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A substantial difference is that healthcare tends to be incredibly regressive in the US. People with good jobs that have good pay tend to get pretty good company insurance. People in jobs that don't pay very well tend to have bad insurance, if they have it at all. Bad insurance typically means you pay a lot of out of pocket costs, meaning lower earning people often pay more out of pocket for the same medical treatment. It's more poignant in reverse though; high earners should expect to pay less than low earners for the same medical care. If it didn't work that way, why would any of us pay for more expensive health insurance?

If you have bad insurance, your options are usually to do the walkin option and pay whatever your insurance won't. That's probably more than you can afford unless you're sick enough to get a doctor to order it (which often means you've missed a critical window in treatment options). Or you can try one of the clinics, and wait for forever trying to get it looked at. Or you can do what many Americans do and ignore it, hoping that it goes away on its own.

We do have better options than other countries, but whether those doors are open often depends on your income level. Socialized healthcare does equalize that, even if it means dragging down the standard of care for the wealthy in exchange for bringing up the average.

waiting lists "can be long" – it's time to stop parroting these misleading statements. They can be, if your test/operation isn't urgent. Urgent things are treated right away.

Frankly, as an American, I think we have shit quality of health service, based on the insurance cos' red tape and restrictions and paperwork alone. Getting healthcare in this country is a bureaucratic nightmare. Maybe the docs and meds and tests are good, but the overall service is bad.

(Disclaimer that I insist on Kaiser, an HMO – I would not live in a US area without it – which is pretty good, but helping family through health issues who had "gold standard" normal PPO was... different).

My friend in Vancouver had lung xray show up something weird and the doctor scheduled her for an MRI. The appointment was in 7 months. Instead she got the MRI in a private clinic for a pretty reasonable cost and came back with the results for her doctor.

If that's not indicative of something broken, then I don't know what to tell you.

If she was able to get the MRI at a reasonable cost, doesn't that suggest that the system isn't that broken? As far as I can tell almost nothing comes at a reasonable cost in the US.

I think the criticism is probably of the Canadian health care system a la "She had to go to another country to get her scan in a reasonable period of time (and that country has a terrible global reputation for being insanely expensive and broken itself in the health care department)."

She didn't have to go to the US for the MRI; implication was the clinic was in Canada. Private care isn't illegal or anything there.

People from the US go abroad for care all the time.

Some forms of getting private care are indeed illegal:

https://www.capitaldaily.ca/news/private-two-tier-healthcare...

From the article

>“In Canada, the absence of a private system is not due to the illegality of private health care per se,” reads a 2001 analysis in the Canadian Medical Association Journal. “Rather, the lack of a flourishing private sector in Canada is most likely attributable to prohibitions on subsidization of private practice from the public plan.”

Seems fair to me.

Things like paying for a non-public health scan are indeed facing legal crackdowns, though:

https://www.kelownanow.com/watercooler/news/news/Provincial/...

So someone in this position now would have fewer options besides waiting their turn in the queue.

> Extra billing is defined as additional fees charged by a physician or a clinic for a publicly-funded health procedure that is medically necessary, or when a patient pays out of their own pocket for such a procedure in a private facility

This is about extra billing, not per se about MRI. So still seems fair to me.

So it's fair that you cannot get an MRI done paying for it?

In any case, that shows that getting private care may not be an option in Canada.

> So it's fair that you cannot get an MRI done paying for it?

Yup, while the system is being subsidized with public money you can't just setup something competing while taking advantage of the public system too.

Sorry, you are correct. Nevermind.

What do you think the odds were that it was something that would cause problems in fewer than seven months, or that if she experienced symptoms that they would move her up in line?

Genuinely asking, since I don't know any details about her situation or much about lung ailments.

I don't know the specifics, but there's also the mental cost of the doctor seeing something concerning enough that warrants an MRI and waiting 7 months just for the test; praying nothing gets worse in the meantime.

