An insurance scheme, not a health care system

If one looks for a workable definition of the term “health care system,” here’s what the World Health Organization says:

“A good health system delivers quality services to all people, when and where they need them… requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicines and technologies.”

Sadly, this doesn’t quite sound like what we have here in Canada.

Take a look at the Government of Canada’s own definition for our country’s medicare system:

“Medicare is a term that refers to Canada’s publicly funded health care system. Instead of having a single national plan, we have 13 provincial and territorial health care insurance plans. Under this system, all Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket.”

Also;

“Roles and responsibilities for health care services are shared between provincial and territorial governments and the federal government. 

The federal government is responsible for:

• setting and administering national standards for the health care system through the Canada Health Act;

• providing funding support for provincial and territorial health care services;

• supporting the delivery of health care services to specific groups; and

• providing other health-related functions.”

So, there you have it — straight from the horse’s mouth. 

In Canada, we don’t have a health care system. We have an insurance scheme, and a badly run one, at that. Don’t believe me? 

Read that second sentence again. “Instead of having a single national plan, we have thirteen provincial and territorial health care insurance plans.” 

It’s like playing a hockey game with 13 different sets of rules. In Toronto and Montreal, for instance, the game will be divided into three twenty-minute periods. But in Ottawa, Winnipeg, and Vancouver, fans will instead be forced to sit through four fifteen-minute quarters. Meanwhile, in Edmonton and Calgary, there will be no breaks at all — the game will simply go on until the full sixty minutes expire and a whistle blows, signaling the end of the match. 

No hockey fan would put up with this kind of craziness. And yet, this is exactly how our so-called “health care system” operates in Canada.

As a former Canadian member of Parliament once explained to me, developing policy is a lot like decorating a Christmas tree. You start out with a tall and sturdy tree, one that stands upright and is noble and beautiful. But by the time everyone has had their say and decorated the tree in their own very special way, that once beautiful Christmas tree is now bent over, its branches bending and almost breaking. The whole tree is ready to collapse under the weight of so many contradictory and conflicting expectations. 

If you think this sounds like a description of Canada’s health care system, you’re right. 

Because our leaders have had no backbone over the past fifty, sixty, seventy years, we’ve ended up with a system that isn’t a system, and a plan that appears to care more about tactics than actual strategy. When you fall in love with tactics — which is quite easy to do, and understandable, as I remind my clients often — you’ll likely find yourself becoming more and more distracted and will inevitably take your eye off the ball.

That’s what I think happened to medicare in Canada.

Our government has continually thrown good money at bad solutions for our health care system. It’s never worked. 

We need to reinvent Canada’s health care system. Tinkering at the edges, with a tweak here and a tweak there and making grandiose announcements just won’t cut it. 

We need to be bold. We need to be brave. We need to, as I just said, not lose our focus but instead dig deeper until we unearth the real problem. Only by identifying exactly where things have gone off the rails and exploring how we might truly reinvent Canada’s health care system, will we be able to build a system that actually works.

Here are ten things we could do tomorrow to reinvent and ultimately fix Canada’s health care system. By no means are these the only changes we need to consider making to save medicare from a fate worse than death, but they’re a good start. My recommendations might be somewhat controversial, but doing nothing is not an option. The health care doomsday clock is ticking.

The Big Fix:

1. Stop lying to us.

2. Put patients first, ideology second.

3. Revise the Canada Health Act so that “quality” becomes the sixth principle.

4. Combine all of Canada’s provincial and territorial health ministries into one federal “super ministry” with one health minister.

5. Stop focusing on illness and figure out how to keep us healthy instead.

6. Open the door to “medical tourism.”

7. Invest heavily in long-term care — or be prepared to face the consequences.

8. Bring back co-payments and user fees and introduce tax-free medical savings accounts.

9. Allow Canadians to pay for the services we want by introducing a parallel private health care system, and allow it to operate above board.

10. Fund it or free it.

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Stephen Skyvington is the former manager of government relations for the Ontario Medical Association and current president of PoliTrain Inc. His book, This May Hurt A Bit: Reinventing Canada's Health Care System, was published in 2019 by Dundurn Press.