Why Canada Doesn't Allow Private Healthcare - "The Canadian system is strange even by the standards of other countries with socialized healthcare. France, Germany, the U.K. and Australia, among others, all take great national pride in ensuring medical coverage for every citizen, but you can still cut a cheque for a boutique appendectomy if you feel like it. “The (Canadian) system is unique in the world in that it bans coverage of … core services by private insurance companies, allowing supplemental insurance only for perquisites such as private hospital rooms,” reads a 2003 analysis in the New England Journal of Medicine... it was only with the 1984 passage of the Canada Health Act, drafted in the final months of Pierre Trudeau’s premiership, that Canada codified its de facto ban on private healthcare. The reason was a wave of “extra billing” that had swept Canadian healthcare in the 1970s. Canadian patients were increasingly being hit with user fees and copays that were gradually chipping away at the supposed universality of Canadian healthcare. A landmark 1980 report condemned these new fees for undermining medicare. Canadians, wrote report author Emmett Hall, were people who had long ago agreed that health services should never “be bought off the shelf and paid for at the checkout stand.” The Canadian Health Act which sprung from Hall’s recommendations explicitly forbade “extra billing,” and prescribed clawbacks in funding to any province found tolerating it. Notably, it’s one of the few major pieces of legislation in Canadian history that passed with virtual unanimous support by the House of Commons. Still, there is technically no blanket federal ban on private healthcare in Canada. Any physician can decide to go private, provided that they completely opt out of working for the public system. A doctor can’t simultaneously bill the province while also billing patients directly; they have to pick one or the other. In addition, since most provinces (including B.C.) ban private health insurance, there’s only so much business a private sector doctor can expect to find. Some provinces tighten the screws even further by restricting private doctors from charging more than the prescribed amounts under the provincial healthcare plan... Still, a very small private sector for medically necessary healthcare manages to cling to life in Canada. By some estimates, roughly 1% of critical medical care in Canada is done outside the public system. Brian Day, the physician leading the challenge against the public health monopoly, is one of Canada’s rare examples of a private sector doctor. Day runs Cambie Surgery Centre in Vancouver, which touts itself as the “only free standing private hospital of its type in Canada.” However, the average British Columbian can’t just walk in and order a round of back surgery. Under B.C.’s Medicare Protection Act, the clinic cannot sell a medical procedure to a British Columbian if that procedure is offered by the B.C. Medical Services Plan. As a result, Cambie Surgery Centre can only serve a small demographic of patients who are explicitly exempt from MSP provisions, including prisoners, members of the armed forces and injured workers covered by WorkSafeBC... Private healthcare in Europe has definitely not eliminated wait times or the other pitfalls of rationed public health care, but it has proved able to co-exist alongside a public system without precipitating the collapse of a country’s system of socialized medicine... That same paper also noted the curious dissonance of provinces rigorously cracking down on private hospital care while simultaneously leaving the likes of dental care or pharmacare almost entirely in the hands of for-profit actors. “In other countries, the public-private financing mix is typically more balanced, with government plans paying for a larger share of drugs, dental and continuing care, but with more private financing for hospital and physician services”... Day has often been accused of working to sabotage Canadian medicare in the service of pro-profit multinationals. The Cambie Surgery Centre founder, meanwhile, contends he is fighting a crusade to free Canadians from a system of waiting lists that is costing lives. His suit includes a small group of co-plaintiffs alleging they suffered serious injury as a result of being forced to wait for MSP care; and accuse the medicare monopoly of violating their Charter rights. Two of those co-plaintiffs have already died as the case has dragged on"
Liberals claim to be pro-choice, but they don't want people to be able to choose their own healthcare and schools (we see this in the UK too)
