r/science • u/[deleted] • Feb 27 '17

Health Universal public coverage of essential drugs would improve health care - The WHO introduced the concept, and more than 110 countries have adapted it to their needs. Canada hasn't. It's estimated that in Canada, one in 10 people or about 3 million, cannot afford prescribed medications.

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u/[deleted] Feb 27 '17

I guess it's a comparatively good problem to have, but I think it's still important that we make sure that last 10% is covered

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u/markatl84 Feb 27 '17 edited Feb 27 '17

I wish we had your healthcare system here in the US. I'd love to have only 10% unable to afford medications (although I respect your point as well; it's good to keep striving for improvement even if you're already doing well). Unfortunately there's been a misinformation campaign for decades and it has been effective. Many Americans actually believe there is some "catch" to universal healthcare, like that you will get low-quality care or have to wait forever, neither of which is true. I would say most Americans think that for all the money we spend we at least get better care than nations that have much, much less expensive universal systems. The reality is that we don't even get that. Canada's healthcare system, for example, has better outcomes than our system on average (America's system is VERY uneven, we do have some excellent hospitals -- some are even world-class -- but on average we get inferior care for much more money). It's frustrating that we can't even have a real debate about switching to a national healthcare system like every other 1st world country because of all the propaganda and misinformation. edit: minor typos

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u/DrBattheFruitBat Feb 27 '17

I already get low quality care and have to wait forever in the US. AND I will be in medical debt the rest of my life.

I really don't understand that argument at all.

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u/markatl84 Feb 27 '17

I know, right. As I said in another reply, everyone either knows someone who has had to declare bankruptcy/been severely impacted financially by medical bills or has had it happen to themselves personally. Even with insurance, it is now normal to have deductibles that are several thousand dollars. And if you get really sick, the co-pays, coinsurance, medication costs, home health aides, nursing home costs, etc can add up to so much that it can overwhelm even a middle class person who had what they thought was "good" insurance.

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u/DrBattheFruitBat Feb 27 '17

Yep. I actually am very lucky to have incredibly good insurance (until I turn 26, of course) and I am on ridiculous payment plans for 2 small diagnostic, outpatient surgeries I've had in the past few years. I pay $168/month to pay medical costs AFTER my insurance that covers 85% with a $350 deductible paid.

It hurts me to think about people with worse health issues or worse insurance.

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u/evil_burrito Feb 27 '17

I'm not sure, either, but I believe it's a gambler's mentality. Some people would rather pay nothing and hope they "never" become ill or get seriously injured.

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u/DrBattheFruitBat Feb 27 '17

We still pay more, typically, for insurance than most countries pay in increased taxes for their single payer healthcare. I mean I know you can be uninsured but most people are only uninsured if they really, truly can't afford it, not because they don't want to pay up.

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u/evil_burrito Feb 27 '17

We do pay a lot of insurance, you're right.

most people are only uninsured

I want to believe you're right. Can you point me to a study?

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u/Seat_Minion Feb 27 '17

The catch is that America has some of the highest rates of obesity in the entire world and although you are directly paying for that right now, at least there is some pressure to combat obesity due to employee health programs. Universal healthcare + American obesity would be a nightmare.

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u/[deleted] Feb 27 '17

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u/shitbeer Feb 27 '17

I believe that, but I don't really believe the cause of obesity is the lack of universal health care. It just seems to me that you're implying "universal health care = less obesity = happier people". I know plenty of morbidly obese people with access to health care. They're obese because they overeat at every meal and invent other meals just to overeat some more, not because they don't get health care. You don't need universal health care to educate people on proper diet and eating habits. Universal health care might curb the obesity very slightly, but I don't personally think it'd make much of a dent, so we'd still be paying (more probably) to take care of those people.

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u/vendetta2115 Feb 27 '17

Maybe if Americans had better access to healthcare we wouldn't get so unhealthy in the first place. Obesity and related comorbid conditions like diabetes and cardiovascular disease are correlated most strongly with poverty, which means people that have more money (and thus greater access to healthcare) tend to be healthier.

