This is a huge problem in US health care financing: we have a fee-for-service model, no price transparency, and a consumer base (insulated from a lot of the costs of procedures by indirect payment through employer-provided insurance) conditioned to think procedures are inherently good. We waste billions annually on procedures that shouldn't be delivered at all.
I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.
To be fair to your latter point, Massachusetts is arguably the biomedical research capital of the world, those MRI machines are being put to research purposes.
I’m reminded of a quote from my biomed days: “If there’s ever a zombie apocalypse, you can bet it started in Cambridge.”
I just thought it an amusing anecdote until COVID, and then realized it’s less that said virus would be developed here and more that we have the business idiots to let it loose.
Careful which Cambridge you are on about. I take you are referring to Cambridge MA, US and not Cambridge, Cambridgeshire off of England, UK.
I'll note that COVID-19 "broke out" in Wuhan a city which has a virology laboratory nearby - the Wuhan Institute of Virology, who perform research on viruses.
I'm sure that is completely incidental to the pandemic of 2020-21. Clearly, some rather nasty live food markets are to blame.
It wasn't your numpties wot did it then, it was another lot that time!
It's not strictly a US health care problem either - I've been dumbfounded by foreign coworkers pressing for totally unnecessary medical interventions as if there's no risk associated with doing such things. It's most apparent from the socialized states where the healthcare is ~free.
My impression is this is a modern civilization stupidity in general.
apropos Dead Kennedys track: <a href="https://www.youtube.com/watch?v=lVULKYbAeEo" rel="nofollow">https://www.youtube.com/watch?v=lVULKYbAeEo
People love to complain about health insurance companies denying claims and prior authorization requests. While there are frequent errors and abuses on the payer side, the reality is that about a fifth of all treatments are "low value care" which aren't justified by evidence-based clinical practice guidelines and may even harm patients. If we want to reduce healthcare costs and improve outcomes then we've got to get that under control.
>"I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada."
Long wait times (6-12 months+) for MRIs (due to a lack of both machines and technicians) are a frequent complaint by Canadians.
Yep. Wealthy Canadians often come to the USA as medical tourists and pay cash to skip the queue at home for elective procedures like MRIs or joint replacements.
Hmm, that's good information to have, I had no idea. I just had an MRI appointment that I had completely forgotten about or what it was for I was waiting so long (and obviously not having the issue for anymore). I'll know this for next time and consider it.
I'm happy to confess I don't understand US medical care but OP was saying that $800 was the price they paid but you're saying that if one had "US insurance" it would be "less than half of that" ?
I mean if you have insurance I don't know why it's costing you anything but regardless it's hardly surprising that you're cost is less than the person paying cash ?
Most people with insurance in the US have something called a “copay” although not all. And yes I’m surprised that it’s quicker or cheaper here than Canada.
That’s about 2X as expensive as the cash pay MRIs near me in the United States, which is interesting. You don’t have to wait a week here, but that’s to be expected with how many MRI machines are all over the place. For specialty imaging like contrast or doing time resolved MRI you do have to wait a little longer to get someone qualified to do it properly. Some of those take a little more expertise that the cash walk-in places aren’t good for.
Yeah is it legal to finance MRI machines as a business then and sell fast imaging? If it’s that bad near a big city could have a batch running constantly. Of course until the government healthcare system finds a bunch of money in a suitcase somewhere and decides to finally buy more machines, which would kill this business.
I would posit this is more of a function of Canada having too few machines, with a median wait of 10 weeks for an MRI. [1]
To me it's crazy that people are waiting an average of nearly 3 months to get imaging. This is probably after waiting a couple months for their doctor's appointment to get the MRI scheduled in the first place.
It's sad that seemingly the top result for this search term is an AI slop lead-gen site, rather than the actual source:
>Disclaimer: Wait times shown are estimates based on publicly reported data from the Fraser Institute, CIHI, and provincial health authority reports.
Also citing Fraser Institute, a known extremely right-wing hack "think tank" is like citing a used car salesman on the benefits of buying a car. Their entire raison d'etre is to privatize any remaining public good in Canada, so they will always hunt for any kind of information or data they can to paint whatever picture they want from their lobby funds.
