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The official residence of the Prime Minister of Canada, at 24 Sussex Drive, is a rodent-infested mess. The once-stately mansion is crumbling inside and out, with water damage, rusty pipes, drafty windows, and electrical problems so serious that it’s become a fire hazard.

The PM and his family have moved out. The staff have evacuated. Yet, no one, from the PM down to the National Capital Commission – the federal agency responsible for its upkeep – wants to make a decision on what to do next. The paralysis over the decades has proven costly.

After decades of neglect, the state of disrepair is such that we need to ask: Can it be rehabilitated, or do we need to tear it down and start anew?

If this sounds familiar, it’s because there are eerily disturbing parallels between the slow, steady desuetude of 24 Sussex and the destruction-by-neglect of Canada’s medicare system.

The residence was once a private home owned by lumber barons until it was expropriated during the Second World War. It became an official residence in 1951.

Canada’s medicare system also had its beginnings in the wake of that war, when private insurance plans were supplanted by publicly funded hospital insurance programs, which were later extended to cover physician services.

Heady times followed, with new public programs like pensions and old age security (in addition to medicare). Governments spent big on public infrastructure such as hospitals, schools and community centres. Much of this investment was necessitated by the coming-of-age of children from the baby boom generation.

Yet, at the same time, the innate conservatism of Canadians remained. Prime minister Louis St. Laurent essentially made medicare a national program by agreeing to split costs 50-50 with the provinces, but he was otherwise hands-off. He also resisted moving into the newly minted official residence, fearing the potential optics of him living off the government teat. The compromise was that the prime minister paid rent to live at 24 Sussex, a practice that continued for two decades. (Could anyone imagine the U.S. President paying to live in the White House, or the British PM signing a lease for 10 Downing Street?)

Canadian fiscal puritanism knows no bounds. That goes a long way toward explaining why, for more than six decades, there has been virtually no substantial upgrades to 24 Sussex, save for the installation of a pool by then-prime minister Pierre Elliott Trudeau in 1975 (which was paid for by private donors).

In 2018, his son Justin Trudeau said out loud what many had been saying privately for years: “No prime minister wants to spend a penny of taxpayer dollars on upkeeping that house.”

And so it rots and houses rats as the repair bill mounts. It’s now estimated it would cost somewhere between $34-million and $100-million to make the property livable and secure, and the costs go up with every passing year.

We see a similar pattern of costly dithering with medicare. Of course, there is no reluctance to spend: Between 1975 and 2022, annual health expenditures grew from $7.4-billion to $331-billion (that works out to $324 per Canadian compared to $8,563, in that same time period). But there has been a stubborn resistance to making fundamental structural changes to adapt to new demographic realities and technological advances.

The Boomers have aged, but the system has not evolved to meet their needs – namely, more chronic care than acute care, and programs like supportive housing in addition to medical care.

There are now 6.5 million Canadians without a primary care practitioner. With a shaky foundation like that, the collapse of the larger system is as predictable as that of 24 Sussex.

Had the upkeep been done over the years, the Prime Minister’s official residence would be fine, or at least livable. The same is true of Canada’s health system. It’s the constant putting-off of necessary fixes – driven by fear of public backlash – that has made the situation untenable and urgent.

Essentially, politicians have done nothing but fiddle around the edges for 60-plus years because they worry that there is no public consensus on how to implement large-scale reform. (The popular rhetoric that any change will result in a “U.S.-style” system certainly doesn’t help.) So we do nothing.

Now, the rebuilding has become urgent. The house of medicare isn’t just decaying slowly; it’s on fire. The rats – private hedge funds and the like – are gnawing at the edges. Foundational health system reform is needed. And unlike an old house, we can’t just tear down medicare and start from scratch.

Or can we?

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