[mabbo]

What I find interesting when comparing the US the Canada on topics like these is that in Canada, there is self-interest in demanding workers be protected. Like beyond the fact that it's a good thing you do.

Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.

There's incentives for our government to protect workers from risks that will cost a fortune to fix.

In America, there's only the "because it's the right thing to do" reason, which is never enough for anyone to actually do anything.

[dang]

Please don't take HN threads on generic nationalistic flamewar tangents. I'm sure you didn't intend it, but that's what this leads to, in the statistical case.

https://news.ycombinator.com/newsguidelines.html

Edit: we've had to ask you not to do this on HN more than once before. Please avoid it in the future.

https://news.ycombinator.com/item?id=34492512 (Jan 2023)

https://news.ycombinator.com/item?id=34073107 (Dec 2022)

[mabbo]

Sorry Dang. I hadn't realized it was coming off that way, but I'll be my best to check myself in the future.

I can see how what I said would be construed that way.

[slumpt_]

He was drawing a pretty reasonable comparison between economic incentives in the respective countries and how it has downstream affects for regulatory response. Don't make it something it isn't.

[haldujai]

Canadian data is relatively poor quality (mostly from the 90s) outside of Alberta (I expect QC and BC probably have the highest rates) but historically and estimates are that we have slightly higher incidence than the US.

https://onlinelibrary.wiley.com/doi/full/10.1111/resp.14242

> There’s incentives for our government to protect workers from risks that will cost a fortune to fix.

There are many examples where this is inaccurate but let’s keep it simple and delve a little deeper into the silicosis problem presented in this specific study.

From the JAMA article:

Although a substantial number of the patients, including some of those who were uninsured or with restricted-scope Medi-Cal, likely had an undocumented immigration status, we did not directly collect information about whether individuals were undocumented immigrants.

Note that public health system in Canada is not “free”. Legal immigrants, documented workers, citizens and refugees have access to provincial or federal health insurance which pays for care.

Undocumented or illegal immigrants have neither (and also would not get WSIB which would be the payer for most silicosis cases) and actually have better coverage in California.

Additionally:

Ten patients (19%) were uninsured, 20 (38%) had restricted-scope Medi-Cal, 7 (13%) had Medi-Cal, 8 (15%) had private insurance, and 7 (13%) had workers’ compensation.

So 34/52 had some form of government provided or mandated insurance.

As an aside while restricted-scope Medi-Cal and uninsured rates are the surrogates for undocumented immigrants in this study, those over the age of 50 (or 19-25) are also eligible for full scope Medi-Cal but were not identified in this study. Medi-Cal will also be expanding in January 2024 to cover undocumented immigrants aged 26-49.

Even if we assume Canada’s silicosis incidence is lower, all of the above strongly suggests your public health system cost-savings incentive hypothesis is incorrect.

[PaulDavisThe1st]

> Note that public health system in Canada is not “free”.

I'm enough of a pedant to annoy the fuck out of most anybody who knows me, but really? Look, there is no "free" health care anywhere, but it's a term that has (perhaps unfortunately) become widely used as a synonym for, depending on your sensibilities "no charge at the point of service" and/or "socialized health insurance and health care coverage".

And Canada is certainly one or both of those.

The metric "well, they don't provide it for undocumented persons" is a weird one, as is the use of California as a counter-example.

[pupppet]

> Canadian data is relatively poor quality

Sure, no axe to grind here. Do tell us your impartial take.

[dghughes]

Then again my Dad who died of a lung disease said the government agency (Coast Guard) he worked for turned a blind eye to what he and his co-workers had to do. Dad would tell me even as the late 1990s his job was to take a powder, wet it, form it into big mats. They were filters for the boiler water. The powder used was or maybe just contained asbestos. He said the workers on the dock were covered in it he said the place looked like it had snowed.

Dad knew but he was stuck in the past of "It had to be done" mentality. And really as a high school drop out he really may not have understood the danger. For years he and my grandfather had a painting business with the paint at that time containing lead.

[Anon1096]

Perhaps unexpectedly, people dying are usually _cheaper_ for a healthcare system than healthy people. This has been studied a lot with smokers, basically people in old age cost far more than young people and thus a true cost-minimizing system would not be how you expect. Of course, we aren't trying to minimize cost so the premise is flawed.

[Sharlin]

Smokers specifically are very much a net cost to society, because smoking kills slowly and in a very expensive manner.

In any case, anything that makes people die young, or more generally reduces people’s capacity to work (like many diseases of affluence) is incredibly expensive to society once you factor in indirect and opportunity costs.

[lazide]

Eh, depends. COPD, or like the article is about, Silicosis, is a long slow drawn out illness.

[DoughnutHole]

This is very dependent on the illness.

From a cost perspective it’s best that people die suddenly. If I live a fairly healthy life into my 80s and die of a heart attack, I might not necessarily have cost my insurer that much, as opposed to if I suffer from a chronic illness for 10, 20, 30 years.