That is kindof crazy! Imagine you are suspicious that something is awry in your soft tissue, in which case I think MRI is the main diagnostic (?). Then you don’t find out for ten weeks, plus some for analysis!
> MRI's are expensive and difficult to amortize for poorer countries or ones that don't have a great healthcare system
Canada is towards the bottom. I see what you did there. I guess I never considered Canada a poor country or one with a bad healthcare system. But at the same time I was only there a few times to a major city and never interacted with their healthcare system.
One of the reasons I left Canada was it took me 6 months to get an MRI after a severe head injury in 2017. I have since gladly paid nearly 500k in taxes to other countries. Fuck Canada.
No, that's illegal. Thats what single payer means, only one payer is allowed [1].
Is meant to encourage rich people to support the health system since everyone's in it. But in reality the very wealthy go to Buffalo and immigrants visit their home countries.
It's also not lost on public policy experts that MAID has the potential of "solving" a lot of structural problems in Canadian health care and... long and behold MAID has expanded tremendously in ten years.
That's not what single payer actually means, since Australia has both a single payer public system and a separate private system. The part that allows these to both exist is that the public system has vast resources (i.e. an entire national/set of state governments) that can act as one for immense negotiating power. This does not preclude a private system from existing.
It's not meant to "encourage the rich to support" the health system, it's meant to avoid completely gutting the public health system by creating a parallel pay-for-play system where only the richest pay and subsequently suck up all of the already finite resources and talent.
Introducing parallel private health care is just accelerationism for privatization wonks who want to just see the death of universal healthcare by sucking it dry for those willing to pay.
There's no magic wand with the resources available for healthcare. Creating private systems so rich people can skip the line doesnt magically create that capability, it means taking that capability from someone who maybe needed it more in the public side of things.
In most other contexts, rich people being able to spend money for some good or service would simply induce more supply ultimately making the product cheaper and better for the masses as well. The rich get to be "early adopters" buying a product when it's expensive and not very good; the poor as "late adopters" get to buy a product that is cheaper and works better once the bugs have been worked out. So...why exactly are resources and talent considered "finite" when it comes to health care and shouldn't we maybe look at FIXING that rather than take it for granted?
Consider, say, food distribution: McDonalds has traditionally made far more money as a private business catering to the tastes of the poor and middle-class than any fancy restaurant ever made catering to the rich. Do fancy restaurants like Per Se "suck up all the resources" needed to cook and serve food? Does the existence of fancy restaurants hurt McDonald's by making it harder to find burger-flippers? And does McDonalds in turn "suck up all the resources" thereby making it harder for people in some other context to find and acquire food? If not, what makes healthcare so different?
There are private clinics like Medcan, which you can pay for checkups, referrals, etc., so it's not all single payer. You usually end up in the same queue for MRIs though, so it doesn't help there.
Medical imaging and diagnostic testing is one of services allowed by private healthcare in Canada.
> Diagnostic Testing: Private labs and clinics provide quicker access to diagnostic tests such as MRI scans, blood tests, and X-rays, which can expedite treatment plans.
Waiting 10 weeks for an MRI is consistent with my experience in the US. This could be a regional thing. When my mom lived in her home state, she had nearly same-month or even same-week access to specialists. Now, living in my state, most appointments are booked more than a year out. She has talked about flying back to her home state every year to have her annual appointments. This is medical tourism within the country.
Not only did I have to wait for my MRI, but as the date approached, I got a call saying that they had canceled it because the insurance refused to cover it. I offered to pay out of pocket. Nope, they simply canceled it.
Of course if you can pay for quicker care in another country, it will seem like care in that country is quicker, but the people living in that country might not have the same privilege. Most of the people I know who move here from outside the US think our system is insane.
There's a billboard on my way to work for a private medical imaging service that offers shorter wait times.
Fwiw I’ve had next day non-emergency mri (and sadly same day emergency mri). And this was across 2 states. I absolutely believe that coverage is spotty. But mri machines are extremely common in most places in the US.
> I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.
I'm also quite fond of pointing out that Canada and the state of California have roughly the same populations.
