JayB

The human-vs-gas powered access divide reminds me of the fly-vs-bait fisherman divide. There can be some serious demographic/cultural divides to cross, but in my experience - a bit of waving, smiling, and chatting (like 30 seconds) is all that's required to keep the overt mutual loathing to a minimum during the interactions. If someone is high-marking above you on a loaded slope, though...

Hey Jarred: I'm not sure which part I feel more sympathy for, or which will cause you more long-term pain - the injury/pre-mature end to an incredible trip or the (minimum) four years on the East Coast (here's to hoping that your wife is enrolled somewhere within range of the Whites or Adirondacks!). Thanks for taking the time to share this experience.

Word. Secure/preserve access first, then squabble over which user groups get priority for what and when.

If only you knew. For what it is or isnt worth the local MT snowmobiler organization helped out greatly in fighting for getting the road plowed for Hyalite canyon. IMO as access to our public lands becomes more and more threatened/limited through privatization fighting for what you and I want will require a louder, more unified voice. To accomplish this will require getting more climbers to give a shit (good luck) or aligning with other user groups that have similar goals (i.e. perserve access). Like snowmobilers, hunters, packers, etc etc Yes they shouldn’t have violated the wilderness boundary. Yes snowmobiles are noisy. Life isn’t fair sometimes. Word.

I've been away from Washington for ~95% of the last four years, and have to agree that when it comes to variety, scenic beauty, etc that alpine climbing in Washington crushes what's on offer in Colorado. I personally think that Colorado has the edge when it comes to pure rock-climbing, and ice climbing, and since you are already there I'd suggest that you'll be much happier if you spend most of your time taking advantage of what's there as opposed to lamenting what isn't. The guy who chimed in about the South Platte knows of what he speaks. Listen to him and go forth into an infinity of granite. Ever heard of Devil's Head? Plug the name into climbingproject.com and see where that takes you. McCurdy Park Tower? Take a look in the back of the Hubble guide and lug your rack to the base. Etc, etc, etc, etc, etc. When it comes to alpine climbing, it's no Washington, but there's enough there to keep anyone happy for years and years and years. Corinthian Column on Pikes, Notch Couloir and Kieners on Longs, etc, etc, etc, etc. If you are looking for adventure, go climb the main ridge on Lindsey and take a look at the backside of Blanca Peak. I think some old-school hardasses from the 30's or 40's put a route or two up there and I doubt it's seen much traffic since. Head down to the Crestone Group and look for new lines. Climb all the 14ers in Winter. If you are living on the Front Range and feeling uninspired, drive 45 minutes east and stare at the horizon for however long it takes for you to count your blessings. The only other bits of advice that I'll throw in are to heed Kurt's words of wisdom concerning the nature of the snowpack, and take the lightning hazard out there very seriously. Start early, climb fast, and get low before the show starts during the summer monsoon season.

Would it be fair to summarize the above as "The absence of competition and profits is a precondition for the optimally efficient use of resources." If not, why? If yes - does this condition hold globally, or is it only true for health care?

Like the data that bill cited above? "Access to Care Well, the medical efficiency of the two systems may not be so different but access to care must vary greatly, right? Canada has an egalitarian, socialist system while the U.S. relies (somewhat) on free-market capitalism to allocate medical services. Below we see that Canada general has a lower disease incidence rate, but treatment rates are generally higher in the U.S. Further, these difference decrease even more if we only look at Caucasians in each country. The authors state “the composition of the non-white group differs by country—predominantly black in the U.S., but Asian in Canada; and racial differences in health outcomes may differ in the two countries.” See CensusScope for more details on the U.S. racial composition. Canada U.S. % with condition % gets treatment % with condition % gets treatment All Asthma 6.6 80.3 7.8 78.8 High blood pressure 8.8 84.1 13.1 88.3 Heart Disease 2.4 67.2 2.6 69.6 Angina 0.9 74.6 1.1 61.0 Whites Asthma 6.9 82.7 7.7 77.6 High blood pressure 9.1 83.2 12.5 87.3 Heart Disease 2.7 69.4 2.4 73.2 Angina 0.9 70.7 0.8 75.1 In Canada, the main reason for an unmet need was because the wait was too long or the treatment was unavailable. In the U.S., most people who do not receive treatment fail to do so because of cost considerations. Preventive Services Probably the most surprising discovery of the paper was that Americans partake in more preventive care than Canadians. * Mammograms: 88.6% of American females 40-69 had ever had a mammogram compared to 72.3% of Canadians. * PAP smear: 86.3% of American females 20-69 had a PAP smear in the last 3 years compared to 75.1% of Canadians. * Prostate screening: 54.2% of American men 40-69 had ever had a PSA test compared to 16.4% of Canadians." Sadly, despite your explicit admission that there isn't enough data to support broad generalizations or sweeping claims about the relative performance of health care systems, I'd be astonished if this minor detail is sufficient to dissuade you from making them.

