[tempestn]

It seems like most of the complaints about healthcare now relate to unpredictable costs and complexity though. I'm not sure the simplicity and stress-reduction of a single-payer system really are appreciated. I'm Canadian, and our system is fair from perfect. That said, it's hard for me to comprehend the stories I regularly read about people's experiences in the American system, trying to decide on plans, sacrificing care due to cost, even just having to figure out what hospital they can go to when they need one. All this hassle has an effect that's significant but difficult to quantify.

I even have one personal anecdote - on a recent trip to Disneyland with some friends, a friend of mine got sick and needed to see a doctor. He had purchased travel insurance, so called the insurance company to figure out where to go. It turned out that the only walk-in clinics covered were halfway across LA. There were other clinics within blocks of our hotel, but they weren't covered. So, he basically wasted an entire day. Now, compared to serious healthcare issues, obviously this isn't a big deal. But still, the experience was just alien to us. Here, if you need to see a doctor, you either book an appointment with your family doctor, or if you need to see someone sooner or it's more convenient or whatever, you just go to a clinic. Any clinic doctor will see you, and will bill MSP (the provincial health plan).

Again, our system isn't perfect. Compared to someone with good coverage in the US, our wait lists for major procedures are generally longer. It's occasionally debated whether private clinics should be allowed to perform these procedures, allowing people who can afford it to jump the queue. The theory is that this leaves more public resources for everyone else, so it's win-win. However, generally politicians steer clear of anything that sounds like private health care, because in general people fear any erosion of the public system. (For example by having good doctors go to private clinics.)

Anyway, that was a bit of a tangent. The point is, there are intangible benefits to single payer healthcare that I don't see often discussed in the US.

[refurb]

As a Canadian as well, I appreciate you being up front about the drawbacks of our system as well. I've heard so many American's say "oh, the Canadian system is so much better". Is it better in coverage? Obviously!

However, when I ask if they'd be ok waiting over a year for joint replacement surgery, they get a weird look on their face. Or, if they have cancer, they aren't going to get to go to the best cancer center in Canada, you go to your local hospital. And if you want the latest and greatest cancer treatment? Well, you'll need to pay for that yourself since the gov't hasn't yet approved it for reimbursement.

There are benefits to both systems, but it's disingenuous to say that a single payer system solves all problems.

[hackuser]

These situations are common in the U.S., unless you are well-connected and can pull strings.

> waiting over a year for joint replacement surgery

1) Remember that many Americans have no access to healthcare outside of emergency rooms; they wait forever. I know plenty, including connected people, who wait months for simple appointments. A year before surgery wouldn't surprise me at all.

> if they have cancer, they aren't going to get to go to the best cancer center in Canada, you go to your local hospital.

2) Again, many Americans wait forever. Few others go to the best treatment centers in the nation - how much capacity do those places have, and who is filling up the local facilities?

> if you want the latest and greatest cancer treatment? Well, you'll need to pay for that yourself since the gov't hasn't yet approved it for reimbursement.

3) Again, some Americans get no funding. Most others are limited to what their insurance companies cover and often have the same problems.

[refurb]

I'm not arguing that many people would be better off. I'm arguing that many people would have to lower their expectations around healthcare.

There is a very big chunk of the US that has very expensive (that they can afford) and very good healthcare.

[hackuser]

Couldn't they still pay extra and get it? Can't you do that in Canada?

[refurb]

Nope! Physicians either have to be a part of the public system 100% or 0%. No doing both.

As a result, there are very few private options for healthcare in Canada.

[wahern]

A family member of mine is an orthopedic surgeon in Vancouver. Several years ago he split his time between a teaching hospital and a private practice, doing knee surgeries at both. At the hospital waiting times were typical. At his private practice waiting times were very short, on the order of days, I think. IIRC, the way surgeons get around the rules is by charging by the hour, not by the procedure. And it's completely out-of-pocket. For the kind of cookie-cutter, out-patient operations he specialized in it worked very well for him and his well-heeled patients.

[tempestn]

Right. As I mentioned in my post, there is a concern that allowing otherwise would erode the public system. Perhaps it's justified; I don't know. Also, those who can afford it can travel to the US or elsewhere if they want to pay for services, which reduces the motivation to create a private alternative here, although it turns out in practice that happens rarely. This is a good overview, also covering the differences in wait times between the systems: https://motherboard.vice.com/en_us/article/fact-checking-tru...

[sdenton4]

And yet. We have a system where the rich are OK and the poor can be destroyed by an encounter with the health care system.

A system where almost everyone is OK and the rich can pay for the best care available is far, far preferable.

[nickv]

How many Americans do you think get to go and get their cancer treated at Memorial Sloan Kettering?

The US private health care system doesn't mean everyone who gets cancer goes to MD Anderson. And, you'd still be very hard pressed to have many private insurance plans cover truly experimental treatments. If I had to choose who gets advanced treatments between those who can pay the most vs those who need it the most I'd go with the latter.

It's funny, many of my Canadian friends talk about the "you can't get the best treatment in the world" problem with their system which, to me, shows how they really don't understand the dire nature of US health care. Wait a year for a surgery? Millions of Americans can only go to emergency rooms.

[refurb]

I'm not arguing that people in the US don't get care, I'm arguing that if you want to cut healthcare spending in the US (to match other countries) people will have to get used to a lower level of healthcare.

[nickv]

I don't understand what you mean there. I think you underestimate the administrative costs alone of the US' hodgepodge system (an entire floor at UCSF is devoted to insurance processing, how many floors does UBC have for billing?)

The US health care system even for the middle class is a disaster. Deductibles are often nearly 8k or higher alone! And nearly ALL plans have "networks" so you can't go to whatever doctor you want anyway. (One of my canadian friends doesnt even know what a deductible is!)

You realize there are nearly as many Americans without any insurance as there are people in Canada (27M vs 34M)? And this was AFTER the ACA expansion.

I get trying to post an alternative view, but it's so out of wack. Have you experienced the US health care system for an extended period of time personally? It sounds like you haven't.

[refurb]

I lived in the US for almost a decade, so I've experienced both systems.

My point is that the US system has problems and the Canadian system has problems. Hell, the Canadian Supreme Court ruled that healthcare wait times combined with a ban on private care violated the Canadian Charter of Rights and Freedoms[1].

There are numerous examples of Canadians either suffering in pain or heading to the US for surgery due to wait times.[2]

Bennett was referred for surgery on her right hip in November of 2013 and said she’s been told she won’t get in until early in 2016. She said her joint has deteriorated so much she is unable to work or even function without strong narcotic painkillers.

[1]https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG) [2]http://www.cbc.ca/news/canada/british-columbia/patients-live...

[ktRolster]

I like to remind myself of the complexity of the situation by remembering:

Sometimes Americans go to Canada for medical treatment, and sometimes Canadians come to America for treatment. It's not a simple better/worse situation.

[weaksauce]

so I recall back in the day when I was in highschool watching a guy on tv blow his brains out on an overpass with a shotgun because apparently his hmo(managed care insurance with a bunch of bullshit rules) screwed him and he couldn't find any recourse other than that.

Just having decent health care is a struggle in america. if you don't have a job and you are not independently wealthy you are basically screwed pre-ACA.

Not having a single payer healthcare in america also changes the risk calculus of starting up your own business.