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Oh my god, I just read news about some "centrist" Democrats arguing against universal single-payer healthcare on the grounds that some segment of the working po

Oh my god, I just read news about some "centrist" Democrats arguing against universal single-payer healthcare on the grounds that some segment of the working population already gets a nice healthcare package as a benefit, and somehow it would be unfair to those people if everyone was eligible to reasonable medical care. I mean, with Democrats like that, why do you even need Republicans?

Accipitriform 7y ago
Right, of course we should want single-payer, just like Canada! Never mind that the average wait time to see a doctor in Canada is almost 20 weeks, and that tens of thousands of Canadians cross the border to the US every year to avoid that wait... There are tradeoffs with everything. Personally I think people should proactively try to live healthier lives - the medical establishment is about making money, not making you healthier. The other major side benefit of that is our society might be able to afford the overall cost of healthcare - it's not looking too good at the moment!
- Sharlin 7y ago
  Oh puh-lease. Even a trivial googling tells me that Canada has longer waiting times than most other comparable countries with single-payer healthcare. And those waiting times? About half of GP visits are same- or next day appointments, with 20% of Canadians having to wait for a week. As for specialists, the median waiting time is roughly four weeks. [1] So those numbers are definitely not optimal compared to many other countries, but your claim about the average being almost 20 weeks is completely ridiculous. You're entitled to your own opinions, but you are not entitled to your own facts. And if your opinions are based on your own facts, don't expect to be taken seriously in any reasonably educated company. Now, according to [2], the US fares well on two metrics: waiting time to see a specialist and waiting time to elective surgeries. Unsurprisingly, both of these are conditional on already having gotten a referral and/or having decided to book the appointment or operation. That is, most of the time, if you have decided you can afford it! Indeed, cost barriers were by far the highest in the US, as measured by the fraction of people who skipped treatment or medication due to cost. [1] https://globalnews.ca/news/3251833/canada-has-some-of-the-longest-wait-times-to-see-doctors-specialists-report/ https://globalnews.ca/news/3251833/canada-has-some-of-the-lo... [2] https://www.cihi.ca/sites/default/files/document/text-alternative-version-2016-cmwf-en-web.pdf https://www.cihi.ca/sites/default/files/document/text-altern...
  - mgkimsal 7y ago
    I may not understand what's being got at with this 'Canadian wait time' issue. I've needed to go see my doctor - usually I can't get a same day appointment. Sometimes I can get a 'next day' - usually it's "pick some time in the next week or two". Am I now "having to wait"? It's been this way for me my entire life in the US (more than 40 years I can remember), across different states, political leadership and insurance companies. I needed a procedure by a specialist last year. Regular checkup produced "this is serious - I'm referring to you ABC for procedure X - we need to get this done ASAP". It was still more than 2 weeks before the specialist could see me. There was an option of seeing someone else sooner, but it would have meant a 2 hour drive. That was possible but very inconvenient, and we decided that the 2 week period was acceptable vs the alternative. Does everyone else in the US get same day service for everything they need, and I've just been wholly unlucky my entire life in multiple regions of the country? Or, do we actually have 'wait times' just like everyone else?
    - Sharlin 7y ago
      Well, I guess that's why you need to creatively misinterpret the statistics in order to make the argument "Canadian wait times long -> single-payer systems baaaaad". Never mind the other logical fallacies in said argument.
- sdwa 7y ago
  Is there any evidence that the reason healthcare is so unaffordable and people go bankrupt is because people are unhealthy? Your "just be healthier" solution is no solution at all. Regardless, people fall ill through no fault of their own all the time. I am very healthy and very active, but right now for all I know I could have a brain tumour. Your response is so stereotypically American: just ignore the problem and encourage people to take responsibility over something they by definition have little control over in the first place.
  - wheno 7y ago
    That is something has always confused me a bit. Many people tend to object to universal system on the basis that it leaves it up to the government. But if you don't have universal systems the government, and the companies operating in the market, have little incentive to take care of its citizens. Because the cost of not doing so is left to you. Even if you want to argue that a health care system is a factor of how healthy people are, it is the universal systems that have the incentive that people are healthy. It is those systems that more often regulate things like transportation or drugs as public health issues.
