[caseysoftware]

> Canada does it, so it demonstrably does work in North America, Europe does it, with varying degrees of efficiency, but it basically works.

Without going into the politics, size and population/density are two major differences:

- Canada has about 10% of the population of the US with much of it clustered around a handful of major cities so the vast majority of citizens can be covered by having good systems in a handful of places.

- Compared to Europe, the difference is even more striking. Just considering Texas: it is roughly the size of France but with half the population despite having 3 of the top 10 biggest US cities. And that's still not even 10% of the US population.

Whatever approach is tried in the US needs to take these differences into account.

[philwelch]

The US "free market" health care system doesn't fix this. Outlying areas still have shitty hospitals and major cities still have world-class hospitals clustered together. If you're too sick for your local small town hospital they pop you in an ambulance and take you to the city.

Texas might be "roughly the size of France" but a huge chunk of that is uninhabited desert.

[raverbashing]

There's no secret to solving this problem, and it works basically the same way everywhere

Yes, in France you might be 1h/2h by car from a hospital depending on what you need

You have a tiered system: 1st level is "everyday stuff", 2nd level is regional centers (so you get routine surgeries and more complex stuff), and at the 3rd level you got your excellence centers for specialized stuff (think transplants, major surgeries, etc)

In the US case yes, you might want to have a 3rd level center per state (might not be exaustive)

[apathy]

Per state? Try per region. My department serves a tertiary referral facility and there's another one across town. Of course, "town" is 18 million people, but you get the idea.

I guess I could see having one tertiary center to serve say VT and NH but if memory serves even they have one apiece.