Canadian health policy is increasingly failing patients and taxpayers. Canadians spend a lot on health care relative to comparable countries. Yet our high relative level of spending does not buy Canadians as many health care resources as patients in other countries enjoy. Shortages of medical resources, as well as improper economic incentives within the Canadian health system have resulted in growing waits for access to publicly funded, medically necessary goods and services. The available evidence indicates that wait times are longer in Canada than in almost all other comparable countries. Not only has our high level of spending not produced better access to health care, government health spending has also been growing at rates that are faster than our ability to pay for it through public means alone. This has resulted in health care consuming ever greater shares of the revenue available to governments, leaving proportionally less available for other public responsibilities and obligations.

Economic research and international experience suggest that economically liberal policy alternatives could dramatically improve the financial sustainability and the value for money spent in the Canadian health system. The expected result of introducing such policies in Canada would be to reduce wait times and increase access to health professionals, medical technologies and new medicines. Most other countries that share Canada's social goal of publicly guaranteeing universal health insurance coverage are increasingly introducing economically liberal reforms into their health systems. Canada has gone the opposite direction in effectively prohibiting user fees for publicly funded services, extra-billing by health providers above public fee levels, and private payment or private health insurance for physician and hospital services. Yet, all or some of these policies have been used successfully in other countries that also have publicly guaranteed universal health insurance systems; and those countries achieve better access to health care resources on a more economically efficient and financially sustainable basis than Canada.

Despite the political obstacles to health care reform, there are several reasons for optimism. While the Canada Health Act (CHA) is a partial barrier to economically liberal policy reforms, there is still a surprising degree of freedom under the act, and ultimately the provinces still have policy autonomy if they choose to exercise it. The nature of health policy liberalization as a wedge issue in a multi-party system also suggests that a reform platform could work as a winning electoral strategy. And the results from various public opinion polls indicate that when the right questions are asked, most Canadians might actually tend to prefer economically liberal and socially minimalist approaches to health policy.