A new report by the Commonwealth Fund says the Canadian health care system ranks ninth out of eleven countries surveyed. This begs the question — why are we so smug about our health care system?
Out of 11 countries surveyed, we have the fewest doctors per person. We are the worst for getting same-day appointments while sick. We have the most patients waiting four months or more for elective surgeries.
“Universal health care” is something Canadians take great pride in. But Canada’s health care is not universal or something to be proud of.
Of course, the Commonwealth Fund report is not the first of its kind. Canada has consistently ranked poorly for health outcomes. The OECD Health at a Glance 2015 report looked at 34 countries, and we ranked near the middle or bottom of the pack on most key indicators.
We are one of the top spenders on health care, but rank 28th in doctors per capita, and 29th for hospital beds per capita. The Fraser Institute says 63,000 Canadians left the country last year for medical care.
Yet all our politicians seem to agree our health care system is perfectly fine. Our provincial premiers say the only thing we need is more money. And politicians attack any proposed changes as “U.S.-style” or “two-tier health care.”
Most blame is aimed at the federal government by provincial politicians. They blame the federal government for a lack of funding, or the lack of some key “national strategy.”
The federal government does deserve some blame — but not for those reasons.
Health care is not a federal responsibility. Canada’s constitution says health care is a provincial responsibility. Federal politicians should not interfere with the delivery of health care.
Instead, the federal government has used the Canada Health Transfer (worth $37B to the provinces in 2017-18) as a weapon against the provinces.
As Brian Lee Crowley writes in the National Post, Saskatchewan has been experimenting with the private delivery of some health care services. The result has been lower costs and reduced wait times for 34 different procedures, according to this Macdonald-Laurier Institute study.
Instead of supporting this innovation, the federal government ordered them to stop, and threatened to cut their health care funding.
Because of this, the provinces have been able to use the federal government as a scapegoat. Provincial politicians are rarely punished for their failures, despite being directly responsible for delivery. For example, while Prime Minister Stephen Harper was in office, he gave the provinces more money than ever for health care — and yet he was routinely criticized for refusing to interfere in provincial health care matters.
Canada’s largest health care system in Ontario has struggled to innovate. They spent millions on new bureaucracy, picked fights with doctors and nurses, and wasted over a billion dollars on an electronic health records system that still has failed to fully materialize after nearly a decade.
Despite this, no provincial party leader has been willing to have an adult conversation about the health care system. Premier Kathleen Wynne wants more money from the federal government. The NDP want more federal intervention. And the Progressive Conservatives? Tim Hudak delivered a sharp criticism of health care bureaucracy in Ontario, but cutting red tape is not a bold idea.
Maxime Bernier was the only leadership candidate for the Conservative Party of Canada to suggest big changes. He wanted to get the federal government out of health care. He’d transfer tax points to the provinces, end the Canada Health Transfer, and let provinces be responsible for health care.
But this idea was met with hysteria from the pundits, the opposition, and even some in his own party. Most of his critics acknowledged he was probably right, but said the issue was “electoral poison.”
Health care is the perfect example of what happens when politicians are more concerned about getting elected than doing the right thing. We’re approaching a health care crisis in Canada, and we’re running out of time.
According to the MLI, the Ontario government is currently spending 46% of its revenue on health care — and that number is expected to grow to 80% by 2030. More money isn’t going to solve this problem — we can’t keep up. We need real innovation. We need it now.
In Canada, 69% of health care expenses are paid for by government. The OECD average is 37%. Despite government doing more, our outcomes are worse. Our “universal” system isn’t universal (ranked 9 out of 11 by the Commonwealth Fund for access), and we aren’t nearly as good at health care as we think we are.
We are proud because our health care system is better than the United States — but when we trail behind everybody else, it’s clearly time for a change.
Canada’s conservatives must think bigger. Brad Wall and the Saskatchewan Party are headed down the right path, but who has the courage to follow? Who will follow their example to its logical conclusion?
We must call on Andrew Scheer, Patrick Brown, the next leader of the United Conservative Party in Alberta, and other conservative leaders to step up and get serious about health care — before its too late.