There is no question about it – Canada’s health care system is severely broken. But there was a time when Canadians boasted about the superiority of our system over that of the USA. Indeed, some politicians touted that our system was among the best in the whole world. This raises two significant and related questions. How did we get into the present state and what needs to be done to restore a properly operating health system?
Reviewing some of the history of how we got to where we are today can be very helpful in attempting answers to the two questions. But it is important to note that health care is a provincial matter.
Canada has, in effect, thirteen health systems. The federal government provides financial support for these health systems with the requirement that the provinces and territories meet certain criteria and standards set by the federal government.
Our health system traces its start to 1947 when Saskatchewan introduced the first universal hospital insurance programme in North America. This prompted the demand for a Canada-wide system.
And the federal government responded with the Hospital Insurance and Diagnostics Act (HIDS) starting in 1958. Under this act the federal government funded approximately fifty percent of hospital and diagnostic costs. But HIDS was not implemented by all provinces until 1961.
This then led to a Royal Commission on Health Services, chaired by Emmet Hall during the years 1961 to 1964, and the Medical Care Act which became effective on July 1, 1968. In 1984 the Medical Care Act was amalgamated with the Hospital Insurance and Diagnostic Services Act to create the Canada Health Act. This act specified five founding principles: (i) public administration on a non-profit basis by public authority, (ii) Comprehensiveness – provincial health plans must insure all services that are medically necessary, (iii) universality – a guarantee that all residents in Canada must have access to public healthcare and insured services on uniform terms and conditions, (iv) portability – residents must be covered while temporarily absent from their province of residence or from Canada, (v) accessibility – insured persons must have reasonable and uniform access to insured health services, free from financial or other barriers.
However, growing financial issues and wait times for some essential medical procedures resulted in the Royal Commission on the Future of Health Care in Canada. The commission was headed by Roy Romanow, former premier of Saskatchewan, and its report was delivered in November of 2002. Although the report covered many issues, controversy developed around its explicit rejection of calls for more privatization. Instead, the federal government was to increase its funding for health care along with a change in the way it provided funds for medicare.
The results were several. The federal government increased its financial contribution but demanded certain explicit results from the provinces and territories. There was increased bickering among the various parties and the debates often centred around narrow political and ideological issues. These differences contributed to the failure to heed the key lessons from the SARS outbreak of 2003.
Rather than address the real issues and needs of our health care system, our political leaders and parties spent their efforts on exaggerating differences in political ideologies and blaming others for increasing shortcomings. So, when the COVID epidemic hit, Canada was totally unprepared. And since January 2020, the situation has deteriorated into almost complete collapse.
I suggest a three-part solution. First, address the immediate needs. The federal and provincial governments seem to have monies for all kinds of emergencies, so immediate action is possible. Second, set up an impartial commission to examine the entire system. Include, not just payment for certain medical services, but rather, look at the entire system and include elder care, mental health, drug availability and costs, training for medical personnel (including costs), education on nutrition and health practices to reduce the need for medical service, special needs for geographically isolated areas, needs for the handicapped and disabled and all related aspects that go into a complete health care system. And, most important, the third part, get the narrow political ideologies out of the system.
