[sh4un]

Canadian healthcare is scary, and it's made worse by these politicians that always go to the US for care.

The joke is that it's gotten so progressive that no one gets better, we all have to equally suffer. You can see clearly how this situation was mishandled.

[southerntofu]

> The joke is that it's gotten so progressive that no one gets better

I don't think that's the reason. Public health systems in Canada/France/Belgium have (had?) a very good reputation because they were in fact really good until the neoliberal turn on the 80s/90s. When you have health workers running the show with a fair budget, wait times are low and results are good, and everyone is happy. Now introduce some managerial feudalism (see David Greaber's talk at CCC last year) and micro-management/benchmarking and things start to degrade.

Add to this mix that big corporations don't pay their dues and the government keeps reducing budgets and pretending they don't know why there's no more money flowing in and suddenly you've got health crisis on a wide scale and most people you know working in hospitals are depressive, either quitting or on the verge of suicide due to contradicting objectives: they want to help people but they're not given the means to do so. Social dues fraud is dozens of billions of euros every year in France, it's well-known and well-flagged and no government wants to do something about it.

If you're working in IT, think about it this way: management is benchmarking how many functions you write per day and does not care about the state of things as a whole. You are incentivized not to produce tests (which would indicate failure from your team specifically) but rather to ship away at once. Are you gonna produce good code?

EDIT: I should make it clear when i talk about social dues fraud, i don't mean individuals gaming the system to gain funds they're not owed (which is < 1% of fraud), and i'm not talking about small companies not paying their dues (the State is really good at harassing those until money flows in), i'm talking about CAC40 corporations who make billions of profit every year. They are the ones responsible for the social security hole ("trou de la sécu") and that's public knowledge.

[fer]

Honest question: what social security hole are we talking about here? What kind of fraud? The gross majority of the social charges of a large company depend on employee wages. Having worked for a few CAC40 companies, knowing the makeup of their workforce, and looking at their public financial data, the numbers seem square.

On the other hand, every day I see small businesses with significant undeclared revenue and obvious money laundering schemes going on. France makes it very easy to anonymously report all sorts of crimes, from domestic violence and child neglect to terrorism, but only a selected few can report to TRACFIN.

Personally I can't wait for France to adopt a fiscal data module like the Belgian HoReCa black-box [0], and given the overreaching arms of the French fisc I'm surprised it hasn't already.

[0] http://www.salesdatacontroller.com/belgium-prices-are-10-hig...

[southerntofu]

About unpaid dues (fraude aux cotisations), the highest financial authority (Cour des Comptes) estimated between 6.8 and 25 billion euros fraud annually in 2014, depending on the evaluation method. [0] Then there's dues exemptions. A study estimated 57 billion euros were exempted in 2015, 57% of which was compensated by the State's budget. [1]

We could also mention tax evasion and other schemes, which affect the ability of the national budget to compensate frauds. Despite arguments about the exact number, most agree big corporations pay less taxes than the small on average [2]. It's interesting to note the evolution over time of subsidiaries of CAC40 companies in fiscal paradises. [3]

Overall, there's plenty of fraud and "legal" exemptions on all levels. Quite enough to close the social security deficit.

> Personally I can't wait for France to adopt a fiscal data module like the Belgian HoReCa black-box

I think that's happening. The law is clear that accounting software has to be certified since a few years (which has been a major hurdle for FLOSS projects). Personally, i'm not so much interested in such measures as most of the fraud is committed by the very wealthy and such measures could affect smaller businesses and common people in some ways: need to invest in more expensive accounting equipment/software, more difficulty for undocumented people to find honest jobs (though they'll still be able to work for big industrial groups who are famous for exploiting them).

[0] https://www.ccomptes.fr/system/files/2019-11/20191202-synthe...

[1] https://www.cairn.info/revue-de-l-ires-2015-4-page-3.htm

[2] https://www.liberation.fr/politiques/2017/02/24/les-entrepri...

[3] https://www.capital.fr/entreprises-marches/les-entreprises-d...

[rdtennent]

Canadians are generally very satisfied with the quality and availability of healthcare in Canada. The issue in this case is not the quality of care but the possibility that the provincial government is suppressing testing that might reveal that a naturally-produced neurotoxin has contaminated bottom-feeding crustaceans such as lobster.

[boringg]

Canadian healthcare is great if you have a life threatening acute problem or you have no ability to or willingness to pay for healthcare. If you have anything in the middle its a giant slog against a large bureaucracy to actually get it treated. And you have ti have some conviction in what it is otherwise diagnose and adios as they say.

