U.S. residents are less healthy, less able to access health care than Canadians
Universal coverage appears to reduce healthcare inequalities

A study by Harvard Medical School researchers in the July, 2006 issue of the American Journal of Public Health finds that U.S. residents are less healthy than Canadians. Moreover, despite spending nearly twice as much per capita for health care, U.S. residents experience more problems getting care and more unmet health needs.

The study analyzes the Joint Canada-U.S. Survey of Health, the first-ever cross national health survey carried out by the two nations’ official statistics agencies. The authors found that U.S. residents were less healthy than Canadians, with higher rates of nearly every serious chronic disease examined in the survey, including diabetes, arthritis, and chronic lung disease. U.S. residents also had more high blood pressure (18% of U.S. residents versus only 14% of Canadians). U.S. rates of obesity and sedentary lifestyle were higher; with 21% of U.S. respondents reporting obesity versus 15% of Canadians. However, U.S. residents were slightly less likely to smoke.

Canadians had better access to most types of medical care (with the single exception of pap smears). Canadians were 7% more likely to have a regular doctor and 19% less likely to have an unmet health need. U.S. respondents were almost twice as likely to go without a needed medicine due to cost (9.9% of U.S. respondents couldn’t afford medicine vs. 5.1% in Canada). After taking into account income, age, sex, race and immigrant status, Canadians were 33% more likely to have a regular doctor and 27% less likely to have an unmet health need. For each of these measures, the average Canadian did about as well as insured U.S. residents.

Race and income disparities, although present in both countries, were larger in the U.S. Non-whites were more likely than whites to have an unmet health need in the U.S. (18.6% vs. 11.1%); while in Canada they were not (10.8% vs. 10.2%). Notably, both white and non-white Canadians had fewer unmet health needs than white U.S. residents. After taking into account income, age, sex, race and immigrant status, poor U.S. residents (making less than $20,000 per year) were 2.6 times less likely to have a regular doctor than the affluent ( those making $70,000 or more). In Canada, the poor were only 1.7 times less likely.

In the U.S., cost was the largest barrier to care. More than seven times as many U.S. residents reported going without needed care due to cost as Canadians (7.0% of U.S. respondents vs. 0.8% of Canadians). Uninsured U.S. residents were particularly vulnerable; 30.4% reported having an unmet health need due to cost.

Lead author Dr. Karen Lasser, primary care doctor at Cambridge Health Alliance and Instructor of Medicine at Harvard commented, “Most of what we hear about the Canadian health care system is negative; in particular, the long waiting times for medical procedures. But we found that waiting times affect few patients, only 3.5% of Canadians vs. 0.7% of people in the U.S. No one ever talks about the fact that low-income and minority patients fare better in Canada. Based on our findings, if I had to choose between the two systems for my patients, I would choose the Canadian system hands down.”

“These findings raise serious questions about what we’re getting for the $2.1 trillion we’re spending on health care this year,” said Dr. David Himmelstein, Associate Professor of Medicine at Harvard and study co-author. “We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live 2 to 3 years longer.”

Dr. Steffie Woolhandler, also an Associate Professor of Medicine at Harvard and study co-author, commented: “Our study, together with a recent study showing that people in England are far healthier than Americans, is a terrible indictment of the U.S. healthcare system. Universal coverage under a national health insurance system is key to improving health. It’s striking that both whites and non-whites do better in Canada. A single-payer national health insurance system would avoid thousands of needless deaths and hundreds of thousands of medical bankruptcies each year. In 1971, Congress almost passed national health insurance. Since then, at least 630,000 Americans have died because they failed to act. How much longer must we wait?”

The study used data from the Joint Canada/U.S. survey of Health (JCUSH), conducted jointly by Statistics Canada (the Canadian counterpart to the U.S. Census Bureau) and the U.S. National Center for Health Statistics. The JCUSH surveyed 3,505 Canadians and 5,183 U.S. residents between November 2002 and March 2003 in order to gauge health status, rates of illness, behavioral risk factors, use of health care, and access to health care services in the two countries.

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Embargoed copies of the study are available to the press at: http://www.pnhp.org/canadastudy/
(password: Geyman)

Physicians for a National Health Program is an organization of 14,000 physicians that support single-payer national health insurance. PNHP is headquartered in Chicago and has chapters and spokespeople across the U.S. To contact a physician-spokesperson in your area, contact nick@pnhp.org or call 312-782-6006. www.pnhp.org.

"But we found that waiting times affect few patients, only 3.5% of Canadians vs. 0.7% of people in the U.S."

In other words you are 5 times more likely to be denied healthcare in Canada due to wait time, or the amount of people that have to wait is 500% higher in Canada than the US. :eek: :eek:

I also noticed the autor convienently said a "recent study showing that people in England are far healthier than Americans, is a terrible indictment of the U.S. healthcare system." while leaving out the fact that the very study he cited as an indictment of the US system specifically said the healthcare system was NOT the reason for the differences. :rolleyes: :rolleyes:

That's without even getting into how bad a "survey" is for evidence and the fact that they "surveyed" 48% more Americans. Did they keep surveying Americans till they got a statisticaly significant number? Maybe they gave out the same number of surveys and over 1600 Canadians were so disgusted with their healthcare system they refused to turn them in. :eek:

We have problems with our health system, there is no doubt about that. I don't know how to fix it, but Tort Reform would help a great deal. However, it is still the best in the World which is made evident by people from all over the world coming to the USA for their healthcare after they have exausted their own possibilitys.

Can you point to a country that has a universal system of healthcare that doesn't screw over its physicians?

That's without even getting into how bad a "survey" is for evidence and the fact that they "surveyed" 48% more Americans. Did they keep surveying Americans till they got a statisticaly significant number? Maybe they gave out the same number of surveys and over 1600 Canadians were so disgusted with their healthcare system they refused to turn them in. :eek:


The participation rate was 69.3% in Canada and 62.7% in the U.S.

The participation rate was 69.3% in Canada and 62.7% in the U.S.

So they had a higher participation rate in Canada but included a higher rate of American responses in the data. Interesting.

The participation rate was 69.3% in Canada and 62.7% in the U.S.

You poor man, you will never get anywhere talking facts with this crowd. They are ideologues. Tort reform and tax cuts for the rich solve all problems. Evidence for the efficiency and equity of universal care is all planted by commie spies. Rational discourse is a foreign language to these people -- if they accept the existence of evidence contradicting their beliefs, the terrorists win.

Why these people were able to get us into a war I will never understand. Talk to one them for five minutes, and you won't trust them with a pair of plastic-guard scissors.

Can you point to a country that has a universal system of healthcare that doesn't screw over its physicians?

Japan

Can you point to a country that has a universal system of healthcare that doesn't screw over its physicians?

Australia.

I consider physicians in the US to be getting just as screwed over as anywhere else, albeit in different ways. We've suffered about 25 years of stagnant wages and rising costs, and looked on as health spending skyrockets and much of the money is dumped into the pockets of bureacrats and administrators who fight a circular battle of profiteering while systematically defrauding those who provide the care.

