82. The second disadvantage is subtler: I broadly refer to it as the low agency or gatekeeper model of healthcare.
Broadly, in Canada, if you have a health problem, the doctor decides what to do about it. In the US, if you have a health problem, *you* decide what to do about it.
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83. In the US, the main gatekeeper of healthcare is your insurance company. If you have the resources, though, you can just ignore what they say and get ~whatever healthcare you want. You can easily shop around for a different doctor if you aren't getting the treatment you want.
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84. In Canada (or at least Ontario), the system is much more centralized. If the government hasn't authorized a treatment,there's little you can do to work around it (except go to another country).
Put another way, Canadians mostly look at all health as public health.
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85. All of this means that if you're trying to solve a health problem that's a huge deal *to you*, but not legibly a big deal to a government bureaucrat, the Canadian healthcare system will fail you.
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For example: I'm not qualified to talk about this in detail, but trans friends tell me that the Canadian healthcare bureaucracy took a long time to catch up to international best practices for gender-affirming care.
The costs of that delay are... enormous. :-(
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87. Let's talk a little bit about higher education.
The best universities in Canada are all large, public universities, roughly equivalent to strong flagship state universities. There's no equivalent of the "Ivy League" or "HYPSM" or equivalently elite American schools.
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88. This has profound effects on the right tail of Canadian education. The most talented Canadian students don't spend their undergraduate years embedded in an ultra-elite crowd.
Overall, this is probably good for society but worse for the most talented individuals.
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IMO, the main advantage of a small, elite university is the *density of potential*: you get to know a lot of people who will go on to become famous scientists, CEOs, politicians.... This provides a ton of social capital to those who attend them.
Dunno if this is net good or bad.
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Good point that it makes sense to break out size and concentration.
I do think that each has pros and cons: small places are naturally more intimate, and can feel safer to young people figuring things out in the world (this was definitely the case for me).
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Concentration can have downsides, too, although I'm more confident that the pros outweigh the cons. I think that diffusing top students probably benefits other students somewhat, although less than concentrating them benefits top students.