NICE + NHS = ICER...

[Blitz2006]

Here is a very objective study, published in Diabetes Care, ADA Journal, comparing Canada vs. USA glycemic control in Type 1 Diabetics.

http://care.diabetesjournals.org/content/25/7/1149

"After adjustment for baseline demographic, lifestyle, and clinical factors, HbA1c levels tended to be slightly lower (not statistically significant) in Canadian patients."

---

Members don't see this ad.

 

[Blitz2006]

Take off your politician's hat for a minute. Which would you prefer, as an INDIVIDUAL with a serious medical concern: a premier health plan in the US, with MRIs everywhere, or care in Canada, with its focus on preventative care?

If it was cancer or STEMI or Parkinson's Disease. Canada. No paperowrk, no co-pays, no deductibles. The outcomes are the same, so who cares. I don't want to deal with the headaches that I see patients deal with all the time here.

Here's a great study from JAMA comparing CABG outcomes in Canada vs. USA, a serious intervention/health issue :

http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486634

"Canadian patients also had lower rates of unadjusted in-hospital mortality (1.4% vs 2.2% [P = .004]) (Table 2). However, after controlling for demographic and clinical differences, there was no significant difference in mortality between countries (Table 4).

So even if I had the rolls-royce of insurance in USA, I still would have the same outcome if I got treated in Canada. Without any of the headaches. Just show my Photo ID in Canada and thats it. And the Cardiac surgeon in Canada is not poor either, he/she is making 500-600k minimum. So its win-win for everyone.

But yes, if I had a super rare condition, or needed to be separated from my siamese twin - USA takes the cake. This is the best place on the planet for ultra specialized medicine. No doubt. OR if I didnt' want to wait 9 months for a hip replacement, then I would consider the U.S.

Thats not my argument. My argument is for the 99% of patients that have mainstream illnesses, like diabetes, STEMIs, etc. As I have argued earlier, there are pros of the U.S private/capitalist healthcare, lets just try to tilt the scale a little more to the other side and improve access/efficient spending. Thats all.

 

[Aether2000]

Again, healthcare outcomes are the same for the US and Canada only because the US population is much less healthy than Canadians as demonstrated above. Take a less healthy population and apply a mediocre medicine system, and I guarantee the outcomes will be worse. I am not arguing that the mediocre Canadian healthcare system is wrong for the US- I believe it is inevitable. But it comes with a cost, and the rosy picture of a utopian Canadian system presented in this thread comes with strings attached. In order to be accepted in the US, there will have to be a major mindset shift in the American public, in hospital funding and administration and focus, in pharmaceuticals, in ancillary services that will be greatly diminished under a single payor system, in litigation, and in insurance costs. Most of these will require comprehensive legislative reform that will need to go much further than Obama did in order to achieve control over our health care spending that now costs as much as 18% of our GDP, and nearly double that of Canada. However, even the Canadian system bite out of the GDP continues to accelerate, so in order to make a healthcare system long term sustainable, there will have to be other sacrifices in care, even beyond those seen in Canada.

The contention that emergency services are always available in Canada if needed is not born out by a recent study: http://www.theglobeandmail.com/news...g-patients-ontario-a-g-finds/article33100229/
A quarter (24%) of all Canadians waited 4 hours or more in the emergency room.[70]

Some cities such as Toronto have hospitals operating at 118% capacity because the Canadian health care system is not nimble enough to build more capacity into the system, and in fact with health care cuts the past year, is in even worse shape. http://www.theglobeandmail.com/news...er-capacity-documents-reveal/article30054790/

With the new tax changes that will slam some medical specialists in Canada with tens of thousands of dollars in new taxes, it is likely there will be a mass exodus of these specialists to the US. http://www.theglobeandmail.com/news...s-over-new-federal-tax-hikes/article33118694/

Other downsides to Canadian Healthcare from formosapost.com and others
1. Health care providers are limited to what they can charge by the government. This limit can cap the earning potential of various providers and make it harder to pay back loans, limit their earning potential, and undermine their overall life. The limit of what they can charge may not keep pace with their cost of living. In other words, these potential health care providers, as well as practitioners, are authorized by the government to charge their patients for a specific amount of money in terms of treatments and other medical bills. Most of the medical bills, however, are relatively high and surprisingly the fees are mostly paid by taxpayers. In some cases, health care providers are paying off their loans to keep up with their businesses, since taxpayers feel the burden to pay high-cost fees. As a result, some health care providers have poor services. This is also a reason patients are on a waiting list.