‘People are dying’: Internationally trained doctors forced to sit on the sidelines as Ontario battles pandemic’s third wave | The Star - "After a second team of East Coast health workers touched down recently to help Ontario dig itself out from under a shortage of medical staff, a Ryerson professor is struggling to understand why hospitals here refuse to call on the thousands of internationally trained doctors already in our midst. “What a waste of resources,” says Shafi Bhuiyan, chair of a network that helps foreign-trained doctors find jobs in Canada. “It is unacceptable. They are not using the tools they have in hand and as a result, people are dying.”... While there are more than 13,000 internationally trained physicians in Ontario, Bhuiyan says, more than 3,500 are qualified to practise immediately and could help the province battle the pandemic’s third wave. They have passed their Canadian licensing exams, he says, have recent clinical experience and, like all residency candidates in the country, have earned the right to practise medicine under the supervision of a licensed physician. For more than a year, and under provincial legislation, hospitals across the province have had the ability to temporarily hire physicians, including internationally trained doctors, even if they have not completed a Canadian residency. That is, if they are qualified for the job and are needed to help save patients’ lives. Yet, since March 2020, hospitals have hired about 12 with this short-term emergency licence, according to the College of Physicians and Surgeons of Ontario (CPSO), which regulates the province’s doctors. Adding insult to injury, Bhuiyan says, 56 Canada-wide residency spots went unfilled in 2020, even though there are thousands of foreign-trained doctors across the country who need one... The Ontario Medical Association told the Star it has long recognized “the number of doctors per capita in Ontario is lower than in most other comparable jurisdictions” and that “never has this been more relevant than during this time of crisis.” In consultation with the CPSO and the Ministry of Health, the OMA says, it is considering international medical graduates in its “planning” for increasing the number of health workers. But, neither the OMA, which advocates on behalf of doctors, nor any of the other governing health authorities the Star has reached out to about foreign-trained physicians has offered an explanation as to why these qualified doctors haven’t been called on yet. Rather, they defer to one another... Bhuiyan says many of his students gave their information to the portal and while some have been called for administrative positions, it is unclear if any have landed a clinical position through the service. Nida Naqi, a family doctor trained in Pakistan and qualified to work in Ontario, told the Star she fed her information into the matching portal several months ago, but hasn’t received anything except the occasional email reminding her to update her resumé. She already knows how difficult it is for international doctors to get a residency position. That’s why, she says, she is willing to go anywhere in the country to work — and why she flew back home in the winter to work as a doctor. If she doesn’t keep working, she will no longer qualify for a residency spot... Bhuiyan, who immigrated to Canada about 10 years ago, says he is proud to have helped several hundred foreign-trained doctors find jobs in Canada. Most recently, he says, two of his students have found residency placements in different parts of the country. But, for some reason, he says, Ontario has made its barriers impossible to scale."
From May 2021
The power of protectionism
Opinion: The myth about Canadian health care that just won’t die | National Post - "Liberal incumbent Chrystia Freeland tweeted a video of Conservative Leader Erin O’Toole talking about health care. Freeland warned voters that O’Toole had secret plans to “bring private, ‘for-profit’ health care” to Canada. Twitter promptly slapped a “manipulated media” warning on Freeland’s video, which had been edited to take O’Toole’s comments out of context... it would be impossible for any politician to “bring” for-profit health care to Canada — it’s already here. For decades, medical imaging, laboratory, and diagnostic services have operated as private, for-profit services within Canada’s publicly-funded, universal health care system. Even though the clinical and business aspects of medicine are heavily regulated in Canada, doctors’ medical offices are still almost all privately owned. Indeed, the fact that many Canadians are completely unaware that these services are already privately provided proves it is possible to incorporate private elements into the system while maintaining universality. Opponents of “for-profit” health care tend to focus on the United States as the only alternative health-care model on earth. It might be a deliberate tactic... But a broader international comparison clearly shows that both Canada and the United States are outliers at opposite ends of the spectrum on health-care design. The U.S. does not have universal access; Canada does. America allows private, for-profit care paid for by patients directly, or with medical insurance; Canada insists that all medically necessary care must be paid for using tax dollars. Virtually every other country with a modern health-care system comes somewhere in between. It should be noted that despite such strikingly different approaches to health care in our two countries, the U.S. actually covers a surprising amount with public funding and Canada has a surprising amount of private funding in its system. Many Canadians pay privately for such items as drugs out of hospital, counselling services, dental etc., with private payments covering around 31 per cent of health costs in Canada. Meanwhile, in the U.S., the public sector funds up to 45 percent of health services: for example, Medicaid, Medicare, and veterans’ care. However, it is by looking beyond comparisons with the U.S. that Canada could find ways to improve. A recent international study of 11 high-income countries ranked Canada 10th overall — including 10th on specific metrics such as equity and health-care outcomes — making