Opinion: How to fix Canadian health care: less talk, more action

Not only am I not dead, I’m not bankrupt either. Canada’s publicly funded system meant I didn’t have to personally bear the cost of multiple craniotomy, lengthy hospital stays, or months of radiation; Nor do I have to pay for the expensive cancer drugs I still take daily to keep the vicious beast at bay.

Suffice it to say that I am deeply grateful to Canadian Health Care. But this fact does not negate the fact that the system urgently needs to be reformed.

In this country (almost a national sport) it’s popular to celebrate our system as vastly superior to that in America, where even those lucky enough to have good health insurance are saddled with premiums, deductibles, and co-payments that vary add up quickly in the face of a serious illness – leaving them in deep financial trouble at times when they should be focusing on fighting disease. The great paradox at the heart of medical care in the United States is that while Americans are consistently world leaders (head and shoulders above everyone else) in healthcare innovation, they still lag behind in a whole range of outcomes — for example in large part because so many citizens are financially constrained to fully take advantage of this coverage.

We’re making things better in Canada, we like to think. But all is not well – far from it.

The guiding principle of healthcare in Canada – equal access for all – is based on the idea that the size of your wallet should never determine the quality of your care. It’s an admirable sentiment, but one that doesn’t stand up to scrutiny: many wealthy Canadians are moving to the US for care (and injecting their money into the US economy) rather than waiting in endless lines in this country. The truth is that the guiding principle of Canadian health care has mutated from “equal access to care” to “equal access to waiting lists”.

The care when you receive it is world class; but good luck with it.

The situation was dire long before COVID-19 hit the scene. The pandemic and its aftermath were the last bales of straw to bring the system to its knees. More than five million Canadians are unable to find a family doctor; Emergency rooms are overwhelmed like never before; Waiting times for specialist treatment and necessary surgeries are stretching into eternity, even as health conditions deteriorate and cancer rates grow unchecked.

we spend more public dollars per capita for health care than almost any other rich, developed country; but when it comes to everything that is important for care, we rank at the bottom: hospital beds, general practitioners, specialists, nurses and medical and surgical equipment.

In one category, however, we are world champions: we have more health managers than you can shake a scalpel with.

As Susan Martinuk describes in her latest book, Patients At Risk: Exposing Canada’s Health Care Crisis, Germany enjoys one of the world’s leading healthcare systems with many doctors, ample acute care beds and diagnostic equipment, and wait times that are only a fraction of what we endure here in Canada.

Both countries spend about the same per capita on health care; However, Canada has more than 10 times the number of healthcare administrators per capita. You read that right: not twice. Not triple. ten times so many.

That’s one administrator for every 1,415 residents in Canada versus one for every 15,545 in Germany. In other words, Canada “needs” nearly 27,000 administrators to serve 38 million citizens, while Germany gets by with fewer than 5,000 double the population – and also ensures much more timely maintenance.

Bloated bureaucracy is a constant plague of effective governance, and in Canada’s healthcare system it has become a runaway malignancy, ruthlessly devouring efficiency and stifling innovation; unchallenged it will eventually strangle the life out of its host.

It’s time for radical surgery. We need a lot fewer administrators and a lot more doctors; far fewer bureaucrats and far more nurses; much fewer managers and much more treatment space and equipment.

What we don’t need are more words; we don’t need more newspaper editors crying about how the system is broken; we don’t need more exhaustive (and hugely expensive) reviews like the Romanov or Kirby reports (which were shelved and gathering dust almost immediately after their publication).

We need less talk and more action—and soon.

And to expedite that action, we must stop bashing America every time someone raises the issue of private sector involvement.

Many other countries – such as France, Germany, the UK, Sweden, Switzerland and the Netherlands – are publicly funding universal, high quality coverage for their citizens, while successfully incorporating smart private investments to introduce efficiencies and drive innovation.

There’s absolutely no reason why we can’t do the same. But we must abandon the idiosyncratic Canadian sensibility of preferring everyone to be equally unhappy to an alternative where everyone is better off, but one where Peter is better off than Paul or Michelle is better off than Mary. It’s a mindset that costs us dearly – not only financially, but especially in terms of our health.

Those of us who work in healthcare know we can do better; we know Canadians earn better.

And we have good ideas for reform, but we need the bureaucrats out of the way so we can get started manufacturing it better.

dr J. Edward Les is a pediatric emergency physician at Alberta Children’s Hospital; clinical assistant professor at the Cumming School of Medicine at the University of Calgary; and Founder and CEO of Medical Maps, a patient navigation service.