2. The health care revenues are redistributed according to demographics but the rural areas may not get the funding that they need to cover all costs like the larger cities do. The facilities in these locations are improved at a slower rate which may require patients to go to city centers to get the care that they need there can be a shortage of specialists and doctors in these areas. In general, the life of the population in rural Canada have higher rates of deaths as well as infant mortality. Due to the lack of knowledge about health issues, the rural areas have very little accesses especially on health education. The number of general practitioners are also very less since the urban area offers more opportunities to grow. It’s also a challenge for these practitioners to treat patients with serious illnesses and that it will take time to transfer them to a bigger hospital. Therefore, it has been a serious matter as of today for the rural Canadians to get their fair share of health care system.

3. The downside of the Canadian health care system is highly a matter of a political issue towards decision making strategy in terms of the direct involvement from the federal level, meaning the public system, or by private funding on the health care outcomes. At the federal level, particular provinces in Canada are mostly responsible for all the administrative processes and the policies of the health care system itself. Whereas, private fundings and services comes from a more private level clinics who can do shorter wait lists for patients. These issues will be unfair especially for low income people and the urban population.

4. Wait times can be long in Canada, both for access to see a specialist, then for access to a hospital to perform the surgery. "Access to a waiting list is not access to health care", wrote Chief Justice Beverly McLachlin of the Canadian Supreme Court. The length of waiting times has reached 20 year highs in 2015. Canada had the longest waits for primary and specialist care of all 11 common wealth countries, and every province had significantly longer waits than the international average[69] Most non-emergency surgeries will require wait times. These wait times may put the patient at risk while they wait for a surgery or their condition may deteriorate as they wait. Those that need priority care make the wait times for others very frustrating. Seniors, those with life threatening conditions, and other urgent cases will be looked after first while others can sometimes wait a long time. Moreover, today, in 2016, these wait times circumstances have becoming more critical since of last year. This year’s waiting times are the longest it’s ever been recorded since 1993. From 9.3 weeks wait list in 1993 went up to 20 weeks, just an increase of 2.3 weeks in 2015. The total wait times that are faced by patients are evaluated in two continuous process. First, patients well-being are being referred from a general practitioner to a specialist. Second, referral from a specialist directly to where patients receive actual treatments. Again, this has become a serious issue for those with serious illnesses.
https://www.fraserinstitute.org/stu...t-times-for-health-care-in-canada-2015-report

5. Single payer reduces creativity. There is no financial incentive for people in research to develop new medicines or new treatment technologies in a single payer system because the government dictates the pay scale for all medical and research professionals. Consider the few advances in medicine that have come from Canada compared to the US. When we reduce the US system to the same mediocre Canadian system, advances in medicine will likely slow considerably.

6. Single payer health care systems can promote abuse of the system as a form of welfare. Many instances have been reported of drug addicts receiving free medical care as well as the drugs that they have become addicted to. The practice is considered to be subsidized drug abuse by some.

7. Some argue that single payer health care systems promote a larger number of people that are welfare recipients. The contention is why work when you can live fairly well off of the efforts of others.

8. One of the largest overlooked factors when comparing the two healthcare systems is lawyers. The US has over 1,000,000 lawyers and a legal system that guarantees the right to sue doctors and hospitals at no cost to the plaintiff. There are 3.6 lawyers per 1000 population in the US and 2.8 per 1000 in Canada, yet Canadians file 1/4 the number lawsuits per capita overall and 1/10 the number of medical malpractice lawsuits per capita because of a profoundly restrictive (and what I consider better) legal system. But without changing the entire legal system in the US, a single payer system could not survive in the US. Part of the mediocre care that Canada renders is that patients wait longer to receive advanced diagnostic testing, since there is no down side. Doctors are protected from litigious patients in Canada partially due to the restrictive legal system, but partially due to the standard of care is lower in Canada, not requiring early diagnostic testing. The medical system in Canada is more relaxed, and if they miss some zebras because they wait long periods before finally obtaining diagnostic testing, then so be it. It is the standard of care there. Not so in the US- changing to a single payer system with the necessary dilution of advanced medical services without drastic changes in the legal system would quickly overwhelm the medical system with litigation in the US.

 

[Blitz2006]

Again, healthcare outcomes are the same for the US and Canada only because the US population is much less healthy than Canadians as demonstrated above. Take a less healthy population and apply a mediocre medicine system, and I guarantee the outcomes will be worse.

