4 ms·

Yes, this it. American care is actually really quite good, but the cost curve is very aggressive, it's something like 2x as much and doesn't cover everyone. A

by jariel 6y ago

Yes, this it. American care is actually really quite good, but the cost curve is very aggressive, it's something like 2x as much and doesn't cover everyone. And inverse is true: Canadians believe in some fantastically weird things about the US system. In my experience as a Canadian living in the US, I was basically shocked at how new, modern and efficient everything was, how service was relatively quick and how knowledgeable the experts were. The Canadian system 'covers everyone' but it absolutely rations care, you will wait quite a while for non essential services, and in some cases a little bit longer than comfortable for other services as well. My concern about comparing the various systems, is that I believe a lot of the 'exceptionalism' of the US system bleeds out into the rest of the world and we benefit from that quite a lot. The challenge is: how do we get the prices down without materially reducing quality of care because even as their gross inefficiencies, it's hard to suck out just the problem costs without affecting the system as a hole - akin to 'losing weight' if you go on a diet, you're going to lose muscle as well as fat.

baybal2 6y ago
And you still have a double digit risk of being screwed even with a reputable insurer. Legalese, and fine script in medical services is a minefield no worse than American financial laws.
- tehwebguy 6y ago
  Exactly - every detail of insurance plans are a scam, and that’s not even enough so they’ll just deny valid claims and make you work for it. An MRI might be “covered” but what if you have to spend 2 hours getting it approved beforehand and then 2 hours after proving that they said they’d cover it? Every time? For 4 MRIs?
bbddg 6y ago
The US system rations care as well. It just rations on the basis of who can afford care. It seems much more logical and humane to ration care based on how essential the service required is.
- maxerickson 6y ago
  The US system also rations equipment based on more or less arbitrary bureaucratic determinations. Want to open a radiology practice with an MRI machine? Better hope the state lets you.
  - jariel 6y ago
    bbdog is correct to point out that rationing is mostly economic. I do agree that there should be a humanitarian component to it. In Canada, it's the other extreme: everyone is treated identically (theoretically) no matter what and it's illegal to sell medical services in most cases. The way 'around' the problem is to hunt down good doctors through the network and word of mouth. Literally the Golf Club is where you find out who the best docs are, and then you apply with them and hope you have enough clout/status that they take you on as a patient, because otherwise you just get 'stand in line at the clinics'. Doctors have their own hierarchy/status, and you want one on the 'inside'.
DubiousPusher 6y ago
I think you may paint an overly rosy image of American health infrastructure. Where you live inside the U.S. has a huge impact on how "new" the available medical equipment is and how "knowledgeable" your local experts are. What's more, most insurance is not generous. The insurer becomes the rationer of care by requiring value interventions before more expensive ones. Essentially any interest a state has in reducing costs an insurance company also already has. The main difference is that the insurance pool is probably healthier than the "everybody" pool. Lastly, even if it is true America's system features better cutting edge medicine, I really doubt making the system less profit motivated would affect global health innovation. Perhaps a bit but quickly governments would realize they are going to have to invest in research more rather than purchase innovations from the U.S. This may actually increase the value proposition of research because there would no longer be a single locus drawing all competition for specialized labor.
- jariel 6y ago
  "Perhaps a bit but quickly governments would realize they are going to have to invest in research more rather than purchase innovations from the U.S." Governments are not this sophisticated or operationally nimble unfortunately. We're in a pandemic, and I watch our Provincial medical leaders come out and talk almost every day, they're all smart, but they don't really understand what is going on - they don't have the data. But in a pandemic that destroys 20% of GDP, maybe it would be a good idea to have every single person who takes a COVID test fill out a questionnaire, so the data can be made available? Masses of unemployed young people that could be put quickly and succinctly onto large-scale contract tracing programs? Releasing communications apps to collect data, getting national level experiments running to determine the primary vectors of propagation etc. etc.. They are all professionals with good intentions, but this does not remotely translate into operational effectiveness. What we need is a 'Dwight D. Eisenhower' kind of leader for this pandemic but his type is long gone and we may not even recognize operational efficiency. Even during a pandemic when much is at stake, they're limited by their own systems. A much broader strategy of 'creating innovation to make up for the American loss' would't work, even throwing $ zillions at it wouldn't solve the problem. The sophistication of Canadian products, and ironically economic diversity has been going down in Canada, as we focus on being 'really good' at being a good 'Foreign HQ' country. My most recent hospital visit here in Quebec was a little scary: broken equipment in the main hall, the water fountain out of service, having to wait in a cold waiting room all day for a very small issue with no updates (and I couldn't even leave the room), the halls were lined with elderly people in beds because they were overcapacity. I did receive competent care, but the economic stresses were visible. And of course I don't doubt for a second how insane the US system can be for billing, financialisations etc.. I think the US should be looking towards the Dutch or Swiss models, not Canada or UK.
throw0101a 6y ago
> In my experience as a Canadian living in the US, I was basically shocked at how new, modern and efficient everything was, how service was relatively quick and how knowledgeable the experts were. As a Canadian I have no doubt that the US healthcare is better than Canada's in many ways… if you have the money to get that care. Or you're willing to go into debt to pay for it: > Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall. * https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most... However, Canada (and most of the Western countries) have lower infant mortality rates, lower maternal mortality rates, higher life expectancy, and a whole host of other health statistics. While often spending half on a per capita basis.
- jariel 6y ago
  The 'health outcomes' comparisons are difficult, and not necessarily a measure of the healthcare system. America has lower life expectancy because of violence, not healthcare. That America has a cohort of poor people w/out care can easily drive a lot of the other numbers out of whack as well. Finally, obesity, bad diet etc. - bad lifestyle choices are not a measure of the system either. By and large, I view the American system as delivering better specific outcomes, without regard to price, all other things being equal. Of course 'price' is a major factor as you indicate, and 'all other things' (diet, violence etc.) are not equal.
  - erterbest 6y ago
    Isn't, from a macro perspective, 'numbers out of whack' due to a cohort of people without care, absolutely a measure of a broken system? You may view the system as providing the best care for you, but that does not mean that the system is best in every sense?
    - jariel 6y ago
      If you want to view it that way, fine, but it's far more than just a 'system'. It's like saying 'transportation' is one key to a healthy 'manufacturing system'. If you are sick and you can have the choice between going to an American Hospital or a Canadian Hospital ... you go to the American one, because they are better, point blank.

