Brian Day is the medical director of Cambie Surgery Centre in Vancouver, and a former president of the Canadian Medical Association. Cambie Surgeries Corporation was one of the plaintiffs in a recent legal challenge seeking to have certain sections of British Columbia’s Medicare Protection Act declared unconstitutional. The B.C. courts ruled in favour of the B.C. government. Cambie is currently seeking leave to appeal to the Supreme Court of Canada.
In a recent highly publicized meeting in Vancouver, our 13 provincial and territorial health ministers met with their federal counterpart to seek solutions to a self-inflicted crisis. The summit of 14 ministers – each of whom preside over a bloated bureaucracy that was almost 11 times as large as Germany’s on a per-capita basis in 2011 – was aimed at helping the millions of Canadians without timely access to quality medical care.
Earlier this month, the Canadian Institute for Health Information (CIHI) announced that total health spending in Canada is forecast to hit a new record high of $331-billion this year, which would represent 12.2 per cent of our GDP. That makes us the highest spender of all similarly developed countries that offer universal care – and yet one of the worst performers.
The facts speak for themselves. A 2021 Commonwealth Fund study ranked 11 countries’ health care systems based on access to care, care process, administrative efficiency, equity and health care outcomes; Canada ranked 10th, above only the U.S., which does not have universal care. According to the Fraser Institute’s analysis of OECD data examining 2019, Canada ranks 26th of 28 OECD countries in available physicians, 14th in available nurses and 25th in available acute-care beds per thousand population.
In 2016, we had nine times as many patients who had to wait four months or longer for surgery as the French, and 18 times as many as the Germans. For each hospital discharge, Canadians paid double that of the OECD median of countries that offer universal care. Last year, more than 11,000 Canadians died waiting for surgeries, diagnostic scans and appointments with specialists, according to the think tank SecondStreet.org. And The Globe and Mail found that, as of this summer, only one in five British Columbians referred to an oncologist received a first consultation within the recommended period of two weeks, despite the importance of timely treatment in cancer care.
In the 2021 Commonwealth Fund report, Canada was also ranked last in equity of the 10 countries with universal care. Our government agencies have documented that Canadians of a lower socioeconomic status have the worst health outcomes and the worst access to care. Any claims that our current system looks after the poor and those in need are false.
But at the Vancouver meeting, the provinces strongly rejected any suggestion that additional funding for our reeling health care system be subjected to performance monitoring. Being accountable is apparently considered inappropriate.
Provincial and territorial governments seem to have ignored the lessons of the 2004 First Ministers’ meeting on health care, at which they agreed on a 10-year accord with added spending of $41-billion. Then-prime minister Paul Martin called it “the fix for a generation”; it fixed nothing. Now, that generation of politicians is gone, and accountability is a forgotten issue. Perhaps that’s why our current politicians are seeking a similar approach – another massive cash infusion to the provinces and territories – rather than looking for real solutions.
The governments’ proposal to prop up the status quo with stopgap funding only defers responsibility to a future generation. The current group of politicians won’t be there to worry about being re-elected.
Governments also plan in three-to-four-year electoral cycles, and by doing so, they often conveniently ignore past errors and omissions. In the early 1990s, governments decided that our doctors and nurses were treating too many patients and blamed them for rising health costs. Their solution was to cut medical school spots, reduce immigrant health workers and close nursing schools. When I came to Canada in the 1970s, we ranked among the top in the world in doctors per population; we now rank 69th. Governments are lamenting the shortages they created.
In a recent statement, the Canadian Nurses Association and the Canadian Federation of Nurses Unions declared that “Canada faces one of the worst health-care crises and nursing shortages in its history.” They are right about the crisis, but it is our hospitals, rather than Canada, that face the shortage. Among developed countries we have an above-average number of nurses, but by failing to deliver on promises of timely care, governments have allowed front-line health care workers to endure the brunt of patients’ frustration – creating a toxic environment in hospitals that many workers have chosen to simply leave.
For many decades, we have lived with false promises. The current problems are not new. I could quote from numerous headlines from more than 25 years ago describing a health care crisis in Canada. The suggested strategy of propping up a failed system by pouring in more tax funds corresponds to the maxim, sometimes attributed to Albert Einstein, that doing the same thing over and over again while expecting different results is a form of insanity. Consistent with that approach, B.C. Health Minister Adrian Dix called for yet another national conference at the conclusion of the most recent summit. Canadian governments have previously called for hundreds of royal commissions and task forces about health care. They are a well-used strategy to evade responsibility or the need for action.
Some have also suggested that taxpayers should simply pay more, through federal rather than provincial taxes. But that proposal ignores the reality of our struggling system, and the reality that both sets of taxes would be extracted from the same Canadians.
Real solutions are available, including from the top-performing social democracies in the world that outrank us in equity and access. We must end, for instance, the practice of funding hospitals in lump sums once a year, so that each ensuing patient visit does not then represent a cost to the facility. In other countries, each public patient brings revenue, paid by the state, which creates an internal market that incentivizes quicker and better care from hospitals that want more revenue.
The provinces should also introduce a care guarantee that patients must not wait longer than a benchmark time, beyond which it is demonstrated that harm may result. If that time is exceeded, the government must fund care elsewhere, even if that involves funding private care or travel to another province or country.
Finally, we must eliminate our unique state-enforced monopoly and allow non-government competition with private insurers and providers. Every other country in the world allows that option. Concerns about low-income Canadians being unable to afford private care can be addressed by ensuring public care is so good that private options are unnecessary, or alternatively by funding their private care.
A 2022 poll by the firm One Persuades showed that nearly 75 per cent of Canadians believe private insurance should be allowed to access care in the face of unacceptably long waiting lists, paralleling a similar finding in a 2018 Ipsos survey. Governments need to listen to this majority. The only special-interest groups that deserve consideration are patients suffering under the status quo. If they fail in this, they will only prove what Winston Churchill said in 1903: “Governments create nothing and have nothing to give but what they have first taken away.”