[Accipitriform]

Right, of course we should want single-payer, just like Canada!

Never mind that the average wait time to see a doctor in Canada is almost 20 weeks, and that tens of thousands of Canadians cross the border to the US every year to avoid that wait...

There are tradeoffs with everything. Personally I think people should proactively try to live healthier lives - the medical establishment is about making money, not making you healthier.

The other major side benefit of that is our society might be able to afford the overall cost of healthcare - it's not looking too good at the moment!

[AlexandrB]

> Never mind that the average wait time to see a doctor in Canada is almost 20 weeks...

The way this is stated is very misleading. The average time to get surgery is 20 weeks. This varies a lot by what kind of surgery you're talking about[1]. The average waiting time to see a doctor in the ER is measured in hours, with 27% of Canadians waiting 4 hours or more[2].

As a Canadian, I'm tired of Americans shitting on Canada's health care system and spreading misinformation to score political points. It's not perfect, but I'll take it over the financial devastation wrought by the US system any day.

Edit: Also, let's not forget that US citizens regularly cross the border into Canada so they can afford basics like insulin[3].

[1] https://globalnews.ca/news/3084366/q-a-how-long-are-medical-...

[2] https://www.cbc.ca/news/health/medical-wait-times-up-to-3-ti...

[3] https://www.cbc.ca/news/canada/windsor/bernie-sanders-insuli...

[wozniacki]

Some preeminent foreign statesmen rulers who have gotten / who are getting their surgeries done in the United States.

Daniel E. "Danny" Williams, QC a Canadian politician, businessman and lawyer who served as the ninth Premier of Newfoundland and Labrador between November 6, 2003, and December 3, 2010. [1]

Abdullah bin Abdulaziz Al Saud was King of Saudi Arabia and Custodian of the Two Holy Mosques from 2005 to his death in 2015. [2]

Moses Veerasammy Nagamootoo is a Guyanese politician and writer who has been Prime Minister of Guyana since 2015. [3]

[1] 'Danny Millions' Williams heads south for heart surgery

https://www.thestar.com/news/canada/2010/02/03/danny_million...

[2] Waldorf-Astoria Bumps Guests for King Abdullah's Entourage / The Room Is Booked, Until the Hotel Says It Isn’t

https://www.nytimes.com/2010/12/14/business/14road.html

[3] Prime Minister Nagamootoo to Undergo Heart Surgery in the United States

https://www.thewestindianonline.com/prime-minister-nagamooto...

edit: typo; rephrased sentence

[Sharlin]

Yes? Nobody's denying that it's easy to get very good medical care very quickly if you have enough money! That's of course, completely irrelevant to the topic of this discussion, or, if anything, emphasizes the inequality inherent in the American system.

[wozniacki]

Just adding context that when it comes critical medical care involving specialized care, the United States almost has no equal - not even close. Whether that is Level 1 trauma facilities, oncology facilities, cutting edge research laboratories or doctors with deep expertise in such fields, the United States is second to none.

This is not an oft brought point when discussing the merits of the U.S system despite its failings and short comings.

Also:

    The Fraser Institute, a Canadian public policy think tank, 
    estimates that 52,513 Canadians received non-emergency medical
    treatment in the U.S. and other countries in 2014, a 25 
    percent jump from the roughly 41,838 who sought medical care 
    abroad the previous year.

    In citing those numbers in its 2015 report, "Leaving Canada for 
    Medical Care," the organization said difficulties in obtaining 
    timely medical care at home is, increasingly, leading Canadians
    to seek it abroad. "It is possible [they] may have left the 
    country to avoid some of the adverse medical consequences of 
    waiting for care, such as worsening of their condition, poorer
    outcomes following treatment, disability, or death," the report 
    says. "Some may leave simply to avoid delay and to make a quicker
    return to normal life."