it clear that the status quo isn’t working for Canadians. What is also clear is that the highest-performing countries — such as Norway, the Netherlands, Australia and France — all allow for a more robust mix of private sector involvement in medically necessary care, while maintaining the principle of universality. Importantly, they are able to achieve these outcomes with per-capita spending levels that are comparable to Canada’s — and in some cases are even getting better results with less money. Canada’s federal nature should, in theory, allow provinces to take these international examples, experiment with different models and learn best practices from each other. After all, health care is an area of provincial responsibility, clearly outlined in Section 92 of the Constitution Act. Unfortunately, the federal Canada Health Act effectively puts this provincial power in a federal straitjacket. Federal spending power is used to entice provincial support for boutique federal programs, while threatening reduced transfers for provinces that dare to permit private health care services. The result is a stagnant health “system” that was groaning under the weight of an aging population long before the pandemic struck. Contrary to Chrystia Freeland’s alarmist claims, the real threat to Canadian health care isn’t private sector involvement. It’s politicians who confuse the issues, defend the status quo, and attempt to stifle any debate or attempt at reform. Meanwhile, Canadians suffer the consequences."
Plus, these are the people who want to regulate "misinformation"
Canadian doctors trained at international medical schools increasingly giving up on their home country for work - The Globe and Mail - "With nearly 300 Canadian students enrolled in its programs, the Royal College of Surgeons in Ireland feels a lot like a medical school in Canada, just separated by 3,340 kilometres of Atlantic Ocean. While this historic university in the heart of Dublin has been producing doctors since 1784, in recent decades, it’s become an important training ground for many young Canadians who go overseas to pursue their dreams of becoming a physician. More than 40 per cent of the students in RCSI’s four-year medical program are from Canada – more than any other nationality... Even the curriculum is geared toward a career in medicine in North America – with an academic calendar built around the writing periods for Canadian and U.S. medical exams. “There’s so many Canadians. It almost feels like you’re at a Canadian school,” said Matthew Macciacchera, an aspiring orthopedic surgeon from Vaughan, north of Toronto, in his final year at RCSI... They’re leaving Canada because it’s nearly impossible to get one of the 2,800 first-year seats in the country’s 17 medical schools – where roughly nine out of 10 applicants are rejected, often despite impeccable grades and qualifications, since demand far outstrips supply. Many want to come home but can’t. These international medical graduates are increasingly working as doctors in other countries, where they’re highly coveted, because they’re often blocked from returning to Canada by a system that’s been slow to respond to crippling physician shortages here... for many physicians who did their studies overseas, the road to a medical career in Canada remains closed because of a lack of provincially funded residency positions – the two-year-long, postgraduation supervised training period required to become a licensed physician... A decade ago, Canada gave 499 residency positions to people who were trained internationally. In the late 1980s, it was nearly 700. As well, the number of residencies within the same pool that are designated for international grads has been in steady decline, from 346 in 2014 to 331 this year... While dozens of RCSI graduates do return to Canada every year, most end up in the American health care system, where international grads are on equal footing with domestically trained medical students... Those trying to find fixes for Canada’s doctor shortage say the most cost-effective solution is to create more training residencies for international medical graduates, at a fraction of the cost of creating new seats at our medical schools. Many international applicants are actually Canadian.. Today’s restrictions on international physicians are the legacy of decisions by governments in the early 1990s to get ballooning health care costs under control, says Dr. Herb Emery, a health economist who heads the Atlantic Institute for Policy Research at the University of New Brunswick. As part of the effort to reduce the supply of doctors, provinces reduced seats in Canadian medical schools by about 10 per cent across the board and began dramatically cutting back the intake of international graduates into residency programs... provincial leaders in 2022 who want to address the health care challenges are running headfirst into an entrenched system of roadblocks that prevents easy fixes. It’s taken a crisis for things to begin changing... Adding residency seats for international grads is a far cheaper, and faster, way to add new doctors into the system than funding more seats at Canadian medical schools, which can take years to produce fully trained physicians. Those who go overseas for their medical degrees aren’t subsidized by Canadian taxpayers but must complete the same assessments and exams as anyone trained domestically if they want to work here."
