Canada's health care crisis takes back seat to tariff panic

If we can tear down interprovincial trade barriers, why not health barriers, too?

One critical national issue has gotten short shrift during the leaders’ debates in this federal election and, as with so much of what’s keeping us up at nights, it’s Donald Trump’s fault.

When the country is facing an existential crisis, it seems only natural, after all, that health care might not be the first topic that comes to mind.

But in normal times the state of our health care systems (plural, because there is one for each province and territory) would be a hot topic, at or near the top of the national priority list. While we fret over just what the U.S. president might do to us next, the problems in Canada’s health care continue to fester: outrageous wait times, a shortage of hospital beds, and unacceptable delays in timely treatment for life-threatening diseases.

Much as we may still crow that “our” system is better than “theirs,” that view applies almost solely to the United States. Held up against other Organization for Economic Co-operation and Development (OECD) countries, health care in Canada is lagging badly. In fact, it’s time to bring in the crash cart.

A few statistics drive the point home.

Canada is short about 23,000 family physicians. Bringing in trained doctors from countries other than the U.S., the United Kingdom and other jurisdictions with similar standards to ours turns into a long and painful process. Canadians wait on average eight months from the time of referral for procedures like hip and knee surgeries. For some, the wait is much longer. In fact, the Fraser Institute found Canada had the worst performance among 30 high-income OECD countries for surgical wait times. An estimated 50,000+ Canadians per year leave the country to get medical treatment. The Fraser Institute estimates that from 2017 to 2021, Canadians spent as much as $2.3 billion on out-of-country health care.

Photo by Mikhail Nilov, Pexels

Hospitals are overwhelmed. OECD countries on average have 4.1 hospital beds per 1,000 population; Canada has 2.59, driving occupancy at times to more than 100 per cent.

And with Canada’s ever-aging population, matters are getting worse. About two-thirds of all the health care spending in the country goes to the care of seniors.

The financial black hole just keeps getting deeper. The Canadian Institute for Health Information has projected that total health spending in Canada will have reached $372 billion in 2024, once all the bills are tallied. That eats up 12.4 per cent of GDP and more than one-third of total spending by provincial and territorial governments. Other OECD countries by comparison spend less than nine per cent of their GDP on health care.

Layered on top of these problems is the perpetual squabbling between the federal government, which transfers health care funds to the provinces, and the provinces themselves, some of which do not want to be held accountable for how they spend the money.

The feds share some of the blame for creating this ever-growing crisis. Starting way back in 1984, successive federal governments decided to limit the swelling cost of health care by tightening financial transfers to the provinces. As a result, provinces cut hospital beds and medical schools provided fewer student admissions than the number of doctors we would need.

Since then, the feds have steadily increased the annual health transfer; in fact, federal contributions have increased faster than the amount provinces spend. The average of increases in funding transfers from 2005 to 2023 was seven per cent; the average increase in spending by the provinces in the same time period was five per cent. In the 2022-23 fiscal year, the feds handed over $1,115.31 per capita.

So, a Canadian might ask, why don’t we just throw some money at it and fix it?

Paul Martin tried to do that when he was prime minister in 2004. He reached an agreement with the provinces to inject $41.3 billion over 10 years. It would be, he said, a health care “fix for a generation.”

That the initiative failed so quickly and completely lays bare the myth that just throwing money at health care will be enough to restore a healthy pulse. Sadly, the problems run deep and are vexing in their complexity.

The frustrations were echoed by a panel of experts in a recent webinar organized by the Globe and Mail. One of the chief concerns is getting provinces – which jealously guard their right to control their health care systems – singing from the same song sheet. If you require treatment in a province other than your own, there is no access to your medical records because, with each province protecting its own turf, there is no standardized record-keeping system.

Think of how many times you have had to fill out medical history forms which duplicate information readily available in a centralized database, if only the health-care provider could access it.

Even Alberta, with its theatrical – some would say tragicomic – repeated attempts to rebuild health care, still only provides citizens with a paper copy of their health card number. Attempts to have a modern digital card repeatedly fail under the weight of cost overruns and privacy concerns.

Surely, if Google and Apple can easily allow you to purchase with a wallet on your phone, the medical record challenge could be solved in the right hands. Spain, for example, required digitized records in 2009 and got it done, Dr. Tara Kiran, Fidani Chair in Improvement and Innovation, University of Toronto, told the Globe panel.

Alberta’s government has embraced the notion that private health care providers can somehow magically deliver the same level of service at lower cost than public institutions. But the province’s fiasco in 2024 with its laboratory services, in which privatization led to chaos and massive delays, suggests there is little magic behind the curtain.

It seems to me the long-term solutions rest in setting aside ideological biases and just looking at what works best, whether it be delivered privately or publicly. And, surely, greater interprovincial cooperation is an absolute essential. If the provinces can rip down interprovincial trade barriers quickly in the face of Trump’s tariffs, it’s hard to see why health barriers could not be torn down as quickly.

The fixes will not be cheap. The experience of other OECD countries suggests we will have to spend more on health. In 2020, the average “voluntary/household out-of-pocket” spending on hospitals in Canada was $164 versus $203 in the OECD, and government spending on hospitals was $1,694 per household in Canada in 2020, compared with $1,877 in OECD-compared countries. Of 34 selected OECD countries, 20 spent more on hospitals per person than Canada did that year. Spending per household would also have to increase by as much as $222 to meet the OECD average.

But in doing so, we must stay laser-focused on value for money spent. We don’t necessarily need more hospital beds, for example, if we can design workable at-home care. It is estimated that such a move would save 20 to 40 per cent and perhaps even provide better services.

Canada needs to build resiliency to adapt to the tariff attacks from the U.S. Getting our health care systems operating more efficiently, so that we have a healthier population, can help us move toward that goal.

©DougFirbyUnfiltered

Reprint with credit to dougfirby.substack.com