    Canadians could expect to wait 9.8 weeks for medically necessary
    treatment after seeing a specialist in 2014, the researchers found,
    three weeks more than the time physicians considered to be 
    clinically "reasonable."[1]

[1]

Canadians Increasingly Come to U.S. For Health Care / Crossing the Border for Care

https://www.usnews.com/news/best-countries/articles/2016-08-...

[SolaceQuantum]

But, again, we’re not talking about how amazing the system is if you have money. We’re talking about how the system utterly fails to disseminate basic healthcare to the vast majority of people in a way that doesn’t destroy them.

[disordinary]

There's also a scale that the United States has over all other OECD countries. It's by far the largest in population and therefore has more specialist equipment. A country like Canada with almost a tenth of the population will have less facilities.

[Sharlin]

Oh puh-lease. Even a trivial googling tells me that Canada has longer waiting times than most other comparable countries with single-payer healthcare. And those waiting times? About half of GP visits are same- or next day appointments, with 20% of Canadians having to wait for a week. As for specialists, the median waiting time is roughly four weeks. [1]

So those numbers are definitely not optimal compared to many other countries, but your claim about the average being almost 20 weeks is completely ridiculous. You're entitled to your own opinions, but you are not entitled to your own facts. And if your opinions are based on your own facts, don't expect to be taken seriously in any reasonably educated company.

Now, according to [2], the US fares well on two metrics: waiting time to see a specialist and waiting time to elective surgeries. Unsurprisingly, both of these are conditional on already having gotten a referral and/or having decided to book the appointment or operation. That is, most of the time, if you have decided you can afford it! Indeed, cost barriers were by far the highest in the US, as measured by the fraction of people who skipped treatment or medication due to cost.

[1] https://globalnews.ca/news/3251833/canada-has-some-of-the-lo...

[2] https://www.cihi.ca/sites/default/files/document/text-altern...

[mgkimsal]

I may not understand what's being got at with this 'Canadian wait time' issue.

I've needed to go see my doctor - usually I can't get a same day appointment. Sometimes I can get a 'next day' - usually it's "pick some time in the next week or two". Am I now "having to wait"? It's been this way for me my entire life in the US (more than 40 years I can remember), across different states, political leadership and insurance companies.

I needed a procedure by a specialist last year. Regular checkup produced "this is serious - I'm referring to you ABC for procedure X - we need to get this done ASAP". It was still more than 2 weeks before the specialist could see me. There was an option of seeing someone else sooner, but it would have meant a 2 hour drive. That was possible but very inconvenient, and we decided that the 2 week period was acceptable vs the alternative.

Does everyone else in the US get same day service for everything they need, and I've just been wholly unlucky my entire life in multiple regions of the country? Or, do we actually have 'wait times' just like everyone else?

[Sharlin]

Well, I guess that's why you need to creatively misinterpret the statistics in order to make the argument "Canadian wait times long -> single-payer systems baaaaad". Never mind the other logical fallacies in said argument.

[sdwa]

Is there any evidence that the reason healthcare is so unaffordable and people go bankrupt is because people are unhealthy? Your "just be healthier" solution is no solution at all.

Regardless, people fall ill through no fault of their own all the time. I am very healthy and very active, but right now for all I know I could have a brain tumour. Your response is so stereotypically American: just ignore the problem and encourage people to take responsibility over something they by definition have little control over in the first place.

[wheno]

That is something has always confused me a bit. Many people tend to object to universal system on the basis that it leaves it up to the government. But if you don't have universal systems the government, and the companies operating in the market, have little incentive to take care of its citizens. Because the cost of not doing so is left to you. Even if you want to argue that a health care system is a factor of how healthy people are, it is the universal systems that have the incentive that people are healthy. It is those systems that more often regulate things like transportation or drugs as public health issues.

[tareqak]

It is not twenty weeks to see any doctor: it is twenty weeks to go from a referral from a general practitioner to receiving treatment from a specialist [0][1][2]. I’m not sure if things like consultations are counted are as treatment or not.

