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jjmarr

I live in Canada and it's illegal to take private insurance if you also take public insurance.

The private healthcare system is virtually nonexistent and is dominated by scammers.

The public healthcare system still has months-long wait times.

If you want to avoid waitlists you need surplus capacity, which public healthcare doesn't provide.

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I live in Canada as well. As far as I can tell there is basically no access to psychologists under the public healthcare system. You're just supposed to pay cash at about $150/hr to talk to a therapist (if you know differently please tell us!). For some people that's fine, but it's an absurd situation if, for example, you're underemployed/poor and facing related mental health challenges. Obviously paying that much to talk to someone can just aggravate the underlying problem.

Some people can access mental health care in the public system through their family doctor. But most people do not have access to this because there are not enough of this type of doctor. As far as I know the only other way is to wait until some sort of crisis then enter the hospital and there -might- be a chance to talk to a psychiatrist.

CAMH and other hospitals provide free outpatient mental health services from psychiatrists to the underemployed/poor.

As you acknowledge, if you end up so badly that you are committed, you can get a referral. They might be underfunded and understaffed but it exists.

"Might be a chance to talk to a psychiatrist" is inaccurate. You will see a psychiatrist quickly if you go to a hospital in Toronto. Can't say the same about rural areas.

The USA is much worse and we shouldn't try to generalize from their experiences. America has hundreds of free outpatient mental health clinics and their goal is to "suicide-bait" you into saying the wrong thing. Then they involuntarily commit you and bill Medicaid/insurance until it runs out.

Those are the hospitals you will never see a psychiatrist in, because they focus on profit and churn.

> it's illegal to take private insurance if you also take public insurance.

This seems like an odd excluded middle. In the UK, you can have private health insurance if you want, but you can always fall back on the NHS; the one wrinkle is that you may not always be able to take a prescription from the private to the public system without getting re-evaluated. (e.g for ADHD)

> which public healthcare doesn't provide

== taxpayers aren't willing to pay for.

It's a slippery slope and we really don't want a 2 class system. If you start allowing doctors to bill for things that public insurance covers, you're 30 seconds away from a losing the egalitarianism that Canadians value. You can pay out of pocket for whatever you want, you can tell the doctor not to bill any insurance, and in some clinics (in my experience not many) that will get you seen faster, but it's not really common and it's very expensive.

Drugs aren't considered healthcare for whatever reason. If I got an ADHD pill in a hospital that's free, but if I wanted to get the same at an outpatient pharmacy it'll cost money in most cases.

Ditto for dental.

So while there isn't any overlap between public and private, there's still a gap. Though our drugs cost 10% of American prices.

This isn’t universal at all. Quebec and Ontario allow for visits and payments to private doctors — usually offered under a subscription model, so that the “subscription” can be picked up by employers in lieu of “insurance”. It’s definitely smaller than in the states, but it’s big enough that it’s in use by the upper-middle class.

In the USA we have huge waitlists for most all types of healthcare. Private healthcare doesn't provide surplus capacity either.

We do? https://worldpopulationreview.com/country-rankings/health-ca... seems to show we are high on the 1 day wait, but not so much on the specialist waits.

That said, I think it would be safe to say I don't understand this statistic. Needing a day of answer from your health provider feels rare to me. The few times I've needed that, I would go to an emergency room.

It's a bit tough to compare between countries like this. Those stats don't reflect the infinite wait time that may be the case for someone without health insurance in the USA.

Even with insurance, in my area, neurologists book out 3-6 months.

Your own link offers this summary:

> A common misconception in the U.S. is that countries with universal health care have much longer wait times. However, data from nations with universal coverage, coupled with historical data from coverage expansion in the United States, show that patients in other nations often have similar or shorter wait times.

You have that in other countries too. In Sweden the govt decides which healthcare is to expensive and they deny that treatment (while americans with healthinsurence might get it). You wouldnt say wait times in sweden are infinite.

Both setups have a "is this deemed medically necessary and be covered" step, yes. The key difference is that "yup, necessary and typically covered" in Sweden gets you the procedure. In the US, it doesn't. You need coverage (or you pay out of pocket) for anything to be covered.

No insurance? The only care you can't be denied over payment is emergency care. (And the definition is narrow - they'll give you pain meds and IV fluids for your cancer and send you home. They will not do surgery/chemo for it without payment.)

As a bonus, Sweden's setup costs half as much, with similar outcomes. That's inclusive of taxation. https://www.oecd.org/en/publications/2023/11/health-at-a-gla...

You’re right of course, but even this comparison gives an incomplete picture. An example is that many other countries can institute drug price caps because the US does not. It’s not unlike how NATO countries can historically pay less into defense because the US pays so much. There’s an argument those are essentially subsidizing lower costs abroad.

That’s not to say the US healthcare system isn’t in need of massive reform, just that it’s a much more complicated problem than many realize.

I ack that it is hard to really grok these numbers. And yeah, I wasn't trying to hide that we have problems. Indeed, my prior would be that we are middling across most stats.