One more statistical nuance that's quite a bit less flattering for the US... As I suggested (a long ways) above, a big chunk of the drop in our murder rate has more to do with improved trauma-care than it does in a reduction in violence: http://www.nytimes.com/2002/08/12/us/medical-gains-reduce-deaths-from-assaults.html?sec=&spon=

More About Life Expectancy Stats for The Evil Homonym: Speaking of statistical studies: Click Here to See Table of Life Expectancy Data wtih and Without Corrections for Fatal Injuries "Two University of Iowa researchers, Robert L. Ohsfeldt and John E. Schneider, reviewed the data for the nations of the OECD to statistically account for the incidence of fatal injuries for the member countries. The dynamic table below presents their findings, showing both the average life expectancy from birth over the years 1980 to 1999 without any adjustment (the actual "raw" mean), and again after accounting for the effects of premature death resulting from a non-health-related fatal injury (the standardized mean). You may sort the data in the dynamic table from low to high value by clicking on the column headings, or from high to low value by clicking a second time. "If you've sorted the data in the dynamic table, you find that without accounting for the incidence of fatal injuries, the United States ties for 14th of the 16 nations listed. But once fatal injuries are taken into account, U.S. "natural" life expectancy from birth ranks first among the richest nations of the world." *I think this is even with our way-more-generous-than-average definition of a "live birth" that accounts for a significant reduction in US life expectancies versus other developed countries. **There's a link to the PDF of the original study there as well.

At the very least I hope you'll furnish methodologically sound studies, conducted by people who make their living doing such things, that demonstrate that the sampling methodologies and bias in life expectancy and infant mortality stats are actually *less* fraught with logical and methodological shortcomings than than studies like the one comparing survival rates for given cancers that I linked to above. In the absence of that, you may as well admit that you have no defensible basis to ground an empirical comparison of health system performance in developed nations upon. I'll happily cede the point that your approach (infant mortality, life expectancy) makes sense when comparing nations with differences where the magnitude of the difference in these stats is so large that controlling for factors that are outside the scope of what the healtcare system can influence makes little or no difference, like Sweden vs Botswana, etc. Having said that, let's have a look at the studies you mentioned that demonstrate that the Canadian health-care system does better than the US system in cases where the health system can actually make a difference. In addition to apples-to-apples survival rate data, there's surely some low hanging fruit like vaccination rates, screening exams, etc on the preventive side as well.

I also think that, like everything else, it's important to be careful when we're talking about health care spending numbers. Is this number just the total amount spent on hospitals, drugs, procedures, dentists, non-prescription drugs etc divided by the population? Or is it the total amount of non-discretionary spending? Are we comparing the total amount that people have to spend on medical care, or a combination of what people have to spend and choose to spend? I think that this distinction is important, and here's why. It stands to reason tht if people in country A make twice what people in country B make, this will affect how much they spend on health care. They may be able to afford to treat conditions that the people in country B just have to suffer with (like acne, mild arthritis, etc) that don't necessarily manifest in increased mortality. Then there's medical care for things that don't even fall into the "medical problem" category, like many cosmetic procedures. Then there's the stuff that falls into borderline areas like the $8,000 that my wife and I spent on LASIK procedures. Medical problem? Sort of - we both had terrible vision. Medically necessary? Nope - glasses work just fine, but worth it? To us - yes, absolutely. Did it add to the top-line spending figure that's used to generate the per-capita spending figure that you cited? I'd sure be interested in finding out.