by jariel 6y ago

baybal2 6y ago

And you still have a double digit risk of being screwed even with a reputable insurer. Legalese, and fine script in medical services is a minefield no worse than American financial laws.

tehwebguy 6y ago
Exactly - every detail of insurance plans are a scam, and that’s not even enough so they’ll just deny valid claims and make you work for it. An MRI might be “covered” but what if you have to spend 2 hours getting it approved beforehand and then 2 hours after proving that they said they’d cover it? Every time? For 4 MRIs?

bbddg 6y ago

The US system rations care as well. It just rations on the basis of who can afford care. It seems much more logical and humane to ration care based on how essential the service required is.

maxerickson 6y ago
The US system also rations equipment based on more or less arbitrary bureaucratic determinations. Want to open a radiology practice with an MRI machine? Better hope the state lets you.
- jariel 6y ago
  bbdog is correct to point out that rationing is mostly economic. I do agree that there should be a humanitarian component to it. In Canada, it's the other extreme: everyone is treated identically (theoretically) no matter what and it's illegal to sell medical services in most cases. The way 'around' the problem is to hunt down good doctors through the network and word of mouth. Literally the Golf Club is where you find out who the best docs are, and then you apply with them and hope you have enough clout/status that they take you on as a patient, because otherwise you just get 'stand in line at the clinics'. Doctors have their own hierarchy/status, and you want one on the 'inside'.

