The argument about the US being too large for X gets made for all kinds of X, all the time. It tends to not make a lot of sense. As the size of the country goes up, so do the available resources. Maybe there will be a couple of layers of additional organizational overhead, but there's going to also be access to a lot more economies of scale so it should be just a wash.

Why would health care be harder to scale up in terms of the size of a country than, e.g. the military or the fire brigades?

As for diversity... I don't buy it for your specific example. Switzerland has:

- Four official languages.

- A federal system with similar levels of decision-making devolved to the cantons as to the US states

- 11 political parties significant enough win seats in the parliament

- High levels of immigration: 30% of the population are immigrants.

The reason Switzerland shouldn't be brought up is that the health care system isn't particularly good, just different. In particular it's the second most expensive in the world.

In Toronto, my doc is always able to see me within two weeks for something non-urgent. They also have 24/7 number I can call to speak with a doc. And my doc responds to emails within a few hours. If there's something non-urgent but I want an answer right away I can go to a walk in clinic and be seen within an hour. The vast majority of Canadians live in dense areas like I do and have access to the same level of care.

Am in Germany and can get a basic check up figuratively every day of the year completely for free. It might take a day for a specific appointment, but if i just went to the doctor they would see me guranteed and could assess any ailments. So there you have a country that is similar enough to the US that shows how a single payer system can work. I agree, that there is no such thing as an ideal healthcare model :)

I am Canadian. This is not true. Doctors are quickly available for check ups and basic stuff. Some surgery have long waiting list. I imagine 6 months would be typical for knee replacement. The good thing is that the thickness of your wallet doesn't affect your priority, just the severity of your medical needs.

US has the worst of both worlds. It's very expensive and the wait times for specialist visit are not particularly fast. Forbes says it takes 24 days on average to set up an appointment with an specialist in the US - https://www.forbes.com/sites/brucejapsen/2017/03/19/doctor-w...

> US has the worst… it takes 24 days… to set up an appointment with an specialist.

The worst?

HN is one of the few forums that repeatedly leaves me speechless.

My indian friends travel to india to get routine medical procedures. My understanding is that you get priority if you have a pressing concern but long wait times for procedures that can wait.

What is considered as "can wait" can be pretty insane sometimes.

So why is size and complexity an issue? Why is it that in a country of 1.3 million people I pay a reasonable amount of taxes, get free healthcare and even if I do prefer a private provider pay EUR 50.- per visit. But a similarly sized US town can’t do that. So maybe the role of the feds is to make it so that the size and complexity would matter less?

Hi from Australia!

Even during Covid lockdowns that Sydney is going through at the moment, I can get a GP appointment this week with a 5 minute travel time.

We have a health system delivered by the States of our commonwealth, enormous distance to cover and extremely high health outcomes.

Canadian here, that’s just not true, you only have to wait if you want to see a specific specialist and they are fully booked, then you have to decide if you would rather wait or see someone else.

why would your experience in UK make gp's canadian friends liars?

what's with blanket dismissals and calling ppl names. 20% of candians are liars?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292524/

"Long wait times have become a defining characteristic of the Canadian health care system. In 2016, the Commonwealth Fund ranked Canada last among 11 countries surveyed on wait times for specialist care.1 Roughly one-fifth of Canadians report being negatively affected by wait times, citing experiences of stress, anxiety, pain, lost income, delays in diagnosis and treatment, duplications of tests, and deterioration in their conditions."

This study talked about accessing a specialist (cardiologist, obstetrician etc) not a general practitioner for a basic health check up. This borders on disingenuous.

> not a general practitioner for a basic health check up

I don't know what op meat by "basic check up". When i injured my knee i was referred to an ortho by my GP who then did a "basic checkup of my knee" to diagnose an mcl tear.

Also op said "basic check up" which you disingenuously changed to "basic health check up" which sounds like a generic health check.

I still do not get why posts like yours get downvoted. What you say about Canada is true. Not always and depends on particular location but still there are examples of everything you just mentioned.

Lot of the anecdotes like yours probably stems from a deliberate propaganda campaign started by US Health Insurance companies. This is quick npr podcast about it- https://www.npr.org/2020/11/06/931990578/why-americans-have-...

> Canadians might wait several weeks or a few months to get a knee replacement

Hard to tell from this what else falls under "knee replacement" category of urgency. I personally know ppl who traveled to india to get a root canal. Weird to dismiss it as " deliberate propaganda campaign " and link to npr article with no actual statistics.