That's without even getting into how bad a "survey" is for evidence and the fact that they "surveyed" 48% more Americans. Did they keep surveying Americans till they got a statisticaly significant number? Maybe they gave out the same number of surveys and over 1600 Canadians were so disgusted with their healthcare system they refused to turn them in. :eek:


Alas where does one start? Dr.V as astute an individual as you are, I was glad to see that you did not accept the statistic at face value. I was suprised though that you felt adding an additional 1600 Canadians to the study would make a difference. The number of Canadians polled is alread MORE than adequate; Canada's pop is only 30 million and they still managed to get 3500 polled (~1/ 10,000 Canadians). The # of americans in this study amounted to 5000 out of a total pop of 300 million (lets say 1/ 55,000 Americans).
Conclusion: more Canadians were NOT needed to substantiate the sample size of this study.

In other words you are 5 times more likely to be denied healthcare in Canada due to wait time, or the amount of people that have to wait is 500% higher in Canada than the US.

Secondly, whats up with this misleading "500% worse wait time in Canada than in the US" nonsense?? For someone who shows such statistical discernment capabilities why didn't take into account that BOTH countries have very very small wait times. And that when dealing with such small proportions any little change in one stat results in a comparitively large change between the two (3.5% for Canada's wait time compared to 0.70% in the US is nothing to brag about ESPECIALLY since americans choose not to treat all patients presented and we Canadians do... even if our wait times suffer as a result).

How Dr. V could spend almost all his reply to this telling study rebuking its statistical legitimacy and only briefly concede to the fact that there are "problems" in the US system is especially concerning.

Rather than calling for even more Canadians to be polled or rejoicing in the 2.8% pts-lower waittime, you should express outrage over the fact that Americans are wasting more money treating less people (proportionally) than Canadians. Or maybe outrage over the fact that being black/latino/poor/american statistically predisposes you to marginalized health care whereas being black/native/poor/canadian does not.

Its a very ugly statistic but its reality.

ps. To suggest that America's health care system is the best in the world is COMPLETELY in disregard/ignorance of reality. Have you explored the possibility that foreigners flocking to the states to practice is the result of an inticing system where ppl pay more for health care ($ to doctors doesnt necessarily = better health care). People are NOT flying to the states from Japan, Canada, Britain, France, or Israel to get treatment period... believe dat!.. especially since breakthrough procedures are performed in these countries without any need for american intervention. (in general terms of course)

Dr. V claims not to have an answer to the ailing american health care system (with an angel on his shoulder) and in the same breath takes the defiant tone that its the best system in the world (someone's been brushin their shoulders).

However, it is still the best in the World which is made evident by people from all over the world coming to the USA for their healthcare after they have exausted their own possibilitys

Can you point to a country that has a universal system of healthcare that doesn't screw over its physicians?

Canada...

Here's the salaries of Canadian MD's per specialty:

www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf (http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf)

And for America:

www.aamc.org/students/cim/specialties.htm


Who is getting screwed?
It should be interesting to hear from all those americans who love belittling the pay of Canadian MD's after they actually do the side by side comparison. :laugh:

In other words you are 5 times more likely to be denied healthcare in Canada due to wait time, or the amount of people that have to wait is 500% higher in Canada than the US. :eek: :eek:

I assume these numbers are based on waiting times for people who are already patients of some sort. I'm willing to wager that if you threw in all the folks in the US who were waiting for Medicare to kick in because they are un/underinsured (which can be years) the numbers would look a little less favorable.

Dr. V claims not to have an answer to the ailing american health care system (with an angel on his shoulder) and in the same breath takes the defiant tone that its the best system in the world (someone's been brushin their shoulders).

Well, you completely missed the point I was making in my post, maybe I failed to properly demonstrate it.

There are lies, damned lies, and statistics, ESPECIALLY when you deal with percentages. Percentages can take a very small difference and make it huge. Drug companies are notorious for doing this by saying "pill X reduces mortality by 50%". When in reality it reduced mortality from .001 to .0005. This "study" of the survey was full of percentages and I just added another percentage to illustrate how they can be manipulated.

Frankly I believe the healthcare "crisis" is greatly exaggerated and people with agendas "create" studies to fit a predestined outcome. It's much like the ballyhooed cry of 40 million (or whatever number it is) uninsured in the country. Half of them are VOLUNTARILY uninsured, they are young and refuse to pay the premiums, but that little fact hardly ever comes up. The biggest problem I see with our system is not access, EVERYONE has access. Walk into any ER in the nation and you will be treated regardless of income/ability to pay. The biggest problem is the people that won't walk into their PCP's office because it cost them 5 bucks copay on Tenncare so they walk across the street to the ER and rack up a 300 dollar bill the taxpayer has to pay. That bill is 300 bucks because in the ER there are protocols to aviod lawsuits and people that don't need a chest X-ray, CT etc get them where a FP can legitimately use clinical judgement and only order clinically needed tests. These same people complain they can't afford their HCTZ but they don't go without their lortabs, tobacco, and cell phone. Bottom line is America wants the best health care and tech. but only when somebody else is paying for it.

I see people from other countries coming here for healthcare quite regularly, including Canada, even at my small hospital. Canada's legal system has fairly recently said the waits were unreasonable for normal citizens and doctors can go around the government and supply fee for service as well as citizens can freely leave the country and pay the difference in what Canada would pay.

Yes, we do have the best healthcare in the World, bar none and people come here because they know while their country may be able to give them free antibiotics they can't supply the latest and greatest new procedure that they need to save their life.

Percentages can take a very small difference and make it huge. Drug companies are notorious for doing this by saying "pill X reduces mortality by 50%". When in reality it reduced mortality from .001 to .0005. This "study" of the survey was full of percentages and I just added another percentage to illustrate how they can be manipulated. . .


If a medication reduces mortality by 50% from a given disease, I don't see why the maker should not so state. I really don't understand what's wrong with this. It is just a straight forward use of statistics.

I see people from other countries coming here for healthcare quite regularly, including Canada, even at my small hospital. Canada's legal system has fairly recently said the waits were unreasonable for normal citizens and doctors can go around the government and supply fee for service as well as citizens can freely leave the country and pay the difference in what Canada would pay.

Yes, we do have the best healthcare in the World, bar none and people come here because they know while their country may be able to give them free antibiotics they can't supply the latest and greatest new procedure that they need to save their life.

Canadians come to you office regularly huh? What procedures are they coming for?... could it be that the Canadians you see are living in the states so naturally they get their health care from the states? The US is the number one vacation destination for Canadians, couldn't canadian tourists also comprise a large portion of the patients u speak of?