That's a very good point.

What were the results? If it was a serious issue that needed treated urgently there is a problem. If it was not then she was prioritised correctly and there's no issue.

By that logic, playing Russian roulette is safe if one doesn't die.

The question isn't whether it was a serious issue, but whether it had a reasonable probability of being one.

I'm in Canada. In 2010 my son was unwell, having issues with lethargy, balance and vomiting. We took him to the local children's hospital and he had a CT scan within 2 hours and an MRI an hour after that.

As part of his ongoing treatment the hospital scheduled an MRI every 3 months for a year, then every 6 months for 5 years, and now it's annual. The scans happen on time every time.

Waiting lists are prioritized based on urgency.

Each province administers it's own health care. So the level of service and time you have to wait varies significantly depending on where you live in Canada. Waiting six months for a specialist appointment is not unusual, for example, in say Quebec.

Not so easy in the US. My sister is in the first trimester of her pregnancy. She had to go to ER last week because she couldn't eat (keeps vomiting and lose sleep because of vomiting). She was in a bad state (very weak and was almost passing out) when they (her in-laws) brought her there. They had to wait for 2 hours to be attended by the nurse/doctor eventually. It's not because the hospital was crowded with COVID patients (Rochester, NY isn't overwhelmed with COVID at the moment). It's mostly because there are few doctors assigned for each shift at the hospital (the supply of doctors in the US is scarce--partly because of the artificial restrictions put in place by American Medical Association [https://www.washingtonexaminer.com/thanks-to-doctors-there-a...)

When I broke my nose, I went to ER and registered at around 12am. A doctor finally treated me at around 8:15am. That's at the Strong Memorial Hospital in Rochester, NY ~6 years ago.

> In Canada the waiting lists for mri and other advanced testing can be long where the same tests/operations can be done as a walkin option that day in the US.

Are there no private MRI machines in Canada? In many countries with free healthcare, you can still "just walk in" to any private hospital/clinic and get an MRI done.

BC banned private MRI clinics a year ago.

They did however bring some under the provincial healthcare fold, so general turnaround times have improved with more scanners... And they are running more often (they weren't running 24/7.

I work in imaging, visited 100s of hospitals in Canada and mainly USA.

Would be uncommon to see a unreported list in USA with exams 24 hours or older.

In Canada it was common to see months. These are scans performed but not interpreted by a radiologist .

So for urgent cases(like dieing in the hospital), there is hardly any wait and read right away.

But if it's somewhat none urgent (friend waiting 1 year for a MRI for nerve/back pain), you might have to wait awhile for the scan and then the report.

If you in a population dense area, you might be waiting awhile, but may get quicker service in smaller nearby towns(I had a 3 month wait for. Knee scan, went for a 2 hours drive for a scan a week later)

Our public healthcare has caps on how much a radiologist can read/get paid, so there is no incentive in Canada for radiologists go full force.

In USA they are paid per exams, and depending on case types could be reading 100s per day.

> BC banned private MRI clinics a year ago.

Would you mind explaining why they'd do such a thing?

It wasn't specific to MRI clinics, but they elimited two tiered healthcare opti9ns as some perception it benefited the wealthy, and would attract doctors to privatized healthcare, further impacting public healthcare.

Same thing for non-elective surgeries.

You can't goto a private clinic for a surgery offered under public healthcare

Basically removed being able to pay to skip the queue, some people felt it was unfair, and to uphold integrity of public healthcare...

2 good recent sources on the topic.

https://globalnews.ca/news/7326893/bc-supreme-court-ruling-p...

https://www.capitaldaily.ca/news/private-two-tier-healthcare...

In Ontario, private MRIs aren't allowed except as a third-party service — such as an employer paying through private insurance. Think professional sports team ordering an mri for a basketball player.

There are private MRI businesses, but not many. When a friend of mine had some hard to diagnose brain malfunction his family drove to NY to get one.

