Public Policy and Governance Review
November 10, 2011
Swept up in the largest social movement our generation has seen in support of Occupy Wall Street. But there are other interests at work and other dialogues to which to listen. Health care, I argue, is an issue deserving constant vigilance. To look away from it for a moment is to relinquish that moment to another interested party – one that, if left unchecked, could seriously damage the quality of health care we receive in this country.
Universal health care is a symbol of Canada, both to its citizens and to its global audience. ‘Universal’ is an assumption that has become natural to Canadians. But what does universal really mean? How is the Canadian health care system universal?
The answer to my former question is obvious to most. Universal could mean that everyone has equal access to health care in Canada, no matter their resources. Why is it a good thing? Because people who wouldn’t be able to afford health care have access to quality care. And to quote the common phrase, without our health, we have nothing.
The latter question is slightly more complicated to answer. First, let me take issue with the title, “Canadian health care system.” Discourse around the Canadian health care system is misleading. It is not so much ‘Canadian’ as it is a series of 10 provincial systems. There is no real national standard, nor the political will to formulate such at present. The Canada Health Act is vague. Violations go unfound and unpunished. If you consider that there are at least 49 surgical clinics selling medically necessary services in Alberta and BC combined[1], the ‘wild west of health care’ seems an apt name.
So how is the Canadian health care system universal? It simply isn’t[G1] when you consider the health care alternatives that do not meet the strict definition of equal access. The number of private health care businesses has been growing in Canada since the 1990s, including a private for-profit surgical and diagnostic industry that emerged in the early 2000s.[2] In addition, more and more Canadians are turning to Complementary and Alternative health care, amounting to a 2006 estimate of $5.6 billion spent out-of-pocket on visits to providers of alternative medicine[3].
Enough Canadians seem to have formed opinions from pop culture, ie. Denzel’s 2002 performance in John Q, or heard cringe-worthy stats (like while the U.S. spends nearly twice as much per person on health care as Canada, more than 45 million people have no health care coverage at all[4]) to put the argument for privatized health care on a shelf.
Enough Canadians, but not all. Terence Corcoran, in his October 4th article, “Nurse, Get Me An Entrepreneur”[5] presents a purely ideological argument for privatized health. In Corcoran’s world, health care is ‘socialized’, doctors are ‘victims’ and facts are absent. Privatize health care and the entrepreneurs will flock to innovate, says Corcoran. Set aside your bleeding heart moral argument and accept that the health industry is just like any other business – open-market competition will make it thrive.
Aside from explaining to Corcoran that innovation does exist in public health care[6], I would point out that in a competition, someone always wins while someone else is sure to lose. How does this make sense for our health? Is it acceptable for a clinic to happily count its monies at the expense of patients suffering down the street? When it comes to health, it shouldn’t be business – it should be personal. It’s the well-being of our families, our communities, our population. Collaboration, not competition, is the key to healthy innovation to be shared by all.
But the Corcorans of Canada remain heard. And perhaps it is the polite Canadian in all of us who listens, and the most generous of all whom offers an ‘institutionalized ambivalent’[7]compromise: let two-tiered health care be the solution. Those who seek to privatize argue that this ‘compromise’ frees up resources in public health care. That opening the system up to more private funding is the only way to remedy escalating costs of care. Those in favour of public health care may agree or disagree. But most may not be equipped to debunk the fallacy.
It certainly can sound appealing to let Canadians who can afford to pay, pay, and allow those who cannot pay to reap the benefits of a lightened public system. But reality doesn’t work that way[8]. To begin, it is unlikely that throngs of wealthy Canadians will race to shell out cash for the same service they could get for free publicly. Further, the private tier would take a disproportionate amount of resources out of the public system to provide faster service, pushing the public system to service almost the same number of patients with far less resources. Finally, we must remember that private health services are highly dependent on employer-sponsored benefit packages, which are subsidized with almost $3 billion in taxpayer money each year[9]. In other words, private investment does not get taxpayers off the hook for healthcare funding[G2] . A compromising compromise indeed.
It can also sound appealing to increase private investment in our system. Again, I question how private investment, which comes strapped to single-minded focus on producing a return for investors, makes sense for the health care industry. If the current trends were to continue, private health care business would open up in urban, densely populated areas, cherry-pick the ideal patient (read – ignore difficult patients who need care the most), and sell services patients may not need[G3] .