Canada's population is incredibly spread out, but also concentrated in about 5 major cities.
When I needed an MRI on my brain is was roughly a week, and that was in a smaller (under 100K people) city.
It's a triage system, although I wouldn't want to suffer through a "less important" issue.
Patients globally think that procedures are inherently good, it's not inherent to the US system.
I'm a doctor working in a government funded public healthcare system, where there is every incentive for the system to NOT do investigations and procedures where there is a poor evidence base. Yet we still waste $BILLIONs every year on them and the majority of this is driven by patient demand.
I frequently get patients where the evidence is for intervention A - that requires the patient to do N amount of work (for example physiotherapy, strengthening exercises) with slow, but real, results. After 15 years of medical practice I can honestly count on one hand how often a patient has genuinely taken an interest in this approach and committed to it. This sentiment is shared across colleagues. The vast majority of patients want a 'quick fix', even when there is no evidence that a quick fix exists.
So they push for intervention B, creating long waits for patients who would genuinely benefit from seeing the interventionist who offers B, resulting in worse outcomes for that cohort.
As the system is free at the point of access patients can simply 'doctor shop' and see as many doctors that are needed until they get one who agrees that intervention B is what is required.
I think it comes from an assumption that lay people have that the body is a machine and if a part of it is broken it can simply be 'fixed'. The truth is, is that the human body and biology are messy. We can't even define broken in a lot of cases, you can have two people with the same finding on a scan and one is in pain and the other is completely symptom free. People find this concept really hard to understand, but most of biology is happening on a microscopic level for which we don't have tests and scans, which again people find hard to accept, that we do not always have an answer. Human biology is not a solved science, not even close. There is also the whole complicated factor of human perception.
Two people can have the exact same experience but have completely different feelings and ideas about it. For one person, post-nasal drip maybe completely distressing and make their life miserable. Another person may have the exact same level of post-nasal drip but it does not bother them at all and they live their entire life with it without ever consulting a doctor. So what partly drives health demand is a patients tolerance and perception of their symptoms, which can change over time.
tptacek · · focus · HN ↗
I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.
kibwen · · focus · HN ↗
stego-tech · · focus · HN ↗
I just thought it an amusing anecdote until COVID, and then realized it’s less that said virus would be developed here and more that we have the business idiots to let it loose.
aleksejs · · focus · HN ↗
excannuk · · focus · HN ↗
[dead]
gerdesj · · focus · HN ↗
I'll note that COVID-19 "broke out" in Wuhan a city which has a virology laboratory nearby - the Wuhan Institute of Virology, who perform research on viruses.
I'm sure that is completely incidental to the pandemic of 2020-21. Clearly, some rather nasty live food markets are to blame.
It wasn't your numpties wot did it then, it was another lot that time!
alexnewman · · focus · HN ↗
SubmarineClub · · focus · HN ↗
alexnewman · · focus · HN ↗
excannuk · · focus · HN ↗
[dead]
readthenotes1 · · focus · HN ↗
It took about 12 hours, much of it waiting for his blood pressure to subside low enough to get admitted (a pre-requisite for the MRI).
This is in a city with of about 750k people and nowhere near Massachusetts.
nradov · · focus · HN ↗
readthenotes1 · · focus · HN ↗
howunfortunate · · focus · HN ↗
Don't even get me started with mental health therapy...
pengaru · · focus · HN ↗
My impression is this is a modern civilization stupidity in general.
apropos Dead Kennedys track: <a href="https://www.youtube.com/watch?v=lVULKYbAeEo" rel="nofollow">https://www.youtube.com/watch?v=lVULKYbAeEo
nradov · · focus · HN ↗
<a href="https://www.bloomsbury.com/us/price-we-pay-9781635574128/" rel="nofollow">https://www.bloomsbury.com/us/price-we-pay-9781635574128/
nickff · · focus · HN ↗
Long wait times (6-12 months+) for MRIs (due to a lack of both machines and technicians) are a frequent complaint by Canadians.
nradov · · focus · HN ↗
Roland303 · · focus · HN ↗
[dead]
harimau777 · · focus · HN ↗
Roland303 · · focus · HN ↗
harimau777 · · focus · HN ↗
Teever · · focus · HN ↗
I think private MRIs have been around, at least in my province anyways, for close to 30 years.
CosmicShadow · · focus · HN ↗
EA-3167 · · focus · HN ↗
Jesus... I can get a chest-abdomen-pelvis MRI on US insurance for less than half of that, and the lead time is measured in weeks at most.
glaucon · · focus · HN ↗
I mean if you have insurance I don't know why it's costing you anything but regardless it's hardly surprising that you're cost is less than the person paying cash ?
EA-3167 · · focus · HN ↗
Aurornis · · focus · HN ↗
juliusdavies · · focus · HN ↗
Aurornis · · focus · HN ↗
excannuk · · focus · HN ↗
[dead]
rdtsc · · focus · HN ↗
FlyingAvatar · · focus · HN ↗
To me it's crazy that people are waiting an average of nearly 3 months to get imaging. This is probably after waiting a couple months for their doctor's appointment to get the MRI scheduled in the first place.
[1] [<a href="https://getmrifast.ca/mri-wait-times" rel="nofollow">https://getmrifast.ca/mri-wait-times]
gruez · · focus · HN ↗
It's sad that seemingly the top result for this search term is an AI slop lead-gen site, rather than the actual source:
>Disclaimer: Wait times shown are estimates based on publicly reported data from the Fraser Institute, CIHI, and provincial health authority reports.
gremlinunderway · · focus · HN ↗
pinkmuffinere · · focus · HN ↗
EA-3167 · · focus · HN ↗
<a href="https://www.statista.com/statistics/282401/density-of-magnetic-resonance-imaging-units-by-country/" rel="nofollow">https://www.statista.com/statistics/282401/density-of-magnet...
Japan is a standout, and then you see most of the West just below them... Canada is way down the list.
excannuk · · focus · HN ↗
[dead]
rdtsc · · focus · HN ↗
Canada is towards the bottom. I see what you did there. I guess I never considered Canada a poor country or one with a bad healthcare system. But at the same time I was only there a few times to a major city and never interacted with their healthcare system.
OsrsNeedsf2P · · focus · HN ↗
skylurk · · focus · HN ↗
brink · · focus · HN ↗
readthenotes1 · · focus · HN ↗
Think of Steve Jobs jumping to the head of the line for a liver transplant
jjtheblunt · · focus · HN ↗
the article below is interesting, as it goes into the hearsay you repeated and the facts of how the system works.
<a href="https://www.nytimes.com/2009/06/23/business/23liver.html" rel="nofollow">https://www.nytimes.com/2009/06/23/business/23liver.html
readthenotes1 · · focus · HN ↗
<a href="https://globalbioethics.org/2013/12/11/did-steve-jobs-cut-the-line-in-order-to-obtain-a-liver-transplant/" rel="nofollow">https://globalbioethics.org/2013/12/11/did-steve-jobs-cut-th...
To restate my now better informed opinion, Jobs money allowed him to increase his chances dramatically of getting a liver transplant.
jjtheblunt · · focus · HN ↗
excannuk · · focus · HN ↗
Is meant to encourage rich people to support the health system since everyone's in it. But in reality the very wealthy go to Buffalo and immigrants visit their home countries.
It's also not lost on public policy experts that MAID has the potential of "solving" a lot of structural problems in Canadian health care and... long and behold MAID has expanded tremendously in ten years.
[1] with some exceptions largely grandfathered in
bigDinosaur · · focus · HN ↗
b112 · · focus · HN ↗
That's what it means. In Australia it can mean something different.
excannuk · · focus · HN ↗
[dead]
pfannkuchen · · focus · HN ↗
This has to be a brand new sentence (post 1950s anyway).
excannuk · · focus · HN ↗
[dead]
gremlinunderway · · focus · HN ↗
Introducing parallel private health care is just accelerationism for privatization wonks who want to just see the death of universal healthcare by sucking it dry for those willing to pay.