Sure, but you're already paying for a public service

We all pay taxes that build and maintain our roads, but that's no reason to not shell out for an airline ticket if we want to get somewhere faster.

In my country I can see a doctor for free after a 0-4hr queue in a hospital waiting room or pay USD$10 to immediately see any of the dozen private doctors within a 5 min drive of my home.

My taxes already pay for free healthcare, but I'm more than happy to pay more to avoid wait times.

But I live in the "third world", so I understand your experience might be different.

I think the waiting lists can be exaggerated sometimes. There are definitely waiting periods, but if something is a priority, things can move pretty fast.

As well, I'm basing this off not a lot of evidence other than doctor shows (which I recognize are probably ridiculously inaccurate), but I get the impression that (for those who have the right insurance) in the U.S. that testing and imaging is overprescribed, and doctors will often order an MRI when an ultrasound or a CT scan would be perfectly fine. So even if MRIs have a relatively longer waiting period, it's overall rarer that you'll need to get one in the first place (and CTs can usually be ordered fairly quickly - I had one today that was booked within a week for relatively minor symptoms)

> I think the waiting lists can be exaggerated sometimes

In fact, you can view it this way: the waiting lists are long because the important things are prioritized. People who really need treatment fast are being consistently moved to the front of the queue with no option to pay to get ahead of them for people at lower priority.

My reference point is Australia, and it was awe inspiring to see how fast things moved for a relative with breast cancer.

I was on a 5 month waiting list to see a provider that took my insurance in a major metro area in the US. Even if I chose to pay for visits upfront and in cash, there were still 3+ month long waiting lists from other providers.

I've also learned from friends who have family members with substance abuse issues that there are 6 or more month long waiting lists for even out-patient rehab, and for doctors that specialize in treating substance abuse. Addiction is often deadly, so it's pretty urgent to treat.

Do Canadians and Australians need as much healthcare as aging and obese Americans do?

I just looked into it now. As of 2018, apparent 38% of Americans are obese and 28% of Australians. So it's probably a difference that _does_ factor into costs, but I wouldn't know how much.

That is such a big difference. Is it food suply related or lifestyle? The states with larger cheese production tend to be heavier than hotter states which could mean location might be the cause but it might be genetic.

Food is more expensive in Australia and serving sizes are smaller.

A related factor: US sugar subsidies make sugar expensive, so a lot of manufactured foods in the US contain High Fructose Corn Syrup (HFCS) instead. On a kilojoule-for-kilojoule basis, excessive intake of HFCS is a lot more harmful to health than excessive intake of sugar is. By contrast, Australia has a long history of being anti-agriculture subsidies, and fewer foods here include HFCS (most of those that do are imported from the US)

> excessive intake of HFCS is a lot more harmful to health than excessive intake of sugar is

That's mostly an inaccurate myth that has persisted for decades. Despite the "High Fructose" part of the name HFCS, the balance of fructose and sucrose in HFCS is roughly the same as regular table sugar, 50/50. HFCS 90 is actually worse for you than table sugar due to it's high fructose content (which is primarily only absorbed in the liver, unlike sucrose), but it is rarely used and the taste is very sweet compared to normal HFCS or sugar.

You can easily search for tons of sources (queries as simple as "HFCS vs sugar" will give you decent results), but including one to back up what I said above:

https://www.berkeleywellness.com/healthy-eating/nutrition/ar...

>On a kilojoule-for-kilojoule basis, excessive intake of HFCS is a lot more harmful to health than excessive intake of sugar is.

Do you have a source for that? I don't see how sucrose from sugar cane is any healthier than HFCS, which is the same thing, just split by an enzyme.

It's similar, but not the same.

There's chemical differences and some HFCS is a lot more fructose than sucrose. But, yeah, I also haven't been able to find any conclusive evidence that it's any worse with your garden-variety HFCS

For clarity, US sugar tariffs make sugar expensive.

We're aging too!