Logically, yes...

But an acquaintance with Canadian relatives told me he knows a middle aged single man that was denied a knee replacement he needed because of these trade-offs. Left with decades to live, partially disabled, because: "Old? No family? Well fuck that guy then."

Every time this discussion comes up people tell stories of "things they heard" but I hear very little first hand experience that validates them. I have had discussions in the past with my very right wing relatives about social healthcare and quality of life abroad (where I have lived and they have not) and they always had a pocket full of stories they heard from someone that undid anything I said in their minds. A more recent one was a supposed tale from a Danish immigrant to the USA who had told them how terrible the quality of life is in Copenhagen (a city while not perfect as none are, that is consistently rated as one of the highest qualities of life in the world) and how America is objectively better in every way which validated their world view. If people cannot even be realistic about the life on the ground...nothing ever changes.

New Zealander here, and I will speak about cases I have direct experience of (and project a little based on what I've read in media).

Firstly, our social healthcare is actually pretty good for emergency procedures.

But there is only so much money budgeted per year for healthcare, and everyone in need competes for that limited pool, so there is a variety of ways care can be delayed or denied.

"Elective" procedures like hip and knee replacements can have long delays (queues) and seemingly odd requirements. One friend was "too" young: they had to wait for years in severe pain because they "shouldn't" need their hip replaced yet. Another acquantance had a record of hurting their knee as a young child: so they were not covered by ACC for knee replacement even though it was a ridiculous excuse in circumstances. Once a procedure is approved, you get reasonable treatment, and it is free.

There is a certain amount of gaming of the system - if you can find a sympathetic specialist you can jump the queue a bit. However that is a zero sum game, and it benefits those with time, intelligence and contacts (and screws some minorities).

Pharmac has a yearly government budget, and they choose which treatments can be afforded. We do the same with roading - cost benefit analysis is done for all roadworks and the best get funded until the fixed budget is met (small country, so one main roading department).

It is interesting that our two biggest healthcare insurers (maybe covering 80% of private insurance) are non-profit co-operatives: all premiums are either paid out in care or pay administration overhead. I think overhead works out to be about 10%. Fantastic system: pay premiums and don't get sick is winning, getting payouts is often actually losing. It's like a socialist system for everyone that has some disposable income. Private healthcare premiums are extremely cheap compared to the US e.g. "the premium for a member aged 0-21 years on our most popular plan, Wellbeing Two, is just $9 a week", and "Pay for 2 kids, the rest are free*"; you can see what is covered by that plan here: https://www.southerncross.co.nz/Portals/0/Society/EFulfillme...

I sympathize, that's exactly what I used to assume. That there are outliers and horror stories for every system and in isolation the stories are inconclusive. Then I met this guy, in person, whose actual Canadian relatives went through this shit. Then it became real. Obviously my internet comment is not the same experience for you, being one step removed and coming from an Internet Random. And yet, having had the experience relatively recently I decided to share.

I apologize if it seemed like a personal jab. I am admittedly sensitive to the issue given my experiences on both sides of the proverbial exam table in the American system. Every time I try and discuss the issue with people in my area they lead with a tale about how terrible it is elsewhere and it put up a wall preventing any discussion. Rather than talking about what can work they shut it down right off the same as they do with anything they don't want to deal with...going right to the failures or abuses.

It is disheartening to see anyone in any system suffer. I am quite sure if I was someone suffering in your example's case it would be hard not to be angry at the system. When it's you hurting you don't care so much if a system if overall better, better for others, or was even better for you 99/100 times thus far, prevents a bigger problem later etc...you just want to stop hurting.

So the fact you haven't heard any anecdotes means other people's experiences are invalid?

> We shouldn't plunder health care funds on $1m per year of life saved interventions

And we especially shouldn't spend huge amounts of money on meds that don't extend life (or even shorten it), and that worsen quality of life.

> you're always free to pony up your own cash to pay for a treatment that isn't covered by your insurance

Is that actually true? AFAIK (from second hand) there is no private insurance in Canada (i.e. far worse than e.g. UK), so you cannot get e.g. MRI by paying for it (and skipping the "official" waiting line of 1+ year).

There's nothing stopping a US insurer from selling an "International" plan to Canadians.

As far as I know, none have tried. Either the demand isn't there, or there's a huge untapped opportunity (doubtful).

There are a few organizations that will arrange for your healthcare in the USA, but the Canadian demand wanting to pay to bypass the Canadian system isn't great. E.g. Cleveland Clinic has a Canadian branch, but just one office in Toronto.

> Of course, you're always free to pony up your own cash to pay for a treatment that isn't covered by your insurance

With the big caveat that you cannot pay for "higher quality" of any services that are covered even if you want to.

90% of the population lives within 100km of the US border.

Unless it's a life-or-death emergency (where the ED has guidelines to see you right away anyway), every Canadian has the option of paying for any level of service they want, even otherwise covered services.

Then there are the firms that walk the line and charge you as "preventative health" services.

Not every Canadian is admissible to the USA, and as a sovereign nation our policy should stand on its own.

Most are, and for those that aren’t, most other Western countries can't check Canadian police records and readily admit Canadian citizens.

And of course that assumes one can afford the treatment, which for non-covered treatments can be hundreds of thousands of dollars.

of course you can, there’s this thing called plane and you jump on in and go to wherever the treatment you want is performed, pay up and get it. There’s absolutely no laws preventing you from getting payed care in the USA or anywhere.

Is there strict rules for those death decisions or just some people acting as they want? In the second case level of corruption must be overwhelming.