6 ms·

And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities. News Fl

And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities. News Flash: The U.S. isn't a welfare state. To benefit from everything this country has to offer, you need to pay for it. Yes, it would be better if that didn't apply to healthcare, but there needs to be some method of exclusion when demand is high and supply is low. Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)

andrewcooke 14y ago
isn't the point that on average, rational actors would prefer the wait, since, on average, that is correlated with better outcomes? perhaps partly because you presented a false choice - it's often a choice between waiting or not being able to afford it? what i mean is, well, great rhetoric, but you know, facts, man. facts.
maushu 14y ago
> Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? At least we get treatment not dependent on the quantity of money we have.
- zanny 14y ago
  I'm American, but I know a lot of people from Canada, and after many conversations, the "2 months for a specialist" is bullshit. In practice, preventative medicine and not having to fear to afford healthcare when you need it drastically reduce the demand on the most expensive and specialized doctors and practices because you deal with problems before they end up in the emergency room. I have no health insurance right now. If I got sick in Canada, I would absolutely visit my doctor, get a prescription and diagnosis, and be on my way. In the US, I have to pray I don't have a severe disease and try using over the counter meds because I can't afford upwards of $800 doctors visits if they perform any tests. It is around $150 just to walk in the door.
  - seanx 14y ago
    How the hell can a doctors visit run to $800?
    - potatolicious 14y ago
      Probably on the high end of things, but it's really not that hard. Based on what I've seen from my insurance co. the base rate for my doctor is about ~$250, even for something as simple as simple consultation about the flu (i.e., no tests or other treatment/equipment). If you have something more complicated, like, say, requiring stitches, or even basic lab testing (urinalysis?), it all adds up on top of all of that. I'd imagine if you went to the doctor and he/she ordered a small battery of tests, you'd run up well over $800 fairly quickly.
viraptor 14y ago
Yes, but on average it seems not to work that well, which the article tries to show. Apparently the possibility of waiting 2 months for a specialist (in reality I very rarely see such situation) seems to be better than the current system in the US.
- njs12345 14y ago
  Also, in many systems (excepting Canada, where I believe there is no alternate private system) you can see a specialist with no wait if you're willing to pay for it.
dataminer 14y ago
What you are referring to are elective procedures, and 2 months of waiting time wouldn't kill you. There is no waiting time for emergencies in Canada or Europe. Yes if you throw alot of money, you get state of art facilities and top doctors, but are you getting the return on investment if the healthcare system is lagging behind the "welfare states".
- refurb 14y ago
  Not true in Canada. The Supreme Court ruled that the wait times in Canada violated the Quebec Charter of Human Rights and Freedoms because there was no private option. http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_General) http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_Ge...
colmvp 14y ago
Better to wait than in a lot of cases not have access to it at all.
scarmig 14y ago
My US-based dad recently had to wait a month for a knee replacement surgery. And, of course, for people who can't afford the inflated prices we've got here... the waiting time is infinite.
- rm999 14y ago
  A surgery can involve a lot of resources, they tend to have long wait times. For comparison, this article from 2007 says the average wait for a surgery in canada is 4.5 months: http://www.cbc.ca/news/health/story/2007/10/15/waittimes-fraser.html http://www.cbc.ca/news/health/story/2007/10/15/waittimes-fra...
gramsey 14y ago
What kind of point are you trying to make? > And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities. People fly to many first-world countries for medical care, including "Canada and Europe". Yes, if people have vast sums of money, they can receive excellent medical treatment in the US (as they could in many countries). However, that's not the problem though, is it. The problem is that in general, most Americans fall behind in health compared to other first-world nations. > but there needs to be some method of exclusion when demand is high and supply is low Are you arguing that the state of health of the majority of the country is irrelevant as long as high-income earners can receive the best medical care?
FireBeyond 14y ago
That's not a valid comparison. "State of the art" facilities are not being argued against, but "health of the populace". People also used to (maybe still do) fly to Australia for cardiac surgery. The US may be able to pull in doctors from around the world with salaries that are high (correlating to high healthcare costs), but the regular individuals access to such doctors is limited: if I, talking to my insurance provider in Washington, said I wanted to go to the East Coast and have Dr Oz do my cardiac surgery (leaving aside any, and indeed valid, controversy over him - I was just looking for a notable/famous surgeon), I'm fairly certain they'd balk (and I'm fairly certain because I've worked on software systems that determine such things for insurance providers).
potatolicious 14y ago
