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Canadian here. We have an extreme version of this, which includes a ban on private pay for anything covered by the public system. It's a bad system, and what's

by cal5k 6y ago

Canadian here. We have an extreme version of this, which includes a ban on private pay for anything covered by the public system. It's a bad system, and what's worse is that it has become politically impossible to even talk of reform. Every politician just promises "more money for hospitals", "more money to reduce wait times", etc. and yet little progress is made on addressing these issues because nobody is willing to tackle the root causes, primarily misaligned incentives. Our wait times for elective surgeries are terrible. Our use of electronic health records is still patchy at best. Innovation is extremely difficult - health tech startups simply cannot sell into the giant health insurance bureaucracy without going under. Co-pays for "medically necessary services" are illegal, meaning there's rampant overuse that drives up costs. The patient experience is often brutal, because nobody is incentivized to provide a good one. If you have a chronic condition the odds are good that you will have poorly coordinated care. Specialist appointments can take months or sometimes over a year to get. We have far fewer imaging machines per capita than almost any other Western country. Getting an MRI or CT can take a long, long time. Instead of money, influence buys you faster access. Hockey players get primo access to imaging and specialists, as do politicians. If you know someone they can help you skip the line. So if you mean "Medicare for all" a la Canada, this is a disaster in the making. If you mean "it would be nice if we found a way to provide basic coverage for everyone", this is a laudable goal that is eminently achievable with a mixed public/private system, where public insurance should really focus on the basics. Healthcare is not as magically different from other industries as people think. Doctors still care about how much they get paid, how many hours they have to work, and how much time they get to spend with their families. Skill and efficiency varies widely across practitioners. Egos are involved. All of the human elements don't simply vanish because you declare that healthcare must be available to everyone for free. Markets do a lot of things well. America does not have truly free-market healthcare, unfortunately, but you do not want the Kafkaesque, bureaucratic disaster we have up north.

caconym_ 6y ago
If everybody in Canada has realistic access to essential healthcare (including dental and vision), you’re already doing better than we are in America. A lot of your complaints apply to our system, too—in the sense that I’ve experienced them firsthand—but I honestly consider myself lucky just in that I can afford care (cushy tech job) and I’ve never caught a hospital bill large enough to clean me out (at least, not since I was a kid without a lot of money). Seriously. There are people in America who literally have to choose between fixing the constant pain of mouths full of rotten teeth and caring for their children. It’s not like there are no bright spots, but our outcomes are some of the worst (if not the worst) out of (ostensibly) first-world countries by most (if not all) attempts at objective measurement I’ve seen, and that’s generally not even including non-health outcomes like medical bankruptcy. I wouldn’t say extant socialized systems couldn’t be improved upon, but I tend to think people complaining about those systems are either a) in a position where they could afford care in America, which absolutely isn’t everyone, or b) just don’t know how good they have it.
- robomartin 6y ago
  > There are people in America who literally have to choose between fixing the constant pain of mouths full of rotten teeth and caring for their children And if government got out of the business of healthcare --other than ensuring a fair and safe market-- these people would not have to make that choice. Take corrective eye surgery as a very simple single-variable example. It used to cost tens of thousands of dollars to have your eyesight corrected with laser surgery. I think we are down to $500 or $1,000 these days. Imagine that, with different scales, applied across the entirety of healthcare. Let entrepreneurs do what they do best. It has proven to lift more lives than anything else in our history.
  - ClumsyPilot 6y ago
    Interesting example: you are arguing government is the problem. In what way is eye surgery is regulated less than dentistry? On the other hand laser technology has hugely improved in the past couple of decades. Much of it thanks to publically funded research. Science and technology has lifted lives out of dirt and poverty, not abstract 'enterpreneurship'. Our Nobel prise winners do not become businesmen, and do not die billionairs. They give away fruits of their labour in public reports, they keep no IP or patents.
  - caconym_ 6y ago
    > And if government got out of the business of healthcare --other than ensuring a fair and safe market-- these people would not have to make that choice. I don't follow. As far as the people I'm talking about are concerned, the government is not in the dentistry business, so what business are you imagining them getting out of? And how would said getting-out make dental treatment affordable for these people? In fact, dentistry seems to be managed more or less on the same basis as vision in this country, i.e. the ceiling on cost is relatively constrained and either you pay for it yourself or you have insurance that's separate from any standard health insurance you may or may not have. With regard to your LASIK example, as far as I can tell, lots of things in dentistry—e.g. orthodontic treatment—have gotten easier and cheaper and more effective, but they haven't invented an automated dentist-bot yet, and I am very skeptical of your (apparent) implicit claim that government meddling in the dentistry industry is to blame for that. It seems a lot more likely that different problems are different, and some are less amenable to technological breakthroughs and automation than others.
robomartin 6y ago
> Our wait times for elective surgeries are terrible. Our use of electronic health records is still patchy at best. Innovation is extremely difficult - health tech startups simply cannot sell into the giant health insurance bureaucracy without going under. Americans who propose such systems have no awareness of this reality. While "healthcare for all" sounds great and makes for a good political campaign slogan and bumper-sticker, none of these people would tolerate living under that system for a microsecond. Some of us have had the experience of living in countries where you have "healthcare for all". And, I have to tell, you, it isn't "healthcare" and it sure as hell isn't "for all". Wait times in the hours, days and months are not uncommon. I have to believe entrepreneurs could do far better than government ever could. This has been the case for nearly every human pursuit in history. Not sure why we don't give it a shot. Setup a competition. Let the best system win. Let people choose.
FpUser 6y ago
I am Canadian, live in Toronto. Lots of what you say is true. But generally there are good sides as well. I've had either experience. One has to be smart though. I know it is nigh to impossible to get to walk-in clinic where I live. Multi hour wait guaranteed. What I do in this case - buy bottle of vodka and go visit my friend in Vaughan and show up in their clinic. Most of the time there is no wait there at all. Obviously describing pre Covid situation