You keep using this argument over and over again. I've posted several studies that show when you select patients of equal, lower health (ie. diabetic, requiring CABG, etc.), the outcomes are the same. Just because you are calling it mediocre, doesn't make it mediocre.

The contention that emergency services are always available in Canada if needed is not born out by a recent study: http://www.theglobeandmail.com/news...g-patients-ontario-a-g-finds/article33100229/
A quarter (24%) of all Canadians waited 4 hours or more in the emergency room.[70]


http://www.businessinsider.com/utah...room-wait-time-average-is-a-us-record-2011-11

Ok well, the average wait time in USA ER is 4 hours and 9 minutes.
The average wait time in Canada ER is 4 hours. So its the SAME

Here is the official stats of Canada ER wait time: https://www.cihi.ca/en/health-syste...ait-times/canadians-continue-to-wait-for-care

But yes, you are correct with the percentage of people waiting more than 4 hours:

"Canada actually has the highest percentage of patients waiting four hours or more in the ED before being treated."

Some cities such as Toronto have hospitals operating at 118% capacity because the Canadian health care system is not nimble enough to build more capacity into the system, and in fact with health care cuts the past year, is in even worse shape. http://www.theglobeandmail.com/news...er-capacity-documents-reveal/article30054790/

Ok and there are hospitals in the U.S that are overcapacity. Official study on overrcapacity of ERs in USA:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540619/

Take a look at Figure 1, and you can see all the EDs in the U.S that are overcapacity, ranging from teaching hospitals to rural hospitals.

You honestly don't think there are hospitals in NYC/SF that are not overcapacity??



With the new tax changes that will slam some medical specialists in Canada with tens of thousands of dollars in new taxes, it is likely there will be a mass exodus of these specialists to the US. http://www.theglobeandmail.com/news...s-over-new-federal-tax-hikes/article33118694/

Sure, Liberal Justin Trudeau came in 1 year ago and hiked taxes. Just like Obama came in 8 years ago and hiked taxes, and now trump is in and taxes are lowered. And in 4 years from now when someone else comes in and hikes taxes. Its cyclical. Canada's healthcare has been universal since 1961. One recent election result shouldn't be a factor.

Other downsides to Canadian Healthcare from formosapost.com and others
1. Health care providers are limited to what they can charge by the government. This limit can cap the earning potential of various providers and make it harder to pay back loans, limit their earning potential, and undermine their overall life.



I mean, this is wrong.

http://www.medpagetoday.com/publichealthpolicy/publichealth/15931

"In Canada, a family practitioner can expect to take home, on average, $140,124 a year, from a gross income of $216,575, according to the Canadian Medical Association.Again, the specialists have higher incomes. In 2006/2007, the average gross income for a medical specialist was $262,429 and for a surgical specialist was $362,878."

I know here in NYC area academic pain jobs pay around 240k, and group practice setting around 275-300k. I understand its NYC, and its lower in the northeast, but the pay is not that much higher overall here in the U.S. I suspect the average medical specialist earns 300k and surgical specialist 400k in the U.S. But no way are Canadian doctors "undermined".


2. The health care revenues are redistributed according to demographics but the rural areas may not get the funding that they need to cover all costs like the larger cities do. The facilities in these locations are improved at a slower rate which may require patients to go to city centers to get the care that they need there can be a shortage of specialists and doctors in these areas. In general, the life of the population in rural Canada have higher rates of deaths as well as infant mortality. Due to the lack of knowledge about health issues, the rural areas have very little accesses especially on health education. The number of general practitioners are also very less since the urban area offers more opportunities to grow. It’s also a challenge for these practitioners to treat patients with serious illnesses and that it will take time to transfer them to a bigger hospital. Therefore, it has been a serious matter as of today for the rural Canadians to get their fair share of health care system.

Well yeah...but you honestly think people in rural areas of US get the same level of care in Boston/NYC/SF? Thats ridiculous!

https://www.ruralhealthweb.org/about-nrha/about-rural-health-care

This entire link shows you how inequal rural vs. urban healthcare is in the U.S.

"Ease of access to a physician is greater in urban areas. The patient-to- primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas. This uneven distribution of physicians has an impact on the health of the population."

3. The downside of the Canadian health care system is highly a matter of a political issue towards decision making strategy in terms of the direct involvement from the federal level, meaning the public system, or by private funding on the health care outcomes. At the federal level, particular provinces in Canada are mostly responsible for all the administrative processes and the policies of the health care system itself. Whereas, private fundings and services comes from a more private level clinics who can do shorter wait lists for patients. These issues will be unfair especially for low income people and the urban population.