> "And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities." Citation sorely needed. This claim is regularly trot around, but nobody has been able to point to data that would suggest that this is anything but extreme outlier behavior. As a Canadian who lives in the US it's often shocking how different the perception of the Canadian health care system is between the US and Canada. Canadians by and large are quite satisfied with the system, while even reasonably liberal Americans I've met seem to believe it's some kind of waitlist-filled hellhole. I've had more than one American express incredulity when I pointed out going to the US for major medical procedures isn't really a thing in Canada, where they thought it was widespread and relatively common. By my own observation, there are a few isolated cases of this happening (mostly among the extremely wealthy), and is not at all widespread. > "but there needs to be some method of exclusion when demand is high and supply is low." The supply of medical capacity is not fixed or subject to a real physical limitation (like, say, rare earth metals). In Canada the response to constricted supply has been expanding the supply, as well as reducing per-use costs to make this possible. The supply is not infinite, but is high enough that people who need it, get it, and at a cost affordable to them (amortized across the entire population). [edit] It's worth mentioning that, due to the economic incentive of single-payer health care, Canada invests a tremendous amount of money in preventative care and screening, which serves to dramatically reduce demand for the most expensive, most supply-constrained treatments. In fact I have a friend who works for the Canadian government right now doing computational screening for early cancer detection. It's interesting stuff, saves lives, and saves money, but requires a dramatic economic incentive to build out that simply doesn't exist in privatized care. > "Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)" Citation, again, sorely needed. I grew up in Canada and have never waited 2 months to see a specialist, nor 2 months for treatment. The longest I've waited for a specialist was a few days. I've also (unfortunately) been to both Canadian ERs and American ERs, and the wait times are not substantially different (immediate (Can), 4 hours (Can), 7 hours (Can), and 6 hours (US)).
- graeme 14y ago
  Also a Canadian, just want to confirm this. I can see a doctor instantly, for free, at any one of the clinics near my house. If I need to see a specialist, the referral usually happens within a few days or a week for anything urgent. Ditto for bloodwork, you just take the referral to a hospital. There are some exceptions, but generally things work well.
slurry 14y ago
This kind of argument probably worked better in the 90s or something, but it does not hold as much water today. First, the exorbitant rate of medical inflation in our "market" healthcare system is a fiscal menace not only to the public sector, but to the private sector as well. Secondly, the deteriorating health of the American workforce is an increasing threat to global competitiveness. An overweight employee pool with high prevalence of unmanaged diabetes is not an attractive one for global capital. Expanding access, controlling costs and emphasizing preventive care are things we need to get better at out of naked self-interest. Saudi sheiks who want to fly in for a quadruple bypass may continue to do so, but if we lose them to somewhere that bows and scrapes to the mega-rich more than we do, good riddance.
amalcon 14y ago
Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe) I would really prefer not to have to do this. Do you have a suggestion for how I could avoid that wait? I live in the U.S. and those timeframes don't seem particularly high compared to what I'm used to.
fatbird 14y ago
My brother in Columbus, Ohio, with a health plan for a director level position in a Fortune 1000 company, got a referral to a neurologist for a pinched nerve. Took six months to actually get inside a neurologist's office. This, in a health care market of 1.5 million people. What's that about wait times in nationalized healthcare countries again? I'm sure he'd have been much more quickly served in Vancouver or Toronto or Manchester.
dguaraglia 14y ago
"Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do?" This is so misinformed it's borderline laughable (if it wasn't thrown out there by someone who is a member of the HN community and, I'd assume, an intelligent peer.) I have been treated in Argentina for urgent and non-urgent issues and never, ever, had to wait 2 months for anything. When I was referred to a specialist (best of her branch of medicine in a city of almost a million inhabitants) I got an appointment the following week and started treatment within a month. Whenever I needed something, like an X-ray or bloodwork, I could either get it free of charge at the local hospitals or just pay for it (incredibly, a CT Scan with the same machines they use in the US costs 1/6 the price in Argentina. How's that for free market economy?) and get a result immediately. So, all in all, this is complete bunk. People who have never experienced any other system are by definition the worst to make a comparison with the US system. I've used the Brazilian, the Argentinian, the British and the US system and by far my worst experience has always been in the US, even while paying through my nose to get the same care I'd get for free in either of the 'developing' nations. Heck, I've used the _private_ system in the UK and even if I paid the extra bit to be seen by a doctor (20' wait at the practice; Oh! The horrors of endless lines and dead panels!) I only had to pay ~£2.50 to get all the medicine he prescribed (that's the upper bound, after that everything else is free.) So yeah, definitely the US is not a welfare state. If anything, it's the contrary: a profiteering system where healthcare is just secondary to profit.

