On Health Insurance in Canada

Canada’s healthcare system is a source of pride for many citizens–it forms a strong part of our national identity. Indeed, the universality of health insurance, which provides services free at the point-of-care, seems like a noble goal.

Because Canadians value healthcare so much, it is worth asking what the dangers of the current system are. Frankly, it could save lives.

Currently, as stipulated by the Canada Health Act, each province receives federal funds to run a public health insurance agency: Medicare. These funds can be subject to certain reductions in proportion to the amount of private healthcare activity occurring in a province. Thus, provincial health policy freedom is somewhat fiscally constrained by the federal government.*

Medicare tends to be associated with long waiting lists for healthcare. The Canadian Wait Time Alliance (WTA) tracks wait times in Canada, as do the Canadian Institute for Health Information (CIHI) and the Fraser Institute. These studies all suggest that wait times for medical care, while already substantial, have been slowly increasing. While difficult to objectively measure, it is entirely probable that Canadians suffer, get sicker, or die while waiting for medical care.

In parallel, the labour market for Canadian doctors is sometimes poor. About 16–20% of new medical specialists in Canada, according to the Royal College of Physicians and Surgeons, cannot find work every year.

Herein lays the paradox of Canadian health policy as it exists today. How can there be potentially thousands of unemployed Canadian doctors looking for patients and, at the same time, close to a million patients waiting for medical procedures?

Opponents of a parallel private healthcare system are right to question whether it would reduce waitlists–after all, a private system would pull doctors from the public system. However, the implicit assumption here is that every doctor starts out employed. In the current state of affairs, a modest proposal would be to allow doctors for which there is “no room” to start accepting private health insurance payments. This would not require a cent of government expenditure, and may actually help government balance sheets–the only thing that would be drawn from the public system is patients on waitlists. Additionally, this could increase access to care for those who remain in the public system.

Surely, there are better ways of retaining universal health insurance coverage for all Canadians, while addressing the systematic harms it can produce. That sounds like the kind of Canadian innovation I am proud of.

Mike Craig is a 2013-2014 Atlantic Institute for Market Studies’ Student Fellow. The views expressed are the opinion of the author and not necessarily the Institute

*A previous edition of this piece stated that, in 2014, the Canada Health Act is up for renegotiation, when in fact it is the Canada Health Accord. In addition, the Canada Health Act does not explicitly ban private health insurance at the provincial level, although this is subject to interpretation of Section 12.

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