- AlexandrB 7y ago
  > Never mind that the average wait time to see a doctor in Canada is almost 20 weeks... The way this is stated is very misleading. The average time to get surgery is 20 weeks. This varies a lot by what kind of surgery you're talking about[1]. The average waiting time to see a doctor in the ER is measured in hours, with 27% of Canadians waiting 4 hours or more[2]. As a Canadian, I'm tired of Americans shitting on Canada's health care system and spreading misinformation to score political points. It's not perfect, but I'll take it over the financial devastation wrought by the US system any day. Edit: Also, let's not forget that US citizens regularly cross the border into Canada so they can afford basics like insulin[3]. [1] https://globalnews.ca/news/3084366/q-a-how-long-are-medical-wait-times-in-canada-by-province-and-procedure/ https://globalnews.ca/news/3084366/q-a-how-long-are-medical-... [2] https://www.cbc.ca/news/health/medical-wait-times-up-to-3-times-longer-in-canada-1.2663013 https://www.cbc.ca/news/health/medical-wait-times-up-to-3-ti... [3] https://www.cbc.ca/news/canada/windsor/bernie-sanders-insulin-caravan-windsor-1.5228228 https://www.cbc.ca/news/canada/windsor/bernie-sanders-insuli...
  - wozniacki 7y ago
    Some preeminent foreign statesmen rulers who have gotten / who are getting their surgeries done in the United States. Daniel E. "Danny" Williams, QC a Canadian politician, businessman and lawyer who served as the ninth Premier of Newfoundland and Labrador between November 6, 2003, and December 3, 2010. [1] Abdullah bin Abdulaziz Al Saud was King of Saudi Arabia and Custodian of the Two Holy Mosques from 2005 to his death in 2015. [2] Moses Veerasammy Nagamootoo is a Guyanese politician and writer who has been Prime Minister of Guyana since 2015. [3] [1] 'Danny Millions' Williams heads south for heart surgery https://www.thestar.com/news/canada/2010/02/03/danny_millions_williams_heads_south_for_heart_surgery.html https://www.thestar.com/news/canada/2010/02/03/danny_million... [2] Waldorf-Astoria Bumps Guests for King Abdullah's Entourage / The Room Is Booked, Until the Hotel Says It Isn’t https://www.nytimes.com/2010/12/14/business/14road.html https://www.nytimes.com/2010/12/14/business/14road.html [3] Prime Minister Nagamootoo to Undergo Heart Surgery in the United States https://www.thewestindianonline.com/prime-minister-nagamootoo-to-undergo-heart-surgery-in-the-united-states/ https://www.thewestindianonline.com/prime-minister-nagamooto... edit: typo; rephrased sentence
- precisioncoder 7y ago
  Uh, maybe in some places in Canada? I grew up in Nova Scotia and seeing a doctor with an appointment was possible within a week, emergency was always possible right away. (Had 34 stitches by the time I was 17 due to growing up on a farm so I had a lot of experience.) Here in Austria it's even easier, I can go directly to my family doctor at any time and wait ~hour with no appointment necessary. Xrays, or other things are usually possible same day and even elective surgery that improves quality of life is free and is plannable within a couple months with the recovery time as paid leave from work.
- mrunkel 7y ago
  > Never mind that the average wait time to see a doctor in Canada is almost 20 weeks... This is just false. The number you're referring to is from here: "Specialist physicians surveyed report a median waiting time of 19.8 weeks between referral from a general practitioner and receipt of treatment—shorter than the wait of 21.2 weeks reported in 2017. This year's wait time is 113% longer than in 1993, when it was just 9.3 weeks." It's for receiving treatment from a specialist (surgery, etc.) not 'seeing a doctor'. Somewhere around 40% of Canadians reported being able to see their primary care physician the same day. Very few reported a wait of longer than 7+ days. Many parts of Canada are very remote. The average waiting time for someone in a major city is not as long as that.
  - blaser-waffle 7y ago
    There simply aren't medical facilities in a lot of remote / regional Canada. If you need a fairly complex or specialized surgery you're essentially going to a big city or regional hub. Keep in mind that Canada may be huge, but has less people than California, and most of them are concentrated in a handful of places. Anecdotal: my wife's wait for an orthopedic surgeon was 3 days... but was in a city 1.5 hours away.
- tareqak 7y ago
  It is not twenty weeks to see any doctor: it is twenty weeks to go from a referral from a general practitioner to receiving treatment from a specialist [0][1][2]. I’m not sure if things like consultations are counted are as treatment or not. [0] https://www.ctvnews.ca/mobile/health/health-care-wait-times-hit-20-weeks-in-2016-report-1.3171718 https://www.ctvnews.ca/mobile/health/health-care-wait-times-... [1] https://globalnews.ca/news/3251833/canada-has-some-of-the-longest-wait-times-to-see-doctors-specialists-report/ https://globalnews.ca/news/3251833/canada-has-some-of-the-lo... [2] https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2017 https://www.fraserinstitute.org/studies/waiting-your-turn-wa...
