Health care consumes a massive share of government budgets, exceeding 40 per cent in provinces such as B.C. It should probably be the number 1 issue for every voter at election time because it costs so much: despite substantial increases in taxation over the last few years, the B.C. government increased the provincial debt from $72 billion in 2020 to over $107 billion in 2024.
Those in their teens to early 40s will inherit that debt and receive the least care from the system. They’ll pay, according to one research paper out of the University of Calgary’s School of Public Policy, a projected $18,000 to $27,000 more in lifetime taxes than they receive in benefits; in contrast, older boomers and seniors will receive about $4,000 more than they contribute. Our youth should pay attention to these realities. As Herbert Hoover stated, “Blessed are the young, for they shall inherit the national debt.”
A prime factor in growing these costs is Canada’s expanding health bureaucracy, which now has 11 times more public health bureaucrats per capita than Germany. Their health system is mostly public, but one in 10 has private insurance. This helps keep the public system accountable. A German orthopedic surgeon told me recently that waits for joint replacements in their public system were very long compared with the private system. When I asked how long, his answer was five weeks. In Canada most wait over ten times as long as that.
International studies confirm a small degree of non-government competition, as is the case in Germany, improves performance in a public system. Monopolies never serve consumers well.
All Canadian provinces have overseen excessive growth in their health bureaucracies. B.C. is the worst culprit, with an almost 1:1 ratio of bureaucrats to doctors, according to a review by the Medical Post. That’s three to six times greater than Alberta, Quebec and Ontario. In the B.C. legislature, the government has been accused of having 64 vice-presidents staffing different health regions.
The number of surgeries performed in developed countries is also a cost driver and has increased significantly in the last 20 years. When Canada’s system was designed, organ transplants, joint replacements, minimally invasive endoscopic procedures, robotic and laser surgeries, MRIs and other complex, expensive treatments did not exist.
The B.C. government’s solution to the cost crisis has been to increasingly ration care — even emergency care. The ER crisis is not new. In late 1999, during the tenure of a former NDP government, a Vancouver Sun front page headline read, Long Waits at Backed-up ERs Leave Ambulances Out of Service.
Our staffing crisis stems from the early 1990’s, when a B.C. NDP government convinced the rest of the country to act on the bizarre conclusions of a provincial royal commission on the health care system and its costs. Known as the Seaton commission, it advised that health care systems should aim to reduce our need for doctors and nurses, that immigrant physicians don’t have a right to practice in B.C. and that positions for graduates of foreign medical schools in acute care hospitals should be limited. It claimed that there was a shortage of nurses, and that the total number of physicians should be limited outright.
Implementation of the above created our current national shortages of doctors and nurses. I remember the era when we were among the top countries for doctors per population; our current rank is 69th, per data from the World Health Organization and the Organisation for Economic Co-operation (OECD) and Development. In world rankings of our overall health system, we are within the top 15 spenders on health care per capita, but outside the top 30 in performance.
B.C. has the longest cancer wait times in Canada. In mid-2023, the NDP government began sending desperate cancer patients to private U.S. clinics at an average cost of $16,000 per patient. The cost for five rounds of radiation therapy here in B.C. is $3,854, which is a regular course of treatment. The province also secretly outsourced cervical cancer screening to a U.S. company for over a year.
The BC Conservatives, vying to win the provincial election on Oct. 19, have proposed policies that include rewarding hospitals by replacing block funding with payment per patient — a patient-first approach common to top-performing countries. Another Conservative proposal is a “wait time guarantee,” which would send patients for cross-border care if their wait stretches beyond acceptable timeframes.
Some critics have stated that we cannot afford such policies, but they’re wrong. A Canadian Medical Association (CMA) study in 2006 looked at just four procedures (total joint replacements, cataract surgeries, coronary bypass grafts and MRI scans) and found that the economic cost of waiting across four provinces (B.C., Alberta, Ontario and Saskatchewan) was $14.8 billion in one year.
The CMA study’s calculations excluded the cost of waiting from a family doctor’s referral to seeing a specialist, and the long-term costs of those who, as a result of waiting too long, develop chronic illnesses, irreversible deterioration, addiction to painkillers and depression. Extrapolating its results to the thousands of other procedures performed across Canada, where patients are estimated to be waiting for 1.2 million procedures, would reveal an extraordinary economic cost. Mental health alone is costly: a different study showed that in 2003, mental illness cost Canada $51 billion in economic losses.
Long waits impose medical and financial harms on patients and negatively impact the economy. Long-term it is much less expensive to treat patients quickly. Sadly, our state-operated monopoly focuses on three-to-four-year electoral cycles. The B.C. government is literally paying to prevent patients from being treated, which is a warped interpretation of the term “preventative medicine.”
Private options alone cannot cure the sad state of our health system, but experience around the world reveals that even a small private option improves a public system. In Canada, we don’t all have that privilege. In 2005, the Supreme Court of Canada granted Quebeckers the right to purchase private insurance in the case of Chaoulli v. Quebec. However, in 2022 when my clinic and five patient plaintiffs attempted to have that right extended to the rest of Canadians before the B.C. Court of Appeal, we were denied.
In Canada, some groups, such as federal employees, federal inmates and armed service members, aren’t covered by the universal public health plan. Premier David Eby, in his former capacity as the B.C. minister responsible for automobile insurance, authorized private payments more than the public fee to allow injured claimants to jump the queue and see a specialist quickly.
Though we lost our constitutional challenge in B.C., some insightful statements were made by the B.C. Court of Appeal. Examples include: “wait times in considerable measure flow from government rationing of health care”; the system “is intentionally under-designed in order to achieve fiscal sustainability” and that “waiting inherently carries the risk of death.”
Most Canadians possess employer-subsidized private “extended” health insurance for what are clearly essential services, including prescription drugs, dentistry, physiotherapy and ambulances. Employers, and individuals who can afford it, should be allowed to expand those plans to cover so-called necessary services. Lower-income groups should have their premiums paid or subsidized by the province.
On Medicare, Tommy Douglas, then the premier of Saskatchewan, stated in 1961, “I think there is a value in having every family and every individual make some individual contribution. I think it has psychological value. I think it keeps the public aware of the cost and gives the people a sense of personal responsibility.”
Only in Canada do governments believe they have the legal right to force you to die on state-enforced wait lists. Last year, SecondStreet.org estimated that some 31,000 patients suffered that fate.
In his assessment of Canada’s health system, Italian health law expert Giandomenico Barcellona noted that “this system is tailor-made just for very rich people, who can get medical care abroad.”
Canadians need to take back control of their own bodies. That process must start at the ballot box.
National Post
Dr. Brian Day is an orthopedic surgeon, health researcher and medical director at Cambie Surgery Centre, a private hospital in Vancouver, and was the 2007-2008 president of the Canadian Medical Association.