Hoping to attract new doctors to Canada, recruiters abroad are hobbled by licensing rules at home - The Globe and Mail - "It’s shortly after 10 a.m. inside an exhibition hall on the stately grounds of the Royal Dublin Society and hundreds of doctors, nurses and health care workers are filing into the building. Many of them will walk out with a job offer in hand. The global competition for physicians and other health workers is laid bare at medical job fairs like this one in Dublin, where recruiters from Prince Edward Island and Newfoundland and Labrador recently came to help fill gaps in their health care systems. The provinces set up booths alongside recruiters from the Middle East, Britain, Australia, New Zealand and Ireland. Even the Cunard cruise line was there trying to hire more doctors. Nearly every exhibitor offered lucrative perks such as signing bonuses, relocation allowances and housing benefits along with help with immigration. Recruiters from the small Canadian provinces say with so many countries fighting over the same health care workers, it’s critical they make their pitch at international events like this... Despite their best efforts to sell the island’s quality of life – the PEI booth promoted the province’s famous beaches, friendly people, red soil and ubiquitous potatoes – recruiters can only do so much. Canada’s system for assessing and integrating physicians who were trained outside of the country is plagued by barriers and chokepoints, and the country is increasingly losing physicians to other places as a result. While fewer graduates of international medical programs are applying to train in Canada, nearly two-thirds of the foreign physicians who came here as immigrants aren’t practising medicine in part because of licensing hurdles... Internationally Trained Physicians of Ontario, an advocacy group, says there are more than 1,200 immigrant physicians in this province alone who are unable to get into the medical system because of a lack of residency positions – the supervised, clinical training required after a medical degree – or opportunities to let them show that their education meets Canadian standards. Many of them would gladly work in communities where the shortage of family doctors is most pressing... Around the world, the race is on to train and attract more doctors, fuelled by a global shortage of physicians that the World Health Organization estimates is approaching 6.4 million MDs. Stephen McLarnon, chief executive officer of Health Sector Talent, the company that put on the Dublin job fair, says Canada has a reputation as a difficult place to get licensed. It’s part of the reason the federal government just announced $90-million to expand the Foreign Credential Recognition Program with projects that streamline medical credential recognition, remove red tape or provide Canadian work experience to internationally trained health workers. Countries such as Australia, where nearly 60 per cent of general practitioners are foreign-born, offer an easier path to work, a national medical licence with fewer restrictions and a greater share of residencies for international graduates... Canada’s inefficient system for assessing foreign credentials and a restrictive, province-by-province licensing regime is among the reasons why there are so many internationally trained doctors working outside the medical field, he said. “International doctors, nurses and physicians, they all talk. They’ll say, ‘Canada is a great country, but it’s a challenging place to work’”... some provinces are expanding their ability to add international doctors more quickly... Licensing authorities in Canadian provinces are well aware of the debate around internationally trained physicians at a time when the doctor shortage is becoming a national crisis. What some see as roadblocks for foreign-trained physicians, they see as safeguards for Canadian patients."
Letters to the editor: ‘Born in Toronto … graduated University College Dublin in medicine – aimed for a U.S. residency because Canadian chances were depressing.’ How Canada loses doctors, plus other letters to the editor for Dec. 15 - The Globe and Mail - "Canada is the only country I could find on our planet with 13 health ministers. Fourteen, if one counts the federal health minister. I find this overstuffed system prohibitively expensive, costing billions of dollars that could be going to support our health system. Each of these ministers has their own department, in 14 different jurisdictions, to support their considerable and ever-growing staffs. Why not one overall health ministry? Most other countries have gone this route: Britain, Germany, France, Australia and New Zealand, to name a few. They’re not perfect, but they have to be more efficient than our system that just keeps blundering along."
