How Might We Fix Canadian Health Care?

Someone once defined insanity as doing the same thing over and over again and expecting different results. I can’t think of a better way to describe the approach taken by elected officials and civil servants when it comes to reforming Canada’s health care system.

Let’s start by addressing the elephant in the room. Embracing the hybrid solution when it comes to health care doesn’t make you a traitor. Nor does it mean you’re in favour of adopting a U.S.-style, two-tier health care system. I have to laugh every time one of my critics uses this line of reasoning to attack me. Why on earth would anyone push for bringing America’s failed ideas to Canada when study after study shows that what our neighbours to the south have is so much worse than our system?

I’m also amused by the other argument that some like to throw at people like Dr. Brian Day and me — that we have a hidden agenda and secretly want to do away with Canada’s public health care system and replace it with a private one.

Not once, not one single time, has anyone in favour of reinventing our health care system ever suggested it would be a good idea to replace our public system with a private system. Yet time and time again, those defenders of the status quo throw themselves into battle, waving the flag and saying things like, “We must defend medicare against those who would do it harm!” What a bunch of baloney.

For as I’ve said elsewhere and often, the best way to ensure we end up with a system like America’s is to do nothing. For burying your head in the sand and pretending Canada’s health care system is the best in the world — and sustainable — is a surefire way to guarantee its demise.

It is pure insanity, watching prime ministers, premiers, and health ministers, year after year, do what I like to call “the health care cha-cha-cha” — seemingly moving forward, backward, and sideways all at the same time. It would be funny if it weren’t so painful to watch.

Honestly, the lengths governments will go to convince us they have things under control when clearly they don’t. They call media conferences. They make announcements. They organize photo ops. Then they do it all over again, re-announcing what they announced six months ago.

So, how do we fix Canada’s health care system? Even more importantly, why would we want to? Well, for one thing, our so-called leaders might start by admitting it’s broken and needs fixing. It would also be useful if we were a little more adept at identifying the problem instead of always allowing ourselves to be distracted by stuff that, at the end of the day, doesn’t add up to a hill of beans.

One of the biggest impediments to progress, I believe, is this obsession that’s developed over the past few years with metrics. “If you can’t measure it,” these techno wizards like to say, “you can’t manage it.” It’s a pithy phrase that sounds good, and makes for a memorable sound bite, but it’s one that’s ultimately meaningless. Case in point: when the Ontario government launched a series of primary care reform pilot projects in the early 2000s, they made a big deal about how they were going to closely monitor everything so we could see for ourselves whether moving away from paying doctors on a fee-for-service basis was a good thing or a bad thing. Well, the pilots went ahead, the doctors and patients did their thing, and the consultants — who were not cheap — made their measurements, crunched the numbers and cashed their cheques.

Then, nothing.

The government didn’t make the results public. Instead, they suppressed the consultants’ reports and announced the pilots had been so successful the province was going to get behind primary care reform in a big way. Thus began the whole alphabet soup of primary care health models — FHGs, FHNs, FHOs, FHTs. Great stuff, right? Only, as it turned out, Ontario soon discovered just how costly primary care reform truly was. After a decade or so of paying doctors not to see patients or spend money on tests and other exploratory interventions, the government decided they couldn’t afford the program. Ironically, it turned out that much maligned fee-for-service was actually a more economical way to pay doctors. Something I suspect those original consultant reports probably showed.

As former Ontario health minister Elizabeth Witmer told George Smitherman after he appeared before the legislative committee looking into the Commitment to the Future of Medicare Act (back in 2004), the reason people were paying money to jump the queue was because they were waiting too long for treatment.

Now, anyone with an iota of common sense would conclude that something needed to be done about wait times. But those in charge decided what was really needed was something that could measure how long a patient would typically have to wait for a specific procedure. Hence the birth of the wait-list website.

Needless to say, the biggest impediment to creating a hybrid health care system in Canada is without a doubt the silliest. “If we allow a second tier of health care,” the argument goes, “it will only benefit the rich.” Every time I hear this, I have to shake my head. The rich don’t need a second tier of health care. They already have it. It’s called the United States. If the fabulously well-to-do need treatment and need it now, they simply hop on a plane.

