The Death of Canadian Medicare
Nearly a fifth of New Brunswick residents don’t have access to a family doctor. Over 400 family doctors in Quebec have left the public healthcare system altogether, and are free to charge what they like. Free, universal healthcare in Canada is on its deathbed; two-tiered healthcare is already here.
When asking locals about finding a doctor, the common response is either a wry laugh or a redirect to controversial healthcare service provider Maple, which unapologetically offers cash healthcare service to Canadians. Those lucky enough to have family doctors tell of long waits to get appointments, and there is a dark humour to the whole topic of health care here in New Brunswick.
Lacking a doctor to consult, our one visit to the hospital in New Brunswick saw our 10 year old daughter left in the waiting room, banned by the triage nurses from eating or drinking anything, for over 18 hours while she waited to be seen. It was only that fast because more than half the people who came gave up and left before being called.
Tommy Douglas and Lester B Pearson are no doubt rolling in their graves. The purpose of creating a universal healthcare system in our country through the Canada Health Act is specific:
The aim of the CHA is to ensure that all eligible residents of Canada have reasonable access to insured health services on a prepaid basis, without direct charges at the point of service for such services.
The five principles of the Canada Health Act are also specific:
Public Administration: The provincial and territorial plans must be administered and operated on a non profit basis by a public authority accountable to the provincial or territorial government.
Comprehensiveness: The provincial and territorial plans must insure all medically necessary services provided by hospitals, medical practitioners and dentists working within a hospital setting.
Universality: The provincial and territorial plans must entitle all insured persons to health insurance coverage on uniform terms and conditions.
Accessibility: The provincial and territorial plans must provide all insured persons reasonable access to medically necessary hospital and physician services without financial or other barriers.
Portability: The provincial and territorial plans must cover all insured persons when they move to another province or territory within Canada and when they travel abroad. The provinces and territories have some limits on coverage for services provided outside Canada, and may require prior approval for non-emergency services delivered outside their jurisdiction.
How did we get from this utopian view of universality to a system where a significant number of Canadians simply can’t access timely healthcare service without putting money up front? Isn’t the whole point of universality the inherent fairness of treating healthcare as a right rather than as something that can be bought?
It would not hurt to go back a few years to 2000, during Jean Chrétien’s final election. One of the big issues in that election was the Canadian Alliance Party’s perspective on universal healthcare. Stockwell Day was left in full damage control after then-campaign chair Jason Kenney promised two-tier healthcare for Canada.
Day only served as party leader for 14 months, but the two served together in Stephen Harper’s cabinets following the 2006 election. Stockwell Day fizzled from public consciousness, and Jason Kenney went on to become premier of Alberta.
There, in Alberta, Kenney did to the healthcare system what he promised, and what Conservative governments have done provincially and federally for generations; he tried to break it. It is worth remembering, for example, that Mike Harris’s “common sense revolution” devastated Ontario’s healthcare and public health systems. As the Ontario Legislative Library clinically explained in this 2000 publication:
The Ontario government created the Health Services Restructuring Commission (HSRC) in March 1996 to expedite hospital restructuring in the province and to advise the Minister of Health on revamping other aspects of Ontario's health services system.
By the end of its mandate in March 2000, the HSRC had issued final directions to 22 communities affecting 110 hospitals. It had amalgamated 45 hospitals into 13, closed 29 hospital sites, directed hospitals to undertake $2.1 billion in capital projects, and recommended that the Ministry invest $1.1 billion in community resources.
Harris started off his term as premier by laying off large numbers of nurses, declaring them obsolete: “Just as hula hoops went out and those workers had to have a factory and a company that would manufacture something else that’s in, it’s the same for government.” Is it any wonder then that Canada’s health care system can no longer keep up?
The consequences of Harris’s cuts were immediate; with the 2003 SARS epidemic laying bare the results. More recently, the COVID19 epidemic has shown the weaknesses of our public policy, and the system has not recovered even while the population pretends the epidemic is over.
For Canada’s public health care system to survive, we have to demand an absolute and unconditional end to privately-funded essential healthcare in the country. Permitting it lets governments off the hook of the five principles, and reduces access to those who are unable to pay out of pocket for services. Moreover, unregulated “non participating” family doctors becoming socially acceptable in Canada will drive doctors out of the public system and further limit access for the Canadian public.
The Canadian Medical Association recently published an updated policy draft proposal based on nation-wide consultations. They state clearly that a “national consensus emerged that our health care system should not favour those who can afford to pay for services.”
It’s time to enforce the Canada Health Act and crack down on the two-tier health care system preferred and pushed by a narrow subset of right wing leaders, and salvage our health care system before health becomes a matter of wealth as it has to our south.