Canada has a universal health care system. But does it really? (2024)

Maybe one day, our universal health care system represented the values of Canadians, but certainly not anymore. American friends, you may know us for our drinking age and “free health care.” