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Comment by slibhb | Hacker News Reader

France has great healthcare but the downside of socialized medicine is rationing.

you have a fixed pool of resources and more demand than there is availability. do you sort the queue by a impact on quality of life heuristic or do you sort the queue by willingness to pay money? in one system, people are more inconvenienced; in the other system, people with no money die or are saddled with debt.

anyways the crazy thing to me was recently learning that americans often still have to wait long periods of time in ERs and to see specialists. you're telling me y'all waste dozens of hours navigating insurance plans but you still have to wait an average of 50 days to see a dermatologist or wait for 6 hours in the ER?

believe it or not i don't wait that long here in canada

This of course does lead us to our next question, which is "why is there more demand than there is availability?"

Also for what it's worth, in all of my recent ER visits in the States (which, to be honest, are not often, perhaps 3-4 in the last decade), did not have long wait times at all. I was always seen by an initial triage doctor within a half hour

Triage doctor? Fancy. In France we're talking nurse or even "volunteer" (ie. those med students everyone hates on, I hear there are actual volunteers too but I've mostly seen students) that do triage.

It's not a fixed pool! The pool can grow.

Also wait times are longer in Canada. And an anecdote: I went to the ER last Monday. No wait. And had a referral to a surgeon that same day. And surgery on Wednesday!

If they didn't limit the number of doctors that can be trained, there wouldn't be as much of a finite supply of resources. Furthermore, how does one decide "quality of life"? What the politicians and bureaucrats think is "quality of life" rarely matches what the patient thinks. Often, it the politician and bureaucrats prioritize what benefits them the most.

As far as wait times in the USA, yes, we have bureaucrats and politicians artificially limiting supply. But, it is only as bad as you say in select areas of the country, and in most cases urgent matters ate attended to faster.

It have nothing to do with socialism. The current situation is due to the doctors lobbying for a restricted number of students. This have been in place since 1971 and have now been removed. But training one doctor requires time (8 to 10 years) and … doctors, that we don’t have enough, so we are going to be in the shit for at least another decade.

But it have nothing to do with the healthcare system, just with cupidity.

Notably Cuba exports doctors because they, despite being a poor country, focus on producing doctors. Humans are not a scarce resource, the will to spend the time to train them is what's lacking. High monetary incentives for doctors probably make it worse, as you said encourages expensive gatekeeping and profit motive rather than a desire to actually perform good work for it's own sake.

When was this removed? Are there still limits on residencies?

Sounds more like merely "good" and not "great" in that case, unfortunately.

Looking at the health outcomes of people from France and the US, it's fairly evident which one is more "great".

Do you mean how the rich travel to the US for healthcare?

Looking at outputs alone can't tell you how good the system is, you also have to consider the inputs.

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