"These issues will be unfair especially for low income people and urban population".!?!???

Right, because Medicaid for low income people is the pinnacle of "fairness"........?????!

4. Wait times can be long in Canada, both for access to see a specialist, then for access to a hospital to perform the surgery. "Access to a waiting list is not access to health care", wrote Chief Justice Beverly McLachlin of the Canadian Supreme Court. The length of waiting times has reached 20 year highs in 2015. Canada had the longest waits for primary and specialist care of all 11 common wealth countries, and every province had significantly longer waits than the international average[69]Most non-emergency surgeries will require wait times. These wait times may put the patient at risk while they wait for a surgery or their condition may deteriorate as they wait. Those that need priority care make the wait times for others very frustrating. Seniors, those with life threatening conditions, and other urgent cases will be looked after first while others can sometimes wait a long time. Moreover, today, in 2016, these wait times circumstances have becoming more critical since of last year. This year’s waiting times are the longest it’s ever been recorded since 1993. From 9.3 weeks wait list in 1993 went up to 20 weeks, just an increase of 2.3 weeks in 2015. The total wait times that are faced by patients are evaluated in two continuous process. First, patients well-being are being referred from a general practitioner to a specialist. Second, referral from a specialist directly to where patients receive actual treatments. Again, this has become a serious issue for those with serious illnesses.
https://www.fraserinstitute.org/stu...t-times-for-health-care-in-canada-2015-report

Yes, this is one argument I agree on. But I've said this all along this thread. Wait times are longer in Canada.

Here is fact-check on the crappy Canada wait times: http://www.factcheck.org/2007/12/comparing-health-care-in-canada-to-the-us/

But again, health outcomes as I continue to beat on a drum, are the same: "But these statistics simply don’t support the notion that universal, single-payer health care is crippling the health of Canadian citizens compared with that of U.S. citizens."



5. Single payer reduces creativity. There is no financial incentive for people in research to develop new medicines or new treatment technologies in a single payer system because the government dictates the pay scale for all medical and research professionals. Consider the few advances in medicine that have come from Canada compared to the US. When we reduce the US system to the same mediocre Canadian system, advances in medicine will likely slow considerably.

???????

Was this written by a highschool kid? Like seriously, McGill, Toronto, McMaster are some of the leading research centers in the world. I'm not even going to waste my time on this.

6. Single payer health care systems can promote abuse of the system as a form of welfare. Many instances have been reported of drug addicts receiving free medical care as well as the drugs that they have become addicted to. The practice is considered to be subsidized drug abuse by some.

7. Some argue that single payer health care systems promote a larger number of people that are welfare recipients. The contention is why work when you can live fairly well off of the efforts of others.

http://www.cnsnews.com/commentary/terence-p-jeffrey/354-percent-109631000-welfare

But the 109,631,000 living in households taking federal welfare benefits as of the end of 2012, according to the Census Bureau, equaled 35.4 percent of all 309,467,000 people living in the United States at that time.

For interest sake, Japan has a wielfare level of 1.71%.

http://www.japantimes.co.jp/news/20...0-years-1-46-million-researcher/#.WGe7ufkrIdU

Meaning, Welfare and universal healthcare are 2 separate entities. Also illustrating the fact that welfare is to some extent cultural bound. I mean, Japan has universal Healthcare, but that cannot be the sole reason why the welfare percent is astronomically low.

I mean according to OECD, US spends 19% of GDP on Welfare, Canada spends 17%.

https://ftalphaville.ft.com/2014/11/27/2053392/welfare-spending-across-the-oecd/

But again, I think welfare and healthcare are 2 separate entities, irrelevant in this discussion. But this is just my opinion, not based on any studies or facts.


8. One of the largest overlooked factors when comparing the two healthcare systems is lawyers. The US has over 1,000,000 lawyers and a legal system that guarantees the right to sue doctors and hospitals at no cost to the plaintiff. There are 3.6 lawyers per 1000 population in the US and 2.8 per 1000 in Canada, yet Canadians file 1/4 the number lawsuits per capita overall and 1/10 the number of medical malpractice lawsuits per capita because of a profoundly restrictive (and what I consider better) legal system. But without changing the entire legal system in the US, a single payer system could not survive in the US. Part of the mediocre care that Canada renders is that patients wait longer to receive advanced diagnostic testing, since there is no down side. Doctors are protected from litigious patients in Canada partially due to the restrictive legal system, but partially due to the standard of care is lower in Canada, not requiring early diagnostic testing. The medical system in Canada is more relaxed, and if they miss some zebras because they wait long periods before finally obtaining diagnostic testing, then so be it. It is the standard of care there. Not so in the US- changing to a single payer system with the necessary dilution of advanced medical services without drastic changes in the legal system would quickly overwhelm the medical system with litigation in the US.