- vidarh 7y ago
  The problem at the very outset with this argument is that a system where patient pays hides the queues, because everyone can afford to go. As such you can not directly compare a system where going to the doctor costs money with one where it does not. This is one of the biggest problems with the US system: Nobody knows the extent of the unserved need, and what that ends up costing society in lost productivity (never mind the human suffering) because people avoid healthcare services they know they can't afford. But we can compare Canada to other socialized systems, and many do more with less and still end up with shorter wait times. The vast majority of the worlds healthcare systems also do not prevent people from going private. Most places also allow you to buy your way past the queues. As such, the difference is stark: Most places you have the choice of waiting, and paying much less, or paying for private services and get seen as quickly as those who can afford it do in the US while a large number of people in the US has no access to a lot of healthcare services at all. Want to bet whether the people who can't afford to buy healthcare services would prefer waiting 20 weeks - or any amount of weeks - to get treated vs. getting no treatment at all? Now consider that average US spending per taxpayer in the US on Medicare and Medicaid is substantially higher than the per taxpayer spending to fully fund universal healthcare in the UK for example. And then on top of that Americans buy private insurance since most are not covered by Medicare and Medicaid. Most Americans pay twice. Meanwhile in the UK only 10% find it worthwhile "paying twice" by having private insurance, even though most private insurances in the UK are very cheap for the simple reason that there's simply no demand for replacing A&E, ICU type services, and relatively little demand for covering private GP services (most people can be seen by their GP quickly, and a private consultation on occasion is cheap), so the insurances mostly cover seeing a specialist quickly if the NHS has a waiting list, or getting surgery quicker if the NHS has a waiting list. This is what I really don't get about the US debate: The poor regulatory regime basically mean Americans are already paying enough towards healthcare to provide universal coverage via taxes alone if the regulations were properly reformed. A start would simply be to remodel Medicare after e.g. the NHS model, and allow it to exercise its market power to drive down costs, and use the savings to extend coverage. As it stands, the inadequacy of the US healthcare system is largely down to corporate welfare in the form of regulations that actively prevent the government from providing cost-effective healthcare services.
wheno 7y ago
The US political spectrum is such that many Democrats are right wing by European, or at least Nordic, standards. What people tend to characterize as "utopia" is the socialist welfare state, where means are tested to a much lesser degree. What countries like Norway have increasingly done is to move from that system to a more liberal one. That is where you find yourself "begging the government for help", because you don't fit into the market. This is a bit of a long paste, but people don't generally understand the differences: --- There are three measures for welfare-state regime stratification: conservative, liberal and social democratic. For the conservative welfare-state regimes, the traditional societal class model is a prevalent idea, but also the rejection of capitalism. Which leaves conservatism between the market based ideology of liberalism and the social democratic wish for social leveling. EspingAndersen distinguishes between two branches of conservatism: corporatism and etatism. Corporatism is described as a response to industrialism and its effects: social fragmentation and individualization. In modern societies, corporatism is described as "...built around occupational groupings seeking to uphold traditionally recognized status distinctions and use these as the organizational nexus for society and economy". Corporatism was mostly influential in the continental European nations, as a response to the Church’s strong position. Etatism, on the other hand, focuses on the primacy of the state. Esping-Andersen illustrates etatism with Bismarck’s wish to tie workers directly to the state with social benefits, instead of tying workers to the guilds, as in the corporatist model. Today, etatism can be traced in two areas of welfare state stratification, where one is giving generous welfare provision to civil servants, giving state servants an elevated position in society, as in countries such as Austria, Germany and France. The other area where etatism can be noted today is the relatively generous poor-relief or income protection, based on the idea of noblesse oblige. The liberal response to the conservative ideas of etatism was the opposite. The state and the stratified society were seen as something that had gotten in the way of market emancipation, and in extension, individual liberty. Social policy were to be replaced by the market in order to achieve social leveling, not to eliminate aid, but to have a less active state. Today, liberalism does accept income-tested social benefits, although it is associated with social stigma to be a social assistance beneficiary. Due to the core liberal idea of the smallest state possible, benefits are usually means-tested and modest, given only to those that are genuinely poor, creating the stigma. The liberal welfare-state system is based on the notion that those who are entrepreneurial and self-reliant should be rewarded. Social insurances exists, but they are privately held and paid for. The socialist movement started as a response both to conservative and liberal reforms. The most important notion of socialism was to change the societal stratification and achieve social leveling. The primary target was to change the means-tested poor laws since they created a stigma within the proletariat and that beneficiaries were disenfranchised. The social democratic idea of universal benefit system as a prolongation of democratic rights was most evident in the Scandinavian countries and particularly in the Swedish "People’s home". The universal benefit system came to include even the middle-class in order to "preserve the solidarity of a universalistic welfare state". A universal benefit system denotes a system where social aid is for everyone. This picture is somewhat simplified, although benefits are universal in general, and more general than the means-tested system where only a limited group qualifies for benefits. Moreover, the socialist movement focused on the concept of solidarity and in extension, one of its most distinctive features: centralized bargaining trough trade unions. --- Do Capitalist Welfare States Still Consist of ”The Good, the Bad and the Ugly?” http://lup.lub.lu.se/luur/download?func=downloadFile&recordOId=4229151&fileOId=4229169 http://lup.lub.lu.se/luur/download?func=downloadFile&recordO...
