At last year’s annual meeting of the Canadian Medical Association, president Dr. Brian Day revealed himself as the enemy of the forces of good in the universe. Having been accused by George Smitherman of being the “Darth Vader of Canadian healthcare,” for running private clinics in Vancouver, and supporting some private delivery of medicine, Dr. Day dressed up in the black cape and helmet of the Star Wars villain. In the process, the outgoing president wryly highlighted the absurdity of the Ontario deputy premier’s extreme language in comparing a public figure who simply questions the all-public, all-the-time orthodoxy of medicare, to one of fiction’s most infamous fiends. This, it seems, is the tenor of the health care debate in Canada–if you can call it a debate at all.
Dr. Day believes it isn’t; that any suggestion of introducing any privatized reform is caricatured into a call to end universal health care forever. “The strategy that proponents of the status quo have used is to present the Canadian public with two options, American or Canadian health care, and at least until Obama came along, anything American was evil,” he says. “I don’t know a single Canadian physician who would like Canada to have an American-style system.”
Tomorrow, when the CMA gathers in Saskatoon, one group, the Canadian Doctors for Medicare, will hold a “celebration” of the 25th anniversary of the Canada Health Act. It is, says Danielle Martin, the group’s chairwoman, “probably the best known piece of legislation in the country and the most identifiable to Canadians as symbolizing the existence of our public health care system.”
The Act, though — which, in outlawing most private insurance and fees, leads governments to ration care — is what numerous policy experts and economists believe has Canada earning middling ranks, or worse, in studies comparing health delivery quality across nations: we are 30th in the world, according to the World Health Organization (the U. S. always performs worse) and 23rd among 32 countries ranked this year by Europe’s Health Consumer Powerhouse. It threatens to get worse, as provincial treasurers consistently warn they cannot sustain medicare spending, now exceeding 40% of budgets in many provinces, and set to balloon as populations age. Already, on the number of doctors, the availability of equipment, wait times, and vaccine access, Canada’s performance on global indices is nothing worth celebrating.
This might normally cause voters to reconsider medicare, as in the U. S., where Americans are hotly debating a greater public role in medicine. Yet, in no Canadian election in memory has the fundamental restructuring of health care ever been discussed, as it was in America. The idea of experimenting with some private options — as is standard in every OECD country offering universal care –is something politicians across Canada refuse to touch.
“Any effort toward change or reform is attacked as being ‘unCanadian,’ and therefore, politically, is trounced upon,” says Albert Schumacher, a former CMA president and head of the Schumacher Research and Leadership Group in Windsor, Ont.
Dr. Schumacher, like Dr. Day, believes our system can accommodate more privatization without violating values of equitable, accessible medicine. A privately run hospital, after all, can still bill the government for its services. Their beliefs may be even less free-market than those of medicare godfather Tommy Douglas, who wanted public funding for catastrophic illness and injury, but thought citizens should pay for some of their own routine care.
And indeed, surveys regularly find that the majority of Canadians are just fine with private insurance, and private hospitals, provided everyone is guaranteed access to health care when they need it. Yet raising the idea is perilous for a politician. When former Alberta premier Ralph Klein announced in 2000 a plan to allow the province to contract out major surgeries to private, for-profit clinics, he was, predictably, accused of sneaking in “American-style,” “pay or pray” health care; his plan to allow patients to pay for “enhanced” services in 2005 met the same outrage, despite getting a green-light from Ottawa. “You mention health care reform and people’s hair lights on fire,” Mr. Klein lamented.
Politicians are naturally eager to exploit any opportunity to paint opponents as destroyers of an institution considered by some the keystone of Canadian identity (interestingly, in Quebec, where identity is wrapped up in French culture, support for private care is highest). But unions, protecting their comfortable place in a generous public system, are behind much of it, too: the vehemently anti-privatization Canadian Health Coalition is literally an arm of the Canadian Labour Congress. Dave Eggen, director of the Friends of Medicare, acknowledges much of his funding is union money — though he, too, believes Canada needs more debate about health care reform. “It’s like the third electrified rail that politicians are scared of,” he says. “Which is unfortunate, because perhaps the largest public program we support constantly needs revision, in our opinion, in order to survive.”
Polls indicate that Canadians know full well the system is unsustainable in its current form, says Stuart Soroka, Director of the Canadian Opinion Research Archive at McGill University. And yet it’s us who are apparently easily alarmed by scare tactics. Mr. Soroka’s studies also find that the more dysfunctional the system gets, the more Canadians seem willing to entertain alternative options. It took war to shake the official narrative of ours as an exclusively peacekeeping nation; it may take health care catastrophe to get Canadians to finally agree to a real debate on the subject. If those pleading for reform are right in their predictions, it may yet come.