How? You were given a result that was concerning, and rightly wanted it investigated. You needed the test and the test cost money. How do you opt out?
I live in a country with a better (though still troubled) system. I can’t see how you fix the US system, even in hand waving terms.
Who can manage an international trip each time they need medical help?
Not everyone can afford the delay, the time, the money or the inconvenience.
If you paid me and made it immediately available I still wouldn’t want to travel internationally for medical care.
> Not everyone can afford the delay, the time, the money or the inconvenience.
If you have no symptoms and it's follow up for a routine screening test, you can probably afford the delay. The time is certainly an issue, although if you can get any needed subsequent tests and care immediately internationally, it might be less time overall. The money could work out in favor of international travel, depending on the details; almost certainly less all things included, but not necessarily less if you're only counting money that comes directly out of your pocket.
The real question is when does it become legal for insurers to send you overseas for care, and when does it become legal for medicare and medicaid to do it.
> “Canada is the only country in the world where it is illegal to obtain private health insurance when there are long wait-lists. That surely says something,” said Dr. Brian Day, medical director of Cambie Surgery Centre in Vancouver and past president of the Canadian Medical Association (CMA).
…
> He launched a legal challenge to the B.C. Medicare Protection Act, saying wait times in the public health system are too long and stopping patients from paying for those services outside the public system violates their rights.
> In July, the B.C. Court of Appeal dismissed the Vancouver surgeon’s challenge.
> However, in their ruling, the judges accepted that the act’s provisions “deprived some patients’ right to security of the person by preventing them from accessing private care when the public system had failed to provide timely medical treatment.”
https://globalnews.ca/news/9099696/canada-private-health-car...
Can you cite a source for people dying in "large" numbers waiting for medical care in Canada?
If Canadians are dying in large numbers waiting for care, something pretty grim is going on south of the border to make the stats worse in the US.
The bottom link is to commentary on the Supreme Court’s recent ruling in the case, and the criticism of a more privatised system is interesting.
“The entire premise underlying the Canada Health Act is that people ought to be able to access health-care services based on need, rather than ability to pay…
It's pretty clear that having physician's practice both in and outside of the public system, if anything, results in longer wait times for patients in the public system, not the other way around…
The people most likely to need urgent surgery are often the least able to pay out of pocket.”
Notably, the legal action was brought by someone with very vested interests.
https://www.statista.com/statistics/274513/life-expectancy-i...
https://www.healthsystemtracker.org/chart-collection/health-...
https://www.cbc.ca/news/canada/british-columbia/analaysis-br...
But would it? Those doing the training (eg surgeons) are benefitting from the high prices.
There are some doctors that works exclusively public or private.
If there is a queue, the price is too low. Surely a good business optimises price such that there is no queue and maximum revenue?
On the other hand, if we allowed a freer market in medicine (anywhere, no particular target country in mind), seeing doctors make more money treating something should spur on new trainees, thus more doctors in that specialism, and hence price drops and improvements in waiting times and possibly techniques, but that would require that freer market that so many seem against.
You can do it based on social status and wealth (America) or on medical necessity.
Obviously this is HN were people have money so they are upset if they are put on a waiting list. We don't hear much about the people from trailer parks getting million dollar cancer treatments thanks to the public healthcare system.
Partly because other professions, like banking, attract greater remuneration. It's also why you'll notice that many new doctors (in the US) choose the ROAD, for many reasons[1], but this one stands out:
> The amounts of money that can be made in dermatology and plastic surgery are a temptation that many people cannot resist
If you want more doctors, and more doctors in things like primary care, then offer incentives. Money is a good one. You may also ask if plastic surgery is still an expense that only a wealthy elite can access, as it was in the past, or if it's become quite commonplace, and then, since it has, why. Could it be that the usual processes that other capitalist goods follow also work in healthcare?
The other side of that is training enough doctors. I think it would be a good question to ask why so few are trained, and I wouldn't be surprised if one of the reasons is that the guild itself, as all guilds do, limits the number of new entrants. That's speculation on my part.
