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I live in Canada and it's illegal to take private insurance if you also take public insurance. The private healthcare system is virtually nonexistent and is do

by jjmarr 1y ago

I live in Canada and it's illegal to take private insurance if you also take public insurance. The private healthcare system is virtually nonexistent and is dominated by scammers. The public healthcare system still has months-long wait times. If you want to avoid waitlists you need surplus capacity, which public healthcare doesn't provide.

pjc50 1y ago
> it's illegal to take private insurance if you also take public insurance. This seems like an odd excluded middle. In the UK, you can have private health insurance if you want, but you can always fall back on the NHS; the one wrinkle is that you may not always be able to take a prescription from the private to the public system without getting re-evaluated. (e.g for ADHD) > which public healthcare doesn't provide == taxpayers aren't willing to pay for.
- neom 1y ago
  It's a slippery slope and we really don't want a 2 class system. If you start allowing doctors to bill for things that public insurance covers, you're 30 seconds away from a losing the egalitarianism that Canadians value. You can pay out of pocket for whatever you want, you can tell the doctor not to bill any insurance, and in some clinics (in my experience not many) that will get you seen faster, but it's not really common and it's very expensive.
- jjmarr 1y ago
  Drugs aren't considered healthcare for whatever reason. If I got an ADHD pill in a hospital that's free, but if I wanted to get the same at an outpatient pharmacy it'll cost money in most cases. Ditto for dental. So while there isn't any overlap between public and private, there's still a gap. Though our drugs cost 10% of American prices.
droopyEyelids 1y ago
In the USA we have huge waitlists for most all types of healthcare. Private healthcare doesn't provide surplus capacity either.
- taeric 1y ago
  We do? https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country https://worldpopulationreview.com/country-rankings/health-ca... seems to show we are high on the 1 day wait, but not so much on the specialist waits. That said, I think it would be safe to say I don't understand this statistic. Needing a day of answer from your health provider feels rare to me. The few times I've needed that, I would go to an emergency room.
  - ceejayoz 1y ago
    It's a bit tough to compare between countries like this. Those stats don't reflect the infinite wait time that may be the case for someone without health insurance in the USA. Even with insurance, in my area, neurologists book out 3-6 months. Your own link offers this summary: > A common misconception in the U.S. is that countries with universal health care have much longer wait times. However, data from nations with universal coverage, coupled with historical data from coverage expansion in the United States, show that patients in other nations often have similar or shorter wait times.
    - taeric 1y ago
      I ack that it is hard to really grok these numbers. And yeah, I wasn't trying to hide that we have problems. Indeed, my prior would be that we are middling across most stats. I also question if using a neurologist wait time is illuminating? What is the average wait time by country for that one? Quick searches shows that isn't necessarily extremely high, either.
      - ceejayoz 1y ago
        You'll see significant variability by specialty, area, and insurance plan. Ultimately, Americans wait for care just like participants in other health systems. It's just a lot more likely to result in a big bill, too.
    - victorbjorklund 1y ago
freeone3000 1y ago
This isn’t universal at all. Quebec and Ontario allow for visits and payments to private doctors — usually offered under a subscription model, so that the “subscription” can be picked up by employers in lieu of “insurance”. It’s definitely smaller than in the states, but it’s big enough that it’s in use by the upper-middle class.
pseudosavant 1y ago
Just going to point out that down here in the US, there is tons of waiting with private insurance. Good luck seeing your actual primary care doctor (not some other doctor or physician's assistant) within 3 months. Specialists? Prepare to wait even longer. On an HMO insurance, make that even longer. While private vs public might affect supply, there are other big factors going on that are limiting access to care.
- refurb 1y ago
  That’s very much a local issue and also patient choice. I have zero issues getting a same day appoint where I am, specialist appointments within a couple weeks. But I also don’t go to a major university medical center which has long waits even for primary care.
thePhytochemist 1y ago
I live in Canada as well. As far as I can tell there is basically no access to psychologists under the public healthcare system. You're just supposed to pay cash at about $150/hr to talk to a therapist (if you know differently please tell us!). For some people that's fine, but it's an absurd situation if, for example, you're underemployed/poor and facing related mental health challenges. Obviously paying that much to talk to someone can just aggravate the underlying problem. Some people can access mental health care in the public system through their family doctor. But most people do not have access to this because there are not enough of this type of doctor. As far as I know the only other way is to wait until some sort of crisis then enter the hospital and there -might- be a chance to talk to a psychiatrist.
- jjmarr 1y ago
  CAMH and other hospitals provide free outpatient mental health services from psychiatrists to the underemployed/poor. As you acknowledge, if you end up so badly that you are committed, you can get a referral. They might be underfunded and understaffed but it exists. "Might be a chance to talk to a psychiatrist" is inaccurate. You will see a psychiatrist quickly if you go to a hospital in Toronto. Can't say the same about rural areas. The USA is much worse and we shouldn't try to generalize from their experiences. America has hundreds of free outpatient mental health clinics and their goal is to "suicide-bait" you into saying the wrong thing. Then they involuntarily commit you and bill Medicaid/insurance until it runs out. Those are the hospitals you will never see a psychiatrist in, because they focus on profit and churn.
- throaway198764 1y ago
  [dead]
insane_dreamer 1y ago
> The public healthcare system still has months-long wait times. I pay an expensive monthly premium and I still have monthly-long wait times in the US. (Putting this here because many people think that the "benefit" of the US healthcare model is that you get "fast/immediate" care instead of "slow/long waits" in those "socialist" countries.
- Apocryphon 1y ago
  Don't forget that we also deal with mountains of confusing paperwork from multiple competing bureaucracies!

