More than 70,000 surgeries were cancelled in Ontario to accommodate a surge of COVID-19 patients who never materialized. As of May, an estimated 30 to 35 Ontarians had died from missed cardiac surgeries as a result of the delayed procedures.
With 60,000 MRIs and 62,000 CT scans cancelled in Ontario, doctors worry that some cancer diagnoses could come too late. Ontario has begun resuming procedures, but it could take years to catch up.
In British Columbia, the government says it will take 17 to 24 months to catch up on the 30,000 surgeries it postponed. There were already 63,000 people waiting.
The fact that it could take years for sick Canadians get these surgeries done should make us angry. Canada is exceptionally bad at treating people within safe amounts of time. Clearing the hospitals for COVID-19 has made a bad wait-times problem worse.
If Canadians dig into why our system forces people to wait so long, they may start to see the ugly truth: governments use bans on private insurance and market pricing in order to monopolize care—something no other Western country does. The result is pain, suffering, and death. This is unconscionable and unconstitutional.
Politicians like this monopoly because it allows them to ration care, which keeps costs down. They use bogeyman rhetoric to scare the public into thinking that allowing private payment for care would lead to a U.S.-style system with the rich getting fixed and the poor left sick or bankrupt.
But the United States is an outlier. Countries in Asia, Europe, and Oceania offer high-quality universal health coverage without banning private insurance. In Germany, roughly 10 percent of people have extra private insurance. It’s true that those who pay more get seen more quickly, but the public system used by 90 percent of Germans also sees people significantly quicker than they would be seen in Canada. A 2016 Commonwealth Fund study that looked at wait times in 11 wealthy countries found that Canada had the highest proportion of patients—18.2 percent—waiting more than four months for surgery. The percentage waiting that long in Germany? Zero.
Allowing private payment means more overall health care dollars to go around. In Canada, we spent US$4,974 per capita on health care in 2018. Germans spent US$5,986 per capita. Many sick Canadians with extra cash would happily spend their money on private insurance which could buy them quality of life and stave off death, but all provinces except Newfoundland and Labrador effectively ban private health insurance for care that governments consider “medically necessary.” That includes things like hip replacements and CT scans but not medication, dentistry, or coverage for wheelchairs.
Allowing those who can afford private insurance to buy it wouldn’t harm other people; in fact, each person who chose private care would be taking pressure off the public system. Public wait lists would shrink.
Canada’s rationed resources could explain why, as German hospitals postponed only elective procedures like hip replacements in March, Canadian hospitals frantically cancelled pressing surgeries. Germany has that kind of flexibility, with six acute care hospital beds per 1,000 inhabitants, compared two in Canada.
Orthopedic surgeon Dr. Brian Day of Vancouver’s private Cambie Clinic has been fighting these monopolies for more than a decade. With the support of the Canadian Constitution Foundation, he’s suing the B.C. government, arguing that restricting private payments interferes with the most fundamental rights guaranteed in the Charter of Rights and Freedoms: life, liberty, and security of the person.
In the case Carter v. Canada, the Supreme Court of Canada struck down the criminal ban on medical assistance in death, in part because our right to liberty means the government cannot interfere with “fundamentally important and personal medical decision-making.” What could be more fundamental than the decision to have a life-saving surgery or scan?
In R v. Morgentaler, which struck down Canada’s limits on abortions, the Supreme Court found that security of the person is infringed when the state “interferes with bodily integrity” or imposes “serious psychological stress.” This was reiterated in Chaoulli v. Quebec, the 2005 case that struck down Quebec’s laws banning private health insurance. The court found that the right to life itself is infringed whenever the state “impose(s) death or an increased risk of death on a person, either directly or indirectly.” That’s exactly what happens when governments create deadly wait lists.
Dr. Day’s challenge to these laws could be decided any day. Whichever way it goes, Canadians should demand that their governments remove the roadblocks to a private payment for care. Now more than ever, it could prevent suffering and save lives.