Over the past year, medical leaders have called on provincial and federal governments to take immediate action to save our health system. Emergency department wait times are breaking records, surgeries are delayed or cancelled, and 15 per cent of Canadians don’t have a family physician. Our system and country cannot continue this trajectory. Our publicly funded health system desperately requires innovation and fortification to deliver care to all.
It is said in politics that no good crisis should go to waste, and there is a lot of talk that some provinces will use this an opportunity to transition to a more investor-owned health-care delivery system.
Yet, Telus Health’s Life Plus program, owned by a corporate giant, has come under review in B.C. for potentially creating a parallel privately funded system and drawing family physicians out of the publicly funded system. The purported goals of privately funded care are to reduce costs by driving competition and improving access, but it creates a slippery slope sliding towards a system that privileges those who can afford to pay.
As Canadian doctors who have studied health policy in the U.S., we can confirm that Canada’s history of equitable access based on need, not ability to pay, will be undermined by adding private-pay to the equation. It will create a mishmash of poorly functioning health-care delivery systems.
In a Lancet publication assessing 60 countries with the Healthcare Access and Quality (HAQ) Index which looks at deaths that could be prevented with timely and effective health care, Canada ranked in the top 25 per cent and the U.S. ranked near the bottom half.
According to a Commonwealth Fund publication comparing 11 OECD countries, the U.S. is ranked last for affordability and it spends more on health care than any other country in the world. Fifty per cent of low-income Americans report cost-related access problems compared to 21 per cent of low-income Canadians. In Canada, this is largely driven by the inability to pay for medications, something that would change with the introduction of national pharmacare. Many European countries perform well, but they have the ability to regulate costs in many ways that Canada cannot.
The U.S. also has the highest infant mortality and lowest life expectancy of the 11 countries in the ranking. The U.S. only has four per cent of the global population but it has had 15 per cent of all deaths globally due to COVID-19. In an analysis of 26 million COVID-19 cases in the U.S., 338,000 deaths due to COVID-19 could have been avoided if all Americans had adequate health insurance.
The U.S. is not a system to copy. In fact, our medical colleagues in the U.S. are advocating tirelessly to improve their system. A privately funded system would not only likely cost Canadians more, but the health of our nation would suffer even further.
Like all nations, Canada has its flaws, but access to health care based on need, and not ability to pay, is a key Canadian value. An overwhelming number of Canadians stepped up to get vaccinated against COVID-19 to protect themselves and their communities. Over 76 per cent of Canadians were vaccinated as of December 2021 compared to 60 per cent of Americans. We care about each other. We are a collectivist society, and private-pay health care can only survive in an individualistic one.
It’s time we stop discussing privately funded health care as a solution and look to strengthen our system to work for every person living in Canada. It is time to stop looking to the U.S. for solutions and instead look to how we can maximize our existing $265 billion in health spending to strengthen our publicly funded system and shift more dollars, not less, into our universal health system.
We have room to innovate by creating a world-class health human resource plan deeply integrated into the needs of communities, funding needed health infrastructure, supporting family medicine, and having greater leadership and co-ordination between federal and provincial/territorial governments.
Let’s embrace our collective nature as Canadians and pull together and demand a better, stronger universal health system for all. It’s the most Canadian thing that we can do.
Dr. Kaylynn Purdy is a neurology resident doctor at the University of Alberta and a health policy masters student at Stanford University.
Dr. Melanie Bechard is chair, Canadian Doctors for Medicare and a paediatric emergency medicine physician.