I'll grant you the less expensive portion, but I'd be very interested in the data concerning outcomes for specific medical conditions. age-adjusted average survival rates from onset for X, etc. I have already mentioned the methodological controls that are necessary to insure that measures like life expectancy and infant mortality have to incorporate in order to render them valid, so if you have studies that control for those points, I hope that you'll share them. Looking forward to seeing the data.

If you are going to make a relevant comparison of the precise contribution that a healthcare system makes to longevity, you first have to make sure that you are measuring outcomes that are actually affected by what happens in clinics and hospitals, no? Not only, because healthcare is also in large part about prevention and because what happens in hospitals is only valid for those who make it to the hospital. Although life expectancy isn't a precise gauge of healthcare system performance, it does give a better indication of how a given system serves it population than a detailed study of outcomes for a specific illness. Here is the last existing ranking of population health and healthcare system performance by the World Health Organization, Canada ranked at #30 and the US ranked at #37: http://www.photius.com/rankings/healthranks.html I'd very much enjoy an entirely separate thread dedicated to evaluating the methodology that the WHO used to develop its rankings. Having said that, I'm familiar enough with the WHO study to assert that it doesn't actually tell you much that's useful about how effectively the health care delivery systems in country A and country B do at dealing with things that doctors, nurses, hospitals, clinics, etc can *actually* so something about. If you define prevention carefully, it makes sense to include it in this category - but throwing every behavior that increases mortality into the mix doesn't make much sense if your aim is to make a logically and methodologically sound comparison of how good the healthcare systems in country A and country B are relative to whatever criteria is under consideration.

For El Jefe: 1: Paediatr Perinat Epidemiol. 2002 Jan;16(1):16-22.Click here to read Links Registration artifacts in international comparisons of infant mortality. Kramer MS, Platt RW, Yang H, Haglund B, Cnattingius S, Bergsjo P. Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada. michael.kramer@mcgill.ca Large differences in infant mortality are reported among and within industrialised countries. We hypothesised that these differences are at least partly the result of intercountry differences in registration of infants near the borderline of viability (<750 g birthweight) and/or their classification as stillbirths vs. live births. We used the database of the International Collaborative Effort (ICE) on Perinatal and Infant Mortality to compare infant mortality rates and registration practices in Norway (n = 112484), Sweden (n = 215 908), Israeli Jews (n = 148123), Israeli non-Jews (n = 52 606), US Whites (n = 6 074 222) and US Blacks (n = 1328332). To avoid confounding by strong secular trends in these outcomes, we restricted our analysis to 1987-88, the most recent years for which data are available in the ICE database for all six groups. Compared with Norway (with an infant mortality rate of 8.5 per 1000), the crude relative risks [95% confidence intervals] were 0.75 [0.69,0.81] in Sweden, 0.97 [0.90,1.06] in Israeli Jews, 1.98 [1.81,2.17] in Israeli non-Jews, 0.95 [0.89,1.01] in US Whites and 2.05 [1.95,2.19] in US Blacks. For borderline-viable infants, fetal deaths varied twofold as a proportion of perinatal deaths, with Norway reporting the highest (83.9% for births <500 g and 61.8% for births 500-749 g) and US Blacks the lowest (40.3% and 37.6% respectively) proportions. Reported proportions of live births <500 g varied 50-fold from 0.6 and 0.7 per 10000 in Sweden and Israeli Jews and non-Jews to 9.1 and 33.8 per 10000 in US Whites and Blacks respectively. Reported proportions 500-749 g varied sevenfold from 7.5 per 10000 in Sweden to 16.2 and 55.4 in US Whites and Blacks respectively. After eliminating births <750 g, the relative risks (again with Norway as the reference) of infant mortality changed drastically for US Whites and Blacks: 0.82 [0.76,0.87] and 1.42 [1.33,1.53] respectively. The huge disparities in the ratio of fetal to infant deaths <750 g and in the proportion of live births <750 g among these developed countries probably result from differences in birth and death registration practices. International comparisons and rankings of infant mortality should be interpreted with caution.

