[jomamaxx]

You can vote me down if you want, but I live in a system where I cannot get a doctor. And it's illegal to pay for one. I' forced by the government, to use local clinics where they don't have my records, I don't have a relationship with the doctor, they can't make longer term prognosis, and frankly, the care is sub-par.

I once had an ailment that was difficult to diagnose, the doctors at the clinics, used to seeing people for coughs and colds could give a shit. I ended up having to pay a few grand for an American entity operating barely within the bounds of legality in Canada (the Cleveland Clinic). I can assure you that it's a pretty desperate feeling when you are locked out of the system.

Notre Dame Hospital in Montreal is lined with people in beds in the hallways, broken chairs, broken, leaking water fountains in the waiting room, broken / discarded beds in the waiting room - I thought I was in Cuba. The doctor was actually nice but the facilities were crazy. A well run McDonald's has more visible operating efficiency.

It's far from optimal.

[dalke]

I think you might be downvoted because your complaint is not an intrinsic problem with single payer systems, nor is it common in those systems.

I could turn around and point to poor people from rural communities in the US, who can't afford healthcare, and depend on free mobile clinics like http://abcnews.go.com/Health/mobile-free-clinic-brings-healt... .

BTW, Cuba appears to have a significantly better system than what you describe.

Cuba also trains doctors for other countries, including people from the US. Medical training in the US is so expensive that people who want to be doctors for the poor can't afford the loans. See http://www.pbs.org/newshour/rundown/cuba-offers-poor-med-stu... .

[jomamaxx]

"uba appears to have a significantly better system than what you describe."

Cuba has no money. They pay their doctors roughly $10/week.

Do you think Cuba can afford all of the drugs, diagnostic equipment, software and services that are required to make a highly functional modern Medical system?

Of course not. I made a reference to Cuba out of sarcasm - there is no defending the Cuban system, other than to say that they can provide adequate 'very basic coverage' to it's citizens, which is good.

They pay their doctors literally less than the cost of many common and important therapeutic drugs. It's an economic non-sequitur.

[dalke]

For your "sarcastic" comment, you happened to pick one of the developing countries known for doing well with limited resources, with child mortality and longevity rates comparable to the US.

A country which, btw, is also promoting medical tourism. Which includes Canadians going there - http://www.nytimes.com/2015/02/18/world/americas/americans-m... . Perhaps you could go there for treatment?

Though from http://bmchealthservres.biomedcentral.com/articles/10.1186/1... it looks like more Canadians go to India. (The US isn't on the list because Canadians don't think of that as international travel.)

[jomamaxx]

Wow, you people really still exist.

My father just came back from Cuba. They are encouraged to bring a 20lb bag of tooth-brushes, toothpaste, clothes, toilet paper - and other items because Cubans cannot afford them.

It's a real stretch of the imagination to suppose that Cubans are doing anything, realistically in this area.

'Longevity' is not in any way a measure of the quality of healthcare - and 'infant mortality' is not so much a function of the sophistication of the healthcare system. Any nation with any civic control can achieve relatively low rates of infant mortality with clean water, reasonably informed doctors, antibiotics and some degree of pre-natal care. It does not take cutting edge healthcare system.

Again - the monthly salary of doctors in Cuba is $25. Please don't even begin to talk about anything until you address that point. Can you tell me how many functional CT scanners they have in Cuba? They have one for Fidel & Co. but the economics of it imply the number is de-facto 0. Anything but the most basic medical equipment is out of bounds for Cuban doctors.

Second - when Cubans send doctors abroad for training, and for 'aid' purposes, they do so whilst holding the doctors family members hostage, given the possibility for defection. If aid agencies pay said cuban doctors $1K/month - Fidel & Co. grab 99% of it, and leave the doctor with their $25 a month.

There is absolutely no preponderance of Canadians going to Cuba for medical care.

When Canadians 'really need healthcare' - they go to the US.

This, not including a) plastic surgery and b) middle class types who want otherwise very expensive surgery. But even in those cases, it's very rare.

[dalke]

I'm questioning why you picked Cuba when most other developing countries are worse. I'm not saying it's great. I'm asking why you picked on the standard American boogieman country.

> "'Longevity' is not in any way a measure of the quality of healthcare" ...

Life expectancy and child mortality are two commonly used proxies for the quality of healthcare.

> "Can you tell me how many functional CT scanners they have in Cuba? They have one for Fidel & Co. but the economics of it imply the number is de-facto 0."

You cannot argue that it's simple economics. The US embargo also has an effect. As https://www.scientificamerican.com/article/as-cuba-u-s-relat... points out:

> Since 2003 more than three dozen companies, including Philips Electronics of North America Corp., have faced penalties due to violations of the travel embargo, according to the Congressional Research Service. The change could also mean more consistent medical scanning options for research. Direct imports of medical supplies from the U.S. have remained rare, and sometimes Cuba has run up against difficulties even getting spare parts. At one point, CT scanners, angiography and ultrasound equipment from Philips—technologies common in health care facilities around Cuba—were lying idle, leaving patients with few options for three years, according to The Lancet Neurology.

I contrast the SciAm statement that CT scanners are "common in health care facilities around Cuba" with your statement that is is de facto 0, based on purely economic reasons.

I found http://www.nejm.org/doi/full/10.1056/NEJMp1215226 which says "A neurologist reports that his hospital got a CT scanner only 12 years ago." and http://www.martinews.com/a/cuba-sells-medical-services-100-c... shows a Siemens CT scanner at the Institute of Cardiology and Cardiovascular Surgery of Havana. In 1997 Calixto Garcia also has a CT scannner, says http://dx.doi.org.sci-hub.cc/10.1016/S0735-6757(97)90143-1 .

I think it's safe to conclude that there is more than 1 scanner in Cuba.

> "There is absolutely no preponderance of Canadians going to Cuba for medical care"

Never said there was. Indeed, I said that many more went to India. One of those links suggested why - there are relatively few English speakers in Cuba.

[DanBC]

You'veused your limited canadian experience to say that single payer everywhere is a terrible idea.

You're using some things which are peculiar to the canadian system (particularly the banning of private medicine) to say why single payer can't work anywhere, even though most other places allow private healthcare.

[jomamaxx]

My experience is not unique, it's common.

'Single payer wherein you cannot buy private services' is basically unique to Canada, and is fundamentally part of the reason that the quality of care and services in Canada is so bad.

My fellow Canadians are smug and righteous about their system, thinking that it's superior to the American system.

Anti-American bigotry is frankly rampant in Canada.

I lived in the US (and abroad) for many years, while most of my peers have never spent more than a few weeks in the US - and their understanding of the system is nill, and comes from the highly biased and borderline propaganda they get from our 'State Controlled National News' entity - the CBC. I generally like the CBC, but they also support national programs, and most of their staff don't have the relevant experience or competence to make any assessment.

My position on healthcare is a lot more nuanced.

Canadians are almost religious about their healthcare system, they have little grasp of how things work elsewhere, and little awareness of how poorly their system fares against other system.