Canada’s Broken Universal Medical System

INTRODUCTION:
Tommy Douglas implemented a single payer, universal health care system in Saskatchewan in
1944 which became the model for the rest of the country. Medicare is an unrivalled pillar of
Canadian national identity and many advocates of universal coverage look at Canada as a model
to emulate. But because of certain issues that we will discuss further Canadian system is
struggling to see new light coming to the current universal healthcare model in Canada it consists
of 5 core principles:
1. Universality i.e. all citizens are covered under this system
2. Comprehensiveness i.e. all medically essential hospitals and doctors’ services are
included
3. Portability i.e. spread across all provinces and territories
4. Public administration i.e. of publically funded insurance
5. Accessibility [1]
Nearly 2/3rd of the Canadians have supplemental private or employer sponsored insurance plans
to cover the cost of prescription drugs, dentistry, vision care, physiotherapy, rehabilitative
service etc. that are not covered under the universal health care system. Canada has failed to
create an actual integrated healthcare system and eventually have created a payment system.
Canada’s universal healthcare system Medicare is supposed to be in danger of becoming
outdated and thus putting its credibility as a global leader at risk. [2]

HISTORY:

The story starts with Tommy Douglas, the Cooperative Commonwealth Federation
(CCF) political leader (who almost lost a leg to a bone infection as a boy because his
parents couldn’t afford his medical treatment) introduced hospital insurance in
Saskatchewan during his first term as premier in 1947. [3]
It didn’t truly start with him, the 1918 flu pandemic (i.e. the Spanish Flu), which was
responsible for 50 million deaths worldwide introduced the concept of “public health” to
many who thought of health in mainly individualistic terms and since then the
Government-backed health insurance plans were a part of the conversation.
Still it was Douglas who advocated for national health insurance since 1943. He argued
that preventative treatment could save lives and reduce the cost of health services—that it
could save the province money and thus he remains a pioneer in the actual
implementation of the national health policy. [4]
The hurdles Douglas faced were:
 It took almost 1.5 decades for him to expand his hospital insurance program.
 It covered the universal hospital in 1947 and then doctors’ costs in 1962.
 This new model inspired fierce opposition from physicians (a bitter political battle
that saw the College of Physicians and Surgeons spend more than $100,000 to fight
Medicare) and insurance groups but proved extremely popular with the people of
Saskatchewan and elsewhere.

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Douglas’ socialized health plan was implemented two years later by his successor,
Woodrow Lloyd, after his 5th term win as a premier in 1960.
The vast majority of the province’s physicians went on strike, because of the fears that
they would lose the right to have a personal practice or they would become fixed salaried
employees like the schoolteachers and thus they left the province almost completely
without healthcare.
After a health care victory in Saskatchewan for a decade there was a long debate over
how to implement a Medicare plan on a national level as Douglas went to become the
leader of the federal New Democratic Party.
The most significant milestone was provided by the 1961 Hall Commission (a.k.a.
Royal Commission on Health Services). The Royal Commission on Health Services
suggested the governments to work together to prepare a list of medicines that should
always be available at a cost of $1 per prescription & also advocated universal dental
coverage, thus taking the idea of health insurance further than even Douglas had in
Saskatchewan.
Doctors started to believe that the new system could save time, money & lives, but the
other professional groups such as the Canadian Dental Association (CDA) and the
pharmaceutical industry (including both pharmacists and manufacturers) couldn’t
see the bright side and were in opposition to the Medicare.
The pharmaceutical drug companies didn’t want state regulations of drug prices & thus
they argued that most of the drug revenue to be reinvested back into the R&D. But seeing
how hard-won the fight was with the doctors, taking on dentists, pharmacists and drug
manufacturers altogether seemed very difficult.
Thus even >50 years after Douglas’s victory and after his arguing in the final years of his
life that Medicare is in danger of “strangulation” -Canada is finally getting ready to take
that 2nd step. Although there are important valuable lessons that needs be learned from
their failures of the past if they want to take that 2nd step forward. [5]

