The story is the same in every province in Canada. Emergency rooms are overwhelmed, hospitals are short-staffed, and ICU space can never seem to keep up with extraordinary pressures whether they be from a local disaster, a flu outbreak, or a spike in COVID-19 cases. Waiting lists for medical specialists continue to grow while it has become nearly impossible in some areas to find a family doctor.
Public health care is a popular political football for every opposition party. They lay every negative medical outcome at the feet of the party in power and imply lack of funding was the cause. While it may make for good politics, blaming underfunding for health-care challenges is disingenuous. Since the COVID-19 pandemic began, every province in Canada dramatically increased funding into their systems. Despite all that investment, health-care systems continue to teeter on the brink of collapse even though the pandemic has eased.
The federal government is fiscally overextended on all fronts, with ballooning debt servicing costs and a looming recession. The Liberals are not eager to commit to the massing spending increases demanded by the premiers. They knew the strings attached to increasing health-care transfers to the provinces would likely kill the deal. It was a political manoeuvre designed to get themselves off the hook.
The elephant in the room that nobody wants to talk about, whether federal or provincial, is that it isn’t the spending model that’s broken, it’s the system. The nation needs to change how it provides health care rather than spend more money on it. That sort of talk is political blasphemy in Canada, however.
Canada has embraced a myth that we have the best health-care system on earth. In 2004, the CBC did a game show-style series to determine who was the “greatest Canadian.” After 13 episodes, it was determined Tommy Douglas was the greatest Canadian of all time because he was considered a founder of the health-care system. Anybody questioning the perfection of Canada’s system is often shouted down and accused of wanting to “Americanize” things. Politicians are terrified to propose substantive changes for fear of being labelled as heartless cads who would have people turned away from health services for lack of money.
Canada needs a frank national discussion on its health-care system. We need to observe the most successful systems in the world and emulate them. The problem is, every single country with a universal system outperforming Canada’s has a more significant element of private involvement in the system. This gives the opening for unions and other defenders of the status quo to turn the discussion back to the American system and start sowing seeds of doubt and fear over health-care reform. Leaders need to stop running away from this debate and start pushing back against opponents to reform.
If we doubled national expenditure on health-care spending today, we would have just as many nurses, specialists, and hospital beds tomorrow. Yes, with more spending we could expand those capacities somewhat, but the contributing factors to our health-care inefficiencies would remain in place. More funds would just lead to more bloating in an already bloated bureaucracy managing the system, while the front-line services continue to decline. The government monopoly in provision would still hinder innovation and allow competing foreign systems to snipe medical specialists away from us.
The discussion needs to move away from dollars and cents and on to outcomes and performance. Canadians don’t seem to be ready for that discussion though, and it’s a shame.
To paraphrase James Carville when he spoke of the economy in 1992: “It’s the system stupid!”