Let’s rethink Canada’s health care system

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Tony Fell is a retired financial executive and former board chair of the University Health Network. He is a fundraiser for the Cambie medical constitutional challenge.

Canadian physicians, surgeons, nurses and other health care workers are as good or better than any in the world. But regrettably, they work in an outdated health care system which had serious structural shortcomings even before the pandemic exposed them for all to see.

The critical issue is this: With an aging population, the cost of government-funded health care is growing considerably faster than GDP, and government finances can’t keep up.

The shortcomings of our health care system are fully documented by the Fraser Institute in a 2020 report which covers the performance of 28 Organisation for Economic Co-operation and Development countries which have a universal health care system. Data for the report came from the OECD, the World Health Organization and the Commonwealth Fund. Seven OECD countries, including the United States, are not included as they do not have a fully universal health care system; all metrics were not available for some countries.

Adjusted for age, Canada ranks second-highest in total health care expenditures as a percentage of GDP and seventh in terms of expenditures per capita. And yet, in terms of physicians per 1,000 people, Canada ranked 26th; on nurses we ranked 14th; 25th of 26 on acute-care beds; 24th on psychiatric beds; and 7th of 25 in terms of long-term care beds. In terms of MRI units per million people, Canada ranks 22nd (out of 26); CT scanners 21st (out of 27); PET scanners 18th (out of 23); Gamma cameras 2nd (out of 21); and mammographs 14th (out of 20). This is not great news.

Importantly, for those countries that did disclose wait times, Canada ranked at the very bottom: 10th place for the percentage of patients who had to wait more than two months for a specialist appointment, and 10th for the percentage of patients who had to wait more than four months for elective surgery, out of 10 countries. In Canada, surgical wait times before the pandemic were at unsatisfactory levels – following the pandemic and the long suspension of elective surgeries, they’re now much longer. Is all of this good enough for Canada? I don’t think so.

Of the 28 countries in the study, Canada is the only one that does not have a private-sector alternative working co-operatively alongside a universal health care system in providing medically necessary services covered by the public plan. Rather, we insist on a national health care monopoly with no competition – one backed by a government that separately works to ensure lively competition in the airline business, grocery industry, telecom sector and gas retailing. Why is that? The government well knows that a bit of competition in any business is good because it encourages change, efficiency and innovation. That is why 27 other countries which have a universal health care system also have a private-sector option.

Now is not the time for our federal government to throw tens of billions more dollars at our health care system, as we have been doing since former prime minister Paul Martin’s 2004 “fix for a generation.” Rather, it’s time for a rethink of how our health care system is – and should be – structured. Ottawa should tweak existing legislation to permit any province to decide for itself whether or not to add private-sector support to its existing universal health care system for medically necessary services.

This is what Dr. Brian Day, the owner of Vancouver’s Cambie Surgery Centre, has been advocating for in his years-long constitutional challenge. While those efforts were initially dismissed at the B.C Supreme Court in September, the case is now before the B.C. Court of Appeal, and is likely to ultimately reach the Supreme Court of Canada. I hope the judges there will do the right thing – rather than the political thing.

Meanwhile, the provinces – which are struggling under major financial pressures in health care, yet have opposed the case – should really be flat-out in favour of this initiative. It would bring billions of new private investment in clinics, surgeries and other services while taking the pressure off our public health care system. Indeed, it would be no surprise if the same governments that have publicly opposed to Dr. Day’s efforts would breathe a sigh of relief if the Supreme Court were to rule in his favour. They’d be able to say that familiar political line – that they fought the good fight, but were overruled by the courts.

Let’s get politics out of health care. A private-sector safety valve is just plain good public policy, based on the international evidence.