Understanding Canadian’s current Healthcare System and its Impact on future

Canada’s health system is among the top healthcare system in the world, it is currently ranked at
37 position according to the recent WHO report.
The current system in Canada is provincial systems i.e they are having single payer system that
discourages the grow of private insurers and often opt to take insurances for the government
bodies. Over the last few years, healthcare-insurance have doubled. Expensive health care
services have also hit the workers severely. Health spending has also increased to sixteen percent
of GDP [6]
Aging Canada’s population needs more health-related care. Hospitals are closing, and
physician’s fees are increasing day by day, which leads to hundreds of patients waiting for the
basic treatments— many patients suffer and, in some cases, die because of the delays.
In Canada’s failing health care system, the most visible outcome is the waiting times for health
care services. In Canada on an average, a person faced four and a half months wait for medically

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necessary treatment after referral by a primary care practitioner. This wait time is almost twice to
when national wait times were measured first. [7]
The Commonwealth Fund’s research depicts Canada has longer waiting times than several other
countries like Luxembourg, Korea, Belgium, the Netherlands, France, Germany, Japan, and
Switzerland—report a minimal problem with wait times. Almost 41 percent of Canadian patients
waited for more than two months for a special type of appointment which when compared to
Switzerland is only five percent. Moving on 25 percent of Canadians waited for four or more
months for the surgery compared to only 5% in the Netherlands. [8]
As the population grows in Canada as more and more people are moving in Canada specially
from third nation the problem will also keep on increasing as more doctors are moving outside
the nation to countries like United States of America where they are getting better opportunities
leading to lesser availability of skilled manpower. So, if they keep moving with this one-payer
system the whole system may collapse. Also, one may not see better treatment launching in the
Canadian market as the treatment needs to be approved by the Canadian government before the
person can get the reimbursement for that particular treatment. That means services like dental
care, out-of-hospital medical & pharmaceuticals, long-term care, physiotherapy, some home
based care services and many others, coverage is provided by a mix of private as well as public
insurance and out-of-pocket payments are now beyond the reach of many low-income Canadians
groups. [9]
Toronto being the biggest city of Canada has the smallest population of physicians and
specialists with the wait time of 6 months to see one of those. And if you think it is bad now than
it is only getting worse.
If a person with has a mental health issue. You’d think his primary care doctor would be a
psychiatrist, but no. He is forced to see a family doctor or walk in clinics as there aren’t any
mental health clinics or psychiatrists in the west part of Toronto. The Psychologists aren’t covered
by the “public” health care system.
Also access to health care is decided by the politicians and bureaucrats, based on policies of
favoritism towards certain ethnicities-particularly Natives and Blacks who receive maximum
taxpayer funding for health care clinics and treatments, non-citizen refugee claimants-who
receive coverage that are denied to the Canadian citizens, age groups-youth is favored over the
seniors and a rampant discrimination occurs against patients with illnesses which carry a stigma,
such as mental illness, addiction, and illnesses that are blamed on “life choices” such as obesity
and all such illness are termed as “wrong ailments” and patients are generally denied treatments
for such ailments. [10]

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Good and bad About Canadian Healthcare System

The Good about the Canadian healthcare system

 Access of Health Care to all the citizens

 Education programs are having to reduce costs leading to more people opting for this
career options
 Veterans are looked in their elder years also
 Best in class primary care
 A total of “B” Ranking for Health performance and quality of life of the citizens
 Zero elaborated Bills and No Co-Pays leading to minimal paper works

Bad About the Canadian healthcare system

 Political influences decision-making strategy leading to lack of Bold leadership

 The health care system needs to be much more active and outgoing to act as a universal
healthcare system
 People in rural areas do not get a proper share of care & healthcare services
 Hospital and healthcare fees are not aligned with the cost of living in Canada [11]
Changes that are required in Canada’s Universal Medical system in order to bring new life
to the old system
For the last 50 years, Canada’s health-care system has remained the same despite great pressures.
The following statistics says everything
• Canada spends 10.7% of its GDP on healthcare expenses
• Only 42% of Canadians think the current system works well with changing conditions
• More than 50% of Canadians say there is a need of fundamental changes in the system
• Only 8% of Canadians say its system needs total rebuilt
These statistics are given by BBC newsgroup which clearly indicates that the Canada healthcare
system clearly needs a change in order to climb up [12]
Actions are required to be taken in order to sustain the Canadian Universal Healthcare System
are:
1. Widening the definition of comprehensiveness of treatments included
So why does the Canadian “universal” health-care system have limited range of coverage to
doctors and the hospital services? Canada needs to distribute its public health investment across a

