David Zitner is a senior fellow at the Macdonald-Laurier Institute. He has participated at every level of Canadian healthcare, including clinical practice, research, administration, governance and patient and professional education.Too many Canadians end up suffering from avoidable discomfort, disability, or even death while waiting for healthcare. In 2024, at least 23,000 people died while waiting for diagnostic procedures, treatment, or care in emergency departments.We Canadians love the utopian idea of Medicare, especially the moral promise of egalitarian treatment, yet that affection seems to be masking the abuses and inefficiencies latent within our system, and causes many to view Medicare with rose coloured glasses. For example, in contrast to the ideal of egalitarian treatment, under Medicare, disparities in the quality of care people receive based on wealth continue to increase. Dr. Margot Burnell, president of the Canadian Medical Association, recent call for stronger government influence over healthcare ignores the system’s failings.The Canada Health Act supports monopolistic provincial health departments, enabling them to act as monopsonies, setting prices and physician working conditions. Many Canadians associate ‘Universal healthcare’ with Canadian values, but is our current monopoly-enforcing system really aligned with Canadian values? Especially when those systems increasingly disadvantage the poor or leave people dying on waiting lists?Provincial healthcare monopolies reduce patients’ ability to approach more accessible providers. Innovative arrangements, such as a health co-op proposed for Pictou County, but rejected by the government of the day, could increase access to care and would reduce the harm people suffer when governments cannot or will not support timely access to necessary care..The associated provincial healthcare monopsonies mean that clinicians also lack choice. For example, physicians aggravated by poorly designed and time-wasting health record systems must accept what the system demands. The Canadian Medical Association notes that administrative burdens, imposed on clinicians by Medicare monopsonies, cause Canadians to “lose 20 million doctor hours each year to useless red tape” and increase physician burnout. Reducing administration would free up time equivalent to hiring an additional nine thousand full-time doctors. Without other choices, doctors and patients accept the fees and working conditions imposed by health departments even when those conditions reduce professional satisfaction and patient access to care.The Canada Health Act also imposes an unethical conflict of interest on governments asked to evaluate and regulate the health services they administer. The Gomery Report recognized conflict of interest problems in the federal government and complained that government bureaucrats exerting control over federal auditors concealed damaging findings that led to a waste of as much as $100 million. The Standing Senate Committee on Social Affairs, Science, and Technology also stressed the serious ethical problems posed by the conflict of interest when governments administer care and control the means to evaluate performance.Federal policy is painfully inconsistent. On the one hand, the federal government imposes monopoly healthcare through the Canada Health Act; on the other, it recognizes monopolies as harmful by enforcing the Competition Act for other sectors..The federal government created the Competition Bureau as “an independent law enforcement agency that protects and promotes competition for the benefit of Canadian consumers and businesses.” They recognize that “competition drives lower prices and innovation.” Most economists recognize that unregulated monopolies, public or private, are harmful because they increase costs, reduce the need to innovate, and limit consumer choice — problems evident in Canadian Medicare. Price controls are harmful because they interfere with innovation and limit consumer access to services where the fees offer insufficient encouragement to providers.Many countries recognize that rich and poor should have timely access to care while accepting private delivery of services that might also be provided by public providers.The Canada Health Act makes private delivery of health services seem unacceptable. Surely, however, the egregious harms experienced by some Canadians suggest it is irresponsible for provinces to continue the status quo. If the federal government is unwilling to reform, it may be up to provinces to use the notwithstanding clause to enable better provincial health system legislation that includes private delivery and independent evaluation.David Zitner is a senior fellow at the Macdonald-Laurier Institute. He has participated at every level of Canadian healthcare, including clinical practice, research, administration, governance and patient and professional education.
