[refurb]

Canadians don’t get the same care as Americans.

McKinsey did a nice analysis of what is driving US healthcare costs. It compares category spending to OECD then compared price and volume.

Turns out the US pays a bit more for drugs (relative to total spend), a little more for inpatient care and a TON more for outpatient care but half of the increase is volume, not price.

As someone who works in healthcare globally, the difference in US care is stark. Americans get much early and more access to new technology than other countries.

If your lymphoma has returned and you have a 20% of living more than a few years the best care is CAR-T with cure rates close to 60%.

Check out CAR-T rates in the US versus Europe, it’s almost 3x. The US started using it in 2014 and Singapore just started paying for last year (11 years later). Even in Europe adopt only ramped up in the last 5 years.

So yes prices are higher, but a big part is more aggressive care with more expensive treatment.

[wisty]

The US healthcare system just upsells on unnessessary crap. It's junk volume or at best it's heroic high tech solutions mostly making up for the fact that people stay away from hospitals until it's too late.

Life expectancy shows that while the US is the best place to have stage 4 cancer, it's probably not the best place overall. Most places do the 80/20 stuff better.

But yeah, you are right that the US does some stuff well. Just not efficiently.

[refurb]

US care is highly aligned with international guidelines. Saying "it's junk volume" just tells me you're not that close to the data.

Life expectancy doesn't measure quality of healthcare, there are far too many confounding variables like genetics, diet, accidental deaths, etc. No serious study of healthcare quality relies on it.

Look at 5-year cancer survival rates. The US is better (significantly better) in many of them than other countries. A big part of that is access to the latest technology.

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2...

[wisty]

Now do maternal death rate. Like I said, a good place to have cancer but they aren't good at stuff that matters.

The US leans aggressive on tests and heroic end of life care. I doubt you really disagree (except maybe on whether you think it's the right call). That is where the money is, since the insurance company can be forced to pay. It's kind of good for the rest of the world though if the US wants to pay (in both money and other issues) to be early adoptors.

Read "When doctors die", the US is the total opposite - everything goes to the big ticket aggressive (and yes, modern and cutting edge) treatment where it's hitting diminishing returns. https://pmc.ncbi.nlm.nih.gov/articles/PMC6179868/

[refurb]

> Now do maternal death rate

Sure!

https://archive.is/rMVJ0

Turns out the CDC changed the way it counts maternal deaths, while other countries didn't, so you're comparing different measures.

The old US measure was deaths that occurred during birth or shortly thereafter, now it's within six months and they added a check box only asking if the woman had been pregnant in the last year.

Not "this woman died because of poor maternal care", but rather "this woman who died had been pregnant in the last year".

This change immediately doubled the number. The data was wildly overestimating maternal deaths and in fact the CDC and many states are revising data collection to improve the number.

[dghlsakjg]

A good tell that someone is utterly full of shit on Canadian healthcare is that they generalize all of Canada.

“Canadian health care” is not a thing. Each province administers its own completely independent system.

Someone on PEI is in a healthcare system that has as much to do with Alberta’s healthcare system as it does their neighbours in Maine. As a result, anyone referencing Canadian healthcare is talking about a dozen or so unrelated systems that do things very differently. The closest it comes is that there are interprovincial billing systems so you don’t have to do the paperwork to get covered for an urgent visit out of province, and not all provinces are signed on.

You can safely dismiss anyone that has reduced that complexity, or is completely ignorant of it. It’s a great way to tell when a foreigner is spouting talking points they picked up from an unreliable source and did not do even a minimal fact check on. “Canadian health care” as it is talked about in the US media is frequently fiction for propaganda purposes.

Canadians almost always talk about problems within a province. What's happening in the Maritimes has nothing to do with BC.

The feds set a minimum standard for a province to qualify for federal funding, and that's about the limit of their influence.

No idea if the rest of his statement is poorly sourced propaganda as the first sentence.

[refurb]

You’re ignoring the fact that provinces can’t fund technology that the federal government hasn’t reviewed and negotiated a price for.

So yes there may be differences between provinces in terms of when they fund what restrictions are put on it, the overall trend across Canada is pretty consistent.

And as I said Canadians don’t get the same care as Americans so concluding the higher cost is entirely higher prices for the same thing is false.

[lostglass]

I lived in Ontario for 20 years then I lived in Seattle for the next 17, I assure you that the healthcare I receive and received is pretty much the same - except in Ontario it's way cheaper.

You're talking about cutting edge technologies available to the tiniest sliver of people - I'm not even able to get access to much of them with my private FAANG insurance - and drawing a false comparison.

[refurb]

Nope. I've not only lived in both countries, I work in healthcare so I'm very close to who gets access to what.

And it's not "the tiniest sliver of people", we're talking about disease like cancer. Check out the CAR-T rates in the US vs. Canada, the difference is stark. And CAR-T is standard of care in some types of lymphoma.

Hell, ask parents with autistic kids what kind of early intervention is available to them in Canada. I had a coworker who moved to the US so he'd have much better access for his kid at a time when it had a big impact.

Look at access to the cystic fibrosis therapy that effectively cures it (e.g. Orkambi). It was paid for by insurance (and Medicaid!) from the day it was launched and avaiable to everyone it could help. In Canada some provinces just started paying for it, but only kids, adults are shit outta luck.

And I don't know the details of your FAANG insurance, but my US insurance (typical corporate insurance) pays for all these new technologies.

Canada is great if you have a routine issue. If you need something specialized you're going to be treated with therapies that are a decade or more old. Hell, even the CBC wrote a whole story about 2 friends with breast cancer and the differences in treatment.

https://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-...

"Then I found out that this other country — which I thought had a healthcare system that was so superior to the U.S. — doesn't test for the tumour marker that saved my life, and doesn't cover this drug that is responsible for pushing my cancer into remission after traditional chemotherapy failed to do that."