from Hacker News

I traded my U.S. medical career for Canada. Here's how the two systems stack up.

by tempestn on 3/26/25, 6:21 AM with 19 comments

• by rfwhyte on 3/26/25, 8:19 PM

  As a Canadian, my take on the debate between the Canadian vs. US health care systems is that the US system is better for the rich, whereas the Canadian system is better for everyone else.

  The US has world leading facilities, doctors and research, but that world-class capability is only really accessible for the top 5%-10% of society.

  The next 20% of folks get something that's roughly equivalent, if a little better, to what folks in say Canada, the UK, or other countries with public healthcare get.

  The problem is, the bottom 70% of society gets worse care, for more money, and suffers from substantially worse health outcomes, while living under the constant risk of crippling debt or personal bankruptcy due to medical issues.

  Personally I'd much rather a system that takes decent care of everyone than a system that takes really good care of the rich whilst everyone else suffers.

• by ggm on 3/26/25, 7:07 AM

  I'd be fascinated by the full matrix, of US/CA/UK/IE/AU/NZ/SG/EU

  I think the core would be US/CA/NZ-or-AU/UK. The AU/NZ/UK axis probably still shares some practices. AU is increasingly driven in US trends, but hires NHS staff who want out of the UK. Its my belief people who dont like the CA model wind up drifting south because $ but culturally AU/NZ/UK would be a better fit.

  A lot of the specialities in AU seem to run as restricted entry guilds. They're keeping the lid on numbers for reasons I cannot fathom. A lot of the candidates have english as a second language it might relate.

  (not in med, just fascinated by it)

• by egberts1 on 3/26/25, 8:51 AM

  When a US surgeon is told by an onsite insurance adjuster/nurse to wait (while patient is in operating room) for a corporate insurance approval, that is when I know that overreach by insuranxe adjuster has become too much.

  Ironically yet somewhat related, same health insurance company's CEO got gunned down for oppressive medical denials.

  Deny, Defend, Depose: it is not just a book, it's reality.

  https://insurancenewsnet.com/oarticle/texas-surgeon-who-post...

  https://www.bu.edu/articles/2024/consumers-rage-against-the-...

  https://ny1.com/nyc/all-boroughs/human-interest/2024/12/11/d...

• by metalman on 3/26/25, 11:57 AM

  I can personaly attest to a long standing divide between Canadian/US medical practice. May parents, both medical, dad a forensic pathologist,etc, and mom a pediatric, intensive care nurse, decided to emigrate to Canada, in the mid 1960's, dad from the Punjab, mom, from Penn state, due too multiple factors involving geo politics (the draft), and medical practice , and the discussions over the decades, with colueges moving to the states, or back to europe and asia, etc, would revolve around, ethics, and MONEY. With Canada always winning on lifestyle and compasionate grounds, and the US always winning on more (much) money and reduced work load. And as both of my parents are now in long term care, and just went through our somewhat deranged medical beuacratic processes, Canada still maintains a compasionate focus to care, but the civilian medical boards, are doing everything they can to undermine and dismantle our universal healthcare system, for one driven by the drug companys and private health care system found elsewhere.

• by dzonga on 3/26/25, 8:12 AM

  > He writes under a pseudonym due to fear of further retribution from members of U.S. medical leadership and U.S. government officials.

  that shouldn't be the case for a free country. unfortunately now it is.

• by kashunstva on 3/27/25, 10:38 PM

  I have some relevant first-hand experience that corresponds very closely to TFA.

  My spouse is a U.S.-born and trained vascular surgeon and I'm a retired internal medicine specialist. We immigrated to Canada just ahead of the first administration of the current U.S. president.

  Her clinical autonomy is practically unconstrained by provincial health insurance issues. Her practice is very much like I remember it being in the early days of my own practice in the U.S. before physicians and surgeons became interchangeable widgets in what could be very generously called "the system."

  From my perspective as a patient, my care, including care for some rather complicated health issues has been extremely prompt and exemplary. I can almost always see my family physician the same day.

  While I do see a hefty tax bill, I never ever see bills from the doctor, the hospital, EOB's, statements of coverage, and other artifacts from "the system."

  And I don't have the cringey feeling of receiving a human right (health care) that others, because of misfortunes of life or an unfortunate starting point in life cannot access. Our health care is universal.

• by bb88 on 3/26/25, 6:57 AM

  What I've come to realize is that bureaucracy costs less than paying patient's medical bills.

  The idea is this. If you can save US$50M by employing an extra $1M to increase bureaucracy, why wouldn't you and take the savings as a windfall?