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November 13, 2005

Comments

Stephen

I attend grad school in Kansas City. It has a distance-learning program where people from all over the US and Canada come to the school for two weeks each fall and spring, spend 8+ hours/day in lectures and then go back to their jobs and lives and finish the papers and reasearch and stuff at home. Out of about 50 people involved at any one time (it's a small school), there's usually at least 10 Canadians participating. To a person, they have expressed in classes and conversations their fear that they might get sick while in the US. They are afraid that getting a cold will bankrupt them.

Nowadays when people start using the Canadian health system as a defense of our present system I start talking about giant alligators in the New York sewer system and how there's this video, if you watch it, you'll die in like a week or something.

parsec

During the '88 primary Sen. Paul Tsongas repeated the claim that if he'd been a Canadian when his cancer appeared he would have been dead by then. It turned out that his treatment had been pioneered in Canada.
Americans have never let reality get in the way of a good anecdote, especially on the subject of health care.

David Andersen

Your context is poorly selected. Comparing the # of Americans who go to Canada for drugs to the # of Canadians who go to the US for medical care is meaningless. It's two completely different things for different reasons.

Medicine is cheaper in Canada because it's subsidized. If the price difference is significant enough, people in the US will make the trip. This has nothing to do with quality of care in either country.

How many Americans go to Canada for healthcare? I'm guessing it is less than 0.09% in an equivalent sampling. What would that mean? Nothing necessarily, but that's the proper comparison, if you're going to make one.

Finally, the notion of Canadians not going to the US for care as evidence of the suitability (or superiority) of the Canadian system is misleading.

People will put up with a lot if it means avoiding spending out of pocket money on healthcare. I bet most of us know one or more people like this. I knew a Canadian who needed his knee replaced after a rugby injury. He was working in the US at the time. It clearly was painful and he walked with a limp, but rather than pay for expedient treatment somewhere he waited 5 months for replacement in Canada. Why? Because he didn't want to spend the money out of pocket and he was already paying for his government insurance. His choice, but not necessarily the best one for his health or comfort. I know of an American who made the same sort of choice, waiting to treat a hernia until Medicare kicked in, even though she could have afforded to take care of the problem immediately. People will put up with a lot to avoid spending money on their health. It seems like mostly men do this in my experience.

I'd like to see a study that asks people something like this:

"If you could have your painful and uncomfortable non-emergency problem "X" treated now for $2000, in 3 weeks for $1000, or in 3 months for free, which would you prefer?"

That may not be the ideal wording, but something along those lines would reveal the magnitude of our tendency to tolerate discomfort in order to minimize out of pocket medical spending.

Put another way, if people are forced to pay for a service there is some percentage of these people who will use the service no matter its quality because it’s already been paid for and they either don’t want to spend additional money for better service or they can’t afford to. I think the same problem exists in the American public school system. People think they are being helpful by mandating taxation for universal service when in fact they very well may be causing more harm than good.

A Canadian

Telemedicine is the solution to saving the health care system. See the Canadian Society of Telehealth

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