It's another contributing factor to the "brain drain" effect. In that it's a worse deal for a US Citizen to move to Canada on a CUSMA visa than for the opposite.

I haven't lived in either country but as someone who lives in a country with socialised healthcare, it mainly benefits the older generations, as health issues begin to crop up nearer retirement.

If a Canadian spends most of their working life in the U.S. then returns to Canada to raise their kids or to retire then they're getting the best of both worlds.

Not really. The internet bubble might make you think that, but actually ordinary people aren't interested.

People with good jobs have health insurance, people without get government subsidized insurance. Either way most people are fine with what they have.

And the issues with healthcare in the US will not be solved by the government being the one to pay. Billing is too complex (i.e. costly), and Dr salaries are too high (compare them to other countries). Neither of those issues are solved by the government paying.

And don't forget how Americans hear stories from other countries about huge waits for care, and they want none of that.

There are zero proposals to make all Dr's employees of the government, on salary, who just take care of whoever shows up. But that might actually work to reduce costs.

It also gets immigrants from the China (772k), UK (427k), Germany, France (100k each). Saying its all stick and all those people are desperate is an insane take.

Believe it or not, not every person in this planet wants to move to the US.

In terms of people in the tech industry I know of who moved to Canada from countries where they get a legitimate pay boost there.. Yes, it makes sense for them. If they never attain permanent residency, at least they made more money than they would have back home for a few years.

However, I've rarely seen one of them turn down a chance to get an additional huge pay boost by moving to the United States afterwards. In fact, it's common for top tier companies to just use Canada as of sort of waiting room or fallback option for folks who are ultimately dreaming of moving to the US to make those higher salaries.

I don't think Canada can compete on pay, but there are certainly people who could get that top pay but would trade it for a chance to live permanently in Canada. I'm guessing those are the sorts of people who have already taken pay cuts to work in highly specialized or speculative areas of science and technology. These are great people to have because they are low risk and high reward in terms of impact on the economy.

Sadly, if you look at any forum for Canadian immigrants you'll find a huge amount of depressing stories about never attaining permanent residency or of grinding for years to game the point system in a way that is soul crushing. It is a broken system on both sides. Let me try to explain what I mean by that.

The European Union does not have a points and lottery based system as it's sole mechanism of entry the way Canada does. If you make above a certain salary, you can get a blue card. You can accumulate time on the blue card in any country in the EU (except for Ireland, which has their own similar system if I recall). After 5 years you can typically apply for permanent residency, in Germany just 2 years so long as you attain B1 German (very practical for usage in daily life and doable in the timeframe without cramming or cutting corners).

The implicit reasoning seems to be that if you can stay out of trouble and earn a good living for 5 years. You're probably worth keeping around. I think a heuristic like that beats a point system which simply encourages gaming behavior anyway.

Check out all of the people cramming French to try to increase their odds in the Canadian lottery for example. Canada probably doesn't get the sorts of genuine francophones they seem to be looking for--cramming for an exam with a verbal component is not the same as fluency--and the people entering the country are doing so by playing arbitrary games instead of living a real life.

And of course the French is just one example, there are also all of the useless courses and degree programs. The points-based lottery encourages and rewards the accumulation of arbitrary points, or in other words, a sort of dissimulation.

I suppose you could argue that Canada is selecting for people who are willing to diligently jump through hoops. If so, that does nothing to address brain drain.