This is the only argument so far that you have presented that I agree with 100%. But this has nothing to do with healthcare/healthcare outcomes. U.S Legal system is completely separate. I just find it sad that here in the U.S, arguable the most "free" country in the world, and yet we are bound by lawyers!?!?
But I do understand that medical-legal culture is strongly embedded in healthcare here, so this is a very reasonable argument.


At the end of the day, I still have yet to be convinced that its better to have healthcare in U.S vs. Canada. Even the waiting times is blown out of proportion. The whole point of healthcare is to have the best outcome. Its not a race to have the most MRIs or the shortest waiting time. Lets say you were diagnosed with cancer, you have 1 year to live assuming you do nothing, and the doctor gave you 2 options:


1) Wait 2 months to have surgery but you will have 95% chance of dying within 1 year.
2) Wait 6 months to have surgery but you will have 95% chance of living after 1 year.

Which option would you pick?

Its all about outcomes.

This is why I came to the U.S. This is the greatest country in the world for evidence based medicine, research. So why can't we apply evidence base to real world issues, like Healthcare, climate change etc?

 

[Ducttape]

This is an interesting discussion. I'd like to add that the goals of both current health care systems are vastly different. Our US system seems geared towards treating existing conditions with heroic treatments. We pay so little attention to preventative medicine.

My suspicion is that the results of similar outcomes is because of this discrepancy.

Now,
Imagine a system that emphasizes preventative medicine and only needs heroic interventions (i.e. Surgery, chemo, even pain interventions) rarely. Unfortunately that will take away a lot of money to hospitals and surgeons (and us, I'm afraid)...

so it's never going to happen. At least, hopefully not til we all retire


Sent from my iPhone using SDN mobile

 

[Aether2000]

Unfortunately you argue that patient suffering is simply an accepted fact in the Canadian system, but acknowledge the time of suffering is much less in the American system, yet you contend all this really doesn't matter because at the end of a year, both patients are alive and breathing. This is probably because of naivite concerning the costs of waiting for health is not all that important in Canada since there are social safety nets to provide for loss of wages and pay the rent whereas in America their safety nets are sometimes delayed by years in implementation. However, it is also a pervasive attitude among Canadian doctors and patients alike that suffering has neither merit nor value, as long as the patient survives.

Also you are naive with respect to the effect of the legal system and the medical system in the US, since many physician decisions regarding patient treatment are strongly influenced by the legal system in the US, but not in Canada.

The average wait in the hospital ERs from arrival to discharge is 2 hours and 15 minutes (http://newsroom.acep.org/fact_sheets?item=29937). You are quoting nearly decade old data.

Regarding taxes- more difficult to evaluate as a take home pay. Canadians making $250,000 (20,833 per month) pay federal, state, and payroll taxes of 46%. Then there is the GST/HST. This tax is up to 15% in Canada on all services, some foods and services, and on electricity. It averages $5000-$10,000 extra in taxes per year for a person making $250,000, therefore raising the tax burden to 50%. The same federal, state, and payroll tax burden in Florida is 30% for that income level. The cost of housing in Canada is much much higher than in the US. The average home price in Canada nationally is $489,000 in 2016 whereas in the US it is $188,000. In some cities such as Vancouver, the AVERAGE house price is $1,077,000 and in Toronto is $710,000. So please, don't try to tell me Canadians have the same spending power as the average American nor that doctors do just as well in Canada even if they make the same yearly $ income.

Of course we could continue this academic jousting all day, but the patient populations are far different, the expectations of patients and doctors are different. I hold steadfastly that Canadian medicine is mediocre, but the reason Canadian doctors dispute this is because they practice medicine differently than in the US and they don't know any difference.