EdSharkey 7y ago
I don't think Democrats (or Republicans when they take power) are clever/smart/kind/honest enough to offer universal single-payer healthcare without rationing. Is there an intent to take my health care choices away, and is that intent benevolent or malicious? You paint a very abstractly wonderful picture, so let's assume yes and benevolent if rationing is to be expected given the finite tax base. I still need more details before I get on board with your plan. First of all, my employer and I pay through the nose for my decent healthcare right now. Under your universal single-payer healthcare system, will I still be able to pay quadruple-through-the-nose to buy supplemental insurance such that I can still continue to get halfway decent service when I want it? Or, am I going to be stuck with everyone else waiting for rationed care out of fairness? Also, are you planning to cap salaries of doctors and profits of hospitals and insurance companies out of fairness? (You think it's hard to get quality specialist care now??) A different opinion from yours goes something like this: US health care is so expensive and inaccessible to 10% of the population because government got involved. The federal government twisted the HC system into a bureaucratic pretzel with no market forces to control costs. The absurd system we have now is a consequence of letting busybody crusaders and insurance company cronies write the laws. I am not saying that viewpoint is accurate, but it's worth getting diverse voices into the discussion so that we don't wind up with an unhealthy progressive monoculture here on HN. If we talk to each other like friends that have differing opinions, then we can find lots of little improvements that a majority of us can agree on, like maybe up-front pricing in hospitals or tort reform. If we can bring costs down and make health care more accessible to more people, then maybe we won't feel forced to take risky steps like forcing everyone to cede their personal health care choices to indifferent government pencil pushers. Reaching out to you as a friend, I feel we both want the same thing - to have the maximum number of people possible receive quality care. I feel we're both frustrated that the current system is so unfair in so many ways. I'm not opposed to setting up a safety net, as long as it doesn't get out of hand cost-wise or turn into a racket for the cronies. I'm thinking like mending broken bones, treating infections, vaccinations, most generics, and addiction treatment all should be abundant, cheap and/or free. Panacea it would not be with a fixed budget so that as a program it cannot grow to crony levels. You could sell me on providing basic health services like that because it just makes sense economically and public health-wise. And I hope you're not opposed to weeding out waste, fraud, and abuse as one approach (of many) to fix a broken system. If we can get costs demonstrably down, maybe you'd even be open to deep cuts in existing nondiscretionary programs like medicare that have insane unfunded liabilities and will eventually crush us. Maybe there is a middle ground that satisfies between us politically such that we can move forward together rather than lurching crazily right and left every 8 years.
mschuster91 7y ago
The core problem at hand is FPTP and the Electoral College. The presidential election is decided in the swing states and with the current system the centrist Democrats do have a point - even if the hardcore Democrat states love Sanders or Warren, their landslide victories in these states won't help anything if all the swing states go Republican. America needs two periods with Democrats: the first one won with/by centrists, who then fix up the electoral system issues (gerrymandering, FPTP, voter suppression, campaign financing) and the second period where the left wing fixes the societal issues (income/wealth inequality, healthcare, "free speech" allowing people to walk with Swastikas).
- dragonwriter 7y ago
  > The presidential election is decided in the swing states That's both true and misleading. The decisive factor in Presidential elections is base turnout. Obviously, the states where the outcome is least certain are most decisive, but this doesn't make centrism a particularly winning general election strategy for either party, which is why the Republicans haven't nominated a centrist Republican in decades, and the Democrats have consistently underperformed where they naturally should perform from party ID (including taking into account he state-by-state distribution), despite nominating candidates from the center-right neoliberal wing in every Presidential election since 1992. > and with the current system the centrist Democrats do have a point No, they don't. Their point is literally “We should keep doing the thing that we've been doing and expect that doing so will result in something other than the results it keeps producing.” > America needs two periods with Democrats: the first one won with/by centrists, who then fix up the electoral system issues (gerrymandering, FPTP, voter suppression, campaign financing) Why would centrists Democrats—who use all those things to argue for why progressives must vote for them instead of actual progressive candidates (and despite the fact that that strategy manifestly doesn't work)—want to fix any of those things and thereby terminate their own argument for dominance within the party? You might as well expect Republicans to fix them; they have just as much (that is, negative) incentive to do so.
