As a young, relatively healthy someone who has also experienced both Canadian and US healthcare, I much prefer the Canadian system. In the US, my insurance was billed 14k USD for a simple diagnostic procedure (stress echocardiogram) that normally would cost a few hundred dollars. I ended up being on the hook for over 2000 USD.

Yes, I got an appointment within a few days, and I got the cardiologist's report shortly after. But when I had a simple question about the report, my doctor suggested I book a follow-up appointment (and get charged another few hundred dollars) to get my question answered. I said no thanks - I'll take my chances and ask my friend in med school. If I knew ahead of time how much the original diagnostic would have cost, I might have had second thoughts about that as well. And while there seems to be nothing wrong with me, for other people in a similar situation that decision could end up being the difference between life and death.

I've had standard lab work done in Canada and have no complaints about the wait. But I'd take waiting a few weeks if that means no one will choose to forego life-saving diagnostics because of extortionate health care costs.

From a cost point of view, I think that's totally reasonable for most care. If you have something catastrophic and need quick access to top-notch care, you don't get that from the Canadian system and our Canadian relatives and friends don't even know how bad it is because that's all they've ever known (wife is from Canada and now realizes how bad it is and is trying to move her parents to the US so that they have access to US care).

> trying to move her parents to the US so that they have access to US care

Why would you have to move to the US for that, can't you just go to your favourite American city and walk into a hospital?

We (my wife and I) currently pay out of pocket for them to see specialists or to get an opinion so that they can see a specialist in Canada. If we apply now, they qualify for medicare in X years and they get higher quality of care + we don't pay out of pocket.

> In the US, my insurance was billed 14k USD for a simple diagnostic procedure (stress echocardiogram) that normally would cost a few hundred dollars. I ended up being on the hook for over 2000 USD.

I agree that the insurance aspect of the system is difficult and could use mild regulation. But I think that the single-provider nature of "universal healthcare" is probably what causes issues with the Canadian system, more than the single payer aspect...

This is what scares me about the push for universal health care in the US. For the majority of the hacker news crowd with employer sponsored care, they'll see a regression to the mean and poorer overall care. I do think there needs to be an option for the poor, but not at the expense of world class care with no wait times.

This is all anecdotal, but here is my experience with the Canadian system:

1. Uncle died of cancer and waited 8 months for chemo and never got it.

2. Almost no family doctors are taking new patients in Vancouver. You can't see a specialist directly unless referred by a family doctor.

3. When mother in law needed a breast scan, we called like 10 different hospitals to ask if they had a breast MRI machine because the wait times were so long and we only found 1 machine.

4. She was also mis-diagnosed with asthma for 3 years because they didn't have the diagnostic tools. We sent her to an allergist in the US and it turned out it was allergies. We've taken to seeing doctors in the US to get referrals to specialists in Canada.

5. Wouldn't let a friend see an OB until 23 weeks and she was bleeding. Friend didn't think it was a thing and we were appalled.

6. Grandfather was mistreated for a low platelet count.

7. No private rooms - if you're deathly ill you're in a hospital bed next to others who are deathly ill.

Why can't we have a combination? Basic free healthcare for those who can't afford to pay for it, and premium care for those who can afford private insurance.

Almost every market in the world has this - if you want and can afford private healthcare, or your employer pays for it, no-one is going to stop you using it. Medicaid alone is more expensive and less effective than the public healthcare systems in other countries and still doesn't provide universal coverage.

It'd be great if there was both but it's not allowed in Canada so the net effect is you get less tail outcomes, both positive and negative. For folks in the US with insurance, it's a big drop in the standard of care and for folks without, it's a big improvement.

One other thing that's not often mentioned is the best doctors tend to move. When my grandfather was super sick, he was next to a man who's 3 sons were there looking after him. They were all doctors and came to the US to practice because Canadian salaries were so low (they too were ranting about how bad the care there was).

That's what the UK has. In fact the free healthcare is better than basic. It's generally very good quality, to the extent that many people don't buy private even if they can afford it.

Medicaid?

In the UK you can choose to purchase private health insurance on top of the state provided health care if you so wish. A quick search suggests the same is true for Canada.

I don't think "proactively healthy people" is the right dividing line. It's more like "wealthy people". The point of the universal system is to provide a reasonable baseline for everyone. In my experience the UK system does this. Of course it has issues. So does the US system. The real debate is about which tradeoffs are preferable at a society-wide level.

The Canadian system is bifurcated - a physician has to either accept govt insurance or private insurance, they can’t get both.

I think the UK system is a good compromise - if you want more you pay more.

Private insurance in Canada tends to cover things the govt system doesn’t.

I'm happy to have a public system to raise the baseline and to act as a safety net as long as there's still a private system and employers still provide insurance.

Having similarly done both, I agree. But, its only because I'm privileged in the US. And I think OP was talking about raising the median, so at least they no longer have to worry about affording health care. In that respect, the Canadian system works great.

If you can afford private care, and are lucky enough to have good insurance through your job, you'll get better care in the US. Not in terms of quality, but in terms of wait times, and how nicely people treat you. I think the actual medical interventions are just as good either way.

I don't know if it would be possible to have it both ways. Give universal health care that's decent to all, yet give even better care to those willing to shell out extra.

I know in Canada its always a big debate. Some people think a hybrid public/private system could do it. Others worry it will just marginalize the affordable health care and lower its quality and increase even more its wait times.

> f you can afford private care, and are lucky enough to have good insurance through your job

Isn't that basically saying "lucky to be full-time salaried"? I don't know anyone in such a position who has bad insurance.

