dalke 10y ago
    For your "sarcastic" comment, you happened to pick one of the developing countries known for doing well with limited resources, with child mortality and longevity rates comparable to the US. A country which, btw, is also promoting medical tourism. Which includes Canadians going there - http://www.nytimes.com/2015/02/18/world/americas/americans-may-see-appeal-of-medical-tourism-in-cuba.html http://www.nytimes.com/2015/02/18/world/americas/americans-m... . Perhaps you could go there for treatment? Though from http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-12-417 http://bmchealthservres.biomedcentral.com/articles/10.1186/1... it looks like more Canadians go to India. (The US isn't on the list because Canadians don't think of that as international travel.)

dalke 10y ago

Health care also isn't like writing software. I know how to write software. I don't know how to select health care plans, and I when I had my own US company I was always afraid that I had made the wrong choice. > "Can you imagine your entire hospital and insurance system being in blocks of 800 000" I now live in Sweden, so I'm not unfamiliar with how single payer works in a country of 9 million people. Do note that it's not so isolated as you think. If I were to travel to France, and fall ill, I am entitled to any medical treatment that a resident would receive. This includes Switzerland, so your statement isn't quite a match to how the system works. And let me say that it's a big relief to not worry about those details anymore. With our first kid on the way, I didn't have to wonder if my insurance would cover everything, or if I was feeding into the cost machine that has caused the price of giving birth to triple over the last 20 years in the US. > "Successful countries that do it are tiny" icebraining pointed out the 63 million people living in the UK with its NHS. Even in the US, there are about 9 million people in the VA system and 55 million people in the Medicare system. Is there some fundamental reason which explains why Medicare cannot scale by a factor of 6? > "the guy who snuck across the border illegally gets the exact same healthcare as you" First, in the US everyone, no matter their immigration status, has the right to emergency care. See http://www.medscape.com/viewarticle/590328 http://www.medscape.com/viewarticle/590328 for how the ethics are clear. So you end up with pregnant women coming to ER to give birth, which is expensive. And you have people coming to ER for things that could have been handled at a clinic more cheaply, and before any complications might have come up. To make things more complicated, how does this hypothetical border crosser live in the US without a job? Because if he had a job enough to live on, then either the US employer is paying under the table, or he has a falsely acquired SSN and is paying into Medicare, even if he can't use it. The same works for universal healthcare - the money comes from payroll tax/automatic salary deductions, so even if someone snuck across the border, as long as they have a job they are paying for healthcare. Second, people visiting (say) France from a country outside Europe are not covered under the French system. They are supposed to pay. Indeed, they do pay. Medical tourism is a thing. People will travel to France for treatment, and they pay for the treatment. It is not free to all comers. When my then-girlfriend visited me in Sweden for a couple of weeks, she needed an emergency root canal. She had to pay, and she did, even though she isn't a dutiful Swedish citizen. But sure, there are people who are in the country but aren't eligible for health care and can't afford to pay or refuse to pay. There are two options 1) treat them, 2) don't treat them and wait until they appear in the ER once the problem gets more serious. (Option 3 is let them die, but I'm not inhumane enough to want that.) Which is why the following happened in Spain. "Under a reform that came into place in September 2012, foreigners without residency papers lost their national health cards which allowed them free treatment in local public health clinics." Then in 2015, "Spain's conservative government said ... it would restore free healthcare for illegal immigrants, overturning a controversial decision taken three years ago." - https://www.thelocal.es/20150331/spain-to-restore-free-health-care-for-illegal-immigrants https://www.thelocal.es/20150331/spain-to-restore-free-healt... And they did it to take the load off of expensive ER care, which even the non-single-payer US does.