I guess the easiest way to refute your claim that the US has the best health care system in the world would be to restate the points that both i and the study raised which u had no comment on:

-being poor/ a minority/ in america statistically predisposes u to worse health care... while in OTHER WESTERN COUNTRIES poverty/race doesn't play a role in the quality of your health because true equality exists (not just in the ER cuz we all know the ER is NO substitute for real health care)

- this leads me to the second pt u ostensibly neglected to address... because too many uninsured americans resort to the ER and not primary care physicians, a disparity exists between the health of Canadians vs Americans; Canadians suffer less from less chronic illnesses (illnesses that are not monitored long-term in your beloved ER health care system)

Canada's legal system has fairly recently said the waits were unreasonable for normal citizens and doctors can go around the government and supply fee for service as well as citizens can freely leave the country and pay the difference in what Canada would pay

Interesting you point this out, because we recently had an election as you know and EVERY politician, perceptive of public opinion, refrained from advocating privitization. Instead what even the conservatives were preaching for is ''guaranteed wait times'' (a nice way of saying that we can always improve our universal health care system but in NO way would we reduce it to an americanized level)

Oh and why did u make no mention to fact that america's wait times are artificially low due to the millions of uninsured americans who don't quite qualify for ER treatment but require medical attention nonetheless. EVERYONE in Canada is insured therefore EVERYONE must be helped. In Canada we don't have the luxury of turning away tens of millions of uninsured and despite this only 3.5 out of 100 Canadian patients have had to wait too long (compared to 0.70 outta 100 americans).

Yes, we do have the best healthcare in the World, bar none and people come here because they know while their country may be able to give them free antibiotics they can't supply the latest and greatest new procedure that they need to save their life.

Wow...i guess ignorace is bliss. I just want to know what sheltered world u live in that led u to believe that america is the only place where people go to get life saving breakthrough procedures. And EVEN if such breakthroughs were exclusively performed in the states (which they aren't) how would such a small minute insigificant fraction of the overall health services performed (like treating the high blood pressure and obeisity which americans disproportionately suffer more from) justify calling your entire health care system superior to any other in the world. If Canada has the best cataract surgery for diabetic women between the ages of 65 and 66 would that make Canada's health care system the best in the world? common get real.

I agree to polls tend to/can be biased, but Dr.V at what point do u stop these erroneous attacks on the statistical methodology and accept that the problems which occur are the result of a failed health care policy? Or perhaps u are alright with maintaining the status quo because it suites you better than change.

Dr.V also says that a substantial amount of Americans can afford health care but just do not pay for it. DUH!... isn't that the reason why people are forced to have car or house insurance. The only difference between the US and Canada is that in Canada it stands to reason that we extend this logic to human lives too. see how it all makes sense?

Yes, we do have the best healthcare in the World, bar none and people come here because they know while their country may be able to give them free antibiotics they can't supply the latest and greatest new procedure that they need to save their life.

Sorry to burst your bubble, but America does NOT have the best health care in the world. We do not even have the best technology in the world, just the greatest saturation. In fact, we have been handily beaten by 36 other countries, who also manage to provide health care to everybody and for much less of their GDP.

http://www.oecdobserver.org/news/fullstory.php/aid/356/Sant%E9_to_the_French_health_system_.html

There is no "qualify" for ER treatment. They come in, they get treated. It's as simple as that. The wait times aren't "artificially low" they are just low, but that's not even my main point. The point was you can "inflate" things by using percentages, enourmously so as I did. Many of those "studies" you guys are pointing at are not accurate. For example, in "infant mortality" some countries don't count premies as "births" so all the ones in the US that are premature that we catalog as "births" which have an extremely high mortality rate, get cataloged as "abortus" within the other systems. That's just one example. A couple of months ago I saw in the AMA journal a nice study that showed NO disparity of race on healthcare etc. As I said before many of these "studies" have a predetermined outcome and they keep changing the parameters of the study until the desired result is obtained.

I believe in personal responsibility. It is not MY responsibility to pay for every lazy persons healthcare that "wants" it. If they want healthcare they can get a job and pay for it, they can purchase their OWN healthcare, or they can find a doctor (like myself) that will do it for free but they have to ASK. I don't mind giving free care, but that is MY choice, it is not right to force other physicians to give free care, that should be THEIR choice. Should we force farmers to just give away their crops and animals? Food is needed by every living human, what's the difference? Slavery is what it's called when you force someone to work without proper payment.

I didn't say the foreigners came to my "office", they come to my hospital. The ones that I have known flying in from other countries specifically for procedures were for Pediatric Surgery. A few have been adults, but it's mostly children.

The healthcare policy is not "failed", it is abused by lazy people that want something for nothing and expect productive members of society to keep them up for their entire life. That is not PC to say, but it's the truth.

... A couple of months ago I saw in the AMA journal a nice study that showed NO disparity of race on healthcare etc...

I believe in personal responsibility. It is not MY responsibility to pay for every lazy persons healthcare that "wants" it. If they want healthcare they can get a job and pay for it, they can purchase their OWN healthcare, or they can find a doctor (like myself) that will do it for free but they have to ASK....
The healthcare policy is not "failed", it is abused by lazy people that want something for nothing and expect productive members of society to keep them up for their entire life. That is not PC to say, but it's the truth.Well the truth shall set u free, and the core argument used by u and the other proponents of universal health care has been unmasked.

If health care is seen as somethig that only those who are able/willing to pay for (like a luxury), then i could see how unattractive universal health would seem. But here in Canada it is not a luxury (it may not entirely be a luxury in the states but it is much less a guaranteed right) and EVERYONE (even those lazy unemployed ppl beneath us) is afforded every level of health care. We pay a price for that (higher taxes) but we also enjoy the benefit of having a more level society, with less disparity, (less crime :laugh: ), and more opportunity for those down'n out. Accordingly these "lazy" people in our society have an opportunity to get on their feet without the incentive of the "its too hard to get up when ur down" mentality. Granted u will have ppl who dont work and dont contribute financially to society, but how does a system which makes it more difficulut for the imporverished to start back up encourage these "lazies" to do work.


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I don't mind giving free care, but that is MY choice, it is not right to force other physicians to give free care, that should be THEIR choice. Should we force farmers to just give away their crops and animals? Food is needed by every living human, what's the difference? Slavery is what it's called when you force someone to work without proper payment..I dont quite get were u are going with this one. I nor anyone here was preaching for american MD's to addopt a halfway universal system whereby u give free services to needy ppl. So dont worry, no one is trying to reverse the emmancipation proclamation for american doctors, at least i'm not.

Here in Canada, MD's are paid very well (not like slaves) and i invite you to check the link that shows the salaries of Canadian MD's vs Americans:
Canada's MDs: www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf

And America: www.aamc.org/students/cim/specialties.htm

As u can see american and canadian physicians are handsomely rewarded personally, and financially.


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Yes, we do have the best healthcare in the World, bar noneThe healthcare policy is not "failed", it is abused by lazy people that want something for nothing and expect productive members of society to keep them up for their entire life.In so much as there are too many poor not receiving adequate health care, the american system is failed. And Dr.V i would greatly appreciate any study that shows that poverty/ income does not significantly affect the healthcare of americans. U dont seem to trust stats a lot, neither do i. So when i come across a stat i try to see how it is/isn't validated by common sense. What part of the way the american health care system as it exists makes u think that the study is displaying flawed results. U pay for ur health care in the US, it stands to reason that those who can pay get the service and those who dont wont. U dont even need a study to tell u this. U can say that there is no "qualify" for ER in the US, but again, how is an ER going to replace primary care. pls school me on this one cuz unlike u, i dont have the everyday exposure that u do.