I also question if using a neurologist wait time is illuminating? What is the average wait time by country for that one? Quick searches shows that isn't necessarily extremely high, either.

You'll see significant variability by specialty, area, and insurance plan.

Ultimately, Americans wait for care just like participants in other health systems. It's just a lot more likely to result in a big bill, too.

When I was looking for a new Primary Care physician, the first appointment I could get was for 6 months out. I wound up being able to solve the problem with a video call, but that only worked because of the specific situation.

The last time my doctor had to reschedule, the next appointment was over 2 months out. Admittedly, it was a reschedule of a yearly checkup, and being 2 months overdue for that isn't a huge deal; but it does indicate lack of "supply".

This was all with good insurance, and the _ability_ to pay out of pocket if I needed to. There is a lack of supply for health care at the moment, at least in the area I live in (NE US).

> Needing a day of answer from your health provider feels rare to me. The few times I've needed that, I would go to an emergency room.

Going to the emergency room for something like the flu or other condition that is easily treatable but needs a diagnosis/test is... crazy. The cost difference between a doctor's visit and the emergency room is staggering.

My question was to ask if we are really that much different than other places? Because, I've heard anecdotes of similar situations from everywhere. And, indeed, the link I posted calls out that the US is basically typical for most things.

And fair that flu or something shouldn't need emergency room, but there are also urgent care clinics that are good for that sort of thing. And the few times I've had to call my doctor, I got through just fine.

Which is all to say, in a distribution, you expect variance. I've largely always found myself on the low end of these distributions, so I'm curious what the distribution is.

And I fully cede that we should continue to strive to get better.

> And, indeed, the link I posted calls out that the US is basically typical for most things.

We are typical in wait times and outcomes.

We pay 2-3x as much as the rest of the developed world for that.

https://www.oecd.org/en/data/indicators/health-spending.html

https://www.oecd.org/en/publications/2024/06/society-at-a-gl...

We have been restricting the supply of medical professionals in the USA since after WW2. Our medical schools have been keeping supply lean by being below what our population needs.

> there are also urgent care clinics that are good for that sort of thing

It's also worth noting that visiting Urgent Care clinics is getting more and more expensive, with insurance covering less and less of it. It's frustrating, because they really are a convenient system.

It's too bad, because Urgent Care is your only option if you're still waiting for your "new patient appointment" with a primary care doc. I was in the same boat as GP poster, where new patient appointments were 6 months in the future, so we just went to Urgent Care for everything in the meantime. Of course, after 6 months, we found out the doctor was retiring and not taking any more new patients, so we had to wait another 6 months for the next primary care doctor on the list. An entire year of waiting, just to get a primary care doctor, in the non-socialized-medicine USA.

Fun fact: Urgent cares owned by hospital chains can be substantially pricier, too. In my area:

https://www.urmc.rochester.edu/getmedia/80e07f2b-b8a4-44f0-b...

> A hospital-based urgent care clinic is a clinic that is owned and operated by a hospital… Services provided at hospital-based urgent care clinics must be billed in the same way they would be billed if those services were provided at the hospital.

"My question was to ask if we are really that much different than other places? Because, I've heard anecdotes of similar situations from everywhere. And, indeed, the link I posted calls out that the US is basically typical for most things."

Yes, it's typical with the addition of being insanely expensive and cost is totally unpredictable even with insurance.

I don't know how it is in other countries, but for me, with my insurance, it's extremely rare to get a specialist appointment in under one month. 2+ months is the norm.

I suppose if there were clearly a serious enough concern they'd book me much quicker. But for semi-routine visits ("probably not an issue, but we should get a specialist's opinion"), under 2 months is rare.

Depends on how large your insurance network is and how well served your region is. I've never had to wait longer than a month to see a specialist aside from non-critical checkups/exams. Granted I pay extra for the "broad network" option at my employer, I'm in a decently well-populated area in suburban Maryland so there's plenty of providers, and I did have to call around to multiple providers to find openings sometimes when I was a new patient.

Everything else wrong with US healthcare aside, I'm pretty sure we have better wait times on average.

The only thing I've ever run into a waitlist was for a neurologist. I'm not really sure what you're referring to.

I've seen waitlists for some specialists.

Maybe I'm just lucky, but it's usually within a couple weeks.

Just going to point out that down here in the US, there is tons of waiting with private insurance. Good luck seeing your actual primary care doctor (not some other doctor or physician's assistant) within 3 months. Specialists? Prepare to wait even longer. On an HMO insurance, make that even longer.

While private vs public might affect supply, there are other big factors going on that are limiting access to care.

That’s very much a local issue and also patient choice.

I have zero issues getting a same day appoint where I am, specialist appointments within a couple weeks.

But I also don’t go to a major university medical center which has long waits even for primary care.

> The public healthcare system still has months-long wait times.

I pay an expensive monthly premium and I still have monthly-long wait times in the US. (Putting this here because many people think that the "benefit" of the US healthcare model is that you get "fast/immediate" care instead of "slow/long waits" in those "socialist" countries.

Don't forget that we also deal with mountains of confusing paperwork from multiple competing bureaucracies!

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