- atq2119 7y ago
  The US had the period of centrist Democrats with Obama, yet none of the things you mention happened.

Accipitriform 7y ago

Right, of course we should want single-payer, just like Canada! Never mind that the average wait time to see a doctor in Canada is almost 20 weeks, and that tens of thousands of Canadians cross the border to the US every year to avoid that wait... There are tradeoffs with everything. Personally I think people should proactively try to live healthier lives - the medical establishment is about making money, not making you healthier. The other major side benefit of that is our society might be able to afford the overall cost of healthcare - it's not looking too good at the moment!

Sharlin 7y ago
Oh puh-lease. Even a trivial googling tells me that Canada has longer waiting times than most other comparable countries with single-payer healthcare. And those waiting times? About half of GP visits are same- or next day appointments, with 20% of Canadians having to wait for a week. As for specialists, the median waiting time is roughly four weeks. [1] So those numbers are definitely not optimal compared to many other countries, but your claim about the average being almost 20 weeks is completely ridiculous. You're entitled to your own opinions, but you are not entitled to your own facts. And if your opinions are based on your own facts, don't expect to be taken seriously in any reasonably educated company. Now, according to [2], the US fares well on two metrics: waiting time to see a specialist and waiting time to elective surgeries. Unsurprisingly, both of these are conditional on already having gotten a referral and/or having decided to book the appointment or operation. That is, most of the time, if you have decided you can afford it! Indeed, cost barriers were by far the highest in the US, as measured by the fraction of people who skipped treatment or medication due to cost. [1] https://globalnews.ca/news/3251833/canada-has-some-of-the-longest-wait-times-to-see-doctors-specialists-report/ https://globalnews.ca/news/3251833/canada-has-some-of-the-lo... [2] https://www.cihi.ca/sites/default/files/document/text-alternative-version-2016-cmwf-en-web.pdf https://www.cihi.ca/sites/default/files/document/text-altern...
- mgkimsal 7y ago
  I may not understand what's being got at with this 'Canadian wait time' issue. I've needed to go see my doctor - usually I can't get a same day appointment. Sometimes I can get a 'next day' - usually it's "pick some time in the next week or two". Am I now "having to wait"? It's been this way for me my entire life in the US (more than 40 years I can remember), across different states, political leadership and insurance companies. I needed a procedure by a specialist last year. Regular checkup produced "this is serious - I'm referring to you ABC for procedure X - we need to get this done ASAP". It was still more than 2 weeks before the specialist could see me. There was an option of seeing someone else sooner, but it would have meant a 2 hour drive. That was possible but very inconvenient, and we decided that the 2 week period was acceptable vs the alternative. Does everyone else in the US get same day service for everything they need, and I've just been wholly unlucky my entire life in multiple regions of the country? Or, do we actually have 'wait times' just like everyone else?
  - Sharlin 7y ago
    Well, I guess that's why you need to creatively misinterpret the statistics in order to make the argument "Canadian wait times long -> single-payer systems baaaaad". Never mind the other logical fallacies in said argument.
sdwa 7y ago
Is there any evidence that the reason healthcare is so unaffordable and people go bankrupt is because people are unhealthy? Your "just be healthier" solution is no solution at all. Regardless, people fall ill through no fault of their own all the time. I am very healthy and very active, but right now for all I know I could have a brain tumour. Your response is so stereotypically American: just ignore the problem and encourage people to take responsibility over something they by definition have little control over in the first place.
- wheno 7y ago
  That is something has always confused me a bit. Many people tend to object to universal system on the basis that it leaves it up to the government. But if you don't have universal systems the government, and the companies operating in the market, have little incentive to take care of its citizens. Because the cost of not doing so is left to you. Even if you want to argue that a health care system is a factor of how healthy people are, it is the universal systems that have the incentive that people are healthy. It is those systems that more often regulate things like transportation or drugs as public health issues.
AlexandrB 7y ago
> Never mind that the average wait time to see a doctor in Canada is almost 20 weeks... The way this is stated is very misleading. The average time to get surgery is 20 weeks. This varies a lot by what kind of surgery you're talking about[1]. The average waiting time to see a doctor in the ER is measured in hours, with 27% of Canadians waiting 4 hours or more[2]. As a Canadian, I'm tired of Americans shitting on Canada's health care system and spreading misinformation to score political points. It's not perfect, but I'll take it over the financial devastation wrought by the US system any day. Edit: Also, let's not forget that US citizens regularly cross the border into Canada so they can afford basics like insulin[3]. [1] https://globalnews.ca/news/3084366/q-a-how-long-are-medical-wait-times-in-canada-by-province-and-procedure/ https://globalnews.ca/news/3084366/q-a-how-long-are-medical-... [2] https://www.cbc.ca/news/health/medical-wait-times-up-to-3-times-longer-in-canada-1.2663013 https://www.cbc.ca/news/health/medical-wait-times-up-to-3-ti... [3] https://www.cbc.ca/news/canada/windsor/bernie-sanders-insulin-caravan-windsor-1.5228228 https://www.cbc.ca/news/canada/windsor/bernie-sanders-insuli...
- wozniacki 7y ago
  Some preeminent foreign statesmen rulers who have gotten / who are getting their surgeries done in the United States. Daniel E. "Danny" Williams, QC a Canadian politician, businessman and lawyer who served as the ninth Premier of Newfoundland and Labrador between November 6, 2003, and December 3, 2010. [1] Abdullah bin Abdulaziz Al Saud was King of Saudi Arabia and Custodian of the Two Holy Mosques from 2005 to his death in 2015. [2] Moses Veerasammy Nagamootoo is a Guyanese politician and writer who has been Prime Minister of Guyana since 2015. [3] [1] 'Danny Millions' Williams heads south for heart surgery https://www.thestar.com/news/canada/2010/02/03/danny_millions_williams_heads_south_for_heart_surgery.html https://www.thestar.com/news/canada/2010/02/03/danny_million... [2] Waldorf-Astoria Bumps Guests for King Abdullah's Entourage / The Room Is Booked, Until the Hotel Says It Isn’t https://www.nytimes.com/2010/12/14/business/14road.html https://www.nytimes.com/2010/12/14/business/14road.html [3] Prime Minister Nagamootoo to Undergo Heart Surgery in the United States https://www.thewestindianonline.com/prime-minister-nagamootoo-to-undergo-heart-surgery-in-the-united-states/ https://www.thewestindianonline.com/prime-minister-nagamooto... edit: typo; rephrased sentence
precisioncoder 7y ago
Uh, maybe in some places in Canada? I grew up in Nova Scotia and seeing a doctor with an appointment was possible within a week, emergency was always possible right away. (Had 34 stitches by the time I was 17 due to growing up on a farm so I had a lot of experience.) Here in Austria it's even easier, I can go directly to my family doctor at any time and wait ~hour with no appointment necessary. Xrays, or other things are usually possible same day and even elective surgery that improves quality of life is free and is plannable within a couple months with the recovery time as paid leave from work.
mrunkel 7y ago
> Never mind that the average wait time to see a doctor in Canada is almost 20 weeks... This is just false. The number you're referring to is from here: "Specialist physicians surveyed report a median waiting time of 19.8 weeks between referral from a general practitioner and receipt of treatment—shorter than the wait of 21.2 weeks reported in 2017. This year's wait time is 113% longer than in 1993, when it was just 9.3 weeks." It's for receiving treatment from a specialist (surgery, etc.) not 'seeing a doctor'. Somewhere around 40% of Canadians reported being able to see their primary care physician the same day. Very few reported a wait of longer than 7+ days. Many parts of Canada are very remote. The average waiting time for someone in a major city is not as long as that.
- blaser-waffle 7y ago
  There simply aren't medical facilities in a lot of remote / regional Canada. If you need a fairly complex or specialized surgery you're essentially going to a big city or regional hub. Keep in mind that Canada may be huge, but has less people than California, and most of them are concentrated in a handful of places. Anecdotal: my wife's wait for an orthopedic surgeon was 3 days... but was in a city 1.5 hours away.
tareqak 7y ago
It is not twenty weeks to see any doctor: it is twenty weeks to go from a referral from a general practitioner to receiving treatment from a specialist [0][1][2]. I’m not sure if things like consultations are counted are as treatment or not. [0] https://www.ctvnews.ca/mobile/health/health-care-wait-times-hit-20-weeks-in-2016-report-1.3171718 https://www.ctvnews.ca/mobile/health/health-care-wait-times-... [1] https://globalnews.ca/news/3251833/canada-has-some-of-the-longest-wait-times-to-see-doctors-specialists-report/ https://globalnews.ca/news/3251833/canada-has-some-of-the-lo... [2] https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2017 https://www.fraserinstitute.org/studies/waiting-your-turn-wa...