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wide range of services. A push for universal pharma-care, let’s say, is currently underway in
Canada. For better social determinants of health improved integration of health and social
services is required.
2. Integration in the Healthcare along with more innovation
Canadian Healthcare stakeholders works in silos. Information sharing and coordination is highly
lacking. Hospitals and other services functions as separately as single entities. Keeping the
patient is at the center will lead to improved, more effective and less expensive medical care -
regardless of where, when or by whom they are being served & treated. More Investments in
information systems will be to the success factor of these efforts
3. Courageous and bold leadership to make change possible
Leadership from government and as well as the health sector need to be more courageous and
bolder essential to bridge the gaps and tear the barriers. Canadians have to accept the changes in
order to have improvements in healthcare system. Canada must change to a better system lead by
a bold leader to honor and maintain those ideals. Canada’s leaders should not be afraid to set
aspirational goals to reach the ultimate universal healthcare system.
4. Improved accountability of healthcare system
Those who serve Canadians for their healthcare needs have to show transition into better
accountability models focused on outcomes rather than the outputs. Canada should award quality
and effectiveness rather than amount of service provided to patients in Canada. Goals of all the
system should be in alignment with professional, patient and healthcare system to make sure that
everyone is working on the top of themselves in the same direction to achieve a better and more
accountable system.
5. Funding aid
The recent announcements from the Wynne government of pouring in $822 into hospital
funding for 2018-19 would acts as a Band-Aid for the wounded universal healthcare system of
Canada. [13]
References
1. https://globalnews.ca/news/4120816/ontario-doctors-say-government-mismanagement-
to-blame-for-broken-health-care-system/

2. https://www.macleans.ca/opinion/the-history-of-why-canadas-healthcare-system-falls-
short/

3. https://medium.com/@Sard0n1ca/i-am-a-victim-of-canadas-broken-health-care-system-
a1eff849632b

4. https://globalnews.ca/news/4120816/ontario-doctors-say-government-mismanagement-
to-blame-for-broken-health-care-system/

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5. https://www.washingtonpost.com/news/worldviews/wp/2018/02/23/canadas-health-
care-system-is-a-point-of-national-pride-but-a-study-shows-it-might-be-
stalled/?noredirect=on&utm_term=.4153825de0ad

6. How healthy is the Canadian health-care system? Retrieved from

http://theconversation.com/how-healthy-is-the-canadian-health-care-system-82674
7. The Ugly Truth About Canadian Health Care
Socialized medicine has meant rationed care and lack of innovation. Small wonder
Canadians are looking to the market. Retrieved from
https://www.city-journal.org/html/ugly-truth-about-canadian-health-care-13032.html
8. 5 Myths About Canadian Health Care Retrieved from
https://www.aarp.org/politics-society/government-elections/info-03-2012/myths-canada-
health-care.html
9. Why Canada’s ‘best’ health-care system just got ranked last — again Retrieved from
https://business.financialpost.com/opinion/william-watson-why-canadas-best-health-
care-system-just-got-ranked-last-again
10. https://medium.com/@Sard0n1ca/i-am-a-victim-of-canadas-broken-health-care-system-
a1eff849632b

11. Pros and Cons of Universal Health Care in Canada

https://www.formosapost.com/pros-and-cons-of-universal-health-care-in-canada/

12. Is Canada's healthcare system as bad as Donald Trump says?

https://www.bbc.com/news/world-us-canada-37603883

13. If Universal Health Care Is the Goal, Don't Copy Canada

https://www.forbes.com/sites/theapothecary/2014/06/13/if-universal-health-care-is-the-
goal-dont-copy-canada/#73f0a39378d5