BRULOTTE: Beyond the ideological trenches — embracing a mixed healthcare system could save Medicare

Dr. Bryan Brulotte is Chairman of Sterling-Trust, a Canadian private equity firm. He brings more than four decades of leadership experience spanning the military, private, and public sectors.Canada does not have to choose between universal healthcare and healthcare reform. What we cannot continue to choose is a system in which Canadians are promised universal care but increasingly cannot access it when they need it.The principle behind Medicare remains simple and worth defending: necessary medical care should be available according to need, not according to the size of your bank account. But defending universal healthcare does not mean defending a delivery system that is increasingly failing the people it was created to serve. Access delayed indefinitely is not meaningful access.The numbers should concern every Canadian. Nearly six million adults still lack reliable access to a family doctor, nurse practitioner, or primary care team. The Canadian Institute for Health Information (CIHI) reported this summer that emergency department wait times have increased substantially from pre-pandemic levels, with overcrowding, staffing shortages, and insufficient hospital capacity contributing to the problem. CIHI has also reported that roughly one-in-five Canadians who visited an emergency department for a non-urgent condition did so because they could not access primary care elsewhere.We are spending enormous amounts of money on healthcare, yet too many Canadians cannot obtain care when they need it. Canada spends more than $350 billion annually on healthcare, or well over $9,000 per person. This is not principally a question of money. It is a question of structure, capacity, and productivity..Canada built Medicare in an era when healthcare revolved largely around doctors, hospitals, and episodic illness. Today, we face an aging population, chronic disease, mental health challenges, and growing demand for home and long-term care. The system has not adapted quickly enough. Our hospitals have become the pressure valve for virtually everything else that does not work. No family doctor? Go to the emergency room. No long-term care bed? Remain in the hospital. Records cannot follow the patient? Repeat the tests, chase the information, and waste the clinician’s time.We also have a workforce problem that borders on the absurd. Canada needs doctors and nurses, while qualified, internationally trained professionals already living here can spend years navigating credential and licencing systems. Meanwhile, Canadian physicians lose millions of hours to paperwork, and doctors licenced to practice safely in one province can still encounter unnecessary barriers when trying to work in another.Some progress is finally occurring. Canada’s premiers have backed efforts to reduce barriers to health worker mobility, while Parliament is considering legislation intended to make health information move more easily between providers. These are sensible reforms, but they should be the beginning rather than the culmination of change.The more difficult conversation involves how care is delivered. Canadians have been conditioned to believe that universal healthcare and government delivery are essentially the same thing. They are not. Canada already has a mixed system: most family doctors operate independently, laboratories may be privately owned, and long-term care facilities can be public, non-profit, or private..Alberta’s latest reforms have reignited the argument over private medicine, and legitimate questions must be asked about protecting universal access. But we should not retreat into the tired ideological trenches that have paralyzed this debate for decades. The test should be straightforward: does a reform provide Canadians with faster, safer, and better care while preserving access based on medical need?If an accredited independent clinic can perform a publicly funded cataract operation, diagnostic procedure, or hip replacement safely and sooner, I have no ideological objection to it. Governments should guarantee universal access, establish standards, regulate quality, and protect patients. They do not necessarily need to own every building, employ every provider, or operate every piece of medical equipment. Reform should be guided by three priorities: access, greater flexibility in how care is delivered, and accountability for outcomes..Primary care must become the true front door of Medicare. Every Canadian should have access to a primary care team incorporating physicians, nurses, nurse practitioners, pharmacists, and mental health professionals working to their full scope of practice. We should expand medical and nursing training, accelerate recognition of qualified foreign-trained professionals, reduce paperwork, integrate home and long-term care, and finally create health records that can securely follow Canadians across institutions and provincial borders.None of this requires abandoning Medicare. It requires remembering what Medicare was supposed to accomplish in the first place. Its promise was never that government would preserve every institution and administrative arrangement forever. It promised that Canadians would receive necessary medical care regardless of their financial circumstances.Access delayed indefinitely is not meaningful access. Patients must come before institutions, and outcomes before ideology. Medicare is worth preserving. That is precisely why we must have the courage to change it.Dr. Bryan Brulotte is Chairman of Sterling-Trust, a Canadian private equity firm. He brings more than four decades of leadership experience spanning the military, private, and public sectors.

BRULOTTE: Beyond the ideological trenches — embracing a mixed healthcare system could save Medicare

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