[jerezzprime]

> Canadians are generally very satisfied with the quality and availability of healthcare.

I'd love to see the list of people you surveyed to draw this conclusion. In my metropolitan area availability is abysmal and (in my experience recently) quality is not great. I am contrasting this to my recent experiences in the US system.

[spanktheuser]

That makes some sense - US healthcare is great if you are wealthy and barely existent if you are not. Canada strikes me as middle of the road - moderate quality for nearly everyone.

If you are one of the lucky 10% at the top of the heap US healthcare will outperform.

[twofornone]

Nonsense. Middle class employment comes with health insurance that makes healthcare generally affordable, barring stories about catastrophic bankrupting illnesses that are actually rare.

Edit: what, am I out of touch? Is health insurance only provided to employees in the top 10%?

[mech422]

>>healthcare generally affordable, barring stories about catastrophic bankrupting illnesses

I think you're being down voted for the 'generally affordable' and 'bankrupting illnesses' parts. "Middle class" doesn't usually equate to tech level salaries or benefits. Family health insurance can be very expensive for middle class families. The extremely high family out-of-pocket max plans can turn even non-catastrophic illnesses into a financial crisis.

[hluska]

I notice you said recently. Keep in mind that we’re in a pandemic and elective procedures/many types of testing have been postponed. That’s because it’s a pandemic. I’m not so selfish to expect healthcare workers to work 24/7.

[Mikeb85]

> Canadians are generally very satisfied with the quality and availability of healthcare in Canada.

If any of us are it's because of the pervasive anti-American propaganda spewn about.

My GF is from the Czech Republic (where we currently are) and since we got here she's been getting all her standard check ups done. Here she can make an appointment only a day in advance (as opposed to weeks or months out in Canada), there's no wait time (in Canada you usually wait even with an appointment) and dental/drugs are included in Czech Republic (in Canada only the most basic care is included, everything else is extra and quite expensive).

Czech Republic is seen as a second-rate EU country (at least what I've heard of it) but health care here is so far ahead of Canada we might as well be a third world country.

Edit - I should add, even before observing European health care, I knew a shocking amount of people who've gone to the US and even Mexico specifically for medical treatment. Canada's health care is abysmal, our politicians just convince everyone that everything is OK because it's "free" (never mind that we pay European-level taxes for far worse care).

Also, I come from the richest (per capita) Canadian province with the best health-care funding, which in my experience is the best in Canada, but still lacking...

[inglor_cz]

Czech here. In theory, our healthcare system should work the way you described. In practice, a shortage of doctors is developing in less lucrative regions. You will always have good service in Prague or Brno, but elsewhere, you may run into problems.

This article shows a hundred-strong queue of patients waiting to register to a newly opened dentist office. Some of them waited overnight.

https://www.idnes.cz/ostrava/zpravy/lhotka-ostrava-fronta-zu...

Mind you, this is Ostrava, the third largest city in the country.

[Mikeb85]

Fair enough. We're in Karlovy Vary region and everything has seemed very efficient.

One thing I have noticed is that Czechs are very critical of their country, which to my eyes seems to function quite well, for what it's worth.

Canadians put up with far worse and yet will defend it. Also, our whole country has a doctor shortage. No sane doctor stays in Canada when the US pays multiples more...

[inglor_cz]

There is definitely a tendency towards some self-flagellation in CZ, though I think this is vastly more widespread elsewhere (just witness the ritual meltdowns in English language media whenever some election does not turn out perfectly "right").

I like to think I am pretty resistant to that. So, some earned praise: Czechia is a very safe country which was able to get some things work better than many others (we even have a functioning gun culture without too much machismo or regular bloodsheds - the compulsory safety and legal tests are a good filter against crazies). Our healthcare is fairly decent, though necessarily limited by the overall economic level, which is, by the standards of Western Europe, second tier.

What is really f_cked up is the real estate market. Our construction permit bureaucracy would make the Byzantine courts blush, a normal block of flats may spend a decade in permission limbo before the first shovel touches the ground. As a result, prices have gone absolutely mad in the last few years, especially in Prague.

(Meanwhile, similarly sized Polish capital Warsaw built 100 000 apartments in five years or so and housing is much more affordable there as a consequence.)

[Mikeb85]

> What is really f_cked up is the real estate market.

Cries in Canadian...

https://www.visualcapitalist.com/least-affordable-cities-to-...

[hluska]

I’m Canadian and am extremely happy with the state of healthcare. It has nothing to do with propaganda but personal experience.