by jjmarr 1y ago

pjc50 1y ago

> it's illegal to take private insurance if you also take public insurance. This seems like an odd excluded middle. In the UK, you can have private health insurance if you want, but you can always fall back on the NHS; the one wrinkle is that you may not always be able to take a prescription from the private to the public system without getting re-evaluated. (e.g for ADHD) > which public healthcare doesn't provide == taxpayers aren't willing to pay for.

neom 1y ago
It's a slippery slope and we really don't want a 2 class system. If you start allowing doctors to bill for things that public insurance covers, you're 30 seconds away from a losing the egalitarianism that Canadians value. You can pay out of pocket for whatever you want, you can tell the doctor not to bill any insurance, and in some clinics (in my experience not many) that will get you seen faster, but it's not really common and it's very expensive.
jjmarr 1y ago
Drugs aren't considered healthcare for whatever reason. If I got an ADHD pill in a hospital that's free, but if I wanted to get the same at an outpatient pharmacy it'll cost money in most cases. Ditto for dental. So while there isn't any overlap between public and private, there's still a gap. Though our drugs cost 10% of American prices.

droopyEyelids 1y ago

In the USA we have huge waitlists for most all types of healthcare. Private healthcare doesn't provide surplus capacity either.

taeric 1y ago
We do? https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country https://worldpopulationreview.com/country-rankings/health-ca... seems to show we are high on the 1 day wait, but not so much on the specialist waits. That said, I think it would be safe to say I don't understand this statistic. Needing a day of answer from your health provider feels rare to me. The few times I've needed that, I would go to an emergency room.
- ceejayoz 1y ago
  It's a bit tough to compare between countries like this. Those stats don't reflect the infinite wait time that may be the case for someone without health insurance in the USA. Even with insurance, in my area, neurologists book out 3-6 months. Your own link offers this summary: > A common misconception in the U.S. is that countries with universal health care have much longer wait times. However, data from nations with universal coverage, coupled with historical data from coverage expansion in the United States, show that patients in other nations often have similar or shorter wait times.
  - taeric 1y ago
    I ack that it is hard to really grok these numbers. And yeah, I wasn't trying to hide that we have problems. Indeed, my prior would be that we are middling across most stats. I also question if using a neurologist wait time is illuminating? What is the average wait time by country for that one? Quick searches shows that isn't necessarily extremely high, either.
    - ceejayoz 1y ago
      You'll see significant variability by specialty, area, and insurance plan. Ultimately, Americans wait for care just like participants in other health systems. It's just a lot more likely to result in a big bill, too.
  - victorbjorklund 1y ago

freeone3000 1y ago

This isn’t universal at all. Quebec and Ontario allow for visits and payments to private doctors — usually offered under a subscription model, so that the “subscription” can be picked up by employers in lieu of “insurance”. It’s definitely smaller than in the states, but it’s big enough that it’s in use by the upper-middle class.

pseudosavant 1y ago

Just going to point out that down here in the US, there is tons of waiting with private insurance. Good luck seeing your actual primary care doctor (not some other doctor or physician's assistant) within 3 months. Specialists? Prepare to wait even longer. On an HMO insurance, make that even longer. While private vs public might affect supply, there are other big factors going on that are limiting access to care.

refurb 1y ago
That’s very much a local issue and also patient choice. I have zero issues getting a same day appoint where I am, specialist appointments within a couple weeks. But I also don’t go to a major university medical center which has long waits even for primary care.

thePhytochemist 1y ago

I live in Canada as well. As far as I can tell there is basically no access to psychologists under the public healthcare system. You're just supposed to pay cash at about $150/hr to talk to a therapist (if you know differently please tell us!). For some people that's fine, but it's an absurd situation if, for example, you're underemployed/poor and facing related mental health challenges. Obviously paying that much to talk to someone can just aggravate the underlying problem. Some people can access mental health care in the public system through their family doctor. But most people do not have access to this because there are not enough of this type of doctor. As far as I know the only other way is to wait until some sort of crisis then enter the hospital and there -might- be a chance to talk to a psychiatrist.

jjmarr 1y ago
CAMH and other hospitals provide free outpatient mental health services from psychiatrists to the underemployed/poor. As you acknowledge, if you end up so badly that you are committed, you can get a referral. They might be underfunded and understaffed but it exists. "Might be a chance to talk to a psychiatrist" is inaccurate. You will see a psychiatrist quickly if you go to a hospital in Toronto. Can't say the same about rural areas. The USA is much worse and we shouldn't try to generalize from their experiences. America has hundreds of free outpatient mental health clinics and their goal is to "suicide-bait" you into saying the wrong thing. Then they involuntarily commit you and bill Medicaid/insurance until it runs out. Those are the hospitals you will never see a psychiatrist in, because they focus on profit and churn.
throaway198764 1y ago
[dead]

insane_dreamer 1y ago

> The public healthcare system still has months-long wait times. I pay an expensive monthly premium and I still have monthly-long wait times in the US. (Putting this here because many people think that the "benefit" of the US healthcare model is that you get "fast/immediate" care instead of "slow/long waits" in those "socialist" countries.

Apocryphon 1y ago
Don't forget that we also deal with mountains of confusing paperwork from multiple competing bureaucracies!