Opinion: Release Canadian health care from the chains of failing government monopolies

Switching to a publicly funded universal health insurance program would solve the crisis

Published Sep 08, 2024  •  Last updated 0 minutes ago  •  5 minute read

Photo by Getty Images/iStockphoto

By Dr. Peter Vaughan, Dr. John Cowell and Dr. Louis Hugo Francescutti

It’s disheartening to hear stories of colleagues enduring lengthy waits in emergency departments while experiencing chest pain and atrial fibrillation, children bleeding on the roadside as they wait for an ambulance for hours and people stuck at home without the ability to access a family doctor.

Article content

Why is it so hard to fix health care in Canada? It’s not for a lack of trying. Many reports, commissions, task forces and consultants have tried. However, this great country has not been able to achieve what many people believe is the crown jewel of its identity. What’s happened to the idea of Medicare put forward by Justice Emmett Hall 60 years ago?

In 1961, Prime Minister John Diefenbaker asked Hall to head a royal commission of inquiry into a potential national health service. In 1964, the commission recommended the establishment of a publicly funded universal health insurance program, funded 50/50 by the provinces and the federal government. Coverage would include medical and nursing services, dental services for children and expectant mothers, prescription drugs, vision care as well as prosthetic and home care. It was not to be state medicine; rather, it was to be based “upon freedom of choice, and upon free and self-governing professions and institutions.”

That system never came to exist. At present, the provinces and territories each operate their own health services with support from the federal government, notwithstanding the trend to contract surgical care to private facilities — and it’s not working. Each agency operates independently, responding to a myriad of great ideas with “we already do that.” The feds don’t trust the provinces and territories, and the provinces and territories don’t trust the feds. Heck, the various alphabet soups of federal departments and agencies don’t trust each other.

Article content

Article content

It’s not working for health professionals either. Data sharing is onerous, even for the most basic medical supplies. There’s no digitized Google or Amazon of health care in Canada to show what supplies are available — no communication with the workforce about shortages. Health workers pick up the pieces and inform blank-eyed citizens that there’s a shortage of chemotherapy drugs. Perform that task, day in and day out, and then ask why doctors and nurses feel disillusioned. Paying them more won’t make them feel better when the only way they find out about a drug shortage is when the pharmacy phones.

Why? This is the tough part. We look to governments, federal, provincial and territorial to fix it. Politicians and their multitude of starry-eyed apparatchiks that come and go every few years take great joy in rearranging the deck chairs. Over the years, some have even tried to overlay structures like regional health authorities to put some distance between them and their political authorities, but it never lasts; the pendulum always swings back to more politics, and the only thing politicians do is throw more money at it and reinforce the status quo.

Article content

Health care is necessarily political in Canada thanks to the constitution, which has placed the matter in the domain of provincial governments since 1867. Because health care is the largest budget item for provinces and territories, the premiers become the de facto chief executives for any health service. Responsible government, as touted by its pre-Confederation advocates, was supposed to ensure the elected members running the machinery of government would be accountable to the people — but not to run health care in the 21st century.

Over time, an element of irresponsibility has crept into the day-to-day operations of government, so clear in health-care delivery.

The back-and-forth swing of governments between micro-management and devolution has hamstrung much-needed innovation to the core, demoralizing staff at all levels. Medical associations are deeply and legitimately concerned about the state of health care.

Alberta is a great case study. When the Alberta government created Alberta Health Services in 2009, the process was done with insufficient preparation and collaboration with key system partners and experts. This resulted in significant confusion and deteriorating clinical performance for six years. From that time to November 2023, governments have made multiple interventions, such as dissolving boards, firing CEOs and senior executives. Each upheaval has an adverse impact on the culture and effectiveness of the organization.

Article content

The power accumulated in the prime minister’s and premiers’ offices means they run health care along with their political children, interest groups and favoured consultants carried along by the prevailing wind, robbing citizens of their ability to choose. Wonder why health care is incapable of reform? Look to the constitutional foundations that divide the spoils among the political victors. Because of the constitution, if you win an election, you’re in charge of health-care delivery. If you want to fix health care for the generations, get it out of the hands of politicians.

Luckily, there is a middle ground that steers clear of both privatization and our current state-controlled health care, which leaves much to be desired.

Canadians must revisit the Hall commission’s recommendations and return to a publicly funded health insurance model, resourced by the provinces, territories and the federal government, accessible through licensed providers and accredited institutions. This would allow the innovative individuals and organizations hindered by our failing government monopolies to deliver a variety of modern health-care options that meet local needs.

Article content

A return to the principles of the Hall report could chart a course between the endless debate over public versus private health care, allowing service providers to innovate within the boundaries of a publicly funded insurance program — Medicare for the 21st century.

The solution to our health-care crisis lies not in spending even greater sums, but in having the courage to tackle the system’s core flaws. The middle way would focus on prevention and accountability by returning to the elegance of the Hall commission’s insurance model and getting governments out of the business of delivering health care. That’s what progress looks like.

National Post

Dr. Peter Vaughan was Deputy Minister of Health and Wellness of Nova Scotia. Dr. John Cowell served as Official Administrator of Alberta Health Services and CEO of the Health Quality Council of Alberta. Dr. Louis Hugo Francescutti is a former president of the Royal College of Physicians and Surgeons of Canada and the Canadian Medical Association.

Recommended from Editorial

1. 

   Brett Belchetz: The Canadian Medical Association is the real threat to health-care access

2. 

   Shawn Whatley: ‘Noses in fingers out’ — How Danielle Smith could transform health care

Article content