Cancer is now usually not a sudden death sentence - treatment is good enough now that most cancers caught early can be treated and patients often go through multiple remissions before it or a complication from treatment finally gets them.

Insurers very much do not want their customers getting cancer, because it is invariable an extraordinarily expensive condition to treat and treatment can go on for years.

[sershe]

Do you have a reference for this? This was a weak hunch for me before but I always assumed I was wrong based on e.g. insurance rates. If insurance prices it higher, it must be more expensive to cover?

[DoreenMichele]

Last I checked, Canada doesn't share a border with Mexico and some portion of these Latino "day workers" are illegal immigrants. Day workers are often paid under the table and when I have read other stories about them, they tend to include medical horror stories like "So, this guy cut 3 of his fingers off and they didn't even take him to the ER. They just returned him to the place where they had picked him up."

This is not exactly the best use case for arguing about Canada versus US healthcare policies.

[mitthrowaway2]

Canada doesn't have a border with Mexico, but it does have its share of undocumented and under-protected workers.

> While there are no accurate figures representing the number or composition of undocumented migrant population in Canada, estimates range between 20,000 and 500,000 persons

> Research suggests most undocumented individuals live in large urban centres and typically work in seasonal and informal sectors, such as construction, agriculture, caregiving and housekeeping.

> Undocumented migrants are a vulnerable group due to their lack of immigration status, as was seen during the COVID-19 pandemic. They have limited access to health care, social services or employment protections.

Source: https://www.canada.ca/en/immigration-refugees-citizenship/co...

Until this year, asylum-seekers could transit through the United States into Canada under the Safe Third Country Agreement, by crossing the border at an irregular crossing like Roxham Road.

Sources: https://www.cbc.ca/news/politics/deal-roxham-road-migrants-b...

https://www.cbc.ca/news/canada/canada-asylum-seeker-increase...

https://web.archive.org/web/20230601135133/https://www.nytim...

[Tao3300]

More policy preaching from ultra-white northern countries that don't let anyone in. It's such a tired trope...

[ChumpGPT]

>What I find interesting when comparing the US the Canada on topics like these is that in Canada, there is self-interest in demanding workers be protected. Like beyond the fact that it's a good thing you do.

Is there any evidence of this? That the Canadian Gov cares more about workers than the US Gov?

>Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.

What evidence do you have that this is the case?

>In America, there's only the "because it's the right thing to do" reason, which is never enough for anyone to actually do anything.

Is this your opinion or is this the reality. I don't know if you have ever walked by a construction site in Toronto to see guys cutting cement or stone. None of them have masks. Sometimes they will have a wet saw when cutting cement on the street but that is to reduce dust for traffic and pedestrians and not so much for their health. The Canadian Postal Union fought the Federal Gov for years to provide an environment where paper dust was considered a health hazard and workers need to be protected. Many postal workers suffered from COPD because paper dust was too fine for the Lungs to filter. What about farmers and dust? I'm sure they suffer just as much as American farmers.

I've come to realize Canadians suffer from an inferiority complex and have to constantly try and make comparisons to make themselves feel better, it's a strange phenomena.

- Expat....

[Aeolun]

I don’t think cutting in the open air and cutting in tiny sweatshops are at all comparable.

[bushbaba]

America offers Medicare so we still bear the cost. Just only if they live long enough to receive the retirement benefits.

Yeah one heck of a perverse incentive.

[cj]

Medicare for the elderly, but we also have Medicaid for people in poverty (< $15k/yr income for a single person w/o a family) which covers most basic medical/dental/ vision needs and is taxpayer funded.

Someone taken out of the workforce may qualify for that if they don’t already qualify for disability insurance or similar payments (although I’m not 100% clear if those are funded via private disability insurance or public programs)

[sologoub]

Since the examples are in CA, there is Medi-Cal for those who are too poor to buy subsidized insurance and it’s not age-related unlike Medicare. It’s an expanded form of Medicaid. I’d bet CA taxpayers do shoulder the costs if the victims know to apply.

[paulddraper]

> Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.

That is true with or without publicly funded healthcare.

[grecy]

You could argue that more sick people is good for the US economy, and it helps rich people get richer.

[AnthonyMouse]

> Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.

The US healthcare system uses private insurance, implying that more use of the healthcare system raises everyone's premiums. And people without insurance then go to emergency rooms which are in turn still passing the cost onto private insurers. So voters already have the same incentive in order to avoid their premiums going up.

[thomastjeffery]

That incentive is obfuscated, though. Every insurer exists as an invisible boundary where cost is not passed to others.

On top of that, insurance is optional. There is no guarantee a person will get affordable care. That's the entire point of the system! If there were a guarantee, it would be indistinguishable from Canada (and practically every other country's) single payer healthcare system.

[yjftsjthsd-h]

> Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.

The taxes part is the same; only the healthcare half is different.