vidarh 7y ago
The problem at the very outset with this argument is that a system where patient pays hides the queues, because everyone can afford to go. As such you can not directly compare a system where going to the doctor costs money with one where it does not. This is one of the biggest problems with the US system: Nobody knows the extent of the unserved need, and what that ends up costing society in lost productivity (never mind the human suffering) because people avoid healthcare services they know they can't afford. But we can compare Canada to other socialized systems, and many do more with less and still end up with shorter wait times. The vast majority of the worlds healthcare systems also do not prevent people from going private. Most places also allow you to buy your way past the queues. As such, the difference is stark: Most places you have the choice of waiting, and paying much less, or paying for private services and get seen as quickly as those who can afford it do in the US while a large number of people in the US has no access to a lot of healthcare services at all. Want to bet whether the people who can't afford to buy healthcare services would prefer waiting 20 weeks - or any amount of weeks - to get treated vs. getting no treatment at all? Now consider that average US spending per taxpayer in the US on Medicare and Medicaid is substantially higher than the per taxpayer spending to fully fund universal healthcare in the UK for example. And then on top of that Americans buy private insurance since most are not covered by Medicare and Medicaid. Most Americans pay twice. Meanwhile in the UK only 10% find it worthwhile "paying twice" by having private insurance, even though most private insurances in the UK are very cheap for the simple reason that there's simply no demand for replacing A&E, ICU type services, and relatively little demand for covering private GP services (most people can be seen by their GP quickly, and a private consultation on occasion is cheap), so the insurances mostly cover seeing a specialist quickly if the NHS has a waiting list, or getting surgery quicker if the NHS has a waiting list. This is what I really don't get about the US debate: The poor regulatory regime basically mean Americans are already paying enough towards healthcare to provide universal coverage via taxes alone if the regulations were properly reformed. A start would simply be to remodel Medicare after e.g. the NHS model, and allow it to exercise its market power to drive down costs, and use the savings to extend coverage. As it stands, the inadequacy of the US healthcare system is largely down to corporate welfare in the form of regulations that actively prevent the government from providing cost-effective healthcare services.

wheno 7y ago

The US political spectrum is such that many Democrats are right wing by European, or at least Nordic, standards. What people tend to characterize as "utopia" is the socialist welfare state, where means are tested to a much lesser degree. What countries like Norway have increasingly done is to move from that system to a more liberal one. That is where you find yourself "begging the government for help", because you don't fit into the market. This is a bit of a long paste, but people don't generally understand the differences: --- There are three measures for welfare-state regime stratification: conservative, liberal and social democratic. For the conservative welfare-state regimes, the traditional societal class model is a prevalent idea, but also the rejection of capitalism. Which leaves conservatism between the market based ideology of liberalism and the social democratic wish for social leveling. EspingAndersen distinguishes between two branches of conservatism: corporatism and etatism. Corporatism is described as a response to industrialism and its effects: social fragmentation and individualization. In modern societies, corporatism is described as "...built around occupational groupings seeking to uphold traditionally recognized status distinctions and use these as the organizational nexus for society and economy". Corporatism was mostly influential in the continental European nations, as a response to the Church’s strong position. Etatism, on the other hand, focuses on the primacy of the state. Esping-Andersen illustrates etatism with Bismarck’s wish to tie workers directly to the state with social benefits, instead of tying workers to the guilds, as in the corporatist model. Today, etatism can be traced in two areas of welfare state stratification, where one is giving generous welfare provision to civil servants, giving state servants an elevated position in society, as in countries such as Austria, Germany and France. The other area where etatism can be noted today is the relatively generous poor-relief or income protection, based on the idea of noblesse oblige. The liberal response to the conservative ideas of etatism was the opposite. The state and the stratified society were seen as something that had gotten in the way of market emancipation, and in extension, individual liberty. Social policy were to be replaced by the market in order to achieve social leveling, not to eliminate aid, but to have a less active state. Today, liberalism does accept income-tested social benefits, although it is associated with social stigma to be a social assistance beneficiary. Due to the core liberal idea of the smallest state possible, benefits are usually means-tested and modest, given only to those that are genuinely poor, creating the stigma. The liberal welfare-state system is based on the notion that those who are entrepreneurial and self-reliant should be rewarded. Social insurances exists, but they are privately held and paid for. The socialist movement started as a response both to conservative and liberal reforms. The most important notion of socialism was to change the societal stratification and achieve social leveling. The primary target was to change the means-tested poor laws since they created a stigma within the proletariat and that beneficiaries were disenfranchised. The social democratic idea of universal benefit system as a prolongation of democratic rights was most evident in the Scandinavian countries and particularly in the Swedish "People’s home". The universal benefit system came to include even the middle-class in order to "preserve the solidarity of a universalistic welfare state". A universal benefit system denotes a system where social aid is for everyone. This picture is somewhat simplified, although benefits are universal in general, and more general than the means-tested system where only a limited group qualifies for benefits. Moreover, the socialist movement focused on the concept of solidarity and in extension, one of its most distinctive features: centralized bargaining trough trade unions. --- Do Capitalist Welfare States Still Consist of ”The Good, the Bad and the Ugly?” http://lup.lub.lu.se/luur/download?func=downloadFile&recordOId=4229151&fileOId=4229169 http://lup.lub.lu.se/luur/download?func=downloadFile&recordO...