andrewcooke 14y ago

isn't the point that on average, rational actors would prefer the wait, since, on average, that is correlated with better outcomes? perhaps partly because you presented a false choice - it's often a choice between waiting or not being able to afford it? what i mean is, well, great rhetoric, but you know, facts, man. facts.

maushu 14y ago

> Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? At least we get treatment not dependent on the quantity of money we have.

zanny 14y ago
I'm American, but I know a lot of people from Canada, and after many conversations, the "2 months for a specialist" is bullshit. In practice, preventative medicine and not having to fear to afford healthcare when you need it drastically reduce the demand on the most expensive and specialized doctors and practices because you deal with problems before they end up in the emergency room. I have no health insurance right now. If I got sick in Canada, I would absolutely visit my doctor, get a prescription and diagnosis, and be on my way. In the US, I have to pray I don't have a severe disease and try using over the counter meds because I can't afford upwards of $800 doctors visits if they perform any tests. It is around $150 just to walk in the door.
- seanx 14y ago
  How the hell can a doctors visit run to $800?
  - potatolicious 14y ago
    Probably on the high end of things, but it's really not that hard. Based on what I've seen from my insurance co. the base rate for my doctor is about ~$250, even for something as simple as simple consultation about the flu (i.e., no tests or other treatment/equipment). If you have something more complicated, like, say, requiring stitches, or even basic lab testing (urinalysis?), it all adds up on top of all of that. I'd imagine if you went to the doctor and he/she ordered a small battery of tests, you'd run up well over $800 fairly quickly.

viraptor 14y ago

Yes, but on average it seems not to work that well, which the article tries to show. Apparently the possibility of waiting 2 months for a specialist (in reality I very rarely see such situation) seems to be better than the current system in the US.

njs12345 14y ago
Also, in many systems (excepting Canada, where I believe there is no alternate private system) you can see a specialist with no wait if you're willing to pay for it.

dataminer 14y ago

What you are referring to are elective procedures, and 2 months of waiting time wouldn't kill you. There is no waiting time for emergencies in Canada or Europe. Yes if you throw alot of money, you get state of art facilities and top doctors, but are you getting the return on investment if the healthcare system is lagging behind the "welfare states".

refurb 14y ago
Not true in Canada. The Supreme Court ruled that the wait times in Canada violated the Quebec Charter of Human Rights and Freedoms because there was no private option. http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_General) http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_Ge...

colmvp 14y ago

Better to wait than in a lot of cases not have access to it at all.

scarmig 14y ago

My US-based dad recently had to wait a month for a knee replacement surgery. And, of course, for people who can't afford the inflated prices we've got here... the waiting time is infinite.

rm999 14y ago
A surgery can involve a lot of resources, they tend to have long wait times. For comparison, this article from 2007 says the average wait for a surgery in canada is 4.5 months: http://www.cbc.ca/news/health/story/2007/10/15/waittimes-fraser.html http://www.cbc.ca/news/health/story/2007/10/15/waittimes-fra...

gramsey 14y ago

What kind of point are you trying to make? > And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities. People fly to many first-world countries for medical care, including "Canada and Europe". Yes, if people have vast sums of money, they can receive excellent medical treatment in the US (as they could in many countries). However, that's not the problem though, is it. The problem is that in general, most Americans fall behind in health compared to other first-world nations. > but there needs to be some method of exclusion when demand is high and supply is low Are you arguing that the state of health of the majority of the country is irrelevant as long as high-income earners can receive the best medical care?

FireBeyond 14y ago

That's not a valid comparison. "State of the art" facilities are not being argued against, but "health of the populace". People also used to (maybe still do) fly to Australia for cardiac surgery. The US may be able to pull in doctors from around the world with salaries that are high (correlating to high healthcare costs), but the regular individuals access to such doctors is limited: if I, talking to my insurance provider in Washington, said I wanted to go to the East Coast and have Dr Oz do my cardiac surgery (leaving aside any, and indeed valid, controversy over him - I was just looking for a notable/famous surgeon), I'm fairly certain they'd balk (and I'm fairly certain because I've worked on software systems that determine such things for insurance providers).

