Over the summer, physicians, politicians and policy experts have rang the alarm bells, warning Canadians about the beleaguered state of our health-care system. While many of the proposed solutions focus on individual issues (the physician shortage, for example), few address the systemic nature of the problem. In reality, Canada’s health-care system has been on the verge of collapse for years, and its long past time to consider the sort of meaningful reforms needed to repair it, if not outright save it.

It’s important to understand that the current situation is not solely due to a system “battered” by the pandemic. Researchers have for decades published reports noting the system’s poor performance compared to our international peers and our system’s growing wait times despite its high price tag.

For example, according to data from 2019 (a year before the pandemic), among 28 developed countries with universal care, Canada was the second-highest spender on health care (as a percentage of GDP) on an age-adjusted basis, yet ranked very low on the availability of key health-care resources. For example, Canada ranked 26th (of 28) for physician availability, 25th (of 26) for acute care beds and last (27th of 27) for hospital activity measured as discharge rates from curative care.

Moreover, we ranked last (10th out of 10) on the timeliness of both specialist and elective surgical care. For example, only 62 per cent of patients in Canada reported waiting less than four months for elective surgery, a much lower percentage than in Germany (99 per cent), Switzerland (94 per cent) and France (90 per cent) in 2020.

Again, data from this period indicate this isn’t simply a COVID problem. In 2019, according to the Fraser Institute’s annual survey of physicians, across 12 specialties (orthopedic surgery, medical oncology, etc.), the median wait time (from GP referral to a specialist and receipt of treatment) in Canada was 20.9 weeks, the second-longest wait in the history of the survey at the time (in 2021, the wait was 25.6 weeks) and 124 per cent longer than the 9.3 week wait in 1993. Clearly, health care in Canada has been severely rationed for years, with Canadians suffering the results.

Indeed, the direct and indirect harm caused by these waits has been well-documented. Data from 2018-19 reveal that at least 1,480 Canadians died waiting for treatment. And public queues for medically necessary care cost Canadian patients an estimated $2.1 billion in lost wages in 2019 (in 2021, this number increased to $4.1 billion).

In light of overwhelming evidence, it’s hard to see how anyone can argue against broad health-care reform in Canada. So where do we go from here?

Fundamentally, Ottawa must get out of the way and allow provinces to experiment with proven solutions based on international experience including policies that are viable within the confines of the Canada Health Act (such as a shifting towards activity-based funding for hospitals so that money follows the patient) and policies that currently lie beyond the Act (such as cost-sharing requirements to help temper demand).

Private clinics can also help alleviate strain on the public system. In Saskatchewan in 2010, the provincial government launched a four-year initiative, which included publicly-funded private surgical clinics, which helped reduce the province’s wait times from 26.5 weeks in 2010 (the highest median wait outside Atlantic Canada) to the second-shortest in 2014 (at 14.2 weeks). These clinics also delivered surgeries (34 different types) at a 26 per cent cheaper rate (on average) than their public-sector counterparts.

Wherever our governments go, we should be wary of the provinces trending in the exact same tired direction as times past; of asking for additional money and producing no lasting results. The need for urgent reform is undeniable. In Ontario, the government is at least talking about potential reforms including publicly-funded private clinics. Other provincial governments must start the conversation. If there was ever a time to be bold in an attempt to fix the Canadian health-care system, it’s now.