In much of Canada, it is possible to circumvent our universal public healthcare system by “going private” for medical appointments, tests, or procedures, and every time any one of us does this, we weaken the universality of the public system.
The premise of our system is that, when it comes to our health, we are all equal. From the homeless to the billionaire, walking into a hospital should result in a triage prioritising us based on our medical needs rather than our connections or ability to pay.
There is plenty of room for private enterprise in our healthcare system, but the bills are meant to be paid by the collective, not the individual, to maintain that universality of access. Most doctor’s offices are small businesses as are many facilities such as diagnostic services, blood test centres, or MRI clinics. This is not the issue that endangers the system. It is not a question of who bills, it is a question of who pays, and the only genuinely fair system is a single-payer system.
Through bad short-term decision making in the 1990s, medical schools cut enrolment and increased requirements across the country meaning that not everyone willing and able to become a doctor or medical professional had access to that opportunity. While we have largely turned this around, it caused significant long-term damage to the system.
This has been compounded by high barriers for foreign-trained doctors to transfer their credentials to Canada, and further by our provinces refusing to automatically recognise credentials from other provinces. There is no rational reason that a doctor licensed to practice in one province could not do so in every other province and territory.
There are, as a result, an artificially finite number of doctors in Canada, and provinces tend to fight over, or with, them rather than fixing the problems at the core of the system that causes the shortage.
What it means is when you and I have trouble finding a doctor, there is a strong financial incentive for a private medical facility to go completely outside the system and offer us a queue jump — for a premium over the government rates. If I feel my need to see a doctor exceeds my belief in the universality of the system, I will go to that private clinic, pay the premium, and have a medical appointment far sooner than you will. In doing so, I will have validated the growing two-tiered nature of our healthcare system while incentivising more doctors to leave the public system for the more lucrative private one, putting further strain on the public system while delaying your ability to get an appointment.
By making it possible for me to pay for my health while you still have to rely on the public system, we have also removed the principled equality of the system. There is no incentive for a ruling class to maintain a public healthcare system if they are not also subject to it. Nor is there an incentive for government to fully fund and maintain the healthcare system if a portion of the population is willing to pay for services outside of it, having the effect of reducing the demand on the public system while also reducing its supply through associated budget cuts.
In short, any option for the private payment of our healthcare system undermines its very purpose and existence. The Canada Health Act exists to prevent this exact scenario, with mechanisms to cut funding to provinces who do not follow the universality principle.
Canada’s healthcare system has enormous weaknesses. The peculiar exception for dental and optometric care, as well as the lack of universal pharmacare, leaves the door open for a significant role for private insurance. It also undermines the core principles of universality of healthcare by still subjecting final health outcomes to individual capacity to pay. We may have a good system, but it is far from the panacea that we often portray.
The private health insurance industry, as it exists south of the border, is notable for having no purpose in existing. As it has often been noted across internet memes and essays, adding a private insurance layer to the health care system adds expenses without adding efficiency, increasing cost while reducing service, and adding a subjective filter to objective medical need.
Through their private system, the United States spends more per capita on healthcare than any other country on the planet while having lower life expectancy and worse health outcomes than any other developed nation, has no universality of service, and is happy to let its citizens die of illness they cannot individually afford to treat.
The system is highly profitable to a ruling class who believe their only purpose in life is to amass resources. It forces a culture of dependency on employer-provided benefits and therefore being employed, reducing individual freedom in very tangible ways. How can one leave a bad boss or job if doing so deprives your entire family of basic health coverage? It also guides people to the one reliable source of publicly funded health care — joining the armed forces.
When US president Donald Trump says that Canada’s public health system is costing the United States some $90 billion per year, it is important to understand what he is actually saying through his dementia-addled brain. He has lost his filter, not his philosophy, and routinely releases the oligarchy’s inner voice.
The $90 billion he discusses is the profit layer that is not being extracted from Canadians because of our public healthcare system. In Canadian dollars, Americans spend between $17000 and $20000 per capita each year on health care while Canadians spend a little under $10,000, and we have better outcomes to show for it.
When the American government attacks Canada’s sovereignty, this is another one of their targets. Destroying the public healthcare system in favour of going purely private is a very profitable prospect, and destroying our healthcare is key to ensuring Americans are not exposed to a better system.
If we apply American costs to Canadian healthcare, it would increase our gross healthcare spending by approximately $300 billion per year across the country at the minimum $7,000 difference per person times 42 million people. That money would land almost entirely on the shoulders of private citizens paying for private services and private insurance whether directly or through the employers in whose service citizens would be further indentured.
Trump’s alleged lost $90 billion? That is about how much of our $300 billion in additional spending that would probably become pure profit for their private medical insurance industry. Ergo, through our single-payer healthcare system, we are costing the American oligarchy around the $90 billion per year.
When our provincial governments allow the incursion of privately billed healthcare into our system, there is a lot of money to be made. We should be asking who wants to allow it and why, and do everything in our individual and collective power — including refusing to pay for private services for medically necessary appointments — to prevent it from happening.
Our universal healthcare system is not even 70 years old. Let’s not put it in a hospice.
Wow: refusing to pay even for medically necessary services is a harsh conclusion.
So, you truly have to die for your beliefs…