I really, really wish Canadian health care were better

OPINION: No, I don’t think we should recreate the U.S. system here. But we need to start talking about how some other countries achieve more than we do while spending less
By Matt Gurney - Published on Jan 07, 2022
Canadian health care provides below-average outcomes and capacity for above-average spending. (Jennifer Kosig/iStock)

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On October 25, 2014, the Boston Bruins defeated the Toronto Maple Leafs 4-1, in Toronto. This prompted famous Canadian singer Anne Murray to tweet simply, “I wish the Leafs were better.”

That tweet is probably my favourite tweet of all time — perhaps rivalled only by a Star Trek joke that is, alas, unprintable here. 

What I love about Murray’s tweet is how it simply and concisely declares something that is profoundly and widely felt. Millions of us wish the Leafs were better and wish that with all our hearts and have wished that for many years. In the spirit of Anne Murray’s disappointment with the Maple Leafs, I’d like to make a brief but deeply felt statement of my own: I wish Canadian health care were better.

The amazing thing about that statement is that there probably isn’t a single person in this country who’d disagree with it, but any attempt to actually discuss that issue is incredibly controversial and leads to bitter debates. The purpose of this column is to simply state something that ought to be obvious and generally is obvious: Canadian health care could and should be better. 

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As Omicron has swept the country, producing a surge in hospital admissions despite causing a milder form of COVID-19, I have watched with interest as many of the same old health-care debates have played out again, now with an Omicron-centric twist. Can we just stay focused on the key point here? A bigger health-care system would not have spared us from Omicron; larger systems than ours are facing similar capacity crunches, due both to Omicron’s incredible infectivity and the number of health-care workers who have been exposed and must isolate. 

That doesn’t mean that a bigger system isn’t worth having, though. Canada’s is too small and, compared to other peer economies, inefficient. We spend a lot of money, relatively speaking, on our health-care system, and we achieve poor outcomes, again, relatively speaking. None of this is new since COVID-19 or was caused by COVID-19, though the pandemic is obviously making the problem broadly worse. These are long-standing problems, and we’ve ignored them too long. And even when we haven’t ignored them, we’ve just tended to have the same arguments over and over again.

The problem seems to be this: health care is more than just public policy in Canada. It’s part of our national identity. This is especially true when we contrast our health-care system with that of the United States, the country we most often (almost exclusively, really) compare ourselves with. This causes us to be irrationally protective of the health-care system and averse to criticizing it. Even people who really ought to know better — public communicators who have studied the issue — sometimes respond to any comment on the imperfection of our system with a reflexive snarl about how lousy the American system is. “What, you’d rather have what they have?”

Overall? No. But some of it? Sure! The U.S. has more ICU beds per capita than we do. I don’t think we need to commit ourselves to wholesale adoption of every aspect of U.S. health care, but we can still envy them their ICU capacity, right? Is there no value in looking at things the Americans do well and asking ourselves how we could get closer to that? 

And though you wouldn’t know it from listening to debates about Canadian health care, the world is actually full of many other countries. Many of these countries do better — providing better outcomes or higher baseline system capacity — than we do, and some of them achieve that while spending less than we do. Check out the latest report by the Commonwealth Fund, which studies and ranks the health-care systems of the advanced democracies. The U.S. consistently places dead last (of the 11 countries in the sample), Canada usually finishes tenth. Indeed, the Commonwealth Fund is so harsh about U.S. health care that it excludes it from some calculations, because the U.S. is such an anomaly. Canada then becomes the worst performing country, despite having overall health-care spending that's middle-of-the-pack (or higher, when the U.S. is excluded). Again, the fact that Canadian health care provides below-average outcomes and capacity for above-average spending is established and is, indeed, long established. Does this bother us? It should!

Hell, forget international comparisons for a minute. We already know some of what’s broken in our own system and how to fix it. A major contributor to congestion in our hospitals is a backlog of patient transfers out to other parts of the health-care system stemming from non-hospital elements operating beyond capacity. Before the pandemic, if we had been any good at getting every patient who was ready to be discharged out of a hospital in a timely fashion and into either a long-term-care home or a rehabilitation facility or back to their homes with community-based support, so-called hallway health care would be virtually ended in Ontario overnight. If we could have fixed the backlog, we’d have (substantially) fixed the hospitals.

The pandemic has changed a lot of this, of course. The health-care system we emerge from this pandemic with will be battered and exhausted. Just getting it shored up will be the top priority, because only then can we begin to erase the backlog of necessary tests and procedures. That will suck up most of the bandwidth among our health-care leaders and elected officials. We’ll need years to clean up this mess.

But I repeat: I wish Canadian health care were better. You probably do, too. When can we start trying to make it so? 

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