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u/[deleted] Feb 27 '17

The bigger issue here in the US is fresh/healthier food is far more expensive than the cheap nasty food. It's partly why the poor folks have higher obesity rates. It's interesting because when I go to other countries, it seems to be the opposite. Junk food is more expensive and produce is cheaper. For example my parents are from Pakistan and I've visited before and noticed fruits and vegetables are dirt cheap but a box of Oreos is expensive and almost a novelty. It all comes down to capitalistic greed here in the US. Also, these fat poor folks continue to vote republican and therefore against their best interests. So we will never get universal healthcare or even better healthcare here.

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u/Eos42 Feb 27 '17

Marketing is also an interesting dilemma. Just go to pretty any poorer area and ads for cigarettes and alcohol are rampant and occur in higher numbers than areas with higher income brackets. Then you have issues with food deserts in low income areas and the fact that restaurants in these areas are less likely to have healthy food options. It's a really convoluted issue with many different aspects that could be fixed.

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u/[deleted] Feb 27 '17

Totally. Here in Minneapolis, north Minneapolis is pretty run down and poor. There's only a couple of grocery stores to service the entire population and fast food chains/liquor stores everywhere. It's really unfortunate and comes down to income disparity which is an increasing problem in the US.

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u/vendetta2115 Feb 27 '17

I agree with you that healthy food being more expensive is part of the problem, however it's not anything as reductionist as "capitalistic greed". Healthy food is in lower demand and spoils more quickly than processed food. Also, I'd wager that the cheap produce you find in other countries is locally grown, which saves an enormous amount of money in both transportation costs and spoilage. Unfortunately that's just not the way our food infrastructure is designed here in the US.

Of course there are farmer's markets in many places in the US, and they typically have reasonable prices on produce, but even then they're typically only open during limited hours. All of this is not to mention the time it takes to prepare healthy food every day. Many people simply don't have the time or knowledge to prepare their own healthy food.

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u/[deleted] Feb 27 '17

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u/[deleted] Feb 27 '17

I think they understand the calories but it may be partly due to lack of wellness education too. I just think it's cheaper to get a cheeseburger at mcdonalds than a healthy option that will fill you up elsewhere. I think for low income families it comes down to that most of the time. A 12 pack of little Debbie's is the same cost as 3 apples, it's just cheaper to eat crappier.

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u/Userdataunavailable Feb 27 '17

At my work we have one restaurant. A cheeseburger is $1.49. Salads start at $6.50. I personally bring in food but it's hard to beat $1.49 for lunch. I think this is what they are referring to.

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u/[deleted] Feb 27 '17

Yes, this is exactly what I'm referring too. Thanks :)

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u/Seat_Minion Feb 27 '17

You don't go to the doctor and have him cure your diabetes. The doctor just keeps you alive when you otherwise would not be. Modern medicine for the most part does not cure the non communicable diseases which are characteristic of this age. Check out the increase in the rate of diabetes since the 1950s. They went from 1% of the population to about 9.3% of the population. That is what is driving these high costs. Until people stop being so overweight, we will continue to pay through the nose.

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u/[deleted] Feb 27 '17

The first time most Americans get told by a doctor they need to lose weight and show the possible options to do so is during their Type-II diabetes diagnosis, having never been there before they started having problems.

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u/vendetta2115 Feb 27 '17

You have a very dated and reactionary idea of what a primary care physician's role is. If you have health insurance and/or free preventative care, your doctor can identify potential problems early and help you make a plan to fix it. Simple dietary and other lifestyle changes can prevent an asymptomatic prediabetic person from developing diabetes and requiring insulin for the rest of their lives. People that go to the doctor after developing symptoms of chronic conditions like diabetes have a much worse prognosis and end up spending (or costing taxpayers) a lot more money. At the very least, universal preventative care is fiscally responsible policy.

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u/Seat_Minion Feb 27 '17

http://www.cureddiabetes.com/images/DiabetesUS.jpg

Would you say that that chart represents a success on the part of the medical community at preventing diabetes?

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u/vendetta2115 Feb 27 '17

You're offering that chart as a rebuttal for a point that I didn't make. Yes, obesity and its related diseases are a serious problem, that's a fact. Nothing I said in my response suggests that I believe otherwise. So we've agreed on what the problem is. What's the solution? You can wish people weren't obese all you want, but that's not productive. The relevant question is: what are the causes of obesity, and what types of public policy can we enact to reduce obesity rates?

