Hacker News Reader

> Private medical care is in most circumstances illegal in Canada and they have large enough wait lists that people are dying in large numbers waiting for medical care. Medical tourism to Canada is a non-starter for Yanks.

Can you cite a source for people dying in "large" numbers waiting for medical care in Canada?

Canadians live longer, and they spend about half as much on healthcare per person.

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...

There's no reason to assume that government care supply would rise to meet demand. If private pay is allowed, and medical school enrollment is not artificially constrained, supply can rise to meet demand at a low price.

> supply can rise to meet demand at a low price.

But would it? Those doing the training (eg surgeons) are benefitting from the high prices.

What is the reason for the wait times, though? If it's availability of doctors, I don't see how paying for private insurance magically makes doctors less busy and able to see you. And if that does work, then it just means that the mostly-unavailable doctors are prioritizing people who can pay them more, which isn't exactly a great outcome either. Or am I missing something?

This is how it happens in Spain: public doctors work from 8:00 to 15:00, with long queues. The same doctor has a private office from 16:00 to 20:00, where the queue is almost zero.

There are some doctors that works exclusively public or private.

> The same doctor has a private office from 16:00 to 20:00, where the queue is almost zero.

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?

It may be that the service provider (in this case, a doctor) realises that to price too many people out would be an optimisation that ignores that not all kinds of suffering are equal e.g. yes, optimise the pricing of Playstations and flight tickets and some people will miss out and feel bad, but the suffering of those priced out of a medical procedure is worse.

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.

Doctors are a finite resource. Ultimately you have to ration that resource.

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.

> Doctors are a finite resource

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...

> that would require that freer market that so many seem against.

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.

You think the kind of regulations that are being discussed in this thread are good things? They don’t seem to benefit anyone but insurance companies. Tell me, why shouldn’t you be able to walk into a doctor’s office and they be able to tell you how much a test costs? I wonder what regulation makes that impossible and what intended good it is supposed to make possible.

> Tell me, why shouldn’t you be able to walk into a doctor’s office and they be able to tell you how much a test costs?

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.

I'm glad to hear that, even if it's not particularly relevant to this thread, but still worthwhile hearing about.

It doesn't clear up why you think a free market and regulations are opposites.

A literal free market is one without regulation. If you want a regulated market, don't call it a free market.

No, that's anarchy. A free market is one where market forces are allowed to work. A market captured by monopolists and anti-competitive agreements is not free at all.

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.

That's a well-regulated market not a free market. I completely agree that regulation is needed, and better by the people than by the biggest bully in the market.

> Canada and they have large enough wait lists that people are dying in large numbers waiting for medical care.

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-...

>Private medical care is in most circumstances illegal in Canada

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.

More or less correct, healthcare in Canada is mostly “private” with a single public payer on a provincial level. One other difference is that hospitals are owned and run by the government (with slight variation between provinces) so they don’t bill the government and are instead given large annual budgets with some incentive based payments.

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.