Shaver: Fixing health care means more private access or more federal support

With no meaningful change, ordinary Canadians will continue to see care delayed, and some will die while waiting. Yet well-connected politicians and others will continue to jump the queue in the public system.

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On July 12, John Staples witnessed a senior in a wheelchair dying in the waiting room of the emergency department of a Fredericton, N.B. hospital. As a result, the provincial health minister was replaced. “They say we have free health care,” Staples said. “It seems that it is coming at the cost of people’s lives.”

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Such scenarios are not unique; they are related to severe staffing shortages. Ontario, for instance, has fewer nurses per capita than any other province. This past long weekend, 14 hospitals were operating without key services including the ICU in Bowmanville and emergency departments in several cities.

In 2020-21, at least 11,581 Canadians died while awaiting surgery, MRI or other scans, or an appointment to see a specialist, according to Canada ranks 69th in the world in doctors per population, and 31st in hospital beds on a population basis.

Yet judges and politicians are often surprisingly unconcerned. Perhaps this is because they never endure 10-hour waits in emergency departments, nor do they wait many months or even years for possible cancer screening, life-saving surgery or procedures within the public system.

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Quebec and several other provinces already have private clinics. There, patients unwilling to wait for several months can and do pay for speedier service within Canada. For example, patients from eastern Ontario can go to Gatineau and for about $750 have a private MRI scan done in only 24 to 48 hours. This is quite legal, as health delivery is provincial/territorial.

Our entire health-care system is in crisis, both from lack of adequate funding and increasingly severe shortages of nurses and other professionals. Should provincial/territorial laws be amended so as to permit a non-governmental safety valve such as exists in other developed countries such as in Europe?

If politicians and the courts balk at any further privatization, the federal government must greatly increase its health transfer payments. Moreover, we have proportionately 11 times as many health bureaucrats as does Germany. Much money could also be saved by pruning the bloated number of administrators in hospitals and provincial/territorial ministries of health and redirecting the savings into hiring more nurses and other health workers. This, among other things, will alleviate the problem of underemployed orthopedic and other surgeons getting insufficient OR time to treat patients who are on a long wait list.

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One obvious criticism of any increase in privatization is that nurses, doctors, etc. will gravitate from the public to the private system, leaving the former even more short-staffed. Hence, adequate paid sick benefits and other financial incentives in the public system are needed immediately in order to encourage nurses and other health professionals to return to the workforce. And the regulatory colleges must find ways to fast track licensure of foreign graduates already in Canada.

The B.C. Court of Appeal recently ruled against Dr. Brian Day and five patients who were challenging the banning of private insurance. This will surely go to the Supreme Court of Canada for a final ruling. Meanwhile, if the federal government fails to increase health transfer payments and creative means are not found very soon to alleviate the acute shortage of nurses and other health workers, the status quo will continue.

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Most ordinary Canadians will continue to wait, many will suffer and a few even die unnecessarily. Yet well-connected politicians and other persons will continue to jump the queue in the public system, with some of the wealthy ones obtaining urgent care by paying out-of-pocket in the United States or in certain provinces.

Dr. Day asked, “Do we or the government own our bodies? Canada is the only country in the world where accessing private health care is outlawed, and where you’re forced onto a state wait-list at risk of harm.”

Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is past chair of the Section on General Internal Medicine of the Ontario Medical Association. These views are his own.

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