It may be that Canadian stabbing and gunshot victims are more likely to survive on average than they are in the US, and if you can find a study that provides good evidence to suggest that this is the case, then that would prove that the Canadian health system is better in this regard. I'll have to disagree with you when you assert that the higher incidence of gunshot wounds, for example, means that our health-care delivery system is worse than Canada's. With regards to infant mortality, if you can establish that the US and Canada have the same criteria for measuring infant mortality, and the US still figures worse than Canada or any other particular country - then they're doing a better job and we should figure out what specific changes we can institute based on the way that they care for pregnant women and infants. Most measures of infant mortality use the number of deaths between the ages of zero and 1 per 1000 *live births* to come up with an infant mortality figure. At the very least, I hope that you'd agree that if you're going to have an accurate comparison between two countries, you have to demonstrate that they use the same standards to determine what constitutes a live birth (see post below). As a minor aside, I think that there *are* differences in the average age of pregnancy, the tendency to seek pre-natal care, etc between say - undocumented immigrants and the general population that have an effect on infant mortality in ways that are difficult (but not impossible) to counter and that do have a minor but real affect on mortality stats in ways that are largely absent in Canada. I also think that this is an issue that's larger than the health system, and we can have that discussion if you wish, but I still think that if your purpose is an accurate, intellectually honest comparison of healthcare in country A versus country B, you have to make an effort to account for things that the health system can, and cannot, reasonably do to save and prolong lives.

At least this is an honest answer - ultimately you want the government to ration care instead of corporations - and I certainly appreciate your candor on this point. I personally don't want my care rationed by anyone, but I'm more comfortable with a system where the government regulates the private insurers and it's still possible to choose what kind of coverage I get, and who I buy it from. While not quite on the same topic, it's impossible to get too far down this road without contemplating what effect a national healthcare monopoly with price controls, which inevitably lead to supply controls, will have on innovation. I think that this is an important consideration, since things that start off as expensive and rare have a tendency to become widespread and relatively cheap it they're significantly better than existing alternatives.

So your contention here is that it's uninsured patients, rather than patients covered by Medicare and Medicaid, that drive the vast majority of cost-shifting onto patients with private insurance. If you have data that proves this claim, I hope that you'll share it.