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U talk about
I didn't say the foreigners came to my "office", they come to my hospital. The ones that I have known flying in from other countries specifically for procedures were for Pediatric Surgery. A few have been adults, but it's mostly children.Unless these patients flying overseas for medical procedures are from countries like Canada, UK, France and the other relevant western countries with the better system ofuniversal health, what does america performing pediatric surgery on foreigners have to do with the issue of Canada's health care system being better for the health of its citizens than american healthcare is for americans? Foreigners fly to Canada/UK/France/Australia to get pediactric care where it is not readily available in their naitive country. Where did u get this impression that america is the hub of innovative medical procedures. Breakthroughs in medicine are everpresent in the Western World, so get off your high horse.


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The healthcare policy is not "failed", it is abused by lazy people that want something for nothing and expect productive members of society to keep them up for their entire life. That is not PC to say, but it's the truth.Doesn't take a genious to know that thats not PC... but is it even C... C as in 'correct'? I would agree that america has the most accountable health care system in the world. If accountability is the standard used to measure which system is the best, then i fold, u win. But if delivering medical resources to as many ppl in need of it is the litmus test used to grade a country's healthcare, then the Canadian system works better.



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I believe in personal responsibility. It is not MY responsibility to pay for every lazy persons healthcare that "wants" it. If they want healthcare they can get a job and pay for it, they can purchase their OWN healthcare...Is the primary goal of health care to ensure that accountability for one's choices determine one's ability to receive non-emergent healthcare? if so then i would agree that lazy people shouldn't expect the best healthcare but instead should expect a modest decrease in the quality of their life/health. Logically, in the US, where ppl like Dr.V hold these standards the, laziest/poorest dont get the best healthcare services in the world (ur only as good as ur weakest link, and in other western countries, the weakest links still get the same healthcare as the wealthiest). this is supported by the the study which Dr.V thinks is misleading.

But if u believe that health care is an indelible right, then it would make sense that even those who are unemployed or even lazy still get the same services provided to them.

Conclusions: as far as guaranteed health care is concerned some like Dr.V think in most cases (non-emergent cases) healthcare is earned its not a right. Others think that in the desire to sustain an equal society regardless of class/income we MUST guarantee universal healthcare. Maybe neither one is necessarily better/worse wrong/right... they just represent different standards of living.

Serving people who can afford it (as a result of their "personal responsibility") is important to the US system u characterize as the best in the world. Serving as many people who need all levels of health care (even if they are unjustifyably lazy and cant afford it as a result) is important to Canada which i think is better.

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Conclusions: as far as guaranteed health care is concerned some like Dr.V think in most cases (non-emergent cases) healthcare is earned its not a right. Others think that in the desire to sustain an equal society regardless of class/income we MUST guarantee universal healthcare. Maybe neither one is necessarily better/worse wrong/right... they just represent different standards of living.

Serving people who can afford it (as a result of their "personal responsibility") is important to the US system u characterize as the best in the world. Serving as many people who need all levels of health care (even if they are unjustifyably lazy and cant afford it as a result) is important to Canada which i think is better.

Hey CanCan

You did a great job of defending the Canadian health care system. You presented your arguments well :thumbup:
I totally agree with your conclusions. It is very hard, if not impossible, to compare the two health care systems as they have very different objectives and mentalities. It's like, as someone has already pointed out sometime before, comparing apples to oranges. It just won't work, and yet there are always some ignorant Americans trying to bash the Canadian universal health care system....it's an ego thing, I guess, (along with bashing the salaries of the Canadian MDs, which leads me to think that all they are after in their profession is money, money and money and that they could care less about the health of their fellow citizens. All of the Canadian MDs whom I know of have a very comfortable lifestyle here. So I really don't know what the problem that some Americans have on the salary issue is). I think that neither system is better than the other and that both systems, indeed, have problems of their own. The two systems are just different, period, and to say that one is system is better than the other is really a matter of personal preference. I think that the Canadian system is better because I think it has more of a 'humanatarian' touch to it, but that's just my personal preference (and maybe because I'm Canadian myself ;) ).

I always enjoy reading your posts. Thank you for them and keep up the great work. :thumbup: :D

Hey CanCan
...I always enjoy reading your posts. Thank you for them and keep up the great work. :thumbup: :D

Thanks i love the Canadian system too it gives me a warm tinglish feeling inside :laugh:

Hi all,

Since I'm getting in in the middle of a conversation, I won't reply to anyone in particular. But I do feel poor Dr V needs a bit of support. I'm a (volunteer) EMT that has worked in France and to some extent in Britain before coming to the US, and seeing how things work here actually made me want to become a physician -with US training and to work in the US system- so I recently started on my pre-med reqs. Anyway, I cannot but laugh when I see the success of the WHO sham who put the self-reported amazing French at the top of the world. Anybody with even a vague, distant knowledge of the French health care system knows it isn't worth anything. Although, you might argue, some foreign VIP do prefer France for their Tx. Col. Qadhafi, Y. Arafat, most recently the Algerian president all favoured the amazing medicine and Vichy medicinal waters. Ahahah.
Of course there are many flaws with the American system, but there is no perfection on this Earth (and since I'm an atheist...). What I have found, and I realise this is more from personal experience, but I don't think they do have any studies in those areas, is that patient care in the US is better than in Europe because, well, here we actually care for the Pt. Pain control is inexistent in France (bit better in Britain, but the surgeons have to clean the floors of the ORs themselves due to cuts in 'unessential personnel'), not to mention infection control, etc. As for disparities in healthcare due to gender/ethnicity, here's a thought for you: in France, no data will be available on those issues as it is illegal to collect data relative to citizens' ethnicity. It is a fact, however, that for a few years (since Sarkozy started as Interior minister) it has been illegal for HCW to provide care to illegal Pts. I.e. the doc has to ask for ID. How's that for discrimination?
I could go on for ages, but my message is just that while there is no perfect system, American medicine is indeed one of the best in the world, amongst other things because it takes the time to criticise itself and to compare itself to other standards. Quality improvement isn't as obvious as you would think.

I don't have any first-hand experience with the US system, but I don't doubt that it is among the best in the world if you can access it and pay for it. In my opinion, the biggest problem with privatized health care is not the "lazy unemployed people on welfare". It's the those who are employed, are responsible citizens and have paid taxes all their lives and still get screwed over. All it takes is a catastrophic event like a car accident or a cancer diagnosis and then guess what .... insurance doesn't cover all this, sorry you have to pay for that, oh too bad you've reached your maximum. The fact that people have to declare bankruptcy to pay medical bills, or worse yet go without care in the richest country in the world is beyond belief.

A friend of mine's Dad was working is the US (they are Canadian) and he was unfortunately diagnosed with pancreatic cancer. He had great insurance and got great care. However, they still had to pay a significant amount for his care. I remember them being shocked at the cost and wondering how people with less or no insurance managed. Lucky for them finances were not an issue. Sadly he did end up passing away about 15 months after diagnosis. Now here's something to think about: he was treated much more aggressively than he would have been in Canada. His cancer was quite advanced at diagnosis, but he was treated for a cure, no matter how small his chances. In Canada, his treament would have likely been palliative. What he eventually died from was sepsis and the last couple of weeks of his life were very hard on him and his family. Maybe it would have been better if he had received palliative treatment and had a "better death". I guess I am just trying to point out that more technology and more treatment is not always better.