EdSharkey 7y ago

I don't think Democrats (or Republicans when they take power) are clever/smart/kind/honest enough to offer universal single-payer healthcare without rationing. Is there an intent to take my health care choices away, and is that intent benevolent or malicious? You paint a very abstractly wonderful picture, so let's assume yes and benevolent if rationing is to be expected given the finite tax base. I still need more details before I get on board with your plan. First of all, my employer and I pay through the nose for my decent healthcare right now. Under your universal single-payer healthcare system, will I still be able to pay quadruple-through-the-nose to buy supplemental insurance such that I can still continue to get halfway decent service when I want it? Or, am I going to be stuck with everyone else waiting for rationed care out of fairness? Also, are you planning to cap salaries of doctors and profits of hospitals and insurance companies out of fairness? (You think it's hard to get quality specialist care now??) A different opinion from yours goes something like this: US health care is so expensive and inaccessible to 10% of the population because government got involved. The federal government twisted the HC system into a bureaucratic pretzel with no market forces to control costs. The absurd system we have now is a consequence of letting busybody crusaders and insurance company cronies write the laws. I am not saying that viewpoint is accurate, but it's worth getting diverse voices into the discussion so that we don't wind up with an unhealthy progressive monoculture here on HN. If we talk to each other like friends that have differing opinions, then we can find lots of little improvements that a majority of us can agree on, like maybe up-front pricing in hospitals or tort reform. If we can bring costs down and make health care more accessible to more people, then maybe we won't feel forced to take risky steps like forcing everyone to cede their personal health care choices to indifferent government pencil pushers. Reaching out to you as a friend, I feel we both want the same thing - to have the maximum number of people possible receive quality care. I feel we're both frustrated that the current system is so unfair in so many ways. I'm not opposed to setting up a safety net, as long as it doesn't get out of hand cost-wise or turn into a racket for the cronies. I'm thinking like mending broken bones, treating infections, vaccinations, most generics, and addiction treatment all should be abundant, cheap and/or free. Panacea it would not be with a fixed budget so that as a program it cannot grow to crony levels. You could sell me on providing basic health services like that because it just makes sense economically and public health-wise. And I hope you're not opposed to weeding out waste, fraud, and abuse as one approach (of many) to fix a broken system. If we can get costs demonstrably down, maybe you'd even be open to deep cuts in existing nondiscretionary programs like medicare that have insane unfunded liabilities and will eventually crush us. Maybe there is a middle ground that satisfies between us politically such that we can move forward together rather than lurching crazily right and left every 8 years.

mschuster91 7y ago

The core problem at hand is FPTP and the Electoral College. The presidential election is decided in the swing states and with the current system the centrist Democrats do have a point - even if the hardcore Democrat states love Sanders or Warren, their landslide victories in these states won't help anything if all the swing states go Republican. America needs two periods with Democrats: the first one won with/by centrists, who then fix up the electoral system issues (gerrymandering, FPTP, voter suppression, campaign financing) and the second period where the left wing fixes the societal issues (income/wealth inequality, healthcare, "free speech" allowing people to walk with Swastikas).

dragonwriter 7y ago
> The presidential election is decided in the swing states That's both true and misleading. The decisive factor in Presidential elections is base turnout. Obviously, the states where the outcome is least certain are most decisive, but this doesn't make centrism a particularly winning general election strategy for either party, which is why the Republicans haven't nominated a centrist Republican in decades, and the Democrats have consistently underperformed where they naturally should perform from party ID (including taking into account he state-by-state distribution), despite nominating candidates from the center-right neoliberal wing in every Presidential election since 1992. > and with the current system the centrist Democrats do have a point No, they don't. Their point is literally “We should keep doing the thing that we've been doing and expect that doing so will result in something other than the results it keeps producing.” > America needs two periods with Democrats: the first one won with/by centrists, who then fix up the electoral system issues (gerrymandering, FPTP, voter suppression, campaign financing) Why would centrists Democrats—who use all those things to argue for why progressives must vote for them instead of actual progressive candidates (and despite the fact that that strategy manifestly doesn't work)—want to fix any of those things and thereby terminate their own argument for dominance within the party? You might as well expect Republicans to fix them; they have just as much (that is, negative) incentive to do so.
atq2119 7y ago
The US had the period of centrist Democrats with Obama, yet none of the things you mention happened.