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Canada has excellent brain surgeons. The reality is immigration isn't as simple as picking up and wandering across a border. There's nativism, protectionism and

Canada has excellent brain surgeons. The reality is immigration isn't as simple as picking up and wandering across a border. There's nativism, protectionism and of course the ties that keep you bound to your local community. Friends, family, shops, restaurants, a house. If I told you that I would pay you 30% more to move to Kansas, would you? Why, and why not? Further, why isn't every brain surgeon in America located in NY, SF and LA? Broadly, America has a pretty bad healthcare system, ranked somewhere in the mid-20s globally. The vast majority of the healthcare systems ranked higher than America are socialized - somewhere between single payer and two tier. With capped pay. Why aren't all those doctors in America? Why isn't every software engineer in the Bay Area currently located in Seattle and Texas? It's really not that simple.

renewiltord 5y ago
My family has medical professionals in Canada. I can assure you your surgeons aren’t being paid anywhere near your rubbish disposal people. If they are, then my family is probably all at the 99th percentile of surgeons and at the 99th percentile of family doctors. So naturally I am unsurprised that Canadian neurosurgeons are good. If they’re anything like other surgical specialties they’re probably also making bank. Or maybe they’re not and my extended family is a bunch of superhumans. Berkeley alone has as many Nobel Prize winners as Canada entire. That’s the kind of society we build here. Winners. And sometimes there’s a price we will pay for that (we’ll have some losers). EDIT: Pay your doctors what you pay your street cleaners and you’ll see what they do. They won’t stay in Canada for that. Oh and sorry about the edit style responses. I have hit my comment rate limit. I guess my simple response to the rest is “show me the code”. No one does this thing except authoritarian regimes limiting emigration. If it is so good, show us.
- arcticbull 5y ago
  My father is an anesthesiologist in Canada and my mother an audiologist, so my position isn't exactly arms-length [edit] and my father has always been very opinionated about the role of the public service within a civil society - before the Alzheimers anyways. I agree with you that they aren't paid the same, just that the band is tighter than in the US. Canadian doctors get paid a good deal less than American doctors. For instance. A US anesthesiologist is paid a median of $400K USD (500K CAD). In Canada the median pay is $393K CAD ($300K USD). In real terms anyways. In PPP adjusted terms, it's closer. > Berkeley alone has as many Nobel Prize winners as Canada entire. That’s the kind of society we build here. Winners. And sometimes there’s a price we will pay for that. Winners and losers. I'm not passing judgement I'm just saying that the American society isn't full exclusively of winners, it's full of winners and the folks I pass on my way home shooting heroin. At the end of the day we all live in a society. > EDIT: Pay your doctors what you pay your street cleaners and you’ll see what they do. They won’t stay in Canada for that. Unless you pay them both an upper middle class wage ;) Either way, thank you for engaging in my thought exercise! > Oh and sorry about the edit style responses. I have hit my comment rate limit. Nothing to apologize for, I appreciate your thoughts! I know this is a bit of a third-rail topic - but that's why I'm extra interested in what the HN community has to say.
  - stale2002 5y ago
    > Unless you pay them both an upper middle class wage ;) Feel free to give an example of an actual major country that does that then. If you can't think of such a real life example, then maybe that is your answer as for why this does not work. As someone who lives in America, I am more than supportive of Canada spending all of their money, overpaying their trash collectors. That way, Canada can get their trash collections, and we in America can get their engineers. Go ahead, other countries. Overpay everyone. I'd love that. That way we can poach your high value citizens who are overtaxed.
    - arcticbull 5y ago
      This is quite an incomplete analysis. First off, neither Democrats nor Republicans are interested in supporting immigration into America. The last major immigration tightening was Clinton with the IIRAIRA and the last amnesty was under Reagan. Since then, neither side has been interested in bringing more legal immigrants to the US. After all, the Biden administration is about to allow 100,000 green cards to expire unprocessed and disappear into the aether. At least Donny was honest about it. > As someone who lives in America, I am more than supportive of Canada spending all of their money, overpaying their trash collectors. I also live in America, and I am not saying anyone's overpaying trash collectors. > That way, Canada can get their trash collections, and we in America can get their engineers. And yet this is only part of the story. > That way we can poach your high value citizens who are overtaxed. The lowest tax rate in the US/CA is Alberta and the highest is Quebec. The rest of the US and Canada exist in between these two Canadian provinces. If you factor in health care, basically all of Canada costs less to live in than America for the average individual. YMMV of course. However, saying Canadians on the whole are "overtaxed" is an indication you haven't given an honest look at what the rest of the western world looks like outside of the US. As I've been saying, that's only part of the equation. Folks don't move to the US to evade taxes lol - Silicon Valley is among the highest taxed places on earth but still attracts the world's best talent. It's not about the taxes - it never has been. Some small tax break isn't going to get me to leave the Bay Area. I'm confident my opportunity here will outperform the delta. Until that opportunity no longer exists, then I will leave without looking back.