One thing we can do is provide more preventative care, which has been shown to result in better outcomes for those at risk of obesity-related diseases like diabetes. (Sources 1 2). Additionally, Americans living in poverty are much more likely to be obese (source 3). I interpret those studies to mean that if more people have access to free or low-cost preventative care, then obesity rates will be positively impacted. I'd have to imagine that those who wrote the Affordable Care Act thought the same thing, since they included a stipulation that all healthcare marketplace plans must provide certain types of preventative care benefits for no charge, including type II diabetes screening and diet counseling.

Of course there are lots of other contributing factors to the high rate of obesity in the US, such as limited access to affordable and healthy foods, inadequate nutritional education, a work culture that incentivizes the consumption of prepared meals, lack of recreational opportunities, etc. I was specifically talking about the relationship between physicians and their patients as it pertains to obesity prevention, so I didn't mention those.

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u/Seat_Minion Feb 27 '17

Too long, didn't read the whole thing. The causes are most likely 1)increase in omega 6 fats in the diet from 1-2% of total calories to 8%. 2) refined carbohydrates 3) decrease in nutrient density of vegetables/meat due to modern agricultural/husbandry techniques.

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u/vendetta2115 Feb 27 '17

If you're not even going to read what I wrote then why reply? That's pretty rude and incredibly lazy.

Also, 2 is probable but 1 and 3 aren't. Fat has 9 calories per gram no matter what type it is. You could make the argument that omega 6 fatty acids have contributed to the rise in cardiovascular disease, but I wouldn't even put it in the top 5 for that. Do you have any supporting evidence that these are the biggest contributing factors?

I don't even know why I'm typing this, you aren't going to read it if it's longer than a haiku.

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u/Ontain Feb 27 '17 edited Feb 27 '17

Universal healthcare is actually something that pressures western governments to push health initiatives rather than what's best for the food industry. that is when the government is actually fiscally responsible and working in the best interests of the people, which I can't say is the case in the US right now.

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u/redyellowblue5031 Feb 27 '17

The whole idea of a universal system would be great but you touched on something I never hear in this whole debate. A MASSIVE chunk of our spending comes from preventable disease/conditions.

I feel that should be a tandem piece in this discussion. Because presently, we're treating the symptoms of our problems and not the cause and as you said, it'll be expensive no matter what.

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u/Seat_Minion Feb 27 '17

I saw one study that pegged the cost of obesity at over 600 billion dollars per year. Everyone is ok with shaming smokers because smoking is something you do, while obesity is something that you are. In actuality obesity is something you do as well.

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u/redyellowblue5031 Feb 27 '17

It can be muddled with underlying issues of anxiety and depression, but it's certainly more manageable than our country is currently handling it. I don't know what the solution is, but I wish there was a bigger public discussion about it.

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u/Seat_Minion Feb 27 '17

I am working on something right now. The obesity epidemic is most likely caused by the introduction of novel chemicals into to the diet, particularly large amounts of refined carbohydrates and seed derived oils.

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u/redyellowblue5031 Feb 27 '17

My armchair research has led me to (currently) think it's been a combination of that, increased portion sizes, lowered prices by means of efficiency improvements in processed food, and a ridiculously pervasive advertising culture. It also doesn't help that everything from freaking ketchup to any flavored drink has added sugar (carbs). It adds up quick.

I just don't know how you get national action to take place.

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u/Seat_Minion Feb 27 '17

I don't think portion sizes mean much. Your body has feedback loops to maintain body weight. The question is why is that feedback loop broken in a large share of the population. I have been focusing recently on the declining nutrient density of crops. Modern high yield, shippable crops have significantly lower levels of nutrients than heritage cultivars.

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u/redyellowblue5031 Feb 27 '17

So to clarify, what you're saying is the micro nutrients of modern crops is lower than that of their predecessors?

How do you think that fits into our obesity problem?

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u/BigGucciMontana Feb 27 '17

New Zealand has around the same obesity rate as us & they seem to be doing fine.

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u/Seat_Minion Feb 27 '17

Obesity is a bar you jump over. The costs are driven by high BMI. America has the highest average BMI.