‘People are dying’: Internationally trained doctors forced to sit on the sidelines as Ontario battles pandemic’s third wave | The Star
The power of protectionism
Opinion | What Alberta’s covid numbers tell us about the deficiencies of Canada’s health-care system - The Washington Post - "Canada’s case rates, after all, have remained lower than America’s for quite some time, a fact once endlessly emphasized as proof of Canadian cultural superiority. What has since become apparent, however, is that low cases are only as impressive as the health-care system’s ability to handle them — and on this front, the deficiencies of the Canadian system may be substantial enough to cancel out other sources of pride... Prime Minister Justin Trudeau demagogued hard against the province of Alberta as a place getting covid-19 very wrong. In the United States, Republican-ruled states in the Deep South have been similarly highlighted by progressives as covid disaster zones. If we compare Alberta with perhaps the most quintessential Southern state, Alabama (which, coincidentally, has a similar-size population distributed in a similar rural-to-urban ratio), we certainly see both places producing equally depressing headlines: “ICU beds in Alabama called crisis situation” vs. “ICU doctors warn health system on ‘verge of collapse’ ” in Alberta. These parallel failures are curious, given Alabama’s covid outbreak is much worse than Alberta’s. Beginning in mid-August, Alabama cases spiked to more than 4,000 a day and have only recently leveled to below 3,000. This is easily attributable to the fact that only 42 percent of Alabamans are fully vaccinated. Alberta, meanwhile, has a vaccination rate of 62 percent, and at worst, daily cases from mid-August onward have rarely climbed above 2,000. Why, then, are both places perceived to be in equal states of “crisis,” producing such strikingly similar stories about overcrowded hospitals and nurses pushed to the brink? The answer lies in the contrasting capacities of their dueling health-care systems. Though both jurisdictions have roughly the same number of hospitals, Alabama, with a population of 4.9 million, has 1,531 intensive-care unit beds, while Alberta, population 4.4 million, has only 370... Now, with a median household income of just $51,113, Alabama is obviously quite a poor place, while Alberta brags of having a GDP per capita that’s “the highest of any state or province in North America.” Of all Canadian provinces, only Newfoundland spends more on health care. So when a state as poor as Alabama possesses a health-care system with a higher emergency capacity than Canada’s wealthiest province, clearly something has gone terribly wrong... Polls routinely show health-care accessibility near the top of issues that matter to Canadian voters, which makes sense. Voters can read horror stories about Alberta ICU bed shortages then flip the page and see projections about deepening government debt and a ballooning Canadian population. Yet health care is also the topic least debated in Canadian politics, given the amount of mud that’s reliably thrown at any politician who so much as wheezes an observation that we could lessen the burden on the public system through a greater role for private care providers. This tendentious tradition of pretending anyone with a problem with the status quo is a right-wing anarchist once seemed silly. Amid Alberta’s crisis, it now looks deadly."
GOLDSTEIN: Pandemic exposed the myths of Canadian health care | Toronto Sun - "adjusted for the age of our population, we spent a higher proportion of our Gross Domestic Product on health care (11.3%) in 2019 than 27 other comparable countries that are members of the Organization for Economic Co-operation and Development. Only Switzerland spent more at 11.4%. The U.S. was excluded because it does not have universal health care... Despite the high expenditures paid by Canadians for health care, Canada ranks 25th out of 26 comparable OECD countries in acute care beds per 1,000 population (2.0); 26th out of 28 in doctors (2.8); 14th out of 28 in nurses (10.4); 24th out of 28 in psychiatric beds (0.37); 21st out of 24 per million population in MRIs (10.5) and 22nd out of 26 in CT scanners (15.2)... the U.S. Commonwealth Fund compared Canada’s health care system to 10 comparable, developed countries — Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., and the U.S. It examined 71 performance measures in five categories: access to care, care process, administrative efficiency, equity, and health care outcomes. Canada finished 10th, the U.S. last. Norway, the Netherlands and Australia were the top three."