I'm a member of a scoliosis forum and some of the statements toward the Canadian health care system are despicable. The same is true for European countries.

Many of the posters complain of unbearable pain along with a waitlist that has them 1.5+ yrs away from seeing a doctor. Anyone who knows about scoliosis knows that 1.5 years can be the difference between a 45-degree spinal curve and a 80+ degree curve (dangerous). One lady had surgery, and one of the screws come loose -- she had to wait 1 year to have it checked out! It's sad really.

I'm a member of a scoliosis forum and some of the statements toward the Canadian health care system are despicable. The same is true for European countries.

Many of the posters complain of unbearable pain along with a waitlist that has them 1.5+ yrs away from seeing a doctor. Anyone who knows about scoliosis knows that 1.5 years can be the difference between a 45-degree spinal curve and a 80+ degree curve (dangerous). One lady had surgery, and one of the screws come loose -- she had to wait 1 year to have it checked out! It's sad really.So i read this...knowing nothing susbtantive about scoliosis, I join a scoliosis forum myself (not only to get the downlow on the american/canadian systems but also to understand the condition).

First impressions based on reading a lot of posts on this forum is that:

1. As far as scoliosis is concerned, people in Canada have NO detterent from visiting a doctor when they first suspect back pains need to be addressed by physicians. Contrarily, i read several stories of kids who had to BEG their parents to see a doctor regarding their back pain. WHY? because the pain associated with scoliosis can be hard for others to truly comprehend (it comes and goes especially the idiopathic form) and as a result people with scoliosis are often told to suck it up and stop whinning. Faced with this misunderstanding (and only in the US) the financial pressure associated with every visit to a doctor (especially when u have low/no insurance), several low income americans end up waiting a loooooooong time until the pain is excruciatingly intolerable before they saw their MD.

2. Scoliosis is too often mistaken/misdiagnosed by doctors and resultingly people with scoliosis in both canada and the US can tend to wait too long for appropriate treatment.

3. IMPORTANT!! when scoliosis is diagnosed properly (even with patients with seemingly bad throracis and lumbar results) the time before surgery depends on MANY FACTORS... so yes.. 1.5 yrs for someone with 45 may seem extreme... but the persons age, their level of pain etc etc play into that. There are some ppl who have very curved spines who dont have any pain AT ALL... and their surgeries are scheduled a year down the road as a preventative measure for the inevitable back problems that will come. Then there are patients who get surgery within 10 weeks. ALSO, with scoliosis it is often important to wait for months to see how the spine is progressing/regressing.

4. When u are dealing with a painful condition of scoliosis waiting ONE DAY is too much (and understandably so... i empathize with all the ppl with scoliosis it seems both physically and mentally exhaustive) so naturally when a patient has to wait months for surgery its going to seem unbearable especially with added anxiety of waiting for surgery.

5. I wonder what would happen to a scoliosis patient whose condition is not severe enough as to definitely require surgery BUT who may opt for it n e how. If insurance doesn't cover it and if they dont have money what happens in cases of this grey area?? How does this represent the best system in the world

The biggest shock i found about the american system was that even some insured ppl end up having to pay thousands of dollars for their treatment. Its ridiculous... i know that as well of as we are here if someone got sick with something serious like scoliosis i'd rather be in Canada; in both countries there are great surgeons... and both american/canadians will hopefully be cured :) BUT daaaaaaaamn... what are u supposed to do after the fact when u cant afford treatment? go bankrupt? And if u do that how does it help u or the health care system.

Again, if u have $$$ the US is a medical utopia. But irrespective of money the Canadian system works magic.



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Now here's something to think about: he was treated much more aggressively than he would have been in Canada. His cancer was quite advanced at diagnosis, but he was treated for a cure, no matter how small his chances. In Canada, his treament would have likely been palliative. What he eventually died from was sepsis and the last couple of weeks of his life were very hard on him and his family. Maybe it would have been better if he had received palliative treatment and had a "better death". I guess I am just trying to point out that more technology and more treatment is not always better.I am sorry for the lost of ur friend's dad. i just want to ask what made u come up with this pallative theory of Canadian oncology/radiation. I don't have a lot of experience with cancer but what little i have is within the realm of the Canadian healthcare system. I, like u, had a friend whose parent was suffering from cancer (skin cancer). His mother never survived BUT had several rounds of treatment. The cancer came back which proved to be fatal. The point here is that during the second diagnosis of cancer it was the choice of the patient as to whether pallative care versus the curative approach. This is a personal decision made by patients based on input from physicians on prognosis. She chose not to keep fighting; this is an ugly reality of cancer that people... how does that reflect on a health care system. Both in Canada and the US u will find people who opt for pallative care; to suggest that cancer patients in Canada under the same condition as ur friends dad would have been left for dead (albeit a less painful death) is absurd and unsubstantiated.


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Of course there are many flaws with the American system, but there is no perfection on this Earth (and since I'm an atheist...). What I have found, and I realise this is more from personal experience, but I don't think they do have any studies in those areas, is that patient care in the US is better than in Europe because, well, here we actually care for the Pt. Pain control is inexistent in France (bit better in Britain, but the surgeons have to clean the floors of the ORs themselves due to cuts in 'unessential personnel'), not to mention infection control, etc. As for disparities in healthcare due to gender/ethnicity, here's a thought for you: in France, no data will be available on those issues as it is illegal to collect data relative to citizens' ethnicity. It is a fact, however, that for a few years (since Sarkozy started as Interior minister) it has been illegal for HCW to provide care to illegal Pts. I.e. the doc has to ask for ID. How's that for discrimination?
I could go on for ages, but my message is just that while there is no perfect system, American medicine is indeed one of the best in the world, amongst other things because it takes the time to criticise itself and to compare itself to other standards. Quality improvement isn't as obvious as you would think.
Premierement, pourquois pas vivre dans le Canada? As tu deja ete, tu l'amerais, je pense,... il y'en a beaucoup ici qui parle fracais (pas moi.. je l'ai apris en ecole et ca fait des ans dès que j'avais besoin de le parler MOIN PLUS L'ECRIRE!!! :eek: )

I am not familiar with the french system, so maybe i shouldn't have used it as an example of good universal healthcare. I'll just stick to how i think Canadian universal health serves better health care to more people from this point. So french surgeons are mopping floors? Is this really true? If your country has universal health care then why wouldn't u exepect even the poorest to receive good health care(even in the absence of data collection)?

I said it once and i'll say it again: what is the goal in providing health care? Accountability? or Universality?

I'm a member of a scoliosis forum and some of the statements toward the Canadian health care system are despicable. The same is true for European countries.

Many of the posters complain of unbearable pain along with a waitlist that has them 1.5+ yrs away from seeing a doctor. Anyone who knows about scoliosis knows that 1.5 years can be the difference between a 45-degree spinal curve and a 80+ degree curve (dangerous). One lady had surgery, and one of the screws come loose -- she had to wait 1 year to have it checked out! It's sad really.

The waiting times are not "to see a doctor," they are for non-emergent imaging or procedures. I actually know someone who emmigrated to Canada so that she could receive superior palliative care for her Pick's disease without her estate getting financially raped. She's pretty much out of it these days, but her care has beaten the Hell out of what she would have faced here (private nursing home until bankruptcy, followed by state-run nursing home).

