> And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities.

People fly to many first-world countries for medical care, including "Canada and Europe". Yes, if people have vast sums of money, they can receive excellent medical treatment in the US (as they could in many countries).

However, that's not the problem though, is it. The problem is that in general, most Americans fall behind in health compared to other first-world nations.

> but there needs to be some method of exclusion when demand is high and supply is low

Are you arguing that the state of health of the majority of the country is irrelevant as long as high-income earners can receive the best medical care?

At least we get treatment not dependent on the quantity of money we have.

I have no health insurance right now. If I got sick in Canada, I would absolutely visit my doctor, get a prescription and diagnosis, and be on my way. In the US, I have to pray I don't have a severe disease and try using over the counter meds because I can't afford upwards of $800 doctors visits if they perform any tests. It is around $150 just to walk in the door.

If you have something more complicated, like, say, requiring stitches, or even basic lab testing (urinalysis?), it all adds up on top of all of that. I'd imagine if you went to the doctor and he/she ordered a small battery of tests, you'd run up well over $800 fairly quickly.

What's that about wait times in nationalized healthcare countries again? I'm sure he'd have been much more quickly served in Vancouver or Toronto or Manchester.

what i mean is, well, great rhetoric, but you know, facts, man. facts.

First, the exorbitant rate of medical inflation in our "market" healthcare system is a fiscal menace not only to the public sector, but to the private sector as well.

Secondly, the deteriorating health of the American workforce is an increasing threat to global competitiveness. An overweight employee pool with high prevalence of unmanaged diabetes is not an attractive one for global capital.

Expanding access, controlling costs and emphasizing preventive care are things we need to get better at out of naked self-interest. Saudi sheiks who want to fly in for a quadruple bypass may continue to do so, but if we lose them to somewhere that bows and scrapes to the mega-rich more than we do, good riddance.

People also used to (maybe still do) fly to Australia for cardiac surgery.

The US may be able to pull in doctors from around the world with salaries that are high (correlating to high healthcare costs), but the regular individuals access to such doctors is limited: if I, talking to my insurance provider in Washington, said I wanted to go to the East Coast and have Dr Oz do my cardiac surgery (leaving aside any, and indeed valid, controversy over him - I was just looking for a notable/famous surgeon), I'm fairly certain they'd balk (and I'm fairly certain because I've worked on software systems that determine such things for insurance providers).

Yes if you throw alot of money, you get state of art facilities and top doctors, but are you getting the return on investment if the healthcare system is lagging behind the "welfare states".

http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_Ge...

Citation sorely needed. This claim is regularly trot around, but nobody has been able to point to data that would suggest that this is anything but extreme outlier behavior.

As a Canadian who lives in the US it's often shocking how different the perception of the Canadian health care system is between the US and Canada. Canadians by and large are quite satisfied with the system, while even reasonably liberal Americans I've met seem to believe it's some kind of waitlist-filled hellhole.

I've had more than one American express incredulity when I pointed out going to the US for major medical procedures isn't really a thing in Canada, where they thought it was widespread and relatively common.

By my own observation, there are a few isolated cases of this happening (mostly among the extremely wealthy), and is not at all widespread.

> "but there needs to be some method of exclusion when demand is high and supply is low."

The supply of medical capacity is not fixed or subject to a real physical limitation (like, say, rare earth metals). In Canada the response to constricted supply has been expanding the supply, as well as reducing per-use costs to make this possible. The supply is not infinite, but is high enough that people who need it, get it, and at a cost affordable to them (amortized across the entire population).

[edit] It's worth mentioning that, due to the economic incentive of single-payer health care, Canada invests a tremendous amount of money in preventative care and screening, which serves to dramatically reduce demand for the most expensive, most supply-constrained treatments. In fact I have a friend who works for the Canadian government right now doing computational screening for early cancer detection. It's interesting stuff, saves lives, and saves money, but requires a dramatic economic incentive to build out that simply doesn't exist in privatized care.

> "Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)"

Citation, again, sorely needed. I grew up in Canada and have never waited 2 months to see a specialist, nor 2 months for treatment. The longest I've waited for a specialist was a few days. I've also (unfortunately) been to both Canadian ERs and American ERs, and the wait times are not substantially different (immediate (Can), 4 hours (Can), 7 hours (Can), and 6 hours (US)).

So I waited for 6 months behind a number of people including those who had similar non-critical injuries but were diagnosed earlier and those who had severe knee injuries requiring reconstruction or replacement. Rationing was done on a need basis rather than my ability to pay. Some people may talk about how terrible this is, and to be honest I probably could have afforded the surgery in a "private" system. Then again, when I was much younger and needed my first knee surgery I would have been hosed in a private system. And no, I wouldn't have been covered under my parent's policy in a private system.

Furthermore, when I have required urgent care, I have received it immediately. The longest I have waited is a few hours in the emergency room. Close friends who have dealt with much more serious life-threatening diseases have started receiving treatment/surgery within a few days or even the same day.

So yes, I experienced the terrible gulag that are Canadian medical wait lists and it really wasn't that bad. The wait lists are based on triaging, rather than wealth, and having wait times based on medical decisions made by professionals rather than economic incentives seems a much more humane system to me. I understand that some will call this "unfair" but that just means our definition of fair is different.

There are some exceptions, but generally things work well.

And, of course, for people who can't afford the inflated prices we've got here... the waiting time is infinite.

This is so misinformed it's borderline laughable (if it wasn't thrown out there by someone who is a member of the HN community and, I'd assume, an intelligent peer.)

I have been treated in Argentina for urgent and non-urgent issues and never, ever, had to wait 2 months for anything. When I was referred to a specialist (best of her branch of medicine in a city of almost a million inhabitants) I got an appointment the following week and started treatment within a month. Whenever I needed something, like an X-ray or bloodwork, I could either get it free of charge at the local hospitals or just pay for it (incredibly, a CT Scan with the same machines they use in the US costs 1/6 the price in Argentina. How's that for free market economy?) and get a result immediately.

So, all in all, this is complete bunk. People who have never experienced any other system are by definition the worst to make a comparison with the US system. I've used the Brazilian, the Argentinian, the British and the US system and by far my worst experience has always been in the US, even while paying through my nose to get the same care I'd get for free in either of the 'developing' nations. Heck, I've used the _private_ system in the UK and even if I paid the extra bit to be seen by a doctor (20' wait at the practice; Oh! The horrors of endless lines and dead panels!) I only had to pay ~£2.50 to get all the medicine he prescribed (that's the upper bound, after that everything else is free.)

So yeah, definitely the US is not a welfare state. If anything, it's the contrary: a profiteering system where healthcare is just secondary to profit.

I would really prefer not to have to do this. Do you have a suggestion for how I could avoid that wait? I live in the U.S. and those timeframes don't seem particularly high compared to what I'm used to.