potatolicious 14y ago

> "And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities." Citation sorely needed. This claim is regularly trot around, but nobody has been able to point to data that would suggest that this is anything but extreme outlier behavior. As a Canadian who lives in the US it's often shocking how different the perception of the Canadian health care system is between the US and Canada. Canadians by and large are quite satisfied with the system, while even reasonably liberal Americans I've met seem to believe it's some kind of waitlist-filled hellhole. I've had more than one American express incredulity when I pointed out going to the US for major medical procedures isn't really a thing in Canada, where they thought it was widespread and relatively common. By my own observation, there are a few isolated cases of this happening (mostly among the extremely wealthy), and is not at all widespread. > "but there needs to be some method of exclusion when demand is high and supply is low." The supply of medical capacity is not fixed or subject to a real physical limitation (like, say, rare earth metals). In Canada the response to constricted supply has been expanding the supply, as well as reducing per-use costs to make this possible. The supply is not infinite, but is high enough that people who need it, get it, and at a cost affordable to them (amortized across the entire population). [edit] It's worth mentioning that, due to the economic incentive of single-payer health care, Canada invests a tremendous amount of money in preventative care and screening, which serves to dramatically reduce demand for the most expensive, most supply-constrained treatments. In fact I have a friend who works for the Canadian government right now doing computational screening for early cancer detection. It's interesting stuff, saves lives, and saves money, but requires a dramatic economic incentive to build out that simply doesn't exist in privatized care. > "Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)" Citation, again, sorely needed. I grew up in Canada and have never waited 2 months to see a specialist, nor 2 months for treatment. The longest I've waited for a specialist was a few days. I've also (unfortunately) been to both Canadian ERs and American ERs, and the wait times are not substantially different (immediate (Can), 4 hours (Can), 7 hours (Can), and 6 hours (US)).

graeme 14y ago
Also a Canadian, just want to confirm this. I can see a doctor instantly, for free, at any one of the clinics near my house. If I need to see a specialist, the referral usually happens within a few days or a week for anything urgent. Ditto for bloodwork, you just take the referral to a hospital. There are some exceptions, but generally things work well.

slurry 14y ago

This kind of argument probably worked better in the 90s or something, but it does not hold as much water today. First, the exorbitant rate of medical inflation in our "market" healthcare system is a fiscal menace not only to the public sector, but to the private sector as well. Secondly, the deteriorating health of the American workforce is an increasing threat to global competitiveness. An overweight employee pool with high prevalence of unmanaged diabetes is not an attractive one for global capital. Expanding access, controlling costs and emphasizing preventive care are things we need to get better at out of naked self-interest. Saudi sheiks who want to fly in for a quadruple bypass may continue to do so, but if we lose them to somewhere that bows and scrapes to the mega-rich more than we do, good riddance.

amalcon 14y ago

Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe) I would really prefer not to have to do this. Do you have a suggestion for how I could avoid that wait? I live in the U.S. and those timeframes don't seem particularly high compared to what I'm used to.

fatbird 14y ago

My brother in Columbus, Ohio, with a health plan for a director level position in a Fortune 1000 company, got a referral to a neurologist for a pinched nerve. Took six months to actually get inside a neurologist's office. This, in a health care market of 1.5 million people. What's that about wait times in nationalized healthcare countries again? I'm sure he'd have been much more quickly served in Vancouver or Toronto or Manchester.

dguaraglia 14y ago

"Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do?" This is so misinformed it's borderline laughable (if it wasn't thrown out there by someone who is a member of the HN community and, I'd assume, an intelligent peer.) I have been treated in Argentina for urgent and non-urgent issues and never, ever, had to wait 2 months for anything. When I was referred to a specialist (best of her branch of medicine in a city of almost a million inhabitants) I got an appointment the following week and started treatment within a month. Whenever I needed something, like an X-ray or bloodwork, I could either get it free of charge at the local hospitals or just pay for it (incredibly, a CT Scan with the same machines they use in the US costs 1/6 the price in Argentina. How's that for free market economy?) and get a result immediately. So, all in all, this is complete bunk. People who have never experienced any other system are by definition the worst to make a comparison with the US system. I've used the Brazilian, the Argentinian, the British and the US system and by far my worst experience has always been in the US, even while paying through my nose to get the same care I'd get for free in either of the 'developing' nations. Heck, I've used the _private_ system in the UK and even if I paid the extra bit to be seen by a doctor (20' wait at the practice; Oh! The horrors of endless lines and dead panels!) I only had to pay ~£2.50 to get all the medicine he prescribed (that's the upper bound, after that everything else is free.) So yeah, definitely the US is not a welfare state. If anything, it's the contrary: a profiteering system where healthcare is just secondary to profit.