Also, be careful about lumping all European healthcare systems into one blanket indictment. This report (http://www.oecd.org/dataoecd/31/10/17256025.pdf) analyzes waiting times for elective surgery between two groups of countries. The first group has well reported problems with excessive waiting times (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom), and the second has relatively small waiting times (Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the United States).

The waiting times are not "to see a doctor," they are for non-emergent imaging or procedures. I actually know someone who emmigrated to Canada so that she could receive superior palliative care for her Pick's disease without her estate getting financially raped. She's pretty much out of it these days, but her care has beaten the Hell out of what she would have faced here (private nursing home until bankruptcy, followed by state-run nursing home).

Also, be careful about lumping all European healthcare systems into one blanket indictment. This report (http://www.oecd.org/dataoecd/31/10/17256025.pdf) analyzes waiting times for elective surgery between two groups of countries. The first group has well reported problems with excessive waiting times (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom), and the second has relatively small waiting times (Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the United States).

The study u show actually does not seperate the groups as u outlined them into those with "excessive wait times" and those wit "small wait times". From the article the first group of "twelve [is] reporting wait times" and the second group of "eight [is] not reporting them". (paragraph 97)

The first groups has a marginally variable set of wait times which the study shows can be associated with things like
"i) to what extent a higher availability of capacity (proxied by the number of
acute care beds and doctors) and resources (proxied by total and public health expenditure) are negatively associated with waiting times; ii) to what extent a higher level of need (roughly proxied by the percentage of older population) is positively associated with waiting times; iii) to what extent a higher percentage of activity performed in day surgery is negatively associated with waiting times;"

It also makes note that in the second group (in which is included the US) there is not a comparison of wait times because "it is not easily observable."

Just a lil clarification

Just a lil clarification

Fair enough, and my bad for not stating things more clearly. All I was trying to point out is that Europe is an extremely heterogenous mixture of healthcare systems, and it is therefore not entirely fair or accurate to lump them all together. From Summary point #3:

"This report is devoted to the second objective. An interesting feature of OECD countries is that while some countries report significant waiting, others do not. Waiting times are a serious health policy issue in the 12 countries involved in this project (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom). Waiting times are not recorded administratively in a second group of countries (Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the United States) but are anecdotally (informally) reported to be low. "

I am sorry for the lost of ur friend's dad. i just want to ask what made u come up with this pallative theory of Canadian oncology/radiation. I don't have a lot of experience with cancer but what little i have is within the realm of the Canadian healthcare system. I, like u, had a friend whose parent was suffering from cancer (skin cancer). His mother never survived BUT had several rounds of treatment. The cancer came back which proved to be fatal. The point here is that during the second diagnosis of cancer it was the choice of the patient as to whether pallative care versus the curative approach. This is a personal decision made by patients based on input from physicians on prognosis. She chose not to keep fighting; this is an ugly reality of cancer that people... how does that reflect on a health care system. Both in Canada and the US u will find people who opt for pallative care; to suggest that cancer patients in Canada under the same condition as ur friends dad would have been left for dead (albeit a less painful death) is absurd and unsubstantiated

I in no way suggested that cancer patients in Canada are "left for dead". In fact I know that Canada has some of the best outcomes for cancer treatments because I worked at the major cancer centre in Vancouver. What I am saying is that in this case his cancer was very advanced (ie distant metastasis) at diagnosis and he had a type of cancer (pancreatic) that even under the best circumstances has a bleak outlook (5-year survival is less than 5%). In his case, palliative treatment from diagnosis was an option and I assume that they went through the decision-making process with their doctor. From speaking to my friend though it seems that the goal from the outset was a cure and he was treated very aggressively. From what I know about treatment in Canada, the goal of his care would have been palliation, not cure.

His case is pretty uncommon. Many cancers are diagnosed at a stage where they are treatable and I know that patients are treated just as aggressively in Canada as they are in the US and this is evidenced in the fact that our survival rates are quite comparable (sorry I don't have link for that but I have seen the numbers before). What I am saying is I think that due to different attitudes in the health care system, some people in the US receive more aggressive treatment which doesn't necessarily improve outcomes and results in a worse quality of life.

A. Again, if u have $$$ the US is a medical utopia. But irrespective of money the Canadian system works magic.
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B. Both in Canada and the US u will find people who opt for pallative care; to suggest that cancer patients in Canada under the same condition as ur friends dad would have been left for dead (albeit a less painful death) is absurd and unsubstantiated.
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C. Premierement, pourquois pas vivre dans le Canada? As tu deja ete, tu l'amerais, je pense,... il y'en a beaucoup ici qui parle fracais (pas moi.. je l'ai apris en ecole et ca fait des ans dès que j'avais besoin de le parler MOIN PLUS L'ECRIRE!!! :eek: )

D. I am not familiar with the french system, so maybe i shouldn't have used it as an example of good universal healthcare. I'll just stick to how i think Canadian universal health serves better health care to more people from this point. So french surgeons are mopping floors? Is this really true? If your country has universal health care then why wouldn't u exepect even the poorest to receive good health care(even in the absence of data collection)?

I said it once and i'll say it again: what is the goal in providing health care? Accountability? or Universality?

Salut, Cancan. I allowed myself to cut and number your post. Hmmm, maybe I should become a surgeon?
A. As noted in above posts, emergent care is ALWAYS available in the US, including for illegal immigrants, etc. Don't know how this works with the Canadian system, but in Europe it's pretty rare. Moreover, there is plenty of free care available in the US that for some reason never gets mentionned. I volunteered in a free health clinic, where Pts. not only get free care, but also get best care, since it is mostly used as a teaching tool by all the medical schools in the area, meaning that it is actually medical faculty that treats those Pts. Sure, there could be even more funding for free clinics, but that's always going to be the case, no matter how much money you pump into it. I don't believe there's any country in the world where absolutely everyone gets the absolute best care possible, because that's simply idealistic and we live in realities. While it is a goal worth striving for, it would be silly to think we could ever attain it, and thinking that it has been attained (e.g. France) presents the risk of not doing any quality improvement. Finally, the large University-affiliated medical centre where I work gives an enormous amount of money away in free care. A lot of the Pts. I see in oncology or palliative care are "charity", and they get exactly the same Tx. and attention as any other Pt. I haven't seen that anywhere but in the US (bear in mind I've never experienced Canada, I'm mostly referring to Europe here).
B. I agree with Cancan on this point. I'll just add that hospice programmes in the US are still expanding, and provide an opportunity to receive free palliative care for terminal patients. But modern societies's attitudes towards death need to evolve in order for those programmes to gain common acceptance.
C. Heard very good things about Canada indeed, thanks for the recruiting drive. Don't exclude popping by there in the future, but I really fell in love with the US.
D. It's not French surgeons that mop floors, but British ones. French surgeons just smoke, don't wash their hands, and smell. :D

As far as the people you seem to think I feel are beneath me, let me just explain that I am one of those people.

I had a Clarks level 4 malignant melanoma with two positive axillary lymph nodes when I turned 18. I had to go to a teaching hospital 2 hours from home and racked up large medical bills (wide local excision "the bear bite" and lymph node dissection). I am still a cancer patient to this day and that was back in 1987. I know a little about the "working poor" and medical bills. I was still covered under my parents insurance because I was 17 when the origional biopsy was performed but we still had to pay a large sum.