EDITORIAL: Fix health care with surgery, not bandages | Toronto Sun - "The signs were there decades before COVID hit, yet any pragmatic politician who dared point out the obvious was shouted down by the voices of complacency who pretended ours was the best system in the world... We allowed our system to wither on the vine because no one dared point out the obvious flaws. Now we’re all fried by our inability to have an adult conversation about health care. In 2020, we were told we needed a two-week lockdown to stop our hospitals from being overwhelmed. Then two weeks turned into long months and we realized we were in trouble... Our system is out of date and underfunded because we’re paralyzed by the fear of doing things differently. It needs an infusion of cash. We can either hike taxes or allow more private delivery of services, so long as it’s paid for from public insurance... Other countries have suffered more cases of COVID, yet have managed to keep their communities out of lockdowns because their hospitals had greater capacity."
Colin Craig: These simple questions reveal Canada's desperate need for health reform - The Hub - "[We] have identified nearly 27,000 cases whereby patients died while waiting for surgery, diagnostic scans, or procedures. To be clear, the aforementioned figure appears to be largely comprised of cases whereby patients died while waiting for activities that could have merely improved their quality of life (e.g. a hip operation) rather than a procedure that could have saved it (e.g. a heart operation). But in many cases, provincial governments simply don’t track the data, and if they do, the data is often incomplete. For example, we received very little data from Quebec and none from Vancouver Coastal Health Region. Further, there also doesn’t seem to be any reporting by governments that specifically look at deaths due to long waiting periods. In Nova Scotia, the government informed SecondStreet.org that 51 patients died last year while waiting for surgeries that could have potentially saved their lives. In “just over three quarters” of the cases, patients waited longer than the recommended timeframe... Another question worth asking is how many patients have developed additional health problems over the past decade because they had to wait too long for surgery?... Ask provincial politicians about how often patients considered suicide or developed mental health problems while they waited long periods for surgery? Further, do long waitlists equate to in terms of foregone tax revenue as some patients are unable to work and pay income taxes? If these questions seem unreasonable, consider the high standards that governments expect private businesses to meet. In 2019, the Manitoba government shut down the Wood Fired Pizza restaurant in Brandon and disclosed the following reason online: “Extensively remodel[ing] a food handling establishment without first registering.”... That same year, WorkSafeBC, the provincial government’s workers compensation board, posted the following information about a workplace accident: “a young worker in the lower mainland was “using stilts while applying drywall mud tripped and fell to the ground.” This accident resulted in “bruising.”"
Janice MacKinnon: Saskatchewan model shows private clinics have a role to play in public health care - "only in Canada would the topic of private health care spark debate. In many OECD countries that have health-care systems that are less expensive and produce better health outcomes than Canada’s, private health care is common and noncontroversial. In Canada, private health-care facilities that allow patients to pay directly for services covered by medicare are contrary to the Canada Health Act, although many such facilities exist. So, why have neither Conservative nor Liberal governments acted in a sustained way to penalize such facilities? Perhaps because health-care delivery is a provincial responsibility and provinces, especially Quebec, are adamant that the federal government should not be telling them how to run their health systems. Another form of private care is the use of private companies to deliver health-care services that are paid for by provincial governments, which is permissible since the Canada Health Act only requires public administration of services. Many services, such as diagnostics, are run by private companies and doctors operate as private contractors. However, when provinces act to move services currently provided in hospitals to privately operated clinics, they encounter a barrage of criticism: quality of care will be compromised; health-care professionals will be drained from the public system, creating shortages of doctors and nurses; and the clinics will “cherry pick” patients requiring the least complicated procedures, leaving the public system to pay for those with more complex medical problems. All of these challenges were addressed when Saskatchewan moved 34 day procedures — such as cataract, dental and orthopedic surgeries — from hospital settings to private clinics, as part of its plan to reduce wait times. The Ministry of Health was transparent about the principles upon which the clinics would operate... The Saskatchewan clinics have offered quality services, which have been reviewed positively by patients, at a cost that is significantly less than what is offered in hospitals. Clinics are located outside the complex and expensive hospital settings and have the advantage of only performing specific procedures that can be delivered more effectively and efficiently. The day procedures performed at the clinics were 26 per cent less costly than the same procedures performed in hospitals. Patients appreciate the convenience of the clinics, with free, accessible parking, and the bright and cheery settings with children’s play areas. They also reduce the risk of patients being exposed to hospital-based infections. The Saskatchewan model shows that private clinics can provide quality services at a lower cost than comparable hospital-delivered services, if they are properly regulated and structured."
