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When we’re not in a pandemic, Canadian hospitals are at perpetual risk of being overrun. In fact, they often are overrun – particularly during cold and flu season – when patients on gurneys are relegated to hallways and storage closets, and when wait times in emergency rooms can balloon to tortuous levels. It is not unusual for hospitals to routinely be operating at or exceeding max capacity.

Analysis by the Organization for Economic Co-operation and Development shows that Canada is among the highest spenders on health care per capita among comparable countries, but we boast some of the poorest results. Canadians wait longer for a specialist appointment than do residents of all other peer countries, including those in Britain, France, Switzerland, Germany and the U.S. We have among the fewest hospital beds per 1,000 people (2.5 in 2019, compared to 5.8 per 1,000 people in France, and 7.9 per 1,000 people in Germany) and rank nearly last for acute care spaces relative to population. And even prepandemic, before hospitals started cutting back on so-called “elective” procedures, Canadians were waiting a median time of around 39 weeks for orthopedic surgery from the time of initial referral from a family doctor.

COVID-19 has tested the limits of health care systems all around the world, but few have proven quite as fragile as ours, which is why Canadians have again been forced to lock down nearly two years into the pandemic. Schools are closing again, strict capacity limits are coming back, restaurants are being shuttered and Quebeckers are once more being subjected to an illogical and inequitable curfew. And it’s all happening in the name of protecting our health care system – something about which Canadians are fiercely proud and unyieldingly protective, but which hovers on the cusp of crisis even in the best of times.

The pandemic has now exacerbated many of the enduring problems plaguing hospitals and health care staff; burned out nurses all across the country are leaving the profession, which has worsened staffing shortages, and thousands upon thousands of delayed surgeries and diagnostics have compounded already crushing backlogs. Back in May, the Financial Accountability Office of Ontario estimated it will take three-and-a-half years to clear the province’s surgical backlog and cost roughly $1.3-billion. Those numbers will likely go up now that Ontario has halted non-urgent surgeries again. Other provinces are facing similar backlogs, and likewise will take years to catch up.

The simplest solution is to throw more money at the problem – to raise our rank even higher as one of the top per capita health care spenders, to marginally improve our bottom-ranking health care quality measures. But considering the decades of neglect with which various levels of government have treated our system, it would take gargantuan levels of investment just to catch up with the needs of our rapidly increasing and aging population. And even then, we’d merely be pouring more cash into a demonstrably inefficient system.

This pandemic should prompt Canadians to reckon with the reality that our health care system isn’t working. Indeed, when a province of millions is brought to a virtual standstill by the prospect of a few hundred additional people in acute care beds, that fact is undeniable. The changes needed to meaningfully improve health care quality and access in Canada have to be substantial, and there are myriad models to consider and explore: the German universal multi-payer system, Japan’s national insurance program, Britain’s system whereby private providers operate alongside the public NHS, to name just a few.

Unfortunately, whenever discussion of substantial health care reform is raised in this country, Canadians are spooked into believing that changes to the system would de facto result in an American-style health care system where patients would go bankrupt to afford chemo treatments. Our proximity to the U.S. makes that concern appear more acute, even though the U.S. is an outlier among developed nations when it comes to its health care model, and the introduction of private health care alternatives would render Canada more like Germany or France, where patients generally wait less time for surgeries and have more access to hospital beds and specialist care.

Politicians like to stoke worry about Canada falling down a slippery slope into American-style health care, because it works. The Liberals demonstrated that in the fall by torquing an offhand comment by Conservative Leader Erin O’Toole about private options and turning it into a multi-day fear fest about the destruction of our beloved universal system.

But unless and until we can confront the reality that our beloved system isn’t really working, and start considering alternative options honestly, Canada will be stuck paying extraordinarily high costs for health care for ever-worsening outcomes. If this pandemic doesn’t catalyze the discussion, nothing will.

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