I have not been able to obtain insurance since unless it was through a group insurance plan on the job. I worked for 12 years in a factory making about 20-25 grand a year, 40-60 hours per week. However, I paid my insurance premiums because I had enough sense to know it should be MY responsibility to care for myself and my family. When I had huge doctor bills I paid them in full becaue it was MY responsibility. That wasn't the job I started out in though. I started in the "backer" and hay fields. I made 2.35 per hour. Then I started work at McDonalds, then at a lumber yard and finally I got my good factory job with benifits that I kept for 12 years. That's another problem with many of the "needy" or "uninsured" they think they are too good to work at a job that doesn't pay 20 bucks an hour. Hell I'm a doctor and only make 9.95 an hour, but they turn down jobs to stay on their government assistance and health plans.

When I needed something done I shopped around for it, and yes I have even went to free eye clinics etc. I was very grateful for that, and I thanked them for their work. They didn't have to do it, and that's what makes it wonderful. Yes there is free care available if people would just be willing to accept it. I know doctors that will NOT provide free care due to the ungratefulness of the majority of the patient population and their litigous nature. Here they criticize the free medicine provided, criticize the free tests run, and try to sue if they can make something up. These doctors go to Mexico, Africa, South America etc for free because those people actually appreciate it.

The entitlement mentality is so great in this country from years of liberal social programs that just teach dependance that many turn down the free clinics because they demand brand name/newer drugs etc. Many of them have no business going to the doctor except for their yearly physical because they are relatively healthy, but they show up every week or two. Of course they won't pay the 5 dollar co-pay at the family physician, they walk across the street to the ER so they can spend that 5 on beer or cigarettes etc. They run to the ER for every sniffle demanding drugs and pain meds, I'm talking about for things as insignificant as colds, bruises, ankle sprains, even lonliness and attention seeking etc. Because it doesn't cost them anything personally they abuse it.

I will do anything I can to help people, that's why I went to medical school and that's why I am going back to a rural area to practice, but I WON'T be made to do anything and I don't believe in making other doctors do things. I will give the free care to who I desire not who the government tells me "needs" it. I will determine the need, is it a real need or is it a lack of responsibility and wanting something for nothing? Since it is my work and my time I will be the one to decide.

I practiced in Canada and the United States. No system is perfect but the AVERAGE Canadians have it better although it is better for a doctor to practice in the US. There is not much difference in primary care and emergency care. The dissatisfaction in Canada occurs with specialty care especially ORTHOPEDICS. It's very difficult to attract specialists in small cities in Canada where I lived and half of the FP's are from South Africa. Even some of the specialists like the Orthopods and OB-GYN's are from South Africa. I was surprised at how low the out-of-pocket expenditures in health care. Medicines are cheaper although some provinces are strict and only certain medications are in the provincial schedule/formulary. Overall, I think they get good primary care and the wait lists may improve (or NOT). In local news there you will occasionally hear of Canadians crossing the broder for radiotherapy or hip replacement. On the other hand, it's also not the most efficient system among those with nationalized health care. The Scandinavian countries are probably more efficient with their funds. Some blame it partly on the proximity to the behemoth (in healthcare expenditure) next door with the increasing demand for technology and increasing malpractice coverage. Their increasing healthcare expenditure in my opinion will also be unsustainable once their population start aging or there is rapid population growth to 50-100 million. The central government is also fiscally conservative so I doubt whether they would pour a lot of money in their health care. With a lot of natural resources (oil and metals) and shrinking debt, they actually have a brighter long-term economic prospect.
In terms of income, the US doctors have it better. Once your income exceeds CD$60k you are paying about 50%. Ronald Reagan will have a convulsion if he is still alive and see that marginal tax rate in the US. Sales taxes in Canada are also generally higher (they probably will decrease this). The work load is also heavier in Canada. As an internist or a pediatrician, you are already considered a specialist. The good thing is all medical/surgical procedures have codes (similar to CPT) and the provincial government pays on time without calling any insurance company or HMO. Doctors will live there comfortably, I just have too much personal loans that's why I left Canada. I'm now in a tax-free British territory but I'm still planning to return to the US eventually (for personal reasons) once my loans are paid.
As a physician, I would choose US first but Canada is a close second. I would choose Canada over Australia or even the UK.

Dr. V.. u have a very strong and touching story. keep up the fight against cancer! Although u represent someone who, despite REAL adversity, is able to persevere and do something positive in life, not everyone is as strong as u (humans are complex things). I have nothing but respect for/admiration of u for your consideration of ppl whom u philanthropically deliver medical services to.
However, when i talk about the Canadian vs American system, i dont think the solution is for americans MDs (like urself) to delivery free services to ppl (I think i might have given you this impression because u keep saying that its your choice and u suggest that ppl wanna force doctors to peform without pay for the needy). When i'm referring to serving ppl that cant/wont pay for medical care i'm talking about how the Canadian system inherently supports this notion, NOT an american system where doctors (like u) would have to forfeit pay to serve the many indigent. My criticism is not of you its of what u supoort; the american health care system which u state is the best. As far as u are concern i repeat: i seriously have nothing but respect for u (bowing my head bring down both hands :o )

What i really think is important about your case though is that because of your diagnosis in 1987 u were forced to make a life altering decision regarding your health for the rest of your life. at the age of 17 u were blessed/cursed with a reality of mortality (something that, if not present, can leave ppl to think about their health as something untouchable for time being). U knew that u HAD to take responsibility for your health; being faced with cancer u were not going to take chances.... But what about ppl who are in their mid 20's ... full of college debt... feeling very healthy...not making alot of money (working poor)... dont u see how, as an example,these ppl, never having experienced the 'cancer wake up call', could be uninsured and how if they were faced with cancer at this point in their life(not covered by their parents' insurance) there would be a seemingly insurmountable financial burden?????

U stated that even though u were insured ur family had a lot to repay as a result of the treatment. I DONT LIKE THAT!!! :mad: and i personally dont mind paying high taxes even if it means that i never get sick and i end up paying for your medical bills. thats just me. thats just Canada.

U (Dr.V) talked about how there really are ppl who are simply unwilling to work in america.. not wanting to work at McDonalds etc etc. I AGREE. thats a social epidemic in america, and u state that its the result of years of social programs... i'd also add that its probly also due to decades of social/government policy of discrimination towards ppl who wanted nothing more than equal opportunity but got the door closed during year of the civil rights movement. But thats A WHOLE DIFFERENT TOPIC.

I think we lost sight of what this thread is about because ur talking about entitlement and that has nothing to do with 'Canada's vs. American healthcare system' so I ask u... how do u think ur life would have been different if u diagnosed in 1997 not 1987? Don't u think that it would have been ridiculously hard to address the payments for your treatment then? (clearly it already has been inspite of ur responsible way of dealing with the costs by working ur behind off and taking charge of ur life)

Also u are not addressing the fact that when u have universal health care AND EVERYONE IS TAXED... the indigent that u refer to as "too good to work at a job that doesn't pay 20 bucks an hour" get taxed through everything from our 15% sales tax to ,when they get a job, even their small salaries. Thats another benefit of universal healthcare; FORCING ppl to pay for health care.

