3 ms·

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 medica

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.
- DubiousPusher 6y ago
  All of your characterization of the Canadian healthcare system nearly equally applies to the U.S. There are many older hospitals here with broken equipment and which become easily overwhelmed. As for unsophisticated but well intentioned provincials that is a problem here as well. My own uncle passed from a cancer which was diagnosed as non-aggressive by a rural for profit hospital yet later rediagnised as extremely aggressive at a more sophisticated facility 2 years later shortly before his death. Geography and demographics create provincialism, organizational structure obviously has an impact on how we respond to that difficult problem but regardless of if a healthcare system is for profit or not, a nation is simply not going to commit the same resources to rural areas. To my mind, the more surprising thing isn't how different the problems of American and Canadian provincial care are but how much the same they are. Regarding > Governments are not this sophisticated or operationally nimble unfortunately. I don't know that this is true. Governments collect and act on a lot of public health information.

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.

DubiousPusher 6y ago
All of your characterization of the Canadian healthcare system nearly equally applies to the U.S. There are many older hospitals here with broken equipment and which become easily overwhelmed. As for unsophisticated but well intentioned provincials that is a problem here as well. My own uncle passed from a cancer which was diagnosed as non-aggressive by a rural for profit hospital yet later rediagnised as extremely aggressive at a more sophisticated facility 2 years later shortly before his death. Geography and demographics create provincialism, organizational structure obviously has an impact on how we respond to that difficult problem but regardless of if a healthcare system is for profit or not, a nation is simply not going to commit the same resources to rural areas. To my mind, the more surprising thing isn't how different the problems of American and Canadian provincial care are but how much the same they are. Regarding > Governments are not this sophisticated or operationally nimble unfortunately. I don't know that this is true. Governments collect and act on a lot of public health information.