TMWNN 5y ago
>Canada has excellent brain surgeons. The reality is immigration isn't as simple as picking up and wandering across a border. There's nativism, protectionism and of course the ties that keep you bound to your local community. Friends, family, shops, restaurants, a house. And yet, despite those obstacles, the brain drain is real and ongoing. In a survey of scientists from 16 countries (<http://spectrum.ieee.org/at-work/tech-careers/the-global-brain-trade http://spectrum.ieee.org/at-work/tech-careers/the-global-bra...>), the US is the top destination from 13 of the 15 others and the #2 choice from the other two. If you are a Canadian scientist, there is a 16% chance (<https://www.reddit.com/r/dataisbeautiful/comments/37lgxg/the_global_brain_trade/ https://www.reddit.com/r/dataisbeautiful/comments/37lgxg/the...>) that you will move to the US. That's not "16% of all Canadian scientists that move out of the country move to the US". Let me repeat: *16% of all Canadian scientists move to the US.* They're also likely to be among the top Canadian scientists, too. By comparison, 5% of all American scientists move to another country, of which 32% go to Canada, so about 1.6-1.7% total. Since the US has nine times more people, that means that in absolute numbers the 1.7% of American scientists is about equal to the 16% of Canadian scientists, but there is no reason to think that the 1.7% makes up the top tier of American scientists; why would the best move north of the border? In other words, the US is receiving the best of Canadian scientists in exchange for an equal number of its non-best. As renewiltord said, "Your brain surgeons will leave and you will be left with the other guy." >If I told you that I would pay you 30% more to move to Kansas, would you? Why, and why not? If Kansas paid 30% more for the same job, maybe you and I wouldn't move but a lot more people would move there than the current status quo. But it doesn't. >Broadly, America has a pretty bad healthcare system, ranked somewhere in the mid-20s globally. The US does quite well in most patient outcomes. It does not do as well as it could because of the opioid crisis which has singlehandedly reduced average lifespans, and which is more or less independent of access to doctors. The US's high per-capita healthcare spending is driven to some degree by the very high spending in R&D (the US by itself produces something like 50% of new drugs globally), and is also a function of its much higher per capita GDP, about 20% higher on a PPP basis than Canada and Western Europe outside Norway. (I wish I could find the analysis that discusses this; I'll edit this if I can locate it.) Regardless, 91% of Americans have health insurance, compared to 95-97% in every other developed country. (There are always people who fall between the cracks, like a Canadian who moves and neglects to update his provincial health care card. The only way to get true 100% coverage is to go the UK NHS route of not requiring a member card at all.) Meanwhile, an amazingly high portion of Canadians don't have a family doctor (<https://www.ctvnews.ca/health/despite-more-doctors-many-canadians-don-t-have-a-family-physician-report-1.4611149 https://www.ctvnews.ca/health/despite-more-doctors-many-cana...>). In Atlantic Canada the shortage is astounding (<https://www.thetelegram.com/in-depth/doctor-shortage/what-we-learned-and-what-you-said-about-doctor-shortage-in-atlantic-canada-286436/ https://www.thetelegram.com/in-depth/doctor-shortage/what-we...>). It's one thing to have shortages in rural areas—that happens in the US too—but Halifax?!? I've heard the same occurs in Vancouver too. I can assure you that such a doctor shortage exists nowhere in the US outside really rural areas. >The vast majority of the healthcare systems ranked higher than America are socialized - somewhere between single payer and two tier. With capped pay. Why aren't all those doctors in America? If tomorrow the US said that every medical doctor and STEM PhD holder from comparable countries (Canada, Western Europe, Australasia, Japan/Korea/Taiwan) could enter the country with unlimited working privileges, what would happen? To some degree you answered your own question above; of course there would be at least some, perhaps many, that would still not move because of local ties, friends, language issues. But Anglophones, and others who are comfortable with English or want to learn, and don't have such binding ties? Remember, 17% of all Canadian scientists already move to the US.

