Let's stop fantasizing about the Canadian health care system. I had family with ALS and the expensive equipment and home modifications required to cope with the later stages of disease aren't covered in Canada, either - except next-to-no Canadians have private health insurance, so instead of just some ALS patients being in this man's situation, almost all of them are.

Instead of editorializing, you should donate to the man's fund, or your local ALS Society - they do incredible work almost completely unappreciated by the broader public.

> Why is it that when I suggest we emulate Canada's system

No. I left the country because of their health care system, and came to the US because of the health care my son would have access to.

In the first 2 weeks here, he had more care for autism then the entire length of time we were up in Canada (which included the more than year long struggle to get him diagnosed properly and get him help.

And he suffered for it. All because of Canada's, as well as Quebec's, health care policies.

I will not allow my son to suffer the way he suffered up there. That system, and the participants were, in short, abusive (and yes, I mean exactly that word).

I don't know why more people don't talk about this. People rave about Canadian health care, but seem to ignore the fact that many, many people with serious illnesses come to the US for treatment because they can get care here that they are apparently unable to get in Canada. Of course, this is going to be limited to the very wealthy or people with private insurance (assuming it covers treatment abroad - I really have no idea).

I don't doubt that Canadian health care is fine for everyday needs, but pretending it will solve everyone's problems is ignoring reality.

I am not saying the Canadian system is perfect. However it's worth noting that they cover everyone for the equivalent of what we pay in the US for Medicare and Medicaid alone. We can afford to do better. Unfortunately often we don't.

If we block-granted the money for Medicare and Medicaid to states, they could choose to mimic the Canadian system with no tax increases, or they could choose to do something different. But what I really like about the Canadian system is that the control is localized. This is what gets me labelled as a right-winger for proposing it.

Edit: I want to apologize if I come across as harsh. This topic is near and dear to my heart. So, please understand that my tone is not directed at you.

> However it's worth noting that they cover everyone for the equivalent of what we pay in the US for Medicare and Medicaid alone.

Everyone is covered, but not all medical conditions are covered. Yeah, if you break your leg, it's great. Having a child? Peace of cake. You don't even see a bill. Things just happen. In that way, it's nice. But when it's serious? No. Serious conditions that require years of effort, or major surgery? It falls down.

And the quality of care is below what we've found in the US.

It looks pretty on paper. My wife was a big fan of the Canadian Health Care system, before she had to rely on it. She feared the US system, until she experienced first hand how it could help.

No system is perfect, but do not imagine for a moment that the Canadian system is in any way a better way. I am serious when I equate what Quebec did to my son as nothing other than pure abuse.

Ok, so here's what I mean by emulating the Canadian system:

You have some sort of a national commitment to fix the health care system. We can discuss the format of that national commitment and the role of the federal government (there would have to be some role particularly for the elderly who may retire somewhere other than where they worked). Then we leave it to the states to iron out the details.

That's what I want to see emulated. I think that most states will choose a single payer system like Canadas but probably with a bit more coverage. But states may try different things.

Two things I would like to see different though is that I would like to see less national government involvement than we see in Canada and even more local control. The federal government in the US should be there to address a few issues the states can't like folks from Minnisota retiring in Florida.

> Then we leave it to the states to iron out the details.

Yeah, that specific model doesn't work for Canada. It's a large part of why we left, and a large reason why my son was abused.

Letting the states handle it will be problematic. What happens then, when a state will not support certain procedures, but other states do? Following the Canadian model, your screwed if you live in the wrong state.

Sure, you can move, but then that becomes another issue entirely. You'll have doctors leaving states to move to states that can provide more jobs. Quebec is suffering this, and the left over doctors are overworked, and offer less than stellar service. And yes, you can incentivize staying all you want, and it won't happen. Or you might require they work X years in the state if they accept some funding for schooling, but then they'll leave when they can for better jobs elsewhere.

I'm sorry, but I've had to deal first hand with this model and the specific problems it causes, and I'll fight to prevent it from following me.

> I don't know why more people don't talk about this.

They do. People dismiss it, calling them the exceptions. The problem is, a lot of people in Canada can't simply come to the US to get care, nor do they realize they could.

Every time someone proposes Canada as a model, I trot out my story in the hopes someone will realize that their is a dark side.

No. Never again. It was no better than child abuse.

Probably because it violates both their parties beliefs.

The problem for some of us in the USA is that we have seen government health care run the USA way. I lived under IHS (Indian Health Service) for a big chunk of my life. They came about 6 hours from killing my Dad and my brothers records "disappeared" and he has a mis-diagnosed back. Google "don't get sick after june" for the typical problems. I myself had a botched root canal (3 surgeries afterwords) and lesser back problems.

Given this, I don't see how they can be more competent with more people under the system. If you cannot get it right for 1.2% of the population, you are not going to get it right for the rest.

That said, there are some things government could do that would help everyone. A "cataclysmic" insurance modeled on flood insurance to take care of costs over a certain dollar figure payed out of the taxes we already pay. Cut the cost of drug approval and work out longer term cheaper payments beyond the patent life. Tort reform for drug approved for the FDA. Scholarships for every nurse and doctor keeping a decent average. Reduce the cost of filling out government paperwork. Loans to needy individuals to pay their healthcare bill, payed back to the IRS.

I'm not very optimistic because I haven't heard any politician looking at what the actual input costs are for health care and trying to reduce those. They seem to accept health care costs will stay high.

IHS is bad, but it's not just that though. As a way of controlling costs, Medicare is a dismal failure. This may be similar wrt IHS, but basically government health care means, in the US, underfunded doctors, and money channelled to large corporate interests, like big pharma.

If we just look at taxpayer dollars spent in the US on health care, we still outspend the rest of the world. If our government could control costs, they would have. States are powerless because a very large minority of expenditures are regulated primarily by the feds, and they actively avoid cost control outside IHS.

We have a system which is so structurally broken I just don't know what you can do without starting with huge structural changes, which would be scary to those on things like Medicare.

The US healthcare system is broken but that doesn't mean that other countries' systems can be transplanted here.

This is true. Most of them won't scale up sufficiently, or rather if you try they will be captured by corporate interests.

But that doesn't mean we can't look at what others are doing and try to fix things here.

Single payer works on a small scale by giving groups of people effective representation in collective bargaining, something that private insurance doesn't do. It also works by giving that same group collective bargaining regarding drugs and medical devices. It doesn't work by creating this huge insurance pool which is what we are told.

We could take the PPACA and change it, requiring that all insurers qualified under the plan are owned and operated by the insured, and then we could require compulsatory licensing of patents for medicines and medical devices.... And then we could take on the AMA's role in accrediting medical schools.

But pigs will fly first.

The issue is whether a state-by-state single payer system would be universal. It would not be in the US--the Republican states would never enact it. How would Canada's system react if Ontario had single payer but British Columbia did not?

Actually Canada has had issues with provinces not coordinating medical issues very well. They are actually less centralized than the US is. One of the reasons why SARS hit Ontario so hard was that there was no equivalent to the CDC nationally or at that time in Ontario.

But for the US, if you sent things to the states, coverage could follow residency, and states could decide the level of coverage they wanted to provide (coverage varies significantly between Canadian provinces btw).

The big problem for the states is you can't do it as long as Medicare is fully federal and Medicaid is so heavily regulated by the federal government. You'd probably have to hand these programs to the states first.

Just noting, provinces in Canada with CDC-like organizations did pretty well regarding SARS. Ontario, OTOH, had one of the highest mortality rates (and public health impacts) in the world. Keep in mind Toronto was closing hospitals due to the spread of the disease there during the public health crisis...