 

[Stim4me]

I always remain cautious when relying on studies comparing healthcare systems internationally. We have enough confounding factors when comparing state by state outcomes. Does Canada have a 3-4 day work week and 3 month vacation-mandate like France and Norway. Is there mandated strike day every Thursday like france . Point is that the work load , stress levels, a chronic LBP, WC injuries, etc are different in captitalist vs socialized countries . There are Many factors why healthcare is costly and considered "over utilized" in the USA.

 

[Blitz2006]

Unfortunately you argue that patient suffering is simply an accepted fact in the Canadian system, but acknowledge the time of suffering is much less in the American system, yet you contend all this really doesn't matter because at the end of a year, both patients are alive and breathing.

No, I'm saying this matters because in Canada, ALL PATIENTS are alive and breathing, not just the ones that have good or any insurance. insurance.

This is probably because of naivite concerning the costs of waiting for health is not all that important in Canada since there are social safety nets to provide for loss of wages and pay the rent whereas in America their safety nets are sometimes delayed by years in implementation. However, it is also a pervasive attitude among Canadian doctors and patients alike that suffering has neither merit nor value, as long as the patient survives.

There's no difference in safety nets between Canada and U.S. I'm not sure what to say to this.

Also you are naive with respect to the effect of the legal system and the medical system in the US, since many physician decisions regarding patient treatment are strongly influenced by the legal system in the US, but not in Canada.

I'm not naive. I acknowledged your statement and even agreed with it.

The average wait in the hospital ERs from arrival to discharge is 2 hours and 15 minutes (http://newsroom.acep.org/fact_sheets?item=29937). You are quoting nearly decade old data.

Ok, nice find. I admit that you are correct on this one.

Regarding taxes- more difficult to evaluate as a take home pay. Canadians making $250,000 (20,833 per month) pay federal, state, and payroll taxes of 46%. Then there is the GST/HST. This tax is up to 15% in Canada on all services, some foods and services, and on electricity. It averages $5000-$10,000 extra in taxes per year for a person making $250,000, therefore raising the tax burden to 50%. The same federal, state, and payroll tax burden in Florida is 30% for that income level. The cost of housing in Canada is much much higher than in the US. The average home price in Canada nationally is $489,000 in 2016 whereas in the US it is $188,000. In some cities such as Vancouver, the AVERAGE house price is $1,077,000 and in Toronto is $710,000. So please, don't try to tell me Canadians have the same spending power as the average American nor that doctors do just as well in Canada even if they make the same yearly $ income.

I never once argued about home prices, I was talking about gross income. Homes are definitely cheaper overall in the U.S. But now you're bringing in economic factors. If you want to bring in home prices into the equation, lets talk about cost of putting kids through college in the U.S? You conveniently brought up home prices, but didn't mention education costs. I'm looking at this purely from a healthcare outcomes point of view. If you want to put 4 kids in medical school in the U.S, vs. Canada/UK, you don't think thats a factor? Educating children in the U.S financially is just as big deal as buying a house. I think we can both agree on that?

Sure taxes are much higher in Canada and UK. But did you know that to go to medical school in England, you can go straight from highschool and start residency at the age of 23? Which means you start earning roughly 5 years earlier than the average US MD grad (28 years old). And did you know that all medical schools in England are 3 000 pounds/year flat (whether you go to University of Nottingham or Cambridge Medical school, top 5 in the world by the way). The average medical student in the UK walks out with debt of around 15-20K USD. But of course, its not that black and white, attending docs in the UK earn much less, etc. But residents earn a starting salary of 50K USD and shoots up to 75K USD by PGY4. And this rate is fixed, throughout the country. So this is where it gets messy. I'm not saying the UK is a better place for doctors financially, but if you're starting to bring in factors like "Housing prices", then this discussion gets much more complex. Buying a house isn't the only financial factor to consider.

And you also unfairly chose the 2 more expensive cities in Canada to further solidfy your argument. I can easily flip it and say American home prices are ridiculously high and use SF/NYC as my examples.

The AVERAGE house price in San Francisco is:
http://www.zillow.com/san-francisco-ca/home-values/
$1,132,300.

The AVERAGE house price in NYC is:
(Manhattam: $1.872 million, Brooklyn: $788,529):
https://www.dnainfo.com/new-york/20...e-prices-brooklyn-queens-hit-new-record-highs

But like you said, it is difficult to evaluate. The physician in smalltown Texas has much more spending power than the physician in SF/NYC. Just like in Canada, the physician in small town Alberta has much more spending power than the physician in Toronto.