renewiltord 5y ago

My family has medical professionals in Canada. I can assure you your surgeons aren’t being paid anywhere near your rubbish disposal people. If they are, then my family is probably all at the 99th percentile of surgeons and at the 99th percentile of family doctors. So naturally I am unsurprised that Canadian neurosurgeons are good. If they’re anything like other surgical specialties they’re probably also making bank. Or maybe they’re not and my extended family is a bunch of superhumans. Berkeley alone has as many Nobel Prize winners as Canada entire. That’s the kind of society we build here. Winners. And sometimes there’s a price we will pay for that (we’ll have some losers). EDIT: Pay your doctors what you pay your street cleaners and you’ll see what they do. They won’t stay in Canada for that. Oh and sorry about the edit style responses. I have hit my comment rate limit. I guess my simple response to the rest is “show me the code”. No one does this thing except authoritarian regimes limiting emigration. If it is so good, show us.

arcticbull 5y ago
My father is an anesthesiologist in Canada and my mother an audiologist, so my position isn't exactly arms-length [edit] and my father has always been very opinionated about the role of the public service within a civil society - before the Alzheimers anyways. I agree with you that they aren't paid the same, just that the band is tighter than in the US. Canadian doctors get paid a good deal less than American doctors. For instance. A US anesthesiologist is paid a median of $400K USD (500K CAD). In Canada the median pay is $393K CAD ($300K USD). In real terms anyways. In PPP adjusted terms, it's closer. > Berkeley alone has as many Nobel Prize winners as Canada entire. That’s the kind of society we build here. Winners. And sometimes there’s a price we will pay for that. Winners and losers. I'm not passing judgement I'm just saying that the American society isn't full exclusively of winners, it's full of winners and the folks I pass on my way home shooting heroin. At the end of the day we all live in a society. > EDIT: Pay your doctors what you pay your street cleaners and you’ll see what they do. They won’t stay in Canada for that. Unless you pay them both an upper middle class wage ;) Either way, thank you for engaging in my thought exercise! > Oh and sorry about the edit style responses. I have hit my comment rate limit. Nothing to apologize for, I appreciate your thoughts! I know this is a bit of a third-rail topic - but that's why I'm extra interested in what the HN community has to say.
- stale2002 5y ago
  > Unless you pay them both an upper middle class wage ;) Feel free to give an example of an actual major country that does that then. If you can't think of such a real life example, then maybe that is your answer as for why this does not work. As someone who lives in America, I am more than supportive of Canada spending all of their money, overpaying their trash collectors. That way, Canada can get their trash collections, and we in America can get their engineers. Go ahead, other countries. Overpay everyone. I'd love that. That way we can poach your high value citizens who are overtaxed.
  - arcticbull 5y ago
    This is quite an incomplete analysis. First off, neither Democrats nor Republicans are interested in supporting immigration into America. The last major immigration tightening was Clinton with the IIRAIRA and the last amnesty was under Reagan. Since then, neither side has been interested in bringing more legal immigrants to the US. After all, the Biden administration is about to allow 100,000 green cards to expire unprocessed and disappear into the aether. At least Donny was honest about it. > As someone who lives in America, I am more than supportive of Canada spending all of their money, overpaying their trash collectors. I also live in America, and I am not saying anyone's overpaying trash collectors. > That way, Canada can get their trash collections, and we in America can get their engineers. And yet this is only part of the story. > That way we can poach your high value citizens who are overtaxed. The lowest tax rate in the US/CA is Alberta and the highest is Quebec. The rest of the US and Canada exist in between these two Canadian provinces. If you factor in health care, basically all of Canada costs less to live in than America for the average individual. YMMV of course. However, saying Canadians on the whole are "overtaxed" is an indication you haven't given an honest look at what the rest of the western world looks like outside of the US. As I've been saying, that's only part of the equation. Folks don't move to the US to evade taxes lol - Silicon Valley is among the highest taxed places on earth but still attracts the world's best talent. It's not about the taxes - it never has been. Some small tax break isn't going to get me to leave the Bay Area. I'm confident my opportunity here will outperform the delta. Until that opportunity no longer exists, then I will leave without looking back.