Finally u make mention ofThey run to the ER for every sniffle demanding drugs and pain meds, I'm talking about for things as insignificant as colds, bruises, ankle sprains, even lonliness and attention seeking etc. Because it doesn't cost them anything personally they abuse it.but ur refering to ppl who have some mental illness/very paranoid personality... we get those too. So i wouldn't group these ppl into the group who can't afford health care but still need medical attention. These are not the in same group. Besides u have to provide for the hypochondriacs because u can't always discern them from the rest of patients and the hyporchondriacs will eventually really get sick.

I really dont agree with your view on american health care and i dont think that the answer in america is to just treat all the ppl who dont pay for free. I think that if u re-evaluate what the goals of the healthcare system are it inevitably points to some sort of universal system.

. Once your income exceeds CD$60k you are paying about 50%. .

Are you kidding me? Who the heck pays 50% of his/her salary in taxes? Canadians certainly don't. One of the pharmacists, from a pharmacy at which I'm currently working part time, makes about 65K CDN and she pays about 32% in taxes. I know this because I handle the payroll of the pharmacy's employees. I think the higher ranges of taxes are about 37-40%, with no way it being about 50%.... that's ludicrous.

Are you kidding me? Who the heck pays 50% of his/her salary in taxes? Canadians certainly don't. One of the pharmacists, from a pharmacy at which I'm currently working part time, makes about 65K CDN and she pays about 32% in taxes. I know this because I handle the payroll of the pharmacy's employees. I think the higher ranges of taxes are about 37-40%, with no way it being about 50%.... that's ludicrous.
I'm sorry I made a mistake. I think I was not accurate on the bracket. If you look at this site on the tax bracket Canadian tax brackets (http://www.taxtips.ca/tax_rates.htm)
The actual marginal rate is actually 46.4% (combined provincial and federal) for income above CD$118K. This was actually lower (due to tax cuts) compared to when I was there. So you are right that you might pay 32% if your income is 65K. But doctors definitely will pay 46% unless you incorporate (which a lot of practice do).

I'm sorry I made a mistake. I think I was not accurate on the bracket. If you look at this site on the tax bracket Canadian tax brackets (http://www.taxtips.ca/tax_rates.htm)
The actual marginal rate is actually 46.4% (combined provincial and federal) for income above CD$118K. This was actually lower (due to tax cuts) compared to when I was there. So you are right that you might pay 32% if your income is 65K. But doctors definitely will pay 46% unless you incorporate (which a lot of practice do).

Yeah, I was partially wrong too, thinking that the upper limits would be around 37-40% for most of Canada, with the exceptions of Alberta and Nunavut...sorry. Thanks for the site, BTW :D

Canada...

Here's the salaries of Canadian MD's per specialty:

www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf (http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf)

And for America:

www.aamc.org/students/cim/specialties.htm

Who is getting screwed?
It should be interesting to hear from all those americans who love belittling the pay of Canadian MD's after they actually do the side by side comparison. :laugh:

This is comparing apples to oranges: These figures are misleading because the Canadian physicians' income shown here is what they BILL the provincial insurance, NOT their salary. Majority of MD's in Canada work fee-for-service, and are not salaried. You have to deduct their office overhead (expenses for rent, secretaries, nurses etc) to arrive at a pre-tax income. If you know anyone who has an office, you know that their overhead hovers around 30 to 40 %.
The US physicians' salaries are just that: salaries. Or their pre-tax income.

Having practiced both in Canada and the US, I know for a fact that physicians, on average, make more $ in the US. No argument there.

No need for all the flattery. I was just raised to be responsible, in my family that was expected. You do have a point that maybe my cancer had something to do with me being so aware of healthcare, but I firmly believe I would have kept my health insurance up to date even without that experience. It's just how I was raised. I was also raised to help the less fortunate and that is why I will happily give free care to people that have a legitimate need and ASK.

U (Dr.V) talked about how there really are ppl who are simply unwilling to work in america.. not wanting to work at McDonalds etc etc. I AGREE. thats a social epidemic in america, and u state that its the result of years of social programs... i'd also add that its probly also due to decades of social/government policy of discrimination towards ppl who wanted nothing more than equal opportunity but got the door closed during year of the civil rights movement. But thats A WHOLE DIFFERENT TOPIC.

Well I can say 100% without a doubt this is not the case for the people I am talking about. I am a hillbilly, there were exactly two minoritys in my entire county and they were in their 80's, married to each other, and they were good, hard working folks that never asked for anything from anyone. They were the only ones in the entire county so "decades of descrimination" were not a factor. (Heck I had to drive 30 minutes to work at McDonalds as we didn't have any fast food or grocery stores in the county either). I saw fine, upstanding families turn into sorry, lazy trash in two or three generations. The first generation usually had a legitimate reason for the government assistance, (accident leaving them unable to work etc), the second saw how easy that was and soon lost the remorse and guilt of not working and by the third generation expecting everything handed to them through taxing of other people is a way of life. There are exceptions in both directions, but by and large the mentality of entitlement grows every year due to being raised that it is OK to do so. Basically this group of people were TAUGHT by our government that they should just lay around and live off the hard work of others. It's encouraged by the government employees (after all they need job security, they are there to "help" people, but their definition of help is getting them the most taxpayer dollars they can.) It will only get worse with each generation and each new entitlement program because we don't think people should "feel bad" about themselves etc, which encourages bad behavior.

I do respect the fact that you don't want anyone to suffer. I don't either but I feel that handouts and "free" services don't help anyone and only foster helplessness. The old saying about teaching a man to fish and all. ;)

Whether the study is reliable doesn't matter. It would only matter if healthcare was a human right. It is not a right. If it were a right you could get your panties in a wad about access. Since it's not a right, I don't care.

By the way, is it possible that there are cultural differences in our countries which contribute to the health of the population? Hard to believe this study found a way to control all variables except the type of healthcare system.

Whether the study is reliable doesn't matter. It would only matter if healthcare was a human right. It is not a right. If it were a right you could get your panties in a wad about access. Since it's not a right, I don't care. As much as i'd love to let this thread end as is... i take exception to the statement that "[healthcare] is not a [human] right". According to who? if we were talking about... lets say dentistry, then i'd agree but the fact that healthcare is guaranteed in emergent cases- in the US- owes to the fact that it is a right not a privilege. The fact that non-emergent cases are pay per visit in the US owes to the fact that capitalism can trump rights- kinda like the way americans pay more for the exact same drugs that canadians get; capitalism, although present in both countries, does not have as heavy an influence north of the border.
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By the way, is it possible that there are cultural differences in our countries which contribute to the health of the population? Hard to believe this study found a way to control all variables except the type of healthcare system.I'm pretty sure that the study's validity shouldn't hinge on Canada being a cultural mirror image of the States not only because such a feat would be impossible but also because what two independent western countries in the world share as much in terms of culture as do Canada and America? At what point to do u stop irrationally trying to discredit the study because it doesn't "control all variables except the healthcare system" and just accept what u shouldn't really need a study to slap u in the face with.