I think it really does depend on whether you have money or good private insurance in the US, whether your healthcare will be better or worse. Here in Montreal, an unemployed, disabled friend of mine with no insurance recently had a kidney transplant followed by a stay in rehab hospital for a few months due to lack of available help at home, and none of it cost him anything. He did have to wait 4 years for the transplant but during that time he got dialysis, fully paid for, including round-trip taxi between home to hospital 3x a week, also paid for. I think the win there would be for Canada unless the transplant would have happened sooner in the US, and if this kind of care is available for low-income people without insurance.
Favouring the US, some years ago my MIL in Ontario got ovarian cancer and the surgeon missed a 5cm tumor (Friday afternoon surgery, statistically bad time for operations). âOptimal debulkingâ (removing all the cancer) doubles survival in ovarian cancer so we wanted the error corrected. The Ontario surgeons we reached out to would not do it, saying it had not been proven that the association between optimal debulking and survival was causal rather than correlational. Desperate, we contacted the top surgeon in the US in this area who took our phone call!! (this would never happen in Canada) and agreed to do the surgery. Estimated cost was $25k for the surgery and prolonged hospital stay. Thus in the US we could access the best treatment by paying for it. In Canada, no amount of money would get this surgery because private payment does not give you access to cancer surgery and slow to change policies determine what surgeries are publicly fundable. So the win here would for the US, assuming one has the money. (Two years later, Ontario changed its policy to acknowledge that optimal debulking drives ovarian cancer survival time. Note that it is research in the US that provided the data that informed Ontarioâs policy so healthcare in Canada would be worse without the research and drug development coming from the US system.)
Agree, the ERs in Montreal and surrounding areas are a disaster right now. Here is another article about a Montreal university student whose parents drove him to Ontario for help after he waited 16 hours at an ER in Montreal with what turned out to be peritonitis (which can kill you.)
I would say the ER disaster is about Montreal specifically rather than healthcare in Canada generally, but I could be wrong.
In the US if you are very low income and have few substantial assets you would qualify for Medicaid, a government funded health care program separate from the ACA/Obamacare. Coverage varies by state with the reddest states having the stingiest coverage. As for a kidney transplant that is dependent on finding a matching donor. I believe that there is a national registry, unless you have a matching family member.
One problem with the US health care system is its complexity. Even just in insurance matters, what you can get varies depending on your age, employment situation, and income level. Sometimes needing to change insurance for reasons not otherwise related to health care (e.g. changing jobs, turning 65 years old, retiring, increasing or decreasing income, etc.) can mean having to change providers due to different insurance plan networks.
The likely reason for the complexity is that each type of insurance is tacked on to an existing âsystemâ rather than the system as a whole being designed in a coherent fashion.
A very good friend of mine has joint pain and her pcp suspects psoriatic arthritis. She waited 7 months to see a rheumatologist who told her they couldnât diagnose this until a dermatologist diagnosed her rash as psoriasis, she now has a dermatologist appointment 9 months away. Please donât tell me the US system is efficient and better than the Canada/UK/Australian systems. She has my insurance so I know itâs good insurance but itâs a lack of specialist care.
My husband has psoriatic arthritis. Iâm sorry your friend has to wait so long. Itâs a long wait for both of those specialists unfortunately.
Sigh. Because it will take the dermatologist 2 seconds to diagnose the psoriasis and the rheumatologist the same to diagnose the arthritis. The big thing is getting on the correct meds.
My S moved to a town adjacent to our state capitol. Itâs not a rural area. He had some health issues soon after he moved, and he couldnât get an appointment with a PCP for six months. He ended up going to an urgent care, which is not ideal (but at least insurance covered it). And wow - insurance companies have drastically cut back on the things that can be done in a well exam - routine urinalysis annd A1C bloodwork arenât even covered by most anymore.
My own PCPâs office is overwhelmed because there arenât enough primary care physicians in our bustling suburban area. A staff member I know outside of the office confided that insurance reimbursements are getting cut on a regular basis. Medicare Advantage plans are really putting the squeeze on primary care providers, who are financially penalized if patients donât do everything they are supposed to do ⊠like if they choose not to get a flu shot. She is concerned that my doctorâs generation will retire & there wonât be enough providers to replace them. I know a lot of young people who went into medicine, and none are primary care physicians âŠ
Primary care doesnât pay enough. Debt load is too large and when you donât start making money until you are 30+, itâs a huge deterrent to start your working career.
When engineers and business majors can make the same kind of money at the same age while making money for close to a decade before to save for retirement, itâs a huge penalty.
Even with PSLF, those years of accumulating debt and not saving, it can be a huge hit. Which is why most med students are going to pick a high paying specialty when they can in order to catch up to their non physician peers.
Donât even get me talking about PTâs or pharmacists.
Add to it, increasing workloads, pressures from insurance companies, the PE firms that increasingly own practices and continuing dissatisfaction from their patients, you have to wonder why anyone goes into medicine. Especially primary care. Or OB/GYN.
Yet most med school grads will work in primary care, because thatâs where most of the physician jobs are (primary care = FP, GP, IM, OBGYN, Ped.) Dreams of being an orthopedic surgeon/insert specialist here often donât work out, even for those who do make it to med school.
The pay/debt consideration is one reason some people may deter students from going into medicine. Students must have a passion to become a physician full stop.
We will continue to see a shift to PAs and nurse practitioners, especially in primary care settings.
Just read about this happening in Alberta; government allowing Nurse Practitioners to set up their own clinics and say NPs can provide â80% of the medical services a family physician can.â
The family physicians are not onboardâŠ
In Quebec, a related model is happening for people without family physicians (35% of pop). For annual blood tests etc. there are modular classroom type buildings set up on the parking lots of hospitals where nurses take blood, measure BP, order tests but under the nominal direction of doctors (havenât seen any on-site)
I am always seen by my PCP but almost always when I see a specialist for a routine visit (follow-up or last week, routine ophthalmologist), the NP or PA does most of the work and the doctor pops in for the last minute.
My whole family sees various NPs as our PCPs these days. My NP PCP is by far the best PCP Iâve ever had. When my daughter broke her arm years ago we never saw anyone beside the PA (simple break but she was a growing child). Since apparently all the doctors in the US are in Silicon Valley now, Iâm glad to have access to good NPs and PAs. Unfortunately they canât cover everything or everyone and they are also in short supply.
When my MIL moved to her current AL facility, she had to give up the absolutely useless primary care doctor she had for years. The AL hooked her up with a NP who actually cares about MIL. Itâs been great.
The NP at my urologistâs office gave me bad information. It was a big deal and I was so upset I made an appointment to see the MD, who assured me I would be OK. Iâve been leery of NPs since then.
PCP specialties tend to be among the lower pay ones. Although that can still be nearly the level that their kids would not get college financial aid at most colleges, it may not seem that high compared to the $400k debt that a new physician just out of residency may have to pay off if they did not have generous parents with money.