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Comment by petesergeant | Hacker News Reader

Private healthcare isn't the problem, lack of free healthcare is the problem.

I would much rather live in the UK where private healthcare is good and reasonably priced than Canada where in most places it's simply not available.

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Nothing is free. We want both low cost and high quality healthcare.

This means we need to have ways in incentivize innovation (AI diagnostics, robotic procedures, drug discovery, deeper R&D).

Free Markets (with government controls against monopoly) are generally better than governments at delivering cost and quality improvements, but healthcare in most countries is somewhere between “100% not a market” and “70% not a market” (the US). In many cases, governments also actively create and enforce monopolies (eg AMA or local hospitals in the US).

There are a million other things but part of what is required for markets to work is skin in the game, which the UK, Canada, and the US all do bad jobs of in their own ways.

Some say medicine has no elasticity. I don’t think that is true for 90% of spend (for gunshot wounds, maybe, but most spending is on chronic diseases where multiple providers and approaches are available and people could price shop).

I would like to see more countries experiment with more free market healthcare. It’s remarkably effective for many pieces of healthcare.

Americans have been propagandized like crazy and don't really understand what can actually be done. "Single-payer" is treated as a synonym for "universal health care." "Private" is seen as mutually exclusive. People will say we should/shouldn't have something like Europe, then describe a system that only a handful of countries have.

Yeah, I find it discouraging that "single-payer" and "fully socialized" are treated like synonyms.

The "Bismarck model"[0] describes a family of healthcare models where people pay into a central healthcare fund, and that fund then pays medical providers -- which can be private businesses.

[0]: https://en.wikipedia.org/wiki/Bismarck_model

All doctor's offices in Canada are in fact private businesses. It's not actually a fully socialized system.

It's just there's a single payer. Those businesses bill the provincial government instead of you. Most of the dysfunctions in the Canadian system come down to provinces screw around with billing and payment and funding.

Take your dissatisfaction with the way the government manages payments to the voting booth instead of advocating dismantling what is on the whole a quite equitable system that has a history of actually producing very good health outcomes.

I actually have on the whole extremely pleasant experiences here in my corner of Ontario. And then I hear horror stories.

The system is underfunded and inconsistent. The province is to blame for that.

> a history of actually producing very good health outcomes

It may outperform the US, but it doesn't outperform normal countries.

> Take your dissatisfaction with the way the government manages payments to the voting booth

And vote for who? I have yet to hear a compelling solution from any party. At most, politicians advocate for throwing more money at the problem.

> The system is underfunded

Hot take: the system will always be underfunded. The demand for healthcare is nearly infinite in practice. What stops people from going to the doctor for every sniffle is either cost (in a private system) or waiting times (in a public system). If you had infinite resources to offer services, there are some folks who would be going in for MRIs every year "just in case" and getting prescriptions for every flu they have.

Yup. Recently drove 6 hours (each way, twice) to get to a Canadian private clinic to get treatment. This saved approximately a year (or more) of waiting in the public system for a routine outpatient procedure that takes 30 minutes to perform. I was lucky this option was even available within driving distance though.

Canada's public healthcare system is massively overloaded and it seems to be getting worse.

I really didn't appreciate how much of a problem this is in my 20s and 30s (while I didn't need much healthcare) and it was easy to assume the bellyaching from older folks was overblown. Time makes fools of us all.

You're describing a provincial issue, not a national one.

This is like the Canadian version of "no true Scotsman". When the province in question has 1/3 of the population of the country, what's the difference?

Its also described as a provincial problem but all of the provinces receive a substantial amount of funding, particularly for healthcare, via the federal government. People say "oh its the provinces fault, they just need to spend more", and then don't reflect on how much room there is for increased taxation, and particularly how much taxation the federal government currently applies. By far the most tax I pay as a Canadian is in the form of federal taxes. Of course, a bunch of this money does find its way back to the province, so the waters are a little muddy, but the federal government has been repeatedly downloading costs onto the provinces, while doing very little about its own spending. The Chretien government in particular did massive downloading of costs to the provincial governments, although their hand was forced by Canada's fiscal situation at the time. So simply saying, oh well the provinces need to step up, is an easy deflection from what is a pretty thorny problem. If the responsibility really is up to the provinces, then why does the federal government need all this money? If the feds are going to continue scooping up the lion's share of tax revenue then they need to continue helping to fund the various provincial responsibilities.

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