TMWNN 5y ago

>Canada has excellent brain surgeons. The reality is immigration isn't as simple as picking up and wandering across a border. There's nativism, protectionism and of course the ties that keep you bound to your local community. Friends, family, shops, restaurants, a house. And yet, despite those obstacles, the brain drain is real and ongoing. In a survey of scientists from 16 countries (<http://spectrum.ieee.org/at-work/tech-careers/the-global-brain-trade http://spectrum.ieee.org/at-work/tech-careers/the-global-bra...>), the US is the top destination from 13 of the 15 others and the #2 choice from the other two. If you are a Canadian scientist, there is a 16% chance (<https://www.reddit.com/r/dataisbeautiful/comments/37lgxg/the_global_brain_trade/ https://www.reddit.com/r/dataisbeautiful/comments/37lgxg/the...>) that you will move to the US. That's not "16% of all Canadian scientists that move out of the country move to the US". Let me repeat: *16% of all Canadian scientists move to the US.* They're also likely to be among the top Canadian scientists, too. By comparison, 5% of all American scientists move to another country, of which 32% go to Canada, so about 1.6-1.7% total. Since the US has nine times more people, that means that in absolute numbers the 1.7% of American scientists is about equal to the 16% of Canadian scientists, but there is no reason to think that the 1.7% makes up the top tier of American scientists; why would the best move north of the border? In other words, the US is receiving the best of Canadian scientists in exchange for an equal number of its non-best. As renewiltord said, "Your brain surgeons will leave and you will be left with the other guy." >If I told you that I would pay you 30% more to move to Kansas, would you? Why, and why not? If Kansas paid 30% more for the same job, maybe you and I wouldn't move but a lot more people would move there than the current status quo. But it doesn't. >Broadly, America has a pretty bad healthcare system, ranked somewhere in the mid-20s globally. The US does quite well in most patient outcomes. It does not do as well as it could because of the opioid crisis which has singlehandedly reduced average lifespans, and which is more or less independent of access to doctors. The US's high per-capita healthcare spending is driven to some degree by the very high spending in R&D (the US by itself produces something like 50% of new drugs globally), and is also a function of its much higher per capita GDP, about 20% higher on a PPP basis than Canada and Western Europe outside Norway. (I wish I could find the analysis that discusses this; I'll edit this if I can locate it.) Regardless, 91% of Americans have health insurance, compared to 95-97% in every other developed country. (There are always people who fall between the cracks, like a Canadian who moves and neglects to update his provincial health care card. The only way to get true 100% coverage is to go the UK NHS route of not requiring a member card at all.) Meanwhile, an amazingly high portion of Canadians don't have a family doctor (<https://www.ctvnews.ca/health/despite-more-doctors-many-canadians-don-t-have-a-family-physician-report-1.4611149 https://www.ctvnews.ca/health/despite-more-doctors-many-cana...>). In Atlantic Canada the shortage is astounding (<https://www.thetelegram.com/in-depth/doctor-shortage/what-we-learned-and-what-you-said-about-doctor-shortage-in-atlantic-canada-286436/ https://www.thetelegram.com/in-depth/doctor-shortage/what-we...>). It's one thing to have shortages in rural areas—that happens in the US too—but Halifax?!? I've heard the same occurs in Vancouver too. I can assure you that such a doctor shortage exists nowhere in the US outside really rural areas. >The vast majority of the healthcare systems ranked higher than America are socialized - somewhere between single payer and two tier. With capped pay. Why aren't all those doctors in America? If tomorrow the US said that every medical doctor and STEM PhD holder from comparable countries (Canada, Western Europe, Australasia, Japan/Korea/Taiwan) could enter the country with unlimited working privileges, what would happen? To some degree you answered your own question above; of course there would be at least some, perhaps many, that would still not move because of local ties, friends, language issues. But Anglophones, and others who are comfortable with English or want to learn, and don't have such binding ties? Remember, 17% of all Canadian scientists already move to the US.