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Exactly. Just repeat 'free healthcare', never mind that many people in Canada can't even find a family Dr, let alone get things like MRIs. Michael Moore said we

by fleitz 9y ago

Exactly. Just repeat 'free healthcare', never mind that many people in Canada can't even find a family Dr, let alone get things like MRIs. Michael Moore said we have wonderful healthcare just like Cuba, so it must be true. Oh it appears that now ERs are shutting down, but hey, free healthcare. Did I mention that you won't get a bill for dying on a waiting list if you use free healthcare in Canada? It's amazing and you can pay for it easily. Don't even have to leave your house to get free treatments. http://www.cbc.ca/news/canada/british-columbia/doctor-shortage-puts-pressure-on-small-town-ers-1.4249835 http://www.cbc.ca/news/canada/british-columbia/doctor-shorta...

JshWright 9y ago
Canada beats the US in just about every metric you can imagine... From infant mortality to overall patient (and doctor) satisfaction.
- fleitz 9y ago
  The US is dead last in the G20, Canada is 2nd last. Our system still sucks.
- jedberg 9y ago
  That's true on average. But if you split the US into wealthy and non-wealthy, the wealthy get excellent care and have better outcomes than almost any other country, whereas the poor fare significantly worse than even many 3rd world countries. That's why people get upset when we talk about this. Some wealthy people point out that their care is far better than Canada's (which is true) while other wealthy people who care about other humans point out that while their care is better than Canada, not everyone's is. And then of course the poor in America just want to not die of totally treatable diseases.
  - fleitz 9y ago
    Exactly, so if you are a median Canadian you're getting very shitty healthcare compared to the median American. In Canada you still get really shitty outcomes for any chronic illness. Basically if any idiot can identify what problem you have heart failure, broken arm, profuse bleeding you get treated for free, and in a reasonably efficient manner. If you have anything that requires tests, scans, diagnostics, a specialist, or isn't going to kill you in the next week plan on spending 5 to 10 years on a waiting list / various waiting lists. My friend has been waiting 4 years for knee surgery that prevents her from working. One of the best things about having a private Dr in Canada is that they know how to work the system and will basically harass the list keepers to bump you up so that the keepers of the lists can go back to doing nothing. Also, most clinics have some sort of consult that you can opt for which makes the waiting list magically disappear. Get a out of pocket brain scan? Voila, brain specialist is available in 2 weeks instead of 2 years.
- adventured 9y ago
  Canada beats the US on infant mortality to such a degree because it's an anti-diversity nation that has historically been against allowing in poor, unskilled immigrants. Which is why Canada is only ~1.3% hispanic and only ~2.5% black. Let Canada take in ten million poor people from Latin America over the next two decades and let's see what happens to their infant mortality numbers and let's see what happens to their healthcare system (both in terms of wait times / rationing and cost). Right now people are getting upset in Canada about the tiny number of refugees trying to enter the nation across the US border. Now, multiply that by 30 or 50 fold for decades and watch the Canadian healthcare system implode.
  - sctb 9y ago
    This is so not the kind of conversation we're trying to have here. Please comment civilly and substantively—don't start flamewars by making baseless inflammatory claims. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
lsiebert 9y ago
Single payer isn't free or a panacea to health care costs, and there are problems in Canada, but the problems you cite are also problems in the US. I end with some thoughts on how free markets and optimization can save us lots of money, so stick with me. That's rural ERs in Canada in the article you link. Same problem is happening in the US, because many doctors want to live in a city, where there is potential job growth and a host of other benefits, rather then out in rural hospitals, which usually can't pay very much. This is a systemic issue that affects all rural health care, not a problem with Canadian health care specifically. Here's a couple of articles from just August about the issue in the US. http://www.spokesman.com/stories/2017/aug/26/rural-america-seeks-more-doctors/ http://www.spokesman.com/stories/2017/aug/26/rural-america-s... https://www.nbcnews.com/health/health-news/new-program-aims-keep-ob-gyns-rural-america-n793991 https://www.nbcnews.com/health/health-news/new-program-aims-... As for wait times, again, also a problem in America. Even if we moved to single payer, it would probably get worse before it got better, since it means more people with health insurance for the same number of doctors in the short term, but then the market would likely correct that. Heres an article on us wait times. https://www.forbes.com/sites/brucejapsen/2017/03/19/doctor-wait-times-soar-amid-trumpcare-debate/2/#21846bd34883 https://www.forbes.com/sites/brucejapsen/2017/03/19/doctor-w... Demand for health care will continue to increase as baby boomers age, new techniques arrive etc. That will always drive up prices or other costs, regardless of if we go single payer or keep the current system here. And it's a big enough system no matter what you do that there will always be some waste and greed that can't be cut. Currently though, what is waste/greed and what is actual increasing cost is very unclear because PBMs and other companies keep things like drug pricing confidential. If conservatives want to fight single payer, they need to lay out an alternative strategy that will actually keep costs in line without sacrificing care. Single payer or our current system, most of the health care dollar doesn't go to the insurer under obama care (obamacare mandated a minimum of 80% for smaller carriers or 85% for larger ones, previously it was 50 - 60% so we did get some savings there), so if you want to cut costs, we really need to cut it at the middle or at the provider/manufacturer level. Now single payer could save something, because operating costs are still higher then in simpler systems (https://newsatjama.jama.com/2017/04/25/jama-forum-where-does-the-health-insurance-premium-dollar-go/ https://newsatjama.jama.com/2017/04/25/jama-forum-where-does...). But single payer has a lot of requirements to be cheaper like the govermnent being allowed to negotiate drug and provider prices. These are things that, except on the state level, most likely would be heavily opposed by medical providers. Total costs for the health care procedures/devices/drugs/providers are higher to insurers, and that's where most of your money goes, and as any developer will tell you, if you want to optimize, you want to optimize where you are spending the most be it in dollars or in processor cycles. So we have to cut that. And that's what conservatives should be focusing on, cutting the underlying costs, and making the pbms and brokers in the middle be transparent, so that cost savings get to insurers which can then be regulated at the state level. My first suggestion to that end is always going to be more transparency to allow for a better free market, but that means adding and enforcing regulations to provide transparency, something which conservatives have resisted, despite the success of regulated open markets like stock exchanges. Drug companies spend more of their money on marketing then R&D, ( http://www.randalolson.com/2015/03/01/design-critique-putting-big-pharma-spending-in-perspective/ http://www.randalolson.com/2015/03/01/design-critique-puttin... ) so there is plenty of fat to cut before you start affecting R&d expenditures, and drug companies are one of the biggest beneficiaries of US research grants and tax benefits. Even a congressional committee investigation would be a start. So it's still possible to keep private insurers, but conservatives need to step up.