http://www.ncpa.org/pub/ba596/#footnotes Overall Cancer Survival Rates. According to the survey of cancer survival rates in Europe and the United States, published recently in Lancet Oncology : 1 * American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women. [see Figure I.] U.S. Cancer Care Is Number One. fig1 * American men have a five-year survival rate of 66 percent — compared to only 47 percent for European men. * Among European countries, only Sweden has an overall survival rate for men of more than 60 percent. * For women, only three European countries (Sweden, Belgium and Switzerland) have an overall survival rate of more than 60 percent. These figures reflect the care available to all Americans, not just those with private health coverage. Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average: British men have a five-year survival rate of only 45 percent; women, only 53 percent. Survival Rates for Specific Cancers. U.S. survival rates are higher than the average in Europe for 13 of 16 types of cancer reported in Lancet Oncology , confirming the results of previous studies. As Figure II shows: * Of cancers that affect primarily men, the survival rate among Americans for bladder cancer is 15 percentage points higher than the European average; for prostate cancer, it is 28 percentage points higher. 2 * Of cancers that affect women only, the survival rate among Americans for uterine cancer is about 5 percentage points higher than the European average; for breast cancer, it is 14 percentage points higher. * The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular). Furthermore, the Lancet Oncology study found that lung cancer patients in the United States have the best chance of surviving five years — about 16 percent — whereas patients in Great Britain have only an 8 percent chance, which is lower than the European average of 11 percent. Results for Canada. Canada's system of national health insurance is often cited as a model for the United States. But an analysis of 2001 to 2003 data by June O'Neill, former director of the Congressional Budget Office, and economist David O'Neill, found that overall cancer survival rates are higher in the United States than in Canada: 3 * For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada. * For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada. Early Diagnosis. It is often claimed that people have better access to preventive screenings in universal health care systems. But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment. For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government. 4 * In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain. * The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly — a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women. Access to Treatments and Drugs. Early diagnosis is important, but survival also depends on getting effective treatment quickly. However, long waits for treatment are “common devices used to restrict access to care in countries with universal health insurance,” according to a report in Health Affairs . 5 The British National Health Service has set a target for reducing waits to no more than 18 weeks between the time their general practitioner refers them to a specialist and they actually begin treatment. A study by the Royal College of Radiologists showed that such long waits are typical, and 13 percent of patients who need radiation never get it due to shortages of equipment and staff. 6 Another reason for the higher cancer survival rates in the United States is that Americans can get new, effective drugs long before they are available in most other countries. A report in the Annals of Oncology by two Swedish scientists found: 7 * Cancer patients have the most access to 67 new drugs in France, the United States, Switzerland and Austria. * Erlotinib, a new lung cancer therapy, was 10 times more likely to be prescribed for a patient in the United States than in Europe. One of the report's authors, Nils Wilking, from the Karolinska Institute in Stockholm, explained that nearly half the improvement in survival rates in the United States in the 1990s was due to “the introduction of new oncology drugs,” and he urged other countries to make new drugs available faster. Conclusion. International comparisons establish that the most important factors in cancer survival are early diagnosis, time to treatment and access to the most effective drugs. Some uninsured cancer patients in the United States encounter problems with timely treatment and access, but a far larger proportion of cancer patients in Europe face these troubles. No country on the globe does as good a job overall as the United States. Thus, the U.S. government should focus on ensuring that all cancer patients receive timely care, rather than radically overhauling the current system. 1. Arduino Verdecchia et al., "Recent cancer survival in Europe : a 2000–02 period analysis of EUROCARE-4 data," Lancet Oncology, 2007, No. 8, pages 784–796. 2. The U.S. bladder cancer data is from "Cancer Facts & Figures 2007," American Cancer Society. Available at http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf. 3. June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S.," National Bureau of Economic Research, NBER Working Paper 13429, September 2007. Available at http://www.nber.org/papers/w13429. 4. K. Davis et al., "Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care," Commonwealth Fund, May 2007. Available at http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678. 5. Sharon Willcox et al., "Measuring And Reducing Waiting Times: A Cross-National Comparison Of Strategies," Health Affairs , Vol. 26, No. 4, July/August 2007, pages 1,078-1,087. 6. M.V. Williams et al., "Radiotherapy Dose Fractionation, Access and Waiting Times in the Countries of the UK in 2005," Royal College of Radiologists, Clinical Oncology , Volume 19, Issue 5, June 2007, pages 273-286. 7. Bengt Jönsson and Nils Wilking, "A Global Comparison Regarding Patient Access to Cancer Drugs," Annals of Oncology , Vol. 18, Supplement 3, June 2007. Betsy McCaughey, a former lieutenant governor of New York, is chairman of the Committee to Reduce Infection Deaths ( http://www.hospitalinfection.org/) .

If you are going to make a relevant comparison of the precise contribution that a healthcare system makes to longevity, you first have to make sure that you are measuring outcomes that are actually affected by what happens in clinics and hospitals, no? If your intention is to make an accurate comparison between countries on this basis, you have to start ruling out things like...murders. Trauma centers can make a marginal difference here (actually, I have to wonder how much of the decline in our vaunted decline in the murder rate is due to substantial improvements in trauma care after things like requiring ER docs to get ATLS training, diffusion of best practices for gunshot trauma, etc), but in most cases killers finish the job before anyone can intervene. Then you have to consider the impact of lifestyle choices (please present any evidence that doctor/nurse + patient interactions have any effect on people's habits), nutrition, immigration, etc. After you've made at least an effort to control for mortality from factors that no one in the health-care system can actually do anything about, *then* you can start making an honest effort to compare the *actual effectiveness* of country A's health-care delivery system relative to country B's. Then you have to make sure that country A and B measure the same thing in the same way. Infant mortality statistics are a wonderful example of a cases where virtually every country determines what constitutes infant mortality in vastly different ways. Then you have to make an effort to adjust for the actual incidence of a disease in country A and country B. If both countries have the same population, and have the same number of deaths from lung cancer, but the incidence of lung cancer is three times as high in country B, what does this say about how good the treatment for lung cancer is in country B versus country A? None of this necessarily amounts to a defense of the American health system. It is quite possible that once you've made an effort to institute the appropriate controls, that the US will look even *worse* relative to the rest of the world - but all too often the data required for an accurate comparison just isn't available - and this is something that intellectually honest scholars on the left and the right often find themselves disagreeing about. I am aware of one study that seems to make a good apples to apples comparison of cancer care between countries, and I'll post a summary of that data below.