There's no magic wand with the resources available for healthcare. Creating private systems so rich people can skip the line doesnt magically create that capability, it means taking that capability from someone who maybe needed it more in the public side of things.
glenra · · focus · HN ↗
Consider, say, food distribution: McDonalds has traditionally made far more money as a private business catering to the tastes of the poor and middle-class than any fancy restaurant ever made catering to the rich. Do fancy restaurants like Per Se "suck up all the resources" needed to cook and serve food? Does the existence of fancy restaurants hurt McDonald's by making it harder to find burger-flippers? And does McDonalds in turn "suck up all the resources" thereby making it harder for people in some other context to find and acquire food? If not, what makes healthcare so different?
M95D · · focus · HN ↗
If there were a limited number of licensed cooks like there are doctors, it would be far different.
excannuk · · focus · HN ↗
[dead]
scratcheee · · focus · HN ↗
excannuk · · focus · HN ↗
[dead]
Cpoll · · focus · HN ↗
monocasa · · focus · HN ↗
> Diagnostic Testing: Private labs and clinics provide quicker access to diagnostic tests such as MRI scans, blood tests, and X-rays, which can expedite treatment plans.
<a href="https://schwartzcohenlaw.com/does-canada-offer-private-healthcare-options/" rel="nofollow">https://schwartzcohenlaw.com/does-canada-offer-private-healt...
Scoundreller · · focus · HN ↗
idontwantthis · · focus · HN ↗
kasey_junk · · focus · HN ↗
l1tany11 · · focus · HN ↗
analog31 · · focus · HN ↗
Not only did I have to wait for my MRI, but as the date approached, I got a call saying that they had canceled it because the insurance refused to cover it. I offered to pay out of pocket. Nope, they simply canceled it.
Of course if you can pay for quicker care in another country, it will seem like care in that country is quicker, but the people living in that country might not have the same privilege. Most of the people I know who move here from outside the US think our system is insane.
There's a billboard on my way to work for a private medical imaging service that offers shorter wait times.
kasey_junk · · focus · HN ↗
doubled112 · · focus · HN ↗
I'm also quite fond of pointing out that Canada and the state of California have roughly the same populations.
Canada's population is incredibly spread out, but also concentrated in about 5 major cities.
When I needed an MRI on my brain is was roughly a week, and that was in a smaller (under 100K people) city.
It's a triage system, although I wouldn't want to suffer through a "less important" issue.
excannuk · · focus · HN ↗
[dead]
onlyrealcuzzo · · focus · HN ↗
rran · · focus · HN ↗
I'm a doctor working in a government funded public healthcare system, where there is every incentive for the system to NOT do investigations and procedures where there is a poor evidence base. Yet we still waste $BILLIONs every year on them and the majority of this is driven by patient demand.
I frequently get patients where the evidence is for intervention A - that requires the patient to do N amount of work (for example physiotherapy, strengthening exercises) with slow, but real, results. After 15 years of medical practice I can honestly count on one hand how often a patient has genuinely taken an interest in this approach and committed to it. This sentiment is shared across colleagues. The vast majority of patients want a 'quick fix', even when there is no evidence that a quick fix exists.
So they push for intervention B, creating long waits for patients who would genuinely benefit from seeing the interventionist who offers B, resulting in worse outcomes for that cohort.
As the system is free at the point of access patients can simply 'doctor shop' and see as many doctors that are needed until they get one who agrees that intervention B is what is required.
I think it comes from an assumption that lay people have that the body is a machine and if a part of it is broken it can simply be 'fixed'. The truth is, is that the human body and biology are messy. We can't even define broken in a lot of cases, you can have two people with the same finding on a scan and one is in pain and the other is completely symptom free. People find this concept really hard to understand, but most of biology is happening on a microscopic level for which we don't have tests and scans, which again people find hard to accept, that we do not always have an answer. Human biology is not a solved science, not even close. There is also the whole complicated factor of human perception.
Two people can have the exact same experience but have completely different feelings and ideas about it. For one person, post-nasal drip maybe completely distressing and make their life miserable. Another person may have the exact same level of post-nasal drip but it does not bother them at all and they live their entire life with it without ever consulting a doctor. So what partly drives health demand is a patients tolerance and perception of their symptoms, which can change over time.