In Andrew Coyne’s recent talk, “Why we [the media] always get it wrong”, he lamented our reliance on the United States for policy learning and suggested looking elsewhere. I couldn’t agree with Mr. Coyne more. Australia, for example, has many lessons to teach, having expanded private health insurance in the same way Canada often considers. Now we can observe how Australian patients are struggling with longer public wait lists, higher overall costs, and unequal access to care[10] – but can we learn?
In the UK, attempts to create a market for primary health care via private financing initiatives (what this side of the Atlantic terms “public-private partnerships”) shifted power away from government and practitioners alike[11] and have ultimately been a deemed a failure. Instead of infusing more money and resources into the system, PFI-funded facilities had less capacity and were subject to overly expensive contracts, among other ills[12]. As of September 2011, 12 million patients were threatened as 60 hospitals teetered on the brink of financial collapse due to costly PFI schemes[13].
But at least the UK is open and honest about their two-tiered system. In Canada we have preferred to ignore the twenty-year trend, and with a lack of admission comes a lack of research, knowledge, and regulation; a lack of regulation that may be responsible for the recent infection alert at a ‘non hospital’ (read- likely private) clinic – an embarrassment that made the BBC headlines[14].
It is time to reach a consensus that universal health care is not a result of bleeding heart voters and purely ‘socialized’ medicine. Universal health care is the best system to provide quality health care for all in both an economic and social sense. But it needs government support through policy and practice. The bad news: the Federal Cash Transfer Program, in its current state, offers little recourse for direct violations of and loopholes found in the Canada Health Act. But the good news is that the two-tier trend is recent and thus reversible. Thus, in solution-speak I observe a crucial need for strict, federal standards regarding our not-so-universal health care system; robust regulation to protect our system from the problems plaguing our commonwealth comrades in Australia and the UK; a level of care to which provinces should be compelled to reach.
And to the screaming provinces I say…relax. Relâchez. Smart, protective health care regulation is not interference – it is leadership.
It is your health and mine. And we can no longer afford to be distracted.
Brianne Kirkpatrick is a candidate for the 2013 Master of Public Policy from the School of Public Policy and Governance at the University of Toronto. Her primary research interest concerns bridging the gap between conventional and complementary and alternative medicine.
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[1] Mehra, Nathalie. Eroding Public Medicare: Lessons and Consequences of For-Profit Health Care Across Canada. Canadian Doctors for Medicare. P. 43.
[2] Mehra, Nathalie. Eroding Public Medicare: Lessons and Consequences of For-Profit Health Care Across Canada. Canadian Doctors for Medicare. P. 14.
[3] Esmail, Nadeem. “Complementary and Alternative Medicine in Canada: Trends in Use and Public Attitudes, 1997-2006.” Vancouver, BC, Canada: Fraser Institute, 2007. P.4.
[4] Council of Canadians. “Protecting Public Health Care.” Viewed October 22 at
[5] Article viewed October 4th, 2011 at
[6] Ontario Hostpital Association. (2006). Inspiring health care innovation: Policy ideas for ontario’s health care system. Toronto, ON, Canada: Ontario Hospital Association.
[7] Tuohy, Carolyn. Policy and Politics in Canada. Philadelphia: Temple University Press, 1992.
[8] Canadian Doctors for Medicare. Bottom 10: Practices to Avoid in Health Care Transformation. P. 2.
[9] Canadian Doctors for Medicare. Bottom 10: Practices to Avoid in Health Care Transformation. P. 2.
[10] Shrybman, Steven. “Defending Medicare: A Guide to Canadian Law and Regulation.” Cupe. 2008. P. 10.
[11] Miller, Emma et al. “The Market for Primary Care.” BMJ. Vol. 35, No. 7618. September 8, 2007. Pp. 475-477.
[12] Atun, Rifat A and Martin McKee. Is the Private Finance Initiative Dead? BMJ. Vol. 331, No. 7520. October 8, 2005. Pp. 792-793.
[13] NHS hospitals ‘crippled’ by PFI Scheme. Viewed October 28, 2011 at < http://www.telegraph.co.uk/health/healthnews/8780363/NHS-hospitals-crippled-by-PFI-scheme.html>
[14] Canada Clinic Infection Alert. Viewed October 17th at http://www.bbc.co.uk/news/world-us-canada-15343972.
[G1]When you consider health care alternatives that do not meet the strict definition of equal access.
[G2]The current approach is for employers to look for ways to reduce these benefit costs ie., pensions
[G3]This occurs with public system given that specialized health care will be found in major urban centers. You can still form an argument that public system is better prepared to address the distance health care challenge.
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