Makes you wonder if there's any cost-shifting going onto private insurers to recoup costs that exceed reimbursement schedules elsewhere...cough...cough. The prices that hospitals charge for care and supplies would make for an interesting conversation* (I'd be surprised to see a pair of latex gloves show up on an itemized bill for less than $50), but let's talk for a moment about mechanisms to control costs. And the rightwing mantra of "leave medicine to the doctors, not the gov't" - what utter bullshit - these are the same clowns who took over, raped, and all but destroyed our medical system in the '80s and '90s with 'managed care'. What makes you think that the the government won't also have to develop and impose additional mechanisms to restrict treatment options in an effort to control costs if we institute a single payer model, and what evidence from other single-payer only systems do you have to support that claim? *Do you disagree that hospital billing practices represent an effort to shift costs from parties who don't pay the full cost of their care onto those who can? If not, why? If so, what's driving this cost shifting?

I'm coming home to watch the activists in "Anti-hegemonic Counter-Narrative Installations" in the "the temporary autonomous zones of street parties and convergence centres liberated in cities during summit protest" use a combination of interactive tofu sculptures and interpretive dance to illustrate the manner in which futures contracts for US No. 2 yellow corn have the potential to fatally undermine the global anticapitalist movement. Let me know if you'll be dressed as "the organic carrot of indeterminate gender" or the "reconceptualized counter-mascot" in the above.

This should help get you started: 1. http://www.latimes.com/news/local/la-kingdrewpulitzer-sg,1,4721261.storygallery 2. http://www.latimes.com/news/opinion/la-op-dustup29jun29,1,7591993.story

I'm actually astonished that you aren't, at this very moment, running around downtown Bellingham, grabbing strangers by the shoulders while screaming "Quadrillions! Quadrillions! Quadrillions in Derivatives! Can't you see, don't you understand! Quadriiiiiiiiiiiiiiiiiiillions!!!!!!!"

That was certainly an outrage, and deserved the international attention that it got. If you have a moment, plug the terms "King Drew Hospital" and any combination of negative adjectives into Google and do some more reading. The saga of that hospital is an indictment of many things, and I'd be curious to hear what conclusions you come to if you take the time to learn some of the background information concerning the problems at that hospital and how they came to pass, and persist.

In fairness to Canada, I have to say that there's a reasonable chance that Richardson would have died had her accident occurred in the US, and that as someone that's married to an ER doc that just finished residency in a major metro area - anyone with a simple fracture of their arm is bound to wait an awfully long time to be seen. One car accident with multiple traumas pretty much pushes everything else to the back of the line for as long as it takes to get the patients stabilized and sent off to surgery, the ICU, or wherever else they need to go. Triage - pure and simple. In fairness to bill, my wife has just recently finished her 6-month stint as an ER doc here in New Zealand, and from speaking with her and other doctors who have practiced in the US - the consensus is that odds of surviving an accident that requires fast care by highly trained specialists and the use of modern diagnostic equipment is higher in the US. Ditto for malignancies, and/or other conditions that are difficult to diagnose and/or treat. Also - if you are beyond a certain age and you have a potentially fatal condition that's costly to treat, or if you are younger and are simply too far gone to have a reasonable chance of living, the odds are pretty high that you'll be limited to palliative care sooner than you would be in the US. I suspect that things fairly similar to the way they are in Canada. Better or worse in general? Depends on the circumstances.