On Monday, President Trump urged Republicans to “do the right thing” and repeal and replace the Affordable Care Act, legislation that extended health-care coverage to millions. The “right thing?” many Canadians are surely wondering, incredulously, given how thoroughly we’ve convinced ourselves of the merits of our own universal health care system. In reality, Canadians could stand to be a lot less certain we’ve got health care figured out. New evidence shows our system has become a model no other developed country would want to follow.
Perhaps Canada’s close proximity to the U.S.—and the regular reminder it offers of our relative superiority in this policy area—helps explain why Canadians are known for adjudging our health-care system to be the best in the world, when it’s really not. In fact, not even close, as a July 14 report by the Commonwealth Fund confirmed. The private foundation’s annual ranking of the world’s 11 most developed nations has placed Canada’s health-care system third last—ahead only of France and the U.S.
The Commonwealth Fund’s report joins a robust collection of similar reports—produced by the OECD and others—that have been saying more or less the same thing for years: that Canada’s health-care system doesn’t perform comparatively well on any number of metrics, such as health outcomes, equity and access.
Canadians could stand to be a lot less certain we’ve got health care figured out
The need for reform is not a new idea, then. Nor can the necessary changes be considered a mystery. The 2002 Romanow Report and 2012 Drummond Report, among others, have made concrete recommendations for how Canada’s health-care system can be improved, with calls for changed incentives for doctors, increased competition within hospitals, and greater coverage for medically necessary items like dental and drugs. The real issue, rather, is an absence of political leadership on this file. As a Queen’s University Discussion Paper noted in 2013, the simplest explanation for “the gulf between aspiration and execution” in Canadian health reform is that “governments are unwilling to spend the political capital required to set healthcare on a new course.”
At their worst, our governments aren’t merely refusing to spend political capital on reform; they’re also spending actual capital opposing it. The government of British Columbia, for instance, is currently spending millions opposing a lawsuit that, if successful, would enable citizens to access private health insurance in the province. B.C. knows it ultimately has little chance of succeeding on the case’s merits, since the Supreme Court of Canada ruled in an almost identical case in Quebec in 2005 that the province was violating individuals’ Charter rights by prohibiting them from accessing private health insurance while failing to provide timely public treatment. “Access to a waiting list is not access to health care,” Justices Beverley McLachlin and John Major memorably wrote at the time.
Our governments aren’t merely refusing to spend political capital on health reform; they’re spending actual capital opposing it
Yet—like the corporate villain in a John Grisham novel, intent on crushing the little guy—B.C. isn’t to be deterred by the clear reasoning of these eminent judges. Instead, it’s waging a war of attrition against the case’s cash-strapped plaintiff, throwing every conceivable procedural motion at it with the presumed aim of preventing the case from ever being heard on its merits. It’s pretty shameful, really, if one believes governments should offer citizens a realistic chance of having their Charter rights adjudicated.
B.C.’s obstructionism is all the more appalling given what we know about systems that allow public and private health options. One of the Commonwealth Fund’s more striking observations is that the world’s top three health-care systems all use strikingly different funding and delivery models. In particular, Australia—which has the best health-care outcomes in the world—funds care through general tax revenues, but many of its hospitals are private, and roughly half its population purchases private health insurance to access care outside the public system.
Like the corporate villain in a John Grisham novel, B.C. seems intent on crushing the little guy
In Canada, health care is not a matter of federal responsibility, but Ottawa could pressure the provinces to allow more private delivery in their jurisdictions. In form, this wouldn’t even be a departure from past practice. The feds have long made its funding transfers conditional on the provinces meeting various conditions under the Canada Health Act.
Arguably, though, Ottawa wouldn’t even need to get coercive about it. Simply dispelling misunderstandings might be the first step. According to one former government advisor, the provinces have historically been reluctant to permit private options within their jurisdictions—not because they’re legally prevented from doing so, but because prior federal Liberal governments made them fear it could affect the level of health funding they received if they did.
This Liberal government could choose to set a different tone—although this so far doesn’t seem likely. In a 2016 speech, Health Minister Jane Philpott acknowledged that Canada requires reforms to bring our system into line with international counterparts, and even cited the Commonwealth Fund studies as support. Yet, she curiously did not draw the obvious conclusions from those studies: that Canada should imitate the mixed systems of the world’s best health care providers. Instead, Philpott emphasized the necessity of “maintain(ing) a strong, publicly funded health infrastructure.”
The Conservatives could embrace health care as an issue on which to meaningfully differentiate themselves from their competitors
Thus, it may fall to braver souls to slay this sacred cow. The Conservatives could embrace health care as an issue on which to meaningfully differentiate themselves from their competitors. As fiscal conservatives, it would make sense for them to sell Canadians on a vision for how health care—something that currently eats up 11 per cent of our GDP, and accounts for, on average, 38 per cent of total provincial spending—could be offered more efficiently and effectively, while still universally.
Presumably, health care reform is an issue that could resonate with Canadians if politicians got the messaging right. The problem, though, is that may first require our leaders to disabuse the public of the fantasy that our system is first-rate—a bubble no politician is likely inclined to voluntarily pop. Perhaps a court ruling confirming long wait times and patient rights will pop it for them.