>Isn't that basically saying "lucky to be full-time salaried"? I don't know anyone in such a position who has bad insurance.

I do. A friend of mine had a cushy tech job in Chicago. He recently quit to start his own business. I asked him about health care. His employer provided insurance was quite bad (high premiums). He's paying only about a $100/mo more than when he had the job.

And then there's the issue of what you mean by "bad insurance". I work in a top tech company which gives us multiple options for insurance. For most people, it works out alright, but for each option, you won't have much trouble finding some employee who thought he got shafted with a high bill (things like someone in the chain of care ended up being out of network even though he had done due diligence to ask all people involved).

The quality is also better if you have insurance. Firstly, because it's easy to see a specialist. Our friends in Canada don't even know you're supposed to see specialists for a lot of ailments. Second, most facilities have access to diagnostic equipment that even hospitals might not have in Canada (MRI machines, etc).

We see these as positives in the US (yay! more specialists! more MRI machines!) but they don't improve outcomes on a population basis and they drive up the cost of care. An MRI machine at every hospital in a metro just means that every hospital will try to get you to use them -- they've got to recoup their costs.

>As a relatively healthy someone who has experienced both universal and US healthcare (Kaiser) I can tell you that KP is far superior to any experience I've had in Canada.

Some questions:

1. Did you pay the full premium for KP, or was some of it employer funded?

2. How many people are you paying for?

I once had KP through an employer. Best provider ever. However, at some point I was pondering quitting my job and looked up how much I'd have to pay in premiums to get the same copay, coverage, etc. It came out to over $900/mo for me + my spouse. That's almost $11K per year. Imagine how much more it would be if I had 2 kids.

I thought I'd just check now to see what the cheaper plans look like. The cheapest plan is $527/mo. Deductible is $6550/person (over $13K for household). So I'd pay over $6K if I didn't seek any treatment. And I could pay as much as $19K out of pocket (premium + deductible) before insurance kicks in.

KP is an awesome provider when I'm not paying for it :-)

BTW, I do have KP currently, under a different employer. Current wait time to see my PCP is 3 weeks (I've seen as high as 4 weeks). It used to be 1-3 days - I always wonder if changing employer plays a role (same PCP).

Kinda interesting that your experience with US healthcare is Kaiser, because being a totally integrated healthcare system, they act most like a good universal system might.

KP is more or less what one could expect from an integrated, universal health care system that is still forced to be competitive and value customer satisfaction..

Plus they have good incentives to do things like focus on preventative care because they lose money by having to treat vs clinics which will make money treating.

On the downside sometimes they try to deny treatments a little to eagerly, when I broke my clavicle, Kaiser suggested I could go without surgery, while a private practitioner said I needed immediate surgery, pronto, right now. Kaiser ultimately had me wait over the weekend 3 days before the surgeon got in on Monday. But the service itself was good.

I have to say, declaring the US system better because Kaiser Permanente is good is a bit like declaring rotten foods are better than fresh because you like yogurt.

Lots of Americans don't have anything like Kaiser, and under the old rules, you could simply die of cancer because you couldn't afford to buy treatment or insurance (as a high school classmate of mine did). 27 years old in 2009; she died of adrenal cancer that probably started in 2004 or earlier but wasn't diagnosed in 2005 because she had no care. She couldn't be covered under her parents' care after college, couldn't get into a state program (they lost the paperwork, then told her she was ineligible because she earned too much at her retail job the year before), then she finally got into another state insurance program once she was poor enough (unemployed & living with parents again after having a surgery to remove a 14-centimeter tumor), and then she finally qualified for General Assistance/Medical Assistance/Medicare. Just about everyone agrees that the progression would have been different if she'd been diagnosed and treated earlier. To not be diagnosed with cancer until your tumor is like 12 cm in diameter because you simply can't afford a visit with a primary care physician --

-- that doesn't happen in Canada.

As someone who has also experienced the US and Canadian healthcare systems I agree. The “average” in Canada might be higher than the US, but people with good insurance in the US (read - middle class job) have access to better healthcare in the US. Of course it also costs them more.

Point being, if the US moves to a single payer system in an effort to lower healthcare costs, a lot of people in the US are going to have to readjust their expectations.

>but people with good insurance in the US (read - middle class job) have access to better healthcare in the US.

Careful. If you read the article, the threshold for middle income in the US in 2014 for a couple is under $35K/yr (household). I doubt most people with that salary get a pretty good insurance policy through work. To give you an idea of what that can cost, see my comment here:

https://news.ycombinator.com/item?id=17676365

Canadians with enough funds can use the US system or other countries. In addition there are also private medical clinics. If you can get past the high taxes, it is nice to have this optionality.

By design the US system should work better for those with more money.

An anecdote with the Canadian system:

A family member was diagnosed with Stage 3 form of cancer, and was receiving Chemo within a week. They have received excellent treatment the past 4 years and have "beat the odds" so far. I'm pretty sure the bill for this would be somewhere in the range of 500K to 1M in the US. The main costs for this so far has been parking, and some travel expenses for an out of City surgery.

I also know of someone of similar age who was going to be waiting well over a year for a hip replacement. (They went out of country I believe)

What city was this in? The wait time was 6-8 months in Toronto for my uncle.

Kelowna, BC

Try New Zealand. Here the ACC will cover most things up to and including various forms of cancer treatment. You might wait a few hours if you just drop into the hospital unannounced but it doesn’t feel like a system that doesn’t work.