THE GLOBE AND MAIL/ISTOCK
Tony Fell is the former chair of the University Health Network and a fundraiser for the Cambie Clinic constitutional challenge.
Amid all the turmoil in Canadian hospitals, we’ve been reminded that the best aspect of our health care system is the people who work in it. We are fortunate that many of the most capable physicians, surgeons, nurses and hospital workers in the world work here. But they are not only overworked and underpaid – they have to participate in an outdated and broken system with rundown facilities, which must be incredibly frustrating and demoralizing. No wonder many are taking early retirement or leaving the industry, resulting in painful shortages of doctors and nurses.
Historically, Canadians have a love for our health care system, but times have changed dramatically. Now, we need to share our love with the people obliged to work in it. And for them, the system is in an absolutely unacceptable state: dysfunctional, sagging under a huge and incompetent government bureaucracy, and devoid of serious governance transparency, financial discipline or real accountability.
That’s despite what our governments have told us. In July, B.C. Health Minister Adrian Dix declared that “our strong public health care system … is a cornerstone of our Canadian identity”; last month, Ontario Health Minister Sylvia Jones said “Ontario and Canada should be proud of the health care system that we have.” What planet are they on? They are effectively chief executives in their industry, and yet they are totally out of touch with what’s actually happening on the ground.
If our beloved existing public health care system is so “strong,” how was it allowed to gradually deteriorate over the past 20 years like a slow-motion train wreck to its present chaotic state, with massive wait lists, procedure postponements and closed-down hospital emergency rooms? Why didn’t anyone listen to the numerous strong warnings over the years that the system was unsustainable? Why did no one in the ministry pay heed? Where were the checks and balances? And who is responsible for this sad state of affairs?
Well, governments are – the same ones insisting that everything is going just fine. It’s the provinces, which brought us the long-term care crisis that killed many thousands across Canada in recent years, and the federal government, which oversaw massive spending overruns and endless scandals in our Department of National Defence as well as bureaucratic messes in our passport offices and airports.
Time and time again, governments have proven systemically incapable of efficiently running a big business or large-scale program. They simply lack the governance, transparency and accountability measures required to do so. So Canadians have to get serious and understand that there needs to be at least some private-sector involvement in our hospitals and health care system – for everyone’s sake.
Successive provincial governments have been failing our system for years. It was obvious 10 to 15 years ago, with a rapidly aging population and hundreds of thousands of new Canadians arriving annually, that the demands for trained medical personnel of all disciplines was going to increase significantly. Yet apparently, there was no forward planning and no communication between provincial health ministries and medical and nursing schools about their future human resource requirements.
The provinces have also failed to provide competitive compensation and benefits, which is critical if we want to attract and retain talented workers. These are educated and highly trained professionals, and with inflation surging to around 8 per cent, governments’ public-sector wage caps – such as the 1-per-cent annual limit that Ontario’s Bill 124 has imposed on its nurses – are an insulting joke.
The federal government, meanwhile, has spoken out of both sides of its mouth on the importance of competition. It has an entire department – the Competition Bureau – whose very mission is to ensure and enforce rigorous competition in all industries, because of the belief that competition delivers lower prices, better service and increased productivity while encouraging innovation. The antitrust regulator has even taken on Canada’s telecom industry recently, throwing the high-profile proposed acquisition of Shaw by Rogers into question over concerns about consumer choice. So why is competition good for every industry but health care?
Indeed, we’ve seen the benefits of competition in other health care systems around the world. A 2021 report based on Commonwealth Fund research ranked the systems of 11 countries based on access to care, care process, administrative efficiency, equity and health care outcomes. Norway, the Netherlands and Australia were the top performers, followed by the United Kingdom, Germany and New Zealand; Canada ranked 10th. All of the better-performing countries had some form of private medical insurance and/or private-sector involvement.
Yet Canada remains the only member country of the Organization for Economic Co-operation and Development that prohibits private-sector health care involvement by federal law. As a result, according to the Fraser Institute’s analysis of OECD data examining 2019, Canada spends the second-most out of 28 OECD countries on health care as a percentage of GDP and the eighth-most per capita, while ranking 26th in available physicians, 14th in available nurses and 25th in available acute-care beds per thousand population.
So our system is a gigantic legal monopoly and an inefficient financial black hole – an absolutely nightmarish model for a $300-billion-plus industry. Is Canada so all-seeing that we know better than all the other countries that leverage private-sector competition to provide better health care than Canada by many metrics, and in many cases at a lower cost?
Worse, we’re actually seeing very little of how our system works – and that’s a problem, since the first step in solving a problem is admitting there is one. And a major advantage of even a small amount of private-sector involvement – apart from providing a relief valve for the public system – is that it could provide a transparent benchmark for productivity comparison purposes, which does not currently exist. It would shine a spotlight on the workings of our health care industry, which is desperately needed.
Indeed, the unwritten “code of silence” that has prevailed over our system over the past 20 years has been incredibly damaging. For years, federal and provincial health ministers have consistently refused to speak out about the obvious growing problems in our hospitals for fear of voter wrath; meanwhile, hospital boards and executives will not speak out for fear that their ministry will cut their funding grants. As a result of these pathetic efforts to sweep the problems under the rug, the damage to our system has only been made worse. I urge all provincial health ministers and hospital chairs and chief executives to tell Canadians, candidly and publicly, about the serious issues the industry is facing.
Governments must stop trying to fix this system by tinkering at the edges or through grand announcements of billions of dollars in investments, as the premiers have urged. Only structural change with at least a modest degree of private sector involvement can address our current health care challenges. Indeed, amid Quebec’s election campaign, François Legault has promised to build two private medical centres that would provide free services to Quebeckers and would be reimbursed by Medicare, in an attempt to ease pressure on emergency rooms. He said there are plans to eventually build a dozen of these centres there. Elsewhere, we could scrap Ontario’s Bill 124 and build some freestanding publicly funded but privately run ambulatory surgical centres.
But whatever changes are agreed to, they have to start now, because the problems are so deep and pervasive that it will take at least 10 years to fix. We have left problems to fester for far too long, and are now paying a heavy price in dollars and lives lost for our negligence.