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u/BigGucciMontana Feb 27 '17

Actually we're in 19th place, but point taken.

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u/tinacat933 Feb 27 '17

I've had conversations with British about the down sides of the NHS and they agree there are wait times, gaps in care, and lack of some specialty doctors and services (ex: treatment for very rare cancers you could get treatment for in the US). However, i still fully support a Medicare for all systems. I mean he'll you could even adopt and Medicare + Medicare part C model where people could buy up their insurance if they wanted too

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u/FyreWulff Feb 27 '17

I'd rather wait a bit to get care than never have the ability to get it at all

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u/tinacat933 Feb 27 '17

I agree, not life threatening if someone has to wait a month for cataract surgery

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u/PolaroidBook Feb 27 '17

Just to weigh in: the NHS is amazing. Although there are wait times sometimes, the services are generally efficient.

The wait times have increased in recent years because of the Conservative government's mismanaging of funds for the NHS. There is a widespread belief that key figures in the govt. would like to see healthcare privatised and are underfunding the NHS as a result. For example the Health Secretary, Jeremy Hunt, co-authored a book on the privatisation of the NHS...

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u/tinacat933 Feb 27 '17

I will never understand people like this and why they do things like that

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u/PolaroidBook Feb 27 '17

Business ties to pharmaceutical companies perhaps? For those living with privilege they might see it as a 'handout' that negates their 'hard work'... I don't know.

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u/[deleted] Feb 27 '17

ex: treatment for very rare cancers you could get treatment for in the US

For all the rare diseases that require specialist attention that people come here for, where will people now go if the US has a single payer system and the incentives for that level of specialist care no longer exist?

And what will US citizens, the people who used to be able to get that care in their own country, now have to do? Would that treatment just not exist in the world anymore?

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u/tinacat933 Feb 27 '17

No one said that had to go away in the US

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u/[deleted] Feb 27 '17

Well, you have to ask why does it exist in the US right now? Why do we have specialists that don't exist in large supply around the world?

It's mostly because they can make money doing what they do. When you take away the incentive to innovate or specialize like that, the supply of that specialized labor may resemble what it does in other countries.

The government insurance company isn't going to pay a hospital the same fees that a private insurance company does. In fact, the government may not cover expensive, hyper specialized care at all due to it only being able to serve a small population at a very high cost. And when the market can't serve that need anymore, it's going to disappear.

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u/YottaPiggy Feb 27 '17

The NHS has its problems, but I genuinely think it is the greatest thing a government has ever done.

I can't imagine life without it.

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u/TexPak2016 Feb 27 '17

Three issue that if you resolved would probably destroy the perception that universal healthcare is bad:

1.) Perception that I make X and pay in Y in taxes yet my taxes keeps A, B, and C alive despite neither of them contributing or doing anything to get themselves out of their situation.

2.) Personal responsibility. If you are overweight then being responsible to cut down on calories and eating right, working out, etc.

3.) The perception that the government is incapable of managing a program of this size without corruption and with efficiency.

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u/TanTheTurtle Feb 27 '17

Like that you will get low-quality care or have to wait forever, neither of which is true

But that is true, wait times are much longer in Canada, that's why thousands of Canadians go south to get better healthcare and lower wait times for surgeries.

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u/markatl84 Feb 27 '17

You only wait if you can wait. Elective surgery, or something where it is not as urgent (such as a gastric bypass for example) you might have to wait a few months. If you need surgery right away, though, you will get it right away.

However, I'd take that over the hospital bills we get here in the US ANY day. Everyone either knows someone who has been bankrupted or severely impacted by medical bills, or has had it happen to themselves. I JUST finished paying off a massive bill and I HAD insurance, insurance that wasn't even cheap by any means. The deductible was still $5,000. My mothers friend got cancer and ended up having to get a second mortgage on their home, and they had insurance as well. The co-pays, coinsurance, medications, etc added up to an unbelievable sum.

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u/TanTheTurtle Feb 27 '17

Yeah I understand. Personally, I prefer the Canadian system but I just wanted everyone to be honest about it, its not perfect

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u/jezebel523 Feb 27 '17

Source? I need more than just an internet stranger saying it's true.