The people who would benefit most from a parallel private health care system, interestingly enough, are what’s left of the middle class. We’re the ones who’d be most likely to take advantage of a hybrid system if we had one. And, ultimately, we’re the ones that are going to drive this issue, because there’s no way any of us are going to put up with waiting a ridiculous amount of time for knee and hip replacements or cataract surgery. My generation is both active and proactive — it’s unlikely we’d allow some mealy-mouthed politician to tell us we can’t make our way to the front of the line to get back on the golf course or tennis court as soon as possible.

Of course, the whole debate about two-tier health care in Canada is something of a joke anyway. We have so many tiers, it’s frankly hard to keep track. There’s the workers’ compensation tier. The RCMP and Canadian Forces’ tier. The professional athletes’ tier. The politicians’ tier. The friends of friends’ tier. And so on and so forth. Honestly, just having two tiers would be an improvement.

I have to call out some of the ideas being put forth by Dr. Danielle Martin and the Canadian Doctors for Medicare group as well. The thinking seems to be that  Canada’s health care system is just fine as is. All it needs are a few tweaks here and there, and a fresh infusion of cash. Lots and lots of cash. 

For example, let’s fund a national pharmacare program. And while we’re at it, how about a guaranteed minimum income for those at the bottom of the socio-economic spectrum? Oh, and don’t forget to tax the living daylights out of doctors. They make too much money anyway and should be grateful for having the privilege of dealing with the mess that is medicare. 

We don’t need this kind of thinking. And we certainly don’t need these kinds of solutions. Not unless you’re looking to bankrupt the country, or have the government spend every nickel and dime they take from taxpayers on health care. Because if you do that, then you’ll be left with no choice but to privatize our education system and turn every road into a toll road. Something I don’t think Canadians would be onside with.

Don’t believe me? Then ask yourself this: “If Canada’s health care system is so good, so worth fighting for and preserving, then why hasn’t anyone else copied what we’re doing?” The answer, my friend, is simple. Our system sucks. While we’ve been standing around for the past fifty-plus years, admiring our collective navels, everyone else has been embracing better models. Change. Innovation. Solutions for an ever-evolving world.

No, what we really need is a strategy — call it a road map or a blueprint, I really don’t care — one that lays out a plan in a logical manner and addresses the real problems Canada’s health care system faces while offering up real solutions. No more health care cha-cha-cha. No more spending like drunken sailors. And for God’s sake, no more wrapping oneself in the flag.

In fact, if our leaders actually had any cojones at all, they’d come clean and admit the truth, that Canada’s health care system is unsustainable; is badly in need of significant, long-lasting change and not just tweaking; and that we can’t afford to go on pretending everything is all right when it obviously isn’t. It’s my belief that if someone did emerge and showed the courage to admit these things and embrace the hybrid solution, their party would win a massive majority when the next election rolled around.

Seriously.

“Fund it or free it.” It’s more than a slogan. It’s a philosophy. And a basic human right. After all, if we can spend money on cigarettes and booze — things we know can do us harm — then why on earth are we prohibited from spending money on health care? If it’s perfectly fine for someone to put aside money in order to buy a big-screen television or save up for a winter vacation in the Caribbean, then what’s wrong with setting up a medical savings account and squirrelling money away for a future medical procedure or health care catastrophe?

What Tommy Douglas came up with in the late 1940s was fine for back then. What Justice Emmett Hall recommended in the mid-1960s did the trick back in the day. Monique Bégin envisioned in 1983 what was thought to be necessary forty-two years ago. Unfortunately, time, as we all know, doesn’t stand still. In order to be great, we have to innovate. As we have seen, those in charge are afraid of change. Very afraid.

“It’s the third rail of Canadian politics,” they say. “Only a fool would dare to suggest introducing a parallel private health care system. Voters would toss you out in a heartbeat if you dared to mess with medicare. It may not be perfect,” they continue, “but it’s better than all the alternatives.” This way of thinking is why, election after election, we never talk about health care, we never have a meaningful debate about what’s right with our system and what’s so badly in need of fixing.

Medicare needn’t be mediocre. As Oscar Wilde once famously put it, “We are all in the gutter, but some of us are looking at the stars.” Dare to dream. We can do better. A whole lot better.

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