Not only am I not dead, I’m not broke either. Canada’s publicly funded system meant that I did not personally bear the costs of multiple craniotomies, extended hospital stays, or months of radiation; nor am I obligated to pay for the expensive cancer drugs I still take daily to keep the evil beast at bay.
Suffice it to say that I am deeply grateful for Canadian health care. But that fact does not negate the reality that the system is in dire need of reform.
It’s popular in this country (almost a national sport) to celebrate our system as far superior to that of the United States, where even those lucky enough to have good health insurance must pay premiums, deductibles, and copays that add up quickly on the front to serious illness, leaving them in great financial distress at a time when they should be laser-focused on fighting the disease. The great paradox at the heart of health care in the United States is that while Americans are perennial world leaders (far above everyone else) in health care innovation, they are perennial laggards in a large number of results, largely because so many citizens are financially constrained to fully access that care.
We do things better in Canada, we like to think. But not everything is fine, far from it.
The guiding principle underpinning Canadian health care (equal access for all) is based on the notion that the size of your wallet should never decide the quality of your care. It’s an admirable sentiment, but one that doesn’t stand up to scrutiny: Many wealthy Canadians head to the US for attention (and pump their money into the US economy) rather than wait in endless lines at this country. The truth is that the guiding principle of Canadian health care has changed from “equal access to care” to “equal access to waiting lists”.
The care, when you receive it, is world class; but good luck getting it.
The situation was serious long before COVID-19 arrived on the scene. The pandemic and its aftermath have been the last straw bales that have brought the system to its knees. More than five million Canadians cannot find a family doctor; emergency departments are overwhelmed like never before; Wait times for needed specialized care and surgeries drag on into eternity, even as medical conditions worsen and cancers grow out of control.
Us spend more public dollars per capita in health care than almost any other rich and developed country; however, we rank last in terms of everything that matters in terms of providing care: hospital beds, family doctors, specialists, nurses, and medical and surgical equipment.
However, we are world champions in one category: we have more health care administrators than you can shake a scalpel.
As Susan Martinuk describes in her recent book, Patients at risk: exposing Canada’s health care crisisGermany enjoys one of the highest rated health care systems in the world, with many doctors, large intensive care beds and diagnostic equipment, and wait times that are a fraction of what we endure here in Canada.
Both countries spend roughly the same per capita on health care; but Canada has more than 10 times the number of health care administrators per capita. You read correctly: not twice. Not triple. Ten times as many.
That’s one administrator for every 1,415 citizens in Canada, compared to one for every 15,545 in Germany. In other words, Canada “needs” almost 27,000 administrators to serve 38 million citizens, while Germany manages with less than 5,000 to double the population – and offers much more timely care to boot.
Bloated bureaucracy is a perennial plague of effective governance and, in the Canadian health system, has become an out-of-control malignancy that mercilessly devours efficiency and strangles innovation; if left unchallenged, it will ultimately strangle the life of its host.
It’s time for radical surgery. We need far fewer administrators and far more doctors; far fewer bureaucrats and far more nurses; far fewer managers and far more treatment space and equipment.
What we don’t need are more words; we don’t need more press articles meowing about how the system is broken; we don’t need more exhaustive (and enormously expensive) reviews like the Romanow or Kirby reports (shelved and dusted almost as soon as they were published).
We need fewer words and more action, and soon.
And to accelerate that action, we need to stop portraying the United States as a boogeyman every time someone raises the issue of private sector involvement.
Many other countries, such as France, Germany, Great Britain, Sweden, Switzerland, and the Netherlands, publicly finance high-quality, universal coverage for their citizens while successfully incorporating smart private investment to introduce efficiencies and drive innovation.
There is absolutely no reason why we can’t do the same. But we need to lose the peculiar Canadian sensibility in which we prefer everyone to be equally miserable to an alternative in which everyone is better off, but Peter is better off than Paul or Michelle is better off than Mary. It is a way of thinking that is costing us dearly, not only monetarily, but more excruciatingly in terms of our health.
Those of us who work in the healthcare trenches know we can do better; we know that canadians deserve better.
And we have good ideas for reform, but we need to get the bureaucrats out of the way, so we can get started. making is better.
Dr. J. Edward Les is a pediatric emergency physician at Alberta Children’s Hospital; clinical assistant professor at the University of Calgary Cumming School of Medicine; and the founder and CEO of Medical Maps, a patient navigation service.