Justin Trudeau has thrown in the towel in the fight to maintain the federal role as gatekeeper of a public, universal, accessible and fair health-care system in Canada. That could have tragic consequences for folks on the lower rungs of the social and economic ladder.

It could also hurt Canadian unity because another key characteristic of our healthcare system, transportability from one province to another, could also get flushed with impunity.

Let’s start with an admission: something had to change.

Tony Blair had it right, there are only two categories in public administration: things that work and things that don’t. The corollary is: if what you’re doing doesn’t work, then try something else.

That’s the territory we’re in right now. A health system where being put on a waiting list is often the only thing they can offer you.

Canadians have always been enamoured of our medicare system. After all, it gave us one thing to brag about to our "heartless" American cousins...

I come from a very large family of ten kids. My parents both worked really hard but doctors’ bills were a reality I remember them talking about. It was expensive.


When medicare was announced, it was a relief for families like ours. In Saskatchewan, Tommy Douglas won his last election on a promise to bring in medical care insurance, based on pre-payment, universal coverage, quality service and government administration.

Douglas himself had needed major medical care as a child. While he was thankful to the physician who cared for him despite his parents’ inability to pay, he wanted to ensure that healthcare would be available to kids, irrespective of their parents’ financial situation.

The CCF (precursor of the NDP) government of Saskatchewan faced a major hurdle as soon as the plan was enacted. The College of Physicians and Surgeons organized a doctors’ strike. Equally determined, the government brought in MDs from Britain and the U.S. to work under the new system. In short order, the Saskatchewan doctors returned to work and accommodations were negotiated. The first medicare system in North America was now in place. Public interest had triumphed over private profit.

A decade later, Douglas’ model was introduced across Canada, thanks to a deal between the federal government and the provinces. Unfortunately, since that time, accessibility has become a major problem that has proven vexingly difficult to address.

The original agreement was a 50-50 sharing of costs between the feds and the provinces.


Today that’s closer to 75-25 with the provinces paying the lion’s share. The provinces needed to get the feds to 35 per cent.

That’s why this week’s federal proposal is so disappointing.

What should’ve been $28 billion this year alone is actually going to be less than $5 billion. Despite fictional numbers of close to $200 billion being spun by Ottawa, the Feds are only offering $4.62 billion a year, for ten years.

Ottawa’s press release was a masterpiece of obfuscation. Columns of figures wearing pancake makeup. They even tried to include pandemic spending in Ottawa’s contribution!

As with the very first medicare deal, the provinces gave up part of their exclusive jurisdiction over healthcare. They accepted the eminently reasonable federal request to provide transparent and objective information on things like wait times and coverage. The premiers rightly considered this to be, essentially, money without new conditions.

On the positive side, for the first time in decades we seem to have been able to move beyond debates about modalities towards an emphasis on measurable results. Outcomes.

Problem is, with the paltry sums being offered, there’s little hope, for real change that will save the essential qualities of the system. The pressure for more privatization thus baked in, it now has to be controlled in the public interest, but by whom?

The Premiers appear to have read the room correctly. The public doesn’t want squabbles, it wants access and reduced waiting lists. Federal Health Minister Jean-Yves Duclos even channelled Pierre Poilievre over the weekend saying the system was broken. On Monday Trudeau echoed that, while avoiding the "broken" wording of his minister, he said Canada's health system simply doesn’t work.

If Ottawa recognizes that this key Canadian institution isn’t working, why do they still refuse to respect the initial deal and pay their fair share? Is it because they’ve bought into the mantra that more competition, meaning private for profit care, is a panacea that will somehow fix everything?!


In Canada we seem to have a penchant for two-tier government services. When provinces subsidize what are supposed to be private schools, workers wind up seeing their taxes pay for the "private" schooling of wealthier families.

Public funds for a private service. As the public system has more and more problems, parents sacrifice a lot to get their kids into the private schools. A vicious downward spiral of the public school system results.

This is the greatest fear as we talk about transferring some of the responsibility for delivering health care to the private sector.

Doug Ford sincerely believes he’s going to improve health care by subcontracting some of the more repetitive work to private clinics. It is hoped that economies of scale will reduce wait times and allow for a decent profit, while reducing government costs. Not a sure bet but one that has become almost inevitable in light of the underperformance of the public delivery system.

It’s amazing to note that Ford’s privatization proposal, that would’ve been an anathema for Mr. Trudeau just a year ago, the prime minister now cheerfully describes as being "innovative".

Promises to only need "a medicare card, not a credit card" only go so far. The real fear is that there will be two systems: one that can be accessed by those with some money and one for the less fortunate.

These clinics will have to be tightly regulated.

Private owners can’t be allowed to cherry pick the best patients, the better to claim superior outcomes. Smoker? Obese? Underlying condition? Sorry, you’ll have to go over to the public system.

The single payer will remain the government, which therefore must also remain the single wicket for sending patients to those private clinics. Otherwise, the toughest patients will be sent to the public system that will be, again, singled out for being too costly and inefficient.

Costs of necessary licensure, inspection and accreditation must be borne by the private clinics. Unlike the tragic neglect that led to the multiple horrors in nursing homes during the pandemic, provinces and territories will actually have to learn how to enforce norms on the private providers.

We have a strong emotional attachment to our medicare system because it is so egalitarian. So fair. Unfortunately, it’s become equally mediocre in too many areas. Good sentiment isn’t a substitute for timely treatment. Political dogma doesn’t provide a service to anyone. We’ve arrived at an inflection point, let’s prepare for it and deal with it correctly in the public interest.

When I hear some politicians say that if we finally bring in pharmacare it has to be purely public, we’re into an area of ideology. Quebec has, by far, the most complete coverage of prescription medication in Canada. It’s a hybrid model where private and public insurance coexist, side by side. It works.

Doctrinal purity, based on an entirely theoretical model, can’t compare to an actual positive result.

So too with health care. Like many progressives, I’ve fought the good fight throughout my career. Battling back against incursions by the privateers! But if we acknowledge that the current model can’t be fixed, at least not at a cost that can be borne by the provinces, then we do have to adapt but we also have to get it right.

When what you’re doing doesn’t work, try something else…but do it with eyes wide open, ensuring that public protection is the only value guiding any private additions to the system.

Canadians deserve the best health care. Let’s figure out how to deliver it in fact, not in theory. That was supposed to begin with the return of an appropriate federal contribution. Now that that’s not on the table, it’s time to figure out a cure for our once vaunted health-care system that doesn’t kill the patient.