by fleitz 9y ago

JshWright 9y ago

Canada beats the US in just about every metric you can imagine... From infant mortality to overall patient (and doctor) satisfaction.

fleitz 9y ago
The US is dead last in the G20, Canada is 2nd last. Our system still sucks.
jedberg 9y ago
That's true on average. But if you split the US into wealthy and non-wealthy, the wealthy get excellent care and have better outcomes than almost any other country, whereas the poor fare significantly worse than even many 3rd world countries. That's why people get upset when we talk about this. Some wealthy people point out that their care is far better than Canada's (which is true) while other wealthy people who care about other humans point out that while their care is better than Canada, not everyone's is. And then of course the poor in America just want to not die of totally treatable diseases.
- fleitz 9y ago
  Exactly, so if you are a median Canadian you're getting very shitty healthcare compared to the median American. In Canada you still get really shitty outcomes for any chronic illness. Basically if any idiot can identify what problem you have heart failure, broken arm, profuse bleeding you get treated for free, and in a reasonably efficient manner. If you have anything that requires tests, scans, diagnostics, a specialist, or isn't going to kill you in the next week plan on spending 5 to 10 years on a waiting list / various waiting lists. My friend has been waiting 4 years for knee surgery that prevents her from working. One of the best things about having a private Dr in Canada is that they know how to work the system and will basically harass the list keepers to bump you up so that the keepers of the lists can go back to doing nothing. Also, most clinics have some sort of consult that you can opt for which makes the waiting list magically disappear. Get a out of pocket brain scan? Voila, brain specialist is available in 2 weeks instead of 2 years.
adventured 9y ago
Canada beats the US on infant mortality to such a degree because it's an anti-diversity nation that has historically been against allowing in poor, unskilled immigrants. Which is why Canada is only ~1.3% hispanic and only ~2.5% black. Let Canada take in ten million poor people from Latin America over the next two decades and let's see what happens to their infant mortality numbers and let's see what happens to their healthcare system (both in terms of wait times / rationing and cost). Right now people are getting upset in Canada about the tiny number of refugees trying to enter the nation across the US border. Now, multiply that by 30 or 50 fold for decades and watch the Canadian healthcare system implode.
- sctb 9y ago
  This is so not the kind of conversation we're trying to have here. Please comment civilly and substantively—don't start flamewars by making baseless inflammatory claims. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