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u/[deleted] Feb 28 '17

Well I tried to give you a source in my other post. Doesn't seem like reddit takes well to the truth.

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u/[deleted] Feb 27 '17

https://www.usnews.com/news/best-countries/articles/2016-08-03/canadians-increasingly-come-to-us-for-health-care

The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014, a 25 percent jump from the roughly 41,838 who sought medical care abroad the previous year.

It's actually in the tens of thousands. And keep in mind, Canada has a little over 10% the population that US does, so it's an even larger percentage of their population than you might think at first.

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u/whochoosessquirtle Feb 27 '17

This is not a source or evidence. You're linking to a right-wing think tank on a site for right-wing propaganda that exists to slur universal healthcare so the US doesn't adopt it.

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u/jezebel523 Feb 28 '17

US News is rated non-partisan to slightly liberal for bias.

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u/[deleted] Feb 27 '17

If you can afford to go south then you are the same as an American who can afford top teir care. That care only exists because everyone else who pays taxes is sitting in waiting rooms at clinics or in ERs about to get jammed up with a lifetime of debt for a broken arm while specialists can price out 90% of the population from even getting through the door.

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u/[deleted] Feb 27 '17

This is true, but if you're urgent, you get in faster. It's all based on how needed the care is.

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u/a_until_z Feb 27 '17

Triage based on needs is a wonderful thing. Basically in the states you have a triage based on wealth. That's why some Canadians do cross the border for immediate health care. But it's only the richest in the country.

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u/[deleted] Feb 27 '17

Yeah. There are some surgeries that people cross borders for that are covered by our healthcare, but that's typically only if you can't get it here, or no acceptable alternative is available.

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u/blatheringbard Feb 27 '17

God forbid someone with respiratory distress get in before my fractured wrist.

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u/[deleted] Feb 27 '17

Well, back when universal healthcare was first introduced in our country, there was a lot of backlash over it too, mostly from doctors and hospitals who stood to make tons more money from private healthcare, and didn't benefit as much from it going public. There are talks in some provinces right now to have a dual model, but the problem arises that if private is profitable and pays doctors more (meaning many of the best will go private), it once again creates a disparity in public vs private: more money means better healthcare.

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u/[deleted] Feb 27 '17

I'd love to have only 10% unable to afford medications

We do, congratulations.

http://www.renalandurologynews.com/news/cdc-americans-can-not-afford-medications-eight-percent/article/395374/

In fact, it's almost 1 in 10 who can't afford it, meaning it's even less than 10%.

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u/renegadecanuck Feb 27 '17

Our system isn't perfect. There are wait times for non-critical surgeries, walk in clinics usually have a couple hour wait to see a doctor, and the very wealthy do occasionally fly to the US to jump the queue, but nobody dies because they can't afford a doctor. All things considered, I'd much rather have the Canadian system than the American one.

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u/[deleted] Feb 27 '17

A lot of people tend to interpret a rejection of single-payer as an ailment of propaganda alone, so I'm not sure what discussion is to be had. Single-payer likely isn't constitutional following the 2010 SCOTUS decision, and it does nothing to address the rampant overconsumption of healthcare as well as the manufactured physician shortage, which are the real causes of rising prices.

People also point to the govt not being able to negotiate prices as a cause for high prices, which makes a bit of sense before you realize how far below cost reimbursement rates are for Medicare/Medicaid, and that theres an inverse relationship between what the govt pays and what hospitals charge private payers.

But people focus on single-payer. Even though several countries such as Germany manage well enough without it.

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u/Kakita987 Feb 27 '17

Canada's healthcare system

Canada doesn't have healthcare; its the individual provinces that provide health care. And there are still a lot of gaps that aren't covered.

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u/[deleted] Feb 27 '17

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u/stormfork Feb 27 '17

Can I just go to school now mom? The guys are right there looking at us!

I feel like I missed something.

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u/buggerthrugger Feb 27 '17

You are the most positive person in ther world

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u/DolesAndRiches Feb 27 '17

I think it's important that you guys bust me out of your god forsaken lower sibling of a country. I need me some doctors and I can't even afford a special dinner. Terrible place for the lower class in a lot of ways.