by cal5k 6y ago

caconym_ 6y ago

If everybody in Canada has realistic access to essential healthcare (including dental and vision), you’re already doing better than we are in America. A lot of your complaints apply to our system, too—in the sense that I’ve experienced them firsthand—but I honestly consider myself lucky just in that I can afford care (cushy tech job) and I’ve never caught a hospital bill large enough to clean me out (at least, not since I was a kid without a lot of money). Seriously. There are people in America who literally have to choose between fixing the constant pain of mouths full of rotten teeth and caring for their children. It’s not like there are no bright spots, but our outcomes are some of the worst (if not the worst) out of (ostensibly) first-world countries by most (if not all) attempts at objective measurement I’ve seen, and that’s generally not even including non-health outcomes like medical bankruptcy. I wouldn’t say extant socialized systems couldn’t be improved upon, but I tend to think people complaining about those systems are either a) in a position where they could afford care in America, which absolutely isn’t everyone, or b) just don’t know how good they have it.

robomartin 6y ago
> There are people in America who literally have to choose between fixing the constant pain of mouths full of rotten teeth and caring for their children And if government got out of the business of healthcare --other than ensuring a fair and safe market-- these people would not have to make that choice. Take corrective eye surgery as a very simple single-variable example. It used to cost tens of thousands of dollars to have your eyesight corrected with laser surgery. I think we are down to $500 or $1,000 these days. Imagine that, with different scales, applied across the entirety of healthcare. Let entrepreneurs do what they do best. It has proven to lift more lives than anything else in our history.
- ClumsyPilot 6y ago
  Interesting example: you are arguing government is the problem. In what way is eye surgery is regulated less than dentistry? On the other hand laser technology has hugely improved in the past couple of decades. Much of it thanks to publically funded research. Science and technology has lifted lives out of dirt and poverty, not abstract 'enterpreneurship'. Our Nobel prise winners do not become businesmen, and do not die billionairs. They give away fruits of their labour in public reports, they keep no IP or patents.
- caconym_ 6y ago
  > And if government got out of the business of healthcare --other than ensuring a fair and safe market-- these people would not have to make that choice. I don't follow. As far as the people I'm talking about are concerned, the government is not in the dentistry business, so what business are you imagining them getting out of? And how would said getting-out make dental treatment affordable for these people? In fact, dentistry seems to be managed more or less on the same basis as vision in this country, i.e. the ceiling on cost is relatively constrained and either you pay for it yourself or you have insurance that's separate from any standard health insurance you may or may not have. With regard to your LASIK example, as far as I can tell, lots of things in dentistry—e.g. orthodontic treatment—have gotten easier and cheaper and more effective, but they haven't invented an automated dentist-bot yet, and I am very skeptical of your (apparent) implicit claim that government meddling in the dentistry industry is to blame for that. It seems a lot more likely that different problems are different, and some are less amenable to technological breakthroughs and automation than others.

robomartin 6y ago

> Our wait times for elective surgeries are terrible. Our use of electronic health records is still patchy at best. Innovation is extremely difficult - health tech startups simply cannot sell into the giant health insurance bureaucracy without going under. Americans who propose such systems have no awareness of this reality. While "healthcare for all" sounds great and makes for a good political campaign slogan and bumper-sticker, none of these people would tolerate living under that system for a microsecond. Some of us have had the experience of living in countries where you have "healthcare for all". And, I have to tell, you, it isn't "healthcare" and it sure as hell isn't "for all". Wait times in the hours, days and months are not uncommon. I have to believe entrepreneurs could do far better than government ever could. This has been the case for nearly every human pursuit in history. Not sure why we don't give it a shot. Setup a competition. Let the best system win. Let people choose.

FpUser 6y ago

I am Canadian, live in Toronto. Lots of what you say is true. But generally there are good sides as well. I've had either experience. One has to be smart though. I know it is nigh to impossible to get to walk-in clinic where I live. Multi hour wait guaranteed. What I do in this case - buy bottle of vodka and go visit my friend in Vaughan and show up in their clinic. Most of the time there is no wait there at all. Obviously describing pre Covid situation