DubiousPusher 6y ago

I think you may paint an overly rosy image of American health infrastructure. Where you live inside the U.S. has a huge impact on how "new" the available medical equipment is and how "knowledgeable" your local experts are. What's more, most insurance is not generous. The insurer becomes the rationer of care by requiring value interventions before more expensive ones. Essentially any interest a state has in reducing costs an insurance company also already has. The main difference is that the insurance pool is probably healthier than the "everybody" pool. Lastly, even if it is true America's system features better cutting edge medicine, I really doubt making the system less profit motivated would affect global health innovation. Perhaps a bit but quickly governments would realize they are going to have to invest in research more rather than purchase innovations from the U.S. This may actually increase the value proposition of research because there would no longer be a single locus drawing all competition for specialized labor.

jariel 6y ago
"Perhaps a bit but quickly governments would realize they are going to have to invest in research more rather than purchase innovations from the U.S." Governments are not this sophisticated or operationally nimble unfortunately. We're in a pandemic, and I watch our Provincial medical leaders come out and talk almost every day, they're all smart, but they don't really understand what is going on - they don't have the data. But in a pandemic that destroys 20% of GDP, maybe it would be a good idea to have every single person who takes a COVID test fill out a questionnaire, so the data can be made available? Masses of unemployed young people that could be put quickly and succinctly onto large-scale contract tracing programs? Releasing communications apps to collect data, getting national level experiments running to determine the primary vectors of propagation etc. etc.. They are all professionals with good intentions, but this does not remotely translate into operational effectiveness. What we need is a 'Dwight D. Eisenhower' kind of leader for this pandemic but his type is long gone and we may not even recognize operational efficiency. Even during a pandemic when much is at stake, they're limited by their own systems. A much broader strategy of 'creating innovation to make up for the American loss' would't work, even throwing $ zillions at it wouldn't solve the problem. The sophistication of Canadian products, and ironically economic diversity has been going down in Canada, as we focus on being 'really good' at being a good 'Foreign HQ' country. My most recent hospital visit here in Quebec was a little scary: broken equipment in the main hall, the water fountain out of service, having to wait in a cold waiting room all day for a very small issue with no updates (and I couldn't even leave the room), the halls were lined with elderly people in beds because they were overcapacity. I did receive competent care, but the economic stresses were visible. And of course I don't doubt for a second how insane the US system can be for billing, financialisations etc.. I think the US should be looking towards the Dutch or Swiss models, not Canada or UK.

throw0101a 6y ago

> In my experience as a Canadian living in the US, I was basically shocked at how new, modern and efficient everything was, how service was relatively quick and how knowledgeable the experts were. As a Canadian I have no doubt that the US healthcare is better than Canada's in many ways… if you have the money to get that care. Or you're willing to go into debt to pay for it: > Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall. * https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most... However, Canada (and most of the Western countries) have lower infant mortality rates, lower maternal mortality rates, higher life expectancy, and a whole host of other health statistics. While often spending half on a per capita basis.

jariel 6y ago
The 'health outcomes' comparisons are difficult, and not necessarily a measure of the healthcare system. America has lower life expectancy because of violence, not healthcare. That America has a cohort of poor people w/out care can easily drive a lot of the other numbers out of whack as well. Finally, obesity, bad diet etc. - bad lifestyle choices are not a measure of the system either. By and large, I view the American system as delivering better specific outcomes, without regard to price, all other things being equal. Of course 'price' is a major factor as you indicate, and 'all other things' (diet, violence etc.) are not equal.
- erterbest 6y ago
  Isn't, from a macro perspective, 'numbers out of whack' due to a cohort of people without care, absolutely a measure of a broken system? You may view the system as providing the best care for you, but that does not mean that the system is best in every sense?
  - jariel 6y ago
    If you want to view it that way, fine, but it's far more than just a 'system'. It's like saying 'transportation' is one key to a healthy 'manufacturing system'. If you are sick and you can have the choice between going to an American Hospital or a Canadian Hospital ... you go to the American one, because they are better, point blank.