The uniquely Canadian fear of private health care
No other universal system bans it like we do
Whenever the prospect of private health care is mentioned in Canada, the usual political reaction is to warn of an imminent descent into the inequitable hell of “U.S.-style privatization.”
“Universal Public Healthcare is a core Canadian value. US-Style Privatization isn’t,” reads a recent tweet by NDP Leader Jagmeet Singh, issued in response to mounting calls for private options to offset unprecedented backlogs in the public system.
In the last federal election, Deputy Prime Minister Chrystia Freeland kicked off the campaign by attacking then-Conservative leader Erin O’Toole for undermining “universal health care” because he had expressed support for the provision of private options “inside of universal coverage.”
An ingrained fear of privatization is even held by our high courts. Last month, the B.C. Court of Appeal upheld a Canadian ban on two-tier health care, even though the justices admitted the decision would impose “real hardship and suffering” on patients stuck in the government queue.
But it’s a curiously Canadian conceit. In virtually every other developed nation that offers universal health care, private options are a common and uncontroversial part of the heath mix. While Canada may see private health care as a harbinger of American inequity, the likes of Australia, Germany and Norway see it as no different than a private school, a paid security guard or a toll road.
A 2003 profile in the New England Journal of Medicine wrote that the Canadian system was “unique in the world” in that it banned coverage of core services by private insurance companies.
What this means is that if a service is offered under the Canada Health Act, it’s illegal to get it covered by private insurance. As a result, while an estimated two-thirds of Canadians have private health insurance (usually through an employer or union), they can only use it to obtain services “excluded under universal health coverage,” such as dental care and prescription drugs.
“This ban constrains the emergence of a parallel private medical or hospital sector,” wrote the journal.
None of the world’s other socialized health systems are quite so repelled by the existence of a parallel system. As Canadian proponents of liberalized private health care will often note, even Communist China allows core services to be covered by for-profit private health insurance.
Australia follows a two-tier system: Aussies are universally covered by a government system that, like Canada, is mostly free of out-of-pocket costs. At the same time, nearly half of Australians take out health insurance that gives them access to a parallel system of private hospitals and clinics.
In 2020, Vox covered the experience of two Australian sisters who gave birth; one in the government system, one in the private system. The government birth was free but “not glamourous.” The private birth cost AUS$5,000, but featured better food, a private room and the option for on-the-spot appointments with an obstetrician.
Germany — the world’s first country to offer socialized health coverage — allows citizens to opt out of the public system and pay for “substitutive coverage.” There are tight government controls on who’s eligible for substitutive coverage; citizens must meet a minimum income threshold and they may be barred from returning to the government system. But as of 2017, roughly 10 per cent of Germans had gone the substitutive route.
Private health care is even an institution in the United Kingdom, whose National Health Service is often held up as the poster child of universal care. In a 2017 New York Times ranking of the world’s best health-care system, the “truly socialized” British system won easily.
Nevertheless, since the NHS’ inception, Britain has retained a parallel system of private hospitals supported in large part by for-profit insurance. As one website notes, the typical family premium can be in excess of 1,800 pounds.
Just like Canada, the U.K. health system has been hit by a severe backlog as it recovers from the COVID-19 pandemic. Unlike Canada, British citizens have the option of opting out of the government queue. A recent poll found that 17 per cent of Brits would go private if faced with waiting times longer than 18 weeks.
The Canadian system does allow the existence of private clinics. Just a few steps from Parliament Hill, for instance, one can find the private ExecHealth clinic offering “punctual, unhurried appointments … to ensure top quality care.”
But the private system is intentionally constrained through tight controls. Any physician billing the private system is prohibited from working in any hospital or clinic that receives public money. And as noted above, government controls on private health insurance mean that most private surgeries or consultations must be paid in cash.
While a clear majority of Canadians support the existence of universal health coverage, polls show that the country may be warming to the existence of a German or British-style two-tier system.
The right-leaning think tank Second Street, commissioned a Leger poll last year finding that 62 per cent of respondents believed that “Canadians should be allowed to spend their own money for the health care they want.” Another 67 per cent favoured “governments using private and non-profit health clinics to reduce surgical backlogs as a result of the pandemic.”
This is all occurring amidst an unprecedented shortage of care within the Canadian health-care system. Just last month — amid mounting wait times and surgical backlogs — a meeting of Canada’s 13 premiers unanimously declared that the country’s health system was “crumbling.”
Meanwhile, an evershrinking pool of family doctors has left more than five million Canadians without access to primary care. In Nova Scotia alone, more than 100,000 of the province’s one million people are on a waiting list for a family doctor — a 45 per cent increase from just 12 months ago.
Germany — the world’s first country to offer socialized health coverage — allows citizens to opt out of the public system and pay for “substitutive coverage.”