[0] https://www.ctvnews.ca/mobile/health/health-care-wait-times-...

[1] https://globalnews.ca/news/3251833/canada-has-some-of-the-lo...

[2] https://www.fraserinstitute.org/studies/waiting-your-turn-wa...

[mrunkel]

> Never mind that the average wait time to see a doctor in Canada is almost 20 weeks...

This is just false.

The number you're referring to is from here: "Specialist physicians surveyed report a median waiting time of 19.8 weeks between referral from a general practitioner and receipt of treatment—shorter than the wait of 21.2 weeks reported in 2017. This year's wait time is 113% longer than in 1993, when it was just 9.3 weeks."

It's for receiving treatment from a specialist (surgery, etc.) not 'seeing a doctor'.

Somewhere around 40% of Canadians reported being able to see their primary care physician the same day. Very few reported a wait of longer than 7+ days.

Many parts of Canada are very remote. The average waiting time for someone in a major city is not as long as that.

[blaser-waffle]

There simply aren't medical facilities in a lot of remote / regional Canada. If you need a fairly complex or specialized surgery you're essentially going to a big city or regional hub.

Keep in mind that Canada may be huge, but has less people than California, and most of them are concentrated in a handful of places.

Anecdotal: my wife's wait for an orthopedic surgeon was 3 days... but was in a city 1.5 hours away.

[precisioncoder]

Uh, maybe in some places in Canada? I grew up in Nova Scotia and seeing a doctor with an appointment was possible within a week, emergency was always possible right away. (Had 34 stitches by the time I was 17 due to growing up on a farm so I had a lot of experience.)

Here in Austria it's even easier, I can go directly to my family doctor at any time and wait ~hour with no appointment necessary. Xrays, or other things are usually possible same day and even elective surgery that improves quality of life is free and is plannable within a couple months with the recovery time as paid leave from work.

[vidarh]

The problem at the very outset with this argument is that a system where patient pays hides the queues, because everyone can afford to go.

As such you can not directly compare a system where going to the doctor costs money with one where it does not.

This is one of the biggest problems with the US system: Nobody knows the extent of the unserved need, and what that ends up costing society in lost productivity (never mind the human suffering) because people avoid healthcare services they know they can't afford.

But we can compare Canada to other socialized systems, and many do more with less and still end up with shorter wait times.

The vast majority of the worlds healthcare systems also do not prevent people from going private.

Most places also allow you to buy your way past the queues. As such, the difference is stark: Most places you have the choice of waiting, and paying much less, or paying for private services and get seen as quickly as those who can afford it do in the US while a large number of people in the US has no access to a lot of healthcare services at all.

Want to bet whether the people who can't afford to buy healthcare services would prefer waiting 20 weeks - or any amount of weeks - to get treated vs. getting no treatment at all?

Now consider that average US spending per taxpayer in the US on Medicare and Medicaid is substantially higher than the per taxpayer spending to fully fund universal healthcare in the UK for example. And then on top of that Americans buy private insurance since most are not covered by Medicare and Medicaid.

Most Americans pay twice. Meanwhile in the UK only 10% find it worthwhile "paying twice" by having private insurance, even though most private insurances in the UK are very cheap for the simple reason that there's simply no demand for replacing A&E, ICU type services, and relatively little demand for covering private GP services (most people can be seen by their GP quickly, and a private consultation on occasion is cheap), so the insurances mostly cover seeing a specialist quickly if the NHS has a waiting list, or getting surgery quicker if the NHS has a waiting list.

This is what I really don't get about the US debate: The poor regulatory regime basically mean Americans are already paying enough towards healthcare to provide universal coverage via taxes alone if the regulations were properly reformed. A start would simply be to remodel Medicare after e.g. the NHS model, and allow it to exercise its market power to drive down costs, and use the savings to extend coverage.

As it stands, the inadequacy of the US healthcare system is largely down to corporate welfare in the form of regulations that actively prevent the government from providing cost-effective healthcare services.