I traded my U.S. medical career for Canada. Here's how the two systems stack up. | Hacker News Reader

I traded my U.S. medical career for Canada. Here's how the two systems stack up.

canadahealthwatch.ca

30 pointstempestn19 comments

As a Canadian, my take on the debate between the Canadian vs. US health care systems is that the US system is better for the rich, whereas the Canadian system is better for everyone else.

The US has world leading facilities, doctors and research, but that world-class capability is only really accessible for the top 5%-10% of society.

The next 20% of folks get something that's roughly equivalent, if a little better, to what folks in say Canada, the UK, or other countries with public healthcare get.

The problem is, the bottom 70% of society gets worse care, for more money, and suffers from substantially worse health outcomes, while living under the constant risk of crippling debt or personal bankruptcy due to medical issues.

Personally I'd much rather a system that takes decent care of everyone than a system that takes really good care of the rich whilst everyone else suffers.

> Personally I'd much rather a system that takes decent care of everyone than a system that takes really good care of the rich whilst everyone else suffers.

This. I'm a retired U.S.-born physician and spent the majority of my career at a large multispecialty world-renowned medical centre in the U.S. What is not often talked about is that there is a category of patients whose access is even more facilitated than the 5-10% you mention. These are the 0.1% - the "Development" patients who are known or potential donors. Their care is carefully orchestrated with the highest of high touch. It's a moral abomination. The fawning, the obsequiousness.

A decade ago, we left and are now Canadian citizens.

I'd be fascinated by the full matrix, of US/CA/UK/IE/AU/NZ/SG/EU

I think the core would be US/CA/NZ-or-AU/UK. The AU/NZ/UK axis probably still shares some practices. AU is increasingly driven in US trends, but hires NHS staff who want out of the UK. Its my belief people who dont like the CA model wind up drifting south because $ but culturally AU/NZ/UK would be a better fit.

A lot of the specialities in AU seem to run as restricted entry guilds. They're keeping the lid on numbers for reasons I cannot fathom. A lot of the candidates have english as a second language it might relate.

(not in med, just fascinated by it)

The matrix would take some effort to account for every member-state of the EU, each one has a different system.

When a US surgeon is told by an onsite insurance adjuster/nurse to wait (while patient is in operating room) for a corporate insurance approval, that is when I know that overreach by insuranxe adjuster has become too much.

Ironically yet somewhat related, same health insurance company's CEO got gunned down for oppressive medical denials.

Deny, Defend, Depose: it is not just a book, it's reality.

https://insurancenewsnet.com/oarticle/texas-surgeon-who-post...

https://www.bu.edu/articles/2024/consumers-rage-against-the-...

https://ny1.com/nyc/all-boroughs/human-interest/2024/12/11/d...

I can personaly attest to a long standing divide between Canadian/US medical practice. May parents, both medical, dad a forensic pathologist,etc, and mom a pediatric, intensive care nurse, decided to emigrate to Canada, in the mid 1960's, dad from the Punjab, mom, from Penn state, due too multiple factors involving geo politics (the draft), and medical practice , and the discussions over the decades, with colueges moving to the states, or back to europe and asia, etc, would revolve around, ethics, and MONEY. With Canada always winning on lifestyle and compasionate grounds, and the US always winning on more (much) money and reduced work load. And as both of my parents are now in long term care, and just went through our somewhat deranged medical beuacratic processes, Canada still maintains a compasionate focus to care, but the civilian medical boards, are doing everything they can to undermine and dismantle our universal healthcare system, for one driven by the drug companys and private health care system found elsewhere.

> He writes under a pseudonym due to fear of further retribution from members of U.S. medical leadership and U.S. government officials.

that shouldn't be the case for a free country. unfortunately now it is.

I have some relevant first-hand experience that corresponds very closely to TFA.

My spouse is a U.S.-born and trained vascular surgeon and I'm a retired internal medicine specialist. We immigrated to Canada just ahead of the first administration of the current U.S. president.

Her clinical autonomy is practically unconstrained by provincial health insurance issues. Her practice is very much like I remember it being in the early days of my own practice in the U.S. before physicians and surgeons became interchangeable widgets in what could be very generously called "the system."

From my perspective as a patient, my care, including care for some rather complicated health issues has been extremely prompt and exemplary. I can almost always see my family physician the same day.

While I do see a hefty tax bill, I never ever see bills from the doctor, the hospital, EOB's, statements of coverage, and other artifacts from "the system."

And I don't have the cringey feeling of receiving a human right (health care) that others, because of misfortunes of life or an unfortunate starting point in life cannot access. Our health care is universal.

What I've come to realize is that bureaucracy costs less than paying patient's medical bills.

The idea is this. If you can save US$50M by employing an extra $1M to increase bureaucracy, why wouldn't you and take the savings as a windfall?

Except that's not true.

The US healthcare system has more bureaucracy and is more expensive, with no overall health benefits and with worse access, than other developed countries.

The US pays more per capita for medical care than any other developed country (something like $12,000/person vs. Norway which is next at $8,500/person, https://worldpopulationreview.com/country-rankings/health-ca...), but overall health outcomes are not better, and "on the whole it has less access to many health care resources". https://publichealth.jhu.edu/2019/us-health-care-spending-hi...

"the United States spends over $1,000 per person on administrative costs — almost five times more than the average of other wealthy countries and more than it spends on long-term healthcare" - https://www.pgpf.org/article/how-does-the-us-healthcare-syst...

Right, and where does the money from the bureaucracy go? Administrative costs? Great, you can profit off that too! The more money one can bring in from premiums, and the less they pay out, the more profit.

Once they have the money in premiums, it's really hard for the company to let go of them.

Correct! Hence the need to switch to single-payer healthcare, to get companies out of the system.

It is time to cap the healthcare admin overhead to 10% from supply to patient.

Make the middle-man duke 'em out for their own justification to exist.

Not this again...Limiting it to a % of something will just make the current system increase costs to the point where 10% becomes enough to continue paying fat checks to all these leeches.

It doesn't work.

Hey. Didn't realize that it was like that child toy that looked like a clear double-lined liquid-gel-filled with sparklers where you squeeze one end and it escapes out bigger at the other end.

Thanks! Good catch.

Ummm, now that I had time to visualize at macroeconomic level, simple cap at each middleman's transactional behooves the supply chain to conspire on price-fixing just to feed and assist all the middlemen down the line to the patient, as you've asserted.

To introduce inter-middleman fighting ensues between favorable price and lower price...

Fixing at 1% total for each step along the way doesn't work because one can just add even more middlemen.

Fixed 2% price, over entire chain: A competing supplier can easily undercut that downstream conspiratorial bloat.

Okay, but it's under 10% now, at about 8.5%, so that won't change anything.

The numbers I gave suggest 2% is what other countries have

Because in healthcare, finance should be just one of the parameters and not the only metric to be accounted for. If you save US$50M from a US$1M bureaucracy which killed 5% more patients, is that worth it in medical terms?

Would you be ok if it was one of your loved ones killed by the increased bureaucracy (since inevitably increased bureaucracy creates more chances for people falling into the cracks)?

Of course that healthcare as anything else in society needs to find a balanced budget, the outcomes of its failure are the most extreme ones so perhaps it's ok to save less money if it means more lives will be saved, isn't that the whole purpose of living in a society: to live?

I'm not arguing against that here.

But returning profit to the shareholders is the primary goal of a corporation. Couple that with Upton Sinclair's quote: "It is difficult to get a man to understand something when his salary depends upon his not understanding it", and I think you get to the heart of the problem.

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