Please don’t claim to speak for me. Your view does not match the typical Canadian’s.

[hungryforcodes]

I'm Canadian and since living abroad I can only say how impressed I am with health care systems OTHER than Canada's. Getting a specialist appointment in Canada can take weeks to months and even then the specialist barely has time for you.

I have friends from Europe who (now) have dual citizenship and fly back to their country of origin for anything beyond a basic checkup.

In Asia I go to the hospital and I get all the results in a folder and can review them myself. There are no hidden mysteries like in Canada -- what are they hiding in Canada? I've asked for a copy of my medical file and they've looked me like I'm a lunatic!

In Canada:

"So when do I get my test results?"

"We'll call you if there is a problem."

No joke!

In Quebec I always have to pay $500 a year for medical -- I guarantee you I can get A+ coverage for that amount of money in any SEA country. So it's definitely not "free".

Canadian health care is most certainly a better financial deal than the US system if stories are to be believed. But it's most certainly not the best world wide.

[mattkrause]

If you're still in Quebec, have you tried the Carnet Santé website? https://carnetsante.gouv.qc.ca/portail

It should have most of your testing, albeit with a 30-day delay that is supposed to let someone discuss potentially-scary test results with you.

[Mikeb85]

How often do you, personally, use healthcare? I was fine with it too because I'm a very healthy man (let's face it, men don't use health care as much as women for obvious biological reasons) in my 30's. The fact it's so shit doesn't affect me, personally.

But it's objectively bad when compared to every country at our level of income, and bad when compared to most first-world countries. We pay more and receive less. My girlfriend is pregnant (part of the reason for all her medical appointments) and legitimately doesn't want to move back to Canada (where we met) because of the state of health care (and education, and infrastructure, and housing costs, but healthcare is a big one with a child on the way).

Edit - in a comment to another person you're saying you're OK with things being postponed in Canada because it's a pandemic. Nothing is postponed or shut down here... We've been getting appointments just fine. Literally made my point.

[sh4un]

No Canadians are not satisfied. It's the biggest complaint of everyone outside of the top few large cities.

The government is clueless, but also the healthcare isn't very good beyond common issues.

It's not like in the US where you have multibillion dollar facilities dedicated to a disease.

Unfortunately the same doctor treating you for cancer is the same doctor putting stitches in some kids finger at the local hospital and not a specialized medical team at the Johns Hopkins Center.

Everything here is treated with Amoxicillin, Tylenol, and if they trust you enough with the hard drugs, maybe some diclofenac.

[nightowl_games]

Just chiming in here as a Canadian to express my immense satisfaction with our public health care. I just got an appointment for a minor issue in less than 24 hours. We recently had a baby and got top shelf care at a new hospital, better than the San Diego hospital my friend just had a baby at. All of it was free. Except the parking. Friggen' parking, amirite.

This case clearly has basically nothing to do with public 'health care' this is clearly political and health research related.

[fartcannon]

Still living 3 years longer then the Americans.

[Scoundreller]

Closer to 4 now: https://en.m.wikipedia.org/wiki/List_of_countries_by_life_ex...

[christophilus]

American obesity may be the explanation here.

[tragictrash]

It's not obesity alone. All of our food contains an excessive amount of salt.

[joecool1029]

Japan does just fine with a higher salt consumption than the US and has the highest life expectancy in the world.

[nobodyandproud]

Isn’t the implication obesity + high salt content?

[elevenoh]

Canadian healthcare is indeed in rough shape.

Our health outcomes have plateaued, wait times increased and costs rocketed.

The inevitable nature of uncompetitive systems.

[vsareto]

>Our health outcomes have plateaued

Healthcare is messy. That plateau might be the best we can accomplish given our current technology, science, healthcare, politics, and culture. It's not necessarily a measurement that always has to go up (like USA stocks).

If you want to put this on non-competitive systems, the USA has a competitive system and it is probably worse than Canada. If not completely worse, then certainly worse on major dimensions like cost and accessibility.

I'd be interested in what these health outcomes measured if you have a link handy.

[metalliqaz]

Unlike here in the US where we have a mostly private health care system.

Our health outcomes are actually dropping, wait times are bad, and costs are the highest in the world.

[southerntofu]

> The inevitable nature of uncompetitive systems.

This is highly misinformed. The problem is precisely the introduction of competitiveness in a system which previously worked well. This is for example explained in Adam Curtis' documentary The Trap Part 2 [0] which you may find online in many places.

[0] https://en.wikipedia.org/wiki/The_Trap_(British_TV_series)