lsiebert 9y ago

Single payer isn't free or a panacea to health care costs, and there are problems in Canada, but the problems you cite are also problems in the US. I end with some thoughts on how free markets and optimization can save us lots of money, so stick with me. That's rural ERs in Canada in the article you link. Same problem is happening in the US, because many doctors want to live in a city, where there is potential job growth and a host of other benefits, rather then out in rural hospitals, which usually can't pay very much. This is a systemic issue that affects all rural health care, not a problem with Canadian health care specifically. Here's a couple of articles from just August about the issue in the US. http://www.spokesman.com/stories/2017/aug/26/rural-america-seeks-more-doctors/ http://www.spokesman.com/stories/2017/aug/26/rural-america-s... https://www.nbcnews.com/health/health-news/new-program-aims-keep-ob-gyns-rural-america-n793991 https://www.nbcnews.com/health/health-news/new-program-aims-... As for wait times, again, also a problem in America. Even if we moved to single payer, it would probably get worse before it got better, since it means more people with health insurance for the same number of doctors in the short term, but then the market would likely correct that. Heres an article on us wait times. https://www.forbes.com/sites/brucejapsen/2017/03/19/doctor-wait-times-soar-amid-trumpcare-debate/2/#21846bd34883 https://www.forbes.com/sites/brucejapsen/2017/03/19/doctor-w... Demand for health care will continue to increase as baby boomers age, new techniques arrive etc. That will always drive up prices or other costs, regardless of if we go single payer or keep the current system here. And it's a big enough system no matter what you do that there will always be some waste and greed that can't be cut. Currently though, what is waste/greed and what is actual increasing cost is very unclear because PBMs and other companies keep things like drug pricing confidential. If conservatives want to fight single payer, they need to lay out an alternative strategy that will actually keep costs in line without sacrificing care. Single payer or our current system, most of the health care dollar doesn't go to the insurer under obama care (obamacare mandated a minimum of 80% for smaller carriers or 85% for larger ones, previously it was 50 - 60% so we did get some savings there), so if you want to cut costs, we really need to cut it at the middle or at the provider/manufacturer level. Now single payer could save something, because operating costs are still higher then in simpler systems (https://newsatjama.jama.com/2017/04/25/jama-forum-where-does-the-health-insurance-premium-dollar-go/ https://newsatjama.jama.com/2017/04/25/jama-forum-where-does...). But single payer has a lot of requirements to be cheaper like the govermnent being allowed to negotiate drug and provider prices. These are things that, except on the state level, most likely would be heavily opposed by medical providers. Total costs for the health care procedures/devices/drugs/providers are higher to insurers, and that's where most of your money goes, and as any developer will tell you, if you want to optimize, you want to optimize where you are spending the most be it in dollars or in processor cycles. So we have to cut that. And that's what conservatives should be focusing on, cutting the underlying costs, and making the pbms and brokers in the middle be transparent, so that cost savings get to insurers which can then be regulated at the state level. My first suggestion to that end is always going to be more transparency to allow for a better free market, but that means adding and enforcing regulations to provide transparency, something which conservatives have resisted, despite the success of regulated open markets like stock exchanges. Drug companies spend more of their money on marketing then R&D, ( http://www.randalolson.com/2015/03/01/design-critique-putting-big-pharma-spending-in-perspective/ http://www.randalolson.com/2015/03/01/design-critique-puttin... ) so there is plenty of fat to cut before you start affecting R&d expenditures, and drug companies are one of the biggest beneficiaries of US research grants and tax benefits. Even a congressional committee investigation would be a start. So it's still possible to keep private insurers, but conservatives need to step up.