Another financial factor you have to consider are overhead costs. In Canada, you can run a solo practice getting by with just a secretary. You don't need a PA, NP, Medical Assistants, etc. There is no redtape with pre-authorizations, pharmacies calling you about insurance issues, speaking to insurance companies. You prescribe Cymbalta, thats the end of discussion. You want a patient to get a Stim, done. You don't need a medical assistant to answer annoying phone calls from pharmacies or insurance companies. Doctors in Canada rarely speak to pharmacies, I know this.

Of course we could continue this academic jousting all day, but the patient populations are far different, the expectations of patients and doctors are different. I hold steadfastly that Canadian medicine is mediocre, but the reason Canadian doctors dispute this is because they practice medicine differently than in the US and they don't know any difference.

Thats great. But I know tons of American doctors working in Canada that prefer the Canadian system, and tons of Canadians working in the U.S that prefer the Canadian system. And they do know the difference (American and Canadian doctors). But this is useless fodder for this discussion, I prefer discussing with objective stats, instead of me bringing up anecdotal data. I don't expect you to care what my friends think. I hold steadfastly (as well as many of my Canadian AND AMERICAN colleagues) that both healthcare systems provide equal outcomes, but Canada has better access.

 

[Blitz2006]

I always remain cautious when relying on studies comparing healthcare systems internationally. We have enough confounding factors when comparing state by state outcomes. Does Canada have a 3-4 day work week and 3 month vacation-mandate like France and Norway. Is there mandated strike day every Thursday like france . Point is that the work load , stress levels, a chronic LBP, WC injuries, etc are different in captitalist vs socialized countries . There are Many factors why healthcare is costly and considered "over utilized" in the USA.

Canadians work roughly the same number of hours/week as Americans. I presume you are joking about the 3 month vacation mandate/strike every Thursday comment on France...

http://www.huffingtonpost.ca/2012/05/10/vacation-time-canada-holidays-by-country_n_1506752.html

"According to a study from Mercer Consulting, released late last year, Canada has fewer government-mandated holidays than any developed country, including even the United States. Canada has 19 mandated days off, including calendar holidays and minimum vacation requirements, and excluding some provincial holidays.
By comparison, the United States has about 25 days, the survey found. That compares to 36 days in the United Kingdom, 30 in Australia, and 29 in Germany."

It should be noted: (The U.S. number was calculated differently. Because the U.S. is the only developed country not to mandate any paid vacation time, Mercer calculated the number using the typical minimum given by companies.)


http://fortune.com/2015/11/11/chart-work-week-oecd/

USA: 34.4 hrs/week
Canada: 32.8 hrs/week


But with regards to physicians in Canada. Its mainly Fee For Service. You eat what you kill. You want to work 7 days a week, 80 hours x 365 days. Go for it. No one is stopping you. You can work like a maniac in Canada if you want, since you don't have as much paperwork/redtape. There are doctors that only take 1 week of vacation. Or you can take 16 weeks. If you work, you get paid. If you don't work, you don't get paid. Its simple.

Obviously, if you take 16 weeks of vacation, you're gonna lose your patients and/or the hospital will find someone who will work harder.

 

[Aether2000]

Again, it is a mindset and tolerance of mediocrity. A person having to wait in Canada for a year for a knee surgery while suffering has the same ultimate outcome as an American patient getting the knee replacement in 3 weeks. Same outcome, mediocre Canadian care. HOWEVER- I think we WILL have some form of the Canadian system eventually, post- Trump. It will be a backlash against the lack of a viable system. We will migrate to a lower cost system, and for all its issues, the Canadian system works

 

[Ligament]

You guys espousing the wonderful Canadian healthcare system are crazy. I have Canadian patients driving down to Seattle frequently, because otherwise they have to wait 6 MONTHS for a sacroiliac joint injection, 6 MONTHS for an MRI, or 1 year to see a pain specialist in consultation. Sure, its free, but it SUCKS.

I just had a Canadian come down last week and self pay for a SCS trial, which he was told he'd need to wait 10 months for in Canada.

Yes, Canadian doctors make great money and have a great lifestyle with lots of vacation, primarily because they have closed the door to FMGs and foreign doctors, and tightly control the supply and demand of physicians in Canada by themselves. They've done a great job being stuck in a socialized system. The board exams are designed to be passed only if you have completed a Canadian residency, as the residency is geared toward passing very specific board questions and scenarios.

