Opinion

Improving our health care will come from greater public investments, not private alternatives

In countries where mixed models of private and public health care exist, higher wages and greater resources can incentivize specialists into private practice.

We should be working within the system we have to reduce wait times and enhance services

Yes, the Canadian health care system is flawed, and there is much room for improvement. So let's work within the system we have to advocate for better access to primary care, better coordination of services, and more long-term care beds. (Shutterstock)

I'm an emergency room physician in Ottawa. I may have even been working when CBC Opinion columnist Neil Macdonald presented for care, which he wrote about back in June. The scene he described of long wait times, fatigued staff, and bed shortages is, unfortunately, all too familiar to me.  

I have great empathy for what he experienced. It is a terrifying thing to be in a hospital, in pain, and unsure of what is wrong. However, I question his conclusion that the answer to this problem is lies in privatization of Canadian health care services. 

Universal health care is a defining trait of Canada, and one that we cannot take for granted. I take great pride in working in a system where everyone can get the care that they need, rather than only those who can afford it getting the care that they want. 

Those "Code Blue, Code White, Code whatevers" that Macdonald so casually referenced in his column are all critical patient emergencies, which require emergency staff to drop everything and run to the patient's side. 

In those situations, every possible measure will be taken to provide every patient with the highest quality of care, regardless of income status. Whether you are a member of parliament or a single parent who is out of work, you will leave the hospital with your cardiac stent, or your emergency surgery, or whatever other treatment is required to get you back to your life and your loved ones. And you will do so without ever opening your wallet. 

Health care spending

Universal health care also allows us access to primary care and preventative medicine to keep our population healthier and prevent those emergencies from developing in the first place. Much of the available evidence suggests that the failings in our health care system are due to a lack of sufficient public spending, not because there is not a private alternative.

In fact, the Scandinavian health care system that Macdonald touts in his column actually devotes a greater percentage of its annual health care spending toward its public systems than we do. According to the Canadian Institute for Health Information, Sweden devoted 84 per cent of its total health expenditure to its public sector in 2017, compared to only 70 per cent in Canada, while achieving higher average life expectancies and lower rates of mortality and morbidity in a population that is older than ours. 

That's not to say that our system doesn't have problems. Wait times for non-emergency procedures, such as joint replacements, are too long. Hospitals are overcrowded. Family doctors are hard to find. I don't deny any of this. But no Canadian will be denied time-sensitive or life-saving care because they can't afford it. Nor will they wake up to a lifetime of crippling medical debt in exchange for the privilege of being alive.

Macdonald noted in his article that he received excellent care at an American public hospital that treats patients with private insurance, Medicare, and Medicaid. But more than one in 10 Americans don't fall into any of those categories.  These are the "working poor," who are not poor enough to qualify for Medicare or Medicaid, but still too poor to afford private insurance. Almost 40 million of these Americans may not be able to access the care they need because they can't afford it. That's not a system that I'm willing to idolize. 

In countries where mixed models of private and public health care exist, such as the two-tiered systems in the UK and Australia, higher wages and greater resources can incentivize specialists into private practice, resulting in a deterioration in the quality of care and resources available to the public sector. These systems have also demonstrated that as private health care spending increases, wait times in the parallel public sectors can also also increase, leaving those who can't afford private care even further behind.

Yes, the Canadian health care system is flawed, and there is much room for improvement.  So let's work within the system we have to advocate for better access to primary care, better coordination of services, and more long-term care beds.  Let's be vocal against governments that want to make further cuts to an already overburdened health care system.   

And to those who look at privately paid health care south of the border with rose-coloured glasses, I ask you to think about those who can't afford to do so, and reassess your position. I'm glad Macdonald came forward with his experience. He sheds light on some critical gaps in our current system, which make being a patient an even harder experience than it already is. But we must have equal compassion for every patient's journey, regardless of their ability to pay, and take a stand for universal health care. 

Then we can take steps toward improving on the foundation of universal access, rather than talk about dismantling it.


This column is part of CBC's Opinion section. For more information about this section, please read our FAQ.

About the Author

Thara Kumar is an emergency room physician based in Ottawa and a graduate student at the Johns Hopkins Bloomberg School of Public Health.

Comments

To encourage thoughtful and respectful conversations, first and last names will appear with each submission to CBC/Radio-Canada's online communities (except in children and youth-oriented communities). Pseudonyms will no longer be permitted.

By submitting a comment, you accept that CBC has the right to reproduce and publish that comment in whole or in part, in any manner CBC chooses. Please note that CBC does not endorse the opinions expressed in comments. Comments on this story are moderated according to our Submission Guidelines. Comments are welcome while open. We reserve the right to close comments at any time.