[haldujai]

Canadian data is relatively poor quality (mostly from the 90s) outside of Alberta (I expect QC and BC probably have the highest rates) but historically and estimates are that we have slightly higher incidence than the US.

https://onlinelibrary.wiley.com/doi/full/10.1111/resp.14242

> There’s incentives for our government to protect workers from risks that will cost a fortune to fix.

There are many examples where this is inaccurate but let’s keep it simple and delve a little deeper into the silicosis problem presented in this specific study.

From the JAMA article:

Although a substantial number of the patients, including some of those who were uninsured or with restricted-scope Medi-Cal, likely had an undocumented immigration status, we did not directly collect information about whether individuals were undocumented immigrants.

Note that public health system in Canada is not “free”. Legal immigrants, documented workers, citizens and refugees have access to provincial or federal health insurance which pays for care.

Undocumented or illegal immigrants have neither (and also would not get WSIB which would be the payer for most silicosis cases) and actually have better coverage in California.

Additionally:

Ten patients (19%) were uninsured, 20 (38%) had restricted-scope Medi-Cal, 7 (13%) had Medi-Cal, 8 (15%) had private insurance, and 7 (13%) had workers’ compensation.

So 34/52 had some form of government provided or mandated insurance.

As an aside while restricted-scope Medi-Cal and uninsured rates are the surrogates for undocumented immigrants in this study, those over the age of 50 (or 19-25) are also eligible for full scope Medi-Cal but were not identified in this study. Medi-Cal will also be expanding in January 2024 to cover undocumented immigrants aged 26-49.

Even if we assume Canada’s silicosis incidence is lower, all of the above strongly suggests your public health system cost-savings incentive hypothesis is incorrect.

[PaulDavisThe1st]

> Note that public health system in Canada is not “free”.

I'm enough of a pedant to annoy the fuck out of most anybody who knows me, but really? Look, there is no "free" health care anywhere, but it's a term that has (perhaps unfortunately) become widely used as a synonym for, depending on your sensibilities "no charge at the point of service" and/or "socialized health insurance and health care coverage".

And Canada is certainly one or both of those.

The metric "well, they don't provide it for undocumented persons" is a weird one, as is the use of California as a counter-example.

[haldujai]

I think you may be “annoying the fuck” out of yourself here. Your reply is full of strawman arguments.

The comment I replied to asserts that the government incentive to reduce healthcare expenditures improves workplace safety, and consequently in the context of this article would have prevented silicosis/PMF in these patients.

I highly doubt most HN commenters are aware of whether undocumented migrants are covered in the Canadian system as they are in California, certainly the person I replied to was not, so I explain differences in coverage.

Consequently, the argument doesn’t hold water as the financial incentive for the government is stronger in California than in Canada as it relates to this study population.

> The metric "well, they don't provide it for undocumented persons" is a weird one, as is the use of California as a counter-example.

I'm not providing any counter examples, undocumented workers in California are the subjects in the article we are commenting on. Where in fact there happens to be socialized healthcare that you seem to think I'm arguing against.

[PaulDavisThe1st]

All good, but you still had to get in the jibe about '"free" healthcare' for reasons that have nothing to do with either TFA or the GP's point.

[haldujai]

It's not a gibe. I used scare quotes around free because it's obvious that a socialized system is funded by taxes, what's not obvious a bill is always generated during healthcare delivery in the Canadian system.

You yourself seem to not understand this distinction with your comment: "no charge at the point of service".

There is always a charge at the point of service and a bill is generated. The difference with the US is that the Canadian healthcare system, which also functions mostly privatized, uses a single payer model so the government is the only one legally permitted to pay for insured services. In other words, each province runs a large insurance company and there is a law that states that no one is allowed to charge any person or company other than the government insurance plan for anything the government has deemed reimbursable for any person covered by the plan.

(So you don't misinterpret my statements again: while government run hospitals, but not the physicians working in them, do get capitation payments they also bill for some services. What is billed vs paid through capitation varies by province. Services rendered to uninsured patients are never from capitation funds and are always charged directly to the patient).

If the services rendered or you are uninsured, like the patients in the article study, it functions the same as the US and you will personally receive a bill in the mail with similarly obscene rates much higher than what the government insurance company would have paid.

This distinction has everything to do with the article and GP's point which asserts that the Canadian government will bear some cost for the care of the patients in the California study which is flatly incorrect. If there was no charge at the point of service none of this would matter.

[PaulDavisThe1st]

> There is always a charge at the point of service and a bill is generated.

I was thinking more broadly than just the US or Canada. In Scotland, for example, there is literally no charge at the point of service.

[haldujai]

Okay... what does Scotland have to do with anything?

The discussion, and the part of my comment you quoted, is specifically about Canada and the US. So I'm not sure what you're even arguing or why.

[pupppet]

> Canadian data is relatively poor quality

Sure, no axe to grind here. Do tell us your impartial take.

[haldujai]

Perhaps you are unfamiliar with medical research but stating that available data is poor quality is an objective assessment. I provided a brief explanation in parentheses which you excluded for some reason.

I also provided a reference that is open access but here is the relevant section for you:

In Canada, there are no national data on the incidence or prevalence of silicosis. In the province of Alberta, where silicosis is a notifiable disease, health insurance data revealed 861 cases with at least one reported diagnosis of ‘silicosis’ during a period of 10 years from 2000. These results were based on raw data and not a secondary review of primary imaging and clinical information. Data from 2000 through 2009 showed that only 29 workers' compensation claims were accepted for silicosis in Alberta. Data from Quebec's compensation system revealed 351 compensated cases of silicosis between 1988 and 1998. Of note, workers who participated in regular surveillance had milder disease at the time of compensation.

The JAMA study is from 2019-2022. Data that is 20-30 years old is relatively poor quality.

Changes in medicine, workplace safety rules and occupational trends makes it hard to compare to silicosis rates in Canada to the US in order to assess the claims of the comment I replied to therefore I think the relative incidence described in this review article (from 2022) is inaccurate.

If you want to disregard my quality assessment, the discussion ends with the review article showing silicosis rates are 3x higher in Canada.

Can you elaborate on how any of this shows I have an axe to grind or that I’m biased?

[retrac]

Canadian here who believes our labour safety standards are generally better than the USA (based on anecdote and experience, not data).

Canadian data is poor quality. On any issue you might care to pick, the topic is better studied in the United States. I run into this all the time. For example, we make allocation decisions at a charity I volunteer at with, about what health problems unemployed LGBT people tend to have. We use data for American urban populations. The data doesn't exist for Canada, AFAIK. It's a smaller country! There's simply less research and statistic-taking done! It's a reasonable statement.

Besides -- commenting on the lack of good data usually implies the exact opposite of what you seem to think -- it is an admission by the poster that their argument is based on weak evidence.

[haldujai]

> it is an admission by the poster that their argument is based on weak evidence.

Which is exactly why I limited my reply to a discussion about the California study and healthcare systems rather than reiterating the claims in the 2022 article I referenced which states silicosis incidence is 3x higher in Canada, based on 20-30 year old data.

Although I live in the US now I’m a dual citizen and practiced medicine in both countries, the only axe I have to grind with Canada is the harsh winters which are incompatible with my fragile desert descent body.