 

[hyperalgesia]

Again, it is a mindset and tolerance of mediocrity. A person having to wait in Canada for a year for a knee surgery while suffering has the same ultimate outcome as an American patient getting the knee replacement in 3 weeks. Same outcome, mediocre Canadian care. HOWEVER- I think we WILL have some form of the Canadian system eventually, post- Trump. It will be a backlash against the lack of a viable system. We will migrate to a lower cost system, and for all its issues, the Canadian system works

The VA system works in large part because it is competing against the private market. I think Canada might be the same way, comparing themselves to America. Once US healthcare goes socialist, which I agree is inevitable, what will prevent further degradation to mediocrity and worse?

 

[Blitz2006]

You guys espousing the wonderful Canadian healthcare system are crazy. I have Canadian patients driving down to Seattle frequently, because otherwise they have to wait 6 MONTHS for a sacroiliac joint injection, 6 MONTHS for an MRI, or 1 year to see a pain specialist in consultation. Sure, its free, but it SUCKS.

http://www.ctvnews.ca/health/more-t...road-for-medical-care-in-2014-study-1.2283121

"A report by the Fraser Institute released Tuesday estimates that 52,513 Canadians sought non-emergency medical treatment last year. The number increased by 26 per cent compared to 2013."

So 0.15% of Canadian population probably think Canada's healthcare sucks. Well, maybe. They might also just be impatient, but could still respect Canada's healthcare.

http://kdvr.com/2015/03/25/americas-favorite-illegal-canadian-import-prescription-drugs/

I can also flip the argument and say Americans think U.S healthcare sucks because of the high cost of prescription drugs, and the fact that 2% of Americans have to cross border to get drugs:

"One survey found 2 percent of American adults buy their medications from Canadian pharmacies but Graczyk says even more Americans simply go without. “A study in 2012 by the Commonwealth Fund basically said that 51 million Americans did not fill their prescription due to costs in 2012.”

I can also argue (anecdotally) that I have friends who are physicians in Windsor who treat Americans crossing the tunnel from Detroit. Why? Because they have crappy insurance and feel the healthcare "sucks" in USA and get it better in Canada (illegally I might add).

WHO Rankings of Healthcare Systems:

http://thepatientfactor.com/canadia...zations-ranking-of-the-worlds-health-systems/

Canada: 30
USA: 37

If Canadian healthcare sucks so much, why is it 7 spots ahead of USA?



“Everyone in Canada is covered by a single payer — the government. But Canadians wait for practically any procedure or diagnostic test or specialist consultation in the public system.”

Vancouverite Finley: “That’s sheer b.s.”

I heard Gratzer say the same thing on Seattle radio station KIRO this week.

Trouble is, it’s nonsense.

http://www.huffingtonpost.com/bill-mann/americans-whove-used-cana_b_215256.html


Ironic how I found an article talking about Seattle media brainwashing Americans on Canadian healthcare......


Yes, Canadian doctors make great money and have a great lifestyle with lots of vacation, primarily because they have closed the door to FMGs and foreign doctors, and tightly control the supply and demand of physicians in Canada by themselves. They've done a great job being stuck in a socialized system.

This is 100% CORRECT.

The board exams are designed to be passed only if you have completed a Canadian residency, as the residency is geared toward passing very specific board questions and scenarios.

This is incorrect.

You can complete a U.S Residency and do Canadian boards. Think of all the Canadian IMGs that do residency in USA and then move back to Canada. There are many dual boarded doctors on both sides of the border. There is a reciprocal treatment between Canada and USA for boards. Just like only Canadians and Americans can do the American boards. My friends in the UK cannot come to the U.S to work, because they have done their residency training in England. You must have Canada or U.S residency training to do American boards.


http://www.royalcollege.ca/rcsite/c...ment-routes-international-medical-graduates-e

"International medical graduates are people who have completed their postgraduate residency training outside Canada or the United States. Applicants do not have to live in Canada or hold Canadian citizenship to be eligible for Royal College exams."

 

[hyperalgesia]

WHO Rankings of Healthcare Systems:
http://thepatientfactor.com/canadia...zations-ranking-of-the-worlds-health-systems/
Canada: 30
USA: 37
If Canadian healthcare sucks so much, why is it 7 spots ahead of USA?

I don't give a flying fk what WHO thinks about how we practice medicine in the US. The anecdotes from some of the guys on this forum hold much more weight than all the articles you posted and the WHO grading system combined. We are leaders in the US, not followers. When I see people I respect going to Canada, and I myself wish to go to Canada for medical care, that's when I will want to make our system more like Canada's.