> Obviously this is HN were people have money so they are upset if they are put on a waiting list.
I thought that everybody gets upset if they're put on a (long) waiting list so I'm not sure what need the ad hominem in your comment serves.
[1] https://medicine.yale.edu/news/yale-medicine-magazine/articl...
I’m not sure that medicine could ever be a poster child for the free market. It’s tightly regulated for good reason. Is there anywhere that has free market medicine? I’d like to read about it, but wouldn’t want to use such a system.
I can. I live in New Zealand. Medical practice here is plenty regulated and complying with these regulations is a meaningful percentage of my day job. Not all of it is worthwhile, lots is.
It doesn't clear up why you think a free market and regulations are opposites.
Take a small market store selling product A and product B. Whichever sells more at a given price wins more profit, great. Free market forces are at work. But then (anything goes, after all) the manufacture for A comes in and says to the store owner: if you sell product B we'll firebomb your market and kill your dog. So then the small market stops selling product B. Now, the small market only sells product A and at a huge markup.
Is product A actually better? Does the consumer win?
Regulations are necessary so the manufacture of A can't do that and make sure that the market is actually free.
Googling shows ~2000 Canadians died waiting for surgical care in 2020. Meanwhile in the US:
* Millions of people delay even starting care in the first place due to costs
* In the seven years from 2000 to 2006 an estimated 162,700 Americans died because of lack of health insurance
* Massively worse medical outcomes than Canada in virtually every metric
* Massively higher costs
* Systemic lying about waitlists and patients to cover up how bad they are [1]
[1] https://www.cnn.com/2014/04/23/health/veterans-dying-health-...
That's not quite right.
As I understand it, private clinics themselves are fine: the very next sentence of your article explains that the doctor in question runs his own private clinic. Instead, the issue is how you pay for services rendered by those clinics since BC's Medicare Protection Act restricts insurance policies that would cover them.
Imagine the US system with Medicare as a single payer setting rates and HHS owning all of the hospitals.
Physicians (for the most part) bill the government on a fee for service basis and most do so through a medical professional corporation that only physicians and certain family members are allowed to be shareholders in.
It is illegal to charge for services insured by the government. It is not illegal to charge for uninsured services (for example some knee arthritis injections) or those not insured (e.g. visiting Americans).
I knew Dr. Day professionally, he has run an ambulatory surgical center (different from a private clinic, all freestanding clinics are “private” in Canada) for several years now and the issue with his practice is they are providing insured services (like joint replacements) charged directly to the patients. Although technically illegal, the BC government has let this happen due to long wait times and lack of political will in their voter base but this recently gone to the legal system.
* you can't get paid by insurance unless you have payment authorization from the patient on an estimate that is within 30% of the actual price (exceptions for emergency care).
* a requirement that all provider participate in an digital marketplace where patents and providers can get immediate quotes for labs/procedures and you get a list of local options+prices.
* anti-trust break up of healthcare cartels
* some price cap like 200% of medicare negotiated rates as a backstop for these really crazy outlier bills.
In your example, suppose I do have A (or K, L, or M). If I wait, how will that affect the costs and prognosis? Or if I go ahead with the test, what are the possible side effects (e.g., for a biopsy) and what would managing them cost? Even if you're confident that you have—and understand—all the relevant information, you're also often making these decisions in an emotionally-charged situation.
remove the insurance ability to negotiate prices.
Ensure American's right to Healthcare.
But it’s hospitals/labs which are as bad or much worse in this regard. “Greedy” pharmaceutical companies are just a boogeyman, insurance companies, hospital admin and doctors are just fine with charging “random”/arbitrary fees based on clients perceived ability to pay and not in anyway related to actual costs.
And well… from the society’s perspective high/very-high prices for new drugs for a decade or so (20 years seems too long though) might be a good deal if it results in very high investment into R&D.