A promise was made to Canadians a half-century ago that governments would make sure that no one would be forced to go without necessary medical care. That promise is the foundation of universal health care in Canada.
But that promise is being broken. Six million people – nearly one in seven Canadians – don’t have a family doctor. Of those Canadians fortunate enough to have a primary care physician, nearly a third have trouble getting a timely appointment, according to the Canadian Medical Association.
Emergency rooms are packed to overflowing, when they aren’t closed, with wait times soaring.
An unhealthy debate
This is part of a series on our health-care system, and the challenges in diagnosing and fixing its problems, as explored in The Globe’s Secret Canada project.
Data: Lack of clarity is unacceptable
Lessons from abroad: Health care, Australian-style
Lessons from the past: Jane Philpott’s prescription for change
Justice: Defining the duty of care
Accountability: What patient power can achieve
Wait times are also rising for surgeries. Just 70 per cent of cataract surgeries were performed within the 16-week surgical benchmark last year, down from 83 per cent in 2010, according to data from the Canadian Institute for Health Information (CIHI). Only two-thirds of hip replacement surgeries took place by the official deadline of 182 days in 2023, down from 84 per cent. (There might be more examples if Ottawa and the provinces could agree on appropriate benchmarks for procedures such as cancer surgeries.)
The health care system cannot be called universal if millions cannot find a family doctor. This country does not have universal health care if routine surgical procedures routinely take far longer than the clinical guidelines.
Faced with this problem, the provinces and territories have demanded more cash from Ottawa, while transparently trying to blame the federal government for the deficiencies of the system they run. For its part, the Liberal government has diverted its attention to ill-thought-out initiatives such as a national single-payer drug program, rather than focusing on the glaring deficiencies in the health care system.
Money is not the answer. If it were, Canadians would enjoy platinum-level health care service. Per capita health care spending, adjusted for inflation, is 40 per cent higher than in 1993. Has that much higher spending resulted in an improved health care system? The question feels like a cruel joke.
Other countries, such as Australia, spend less but get better outcomes for their citizens, a damning indictment of Canada’s health care system.
If there is a cause for optimism, it is this: Canadians increasingly see the need for a shakeup. A recent survey from public relations firm Navigator found that 73 per cent of respondents agreed that the health care system needs “major reform,” a 19-point increase since 2022.
Yet, that sentiment is not showing up in the actions of politicians. Ottawa is intent on punishing any infractions of the Canada Health Act by the provinces, rather than championing reform. And the provinces, with rare exceptions, are only tinkering around the edges of the system.
Why the inaction in the face of such clear, and mounting, problems with Canada’s health care system? Political cowardice is surely part of the answer. But there are also big gaps in the debate over health care that have allowed politicians to avoid action.
Gaps in data diminish the debate. As The Globe and Mail reported on Saturday, there are inconsistent measures on even the basic issue of emergency-room waiting times. CIHI could be a national repository of health care benchmarks, but that idea has been stymied by the provinces.
The law is part of the problem. The Canada Health Act, in outlining basic principles, fails to even mention the one that is of pressing concern to Canadians: timely access.
The reflex to compare Canadian medicare to the inequities of U.S. health care is another factor stultifying debate. And reforms that amount to timid tinkering, rather than transformative proposals that challenge the entrenched interests of the status quo, also contribute to the stasis.
All of it adds up to a dire lack of accountability. When politicians fail to deliver on the promise of universal care – and they are failing – there are no consequences.
Over the next week, this space will look at how to close those gaps, so that Canadians can finally have an honest and accurate debate over health care. After all, as any doctor knows, before a course of treatment can be prescribed, an accurate diagnosis is first needed.