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Comment by pseudo0 | Hacker News Reader

They generally don't move back. Anyone who qualifies for Medicare (10 years of employment in the US) will get significantly higher quality healthcare through Medicare than they would receive in Canada.

The problem is that Canada's healthcare system is a command economy. The government decides how many med school spots there are, how many residency places, and how many procedures will be funded each year. In order to keep costs down this results in rationing. You can't even pay out of pocket - it is against the law for Canadians to purchase private care in Canada. The end result is that people with means end up going to the US, and everyone else waits 6-12 months for medically necessary hip or knee replacements. Even critical medical imaging is backed up weeks. I know someone who waited multiple weeks for urgent cancer screening. The same scans are available in the US in 24-48 hours, for a few hundred bucks.

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To be fair...

- The US government also effectively decides the number of US residency places by how much they will fund Centers for Medicare & Medicaid Services.

- Many places in the US won't see you if you are on Medicare.

- It is quite common to need to wait 6-12 months to see specialists in the US too.

As someone with a chronic condition who has had to make many appointments with specialists over the years, 6-12 months is a gross exaggeration. IME the typical wait time to be seen by a specialist in the US is between 2 and 3 months. The worst I've seen is 4 months.

:) I'm glad your experience hasn't been so bad. I've had to wait that long. My partner is a chronic pain specialist and wait times for new patients often exceed 6 months.

I knew I shouldn't have included the line "often those people move back in retirement for the healthcare" in my comment because it would derail any conversation about the point I was trying to make.

While some of the issues that Canada faces are definitely self inflicted as you describe, the ultimate source of all of Canada's problems are that it is an American vassal state. This relationship results in Canada subsidizing the development of many talented individuals who then make the totally rational self-interested decision to move to the United States where there is significantly more economic opportunity for them. Not only is this a massive drain on Canada's resources and it prevents Canada seeing a return on the investment that it makes in people who are often their brightest and best.

I don't see how "many talented individuals make the totally rational self-interested decision to move to the United States" follows from Canada being an American vassal state. Doesn't this phenomenon apply to every country in the world? If you're born anywhere on Earth it's probably rational to want to make your way to the USA.

It's far easier for Canadians to do this due to the geographic proximity, cultural similarity, and harmonization of immigration systems.

For many Canadians visiting America is a trivial drive across the border, in fact some Canadians make this trip weekly for access to cheaper consumer goods. Hell, I just looked it up and I can get a round trip ticket to Las Vegas for $160 CAD and I'm no where near the border. Hell, I remember a boss telling me that he used to get round-trip tickets to Vegas for $60 and him and his buddies would go there on long weekends. Canadians can travel visa-free and stay in the US for 6 months.

Many younger Canadians who are interested in immigrating may already have grandparents who spend the winter in places like Arizona or Florida[0] so they can draw on the experiences and resources that their grandparents have to make the transition easier.

Additionally most Canadians are native speakers or near native speakers of English usually with accents that are identical or easily masked to blend in with Americans. Canadians who have attended post-secondary have attended institutions that are quite similar to American ones and their accreditation is easily transferable.

I'm not too sure on the specifics but I know that it's easier for Canadians with certain post-secondary education or trade tickets to get work visas in the United States under NAFTA/USMCA.

Culturally speaking the sports are very similar, there are MLB, NHL, and NBA teams in Canada, music is the same, fashion is the same, the food is the same. It's less relevant in the age of the internet but when I was growing up I could watch many local TV stations from the US and watch the nightly news in obscure places like Spokane.

All of this is due to the cultural assimilation and defacto integration of Canada into the United States.

[0] https://www.cbc.ca/news/business/canada-snowbirds-u-s-winter...

> All of this is due to the cultural assimilation and defacto integration of Canada into the United States.

Well except for Quebec, the Indigenous tribes, and the monarchists/loyalists, who definitely are more doubtful and will likely never allow a full integration.

The media environment is also still substantially different, previously even more.

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