[galangalalgol]

Incidentally this is also why everyone working in a nation has to receive these benefits (and any others guaranteed to citizens), otherwise you get migrant workers who suck up this, quite literally in this case, but don't receive healthcare.

[lm28469]

Only illegal migrants aren't covered, legal ones are. If you make it available to everyone regardless of their legality to be on the soil you open up a whole bunch of other issues

[LordShredda]

That could also be resolved by having tight border security and heavily penalizing anyone involved with their entry

[cjbgkagh]

I have ME/CFS and the fact that we're expensive to the general public seems to be the only reason there is any public money spent on treatments and cures at all. However, Canada and others are finding that medically assisted suicide offers an even cheaper alternative solution. So instead of money spent on treatments and cures we get subtle and not so subtle encouragements to kill ourselves, and I expect the problem to keep getting worse. I.e. I don't think the actual emergent behaviour for shared healthcare costs is as altruistic as you appear to except.

[mhb]

We already have the government involved - OSHA. Why would having it more involved be better if its current involvement is not solving the problem? It's pretty to think that the government has some sort of self-interest and if it can save money in the long run by spending money in the short run, it will do that. But that's not how things work, is it?

A more plausible conclusion from observing the results of an entity's involvement in something is that if it is incompetent with the thing you gave it to do, don't give it more stuff to do.

[bastawhiz]

> if it is incompetent with the thing you gave it to do, don't give it more stuff to do.

When my code doesn't work, I don't sunset the code, I fix it. Why would the best course of action be to stop trying instead of fixing the root of the problem?

[rafaelmn]

Not agreeing/disagreeing with this you but I wonder how you feel about obesity tax ? Low physical fitness tax ? There's plenty of evidence that exercise and diet significantly impact health (especially on population level) - like you said there's an incentive to keep those people healthy contributors instead of chronic burdens on the system. Sounds like a logical extension but doesn't seem popular/implemented widely.

[moomoo3000]

Public transit and walkable streets are also incentivized. People naturally end up walking more outside of US.

[morelisp]

If you take this view, any tax on current state is like a "cancer tax" - you're just doubly punishing the person.

Sugar tax, coal tax, corn syrup tax, worked-your-employees-90h/week tax? Sure.

[pydry]

I feel great about slapping a tax on the profits of companies that sell highly processed, sugary, addictive foods so that the market selects for healthier alternatives.

Maybe subsidies for selling fresh fruit and veg also.

I guess you could tax their victims instead though... they don't have a lobby so theyre probably easier to take advantage of.

[mitthrowaway2]

Tax on sugar, sure. But having an obesity tax would be like having a silicosis tax.

[throwaway8378]

What about all the other harmful activities? Recent studies about alcohol usage shows that even small amounts can be much more harmful than previous estimates. In addition to the health issues, we also need to consider all the accidents and violence that is connected to drunkeness.

[ilyt]

The problem is that you generally have to force people to keep their own safety. Else the el cheapo company shitting on any work safety will be cheaper and quicker, coz workers don't know any better, and thus more competitive, at worst killing the companies trying to do it properly.

[frozenport]

Does Canada have a different policy on engineered stone?

[lazide]

How do you explain the massive push to ban/stop Smoking?

The US is pretty much the only country to successfully reduce it, near as I can tell (perhaps Canada has had success too?).

[mitthrowaway2]

I'm curious about how you got that impression. In Canada, smoking is down from 26% in 2001[1] to 15% in 2019[2]. (Cannabis consumption is probably trending upward though). I have no reason to believe that this decline is particular to the US and Canada. Japan has been trending down from 33% in 2000 to 20% in 2020[3]. I expect this will have accelerated since the government made a strong anti-smoking push during the Tokyo Olympics. In fact, this seems to be a trend across the entire developed world, see this chart[4] showing that cigarette sales per adult per day peaked by the 1980s in every developed country surveyed, and all have been trending downward for decades. The US shows up as exceptional mainly in how extremely high its cigarette consumption habits were in the '60s and '70s.

[1] https://www150.statcan.gc.ca/n1/pub/82-624-x/2012001/article...

[2] https://www150.statcan.gc.ca/n1/pub/82-625-x/2020001/article...

[3] https://www.macrotrends.net/countries/JPN/japan/smoking-rate...

[4] https://ourworldindata.org/grapher/sales-of-cigarettes-per-a...

[steve_adams_86]

Canada worked to discourage and regulate smoking more aggressively around 20-30 years ago, and in 20 years we’ve gone from around 1 in 4 people smoking to more like 1 in 10. It steadily trends down.

https://uwaterloo.ca/tobacco-use-canada/adult-tobacco-use/sm...

[Shaanie]

What's with Americans and their strange view that the US is somehow managing to do something nobody else has? Just as an example I checked my country: https://www.researchgate.net/figure/Prevalence-of-daily-smok...

I'm pretty sure the figures will look somewhat similar in most western countries.

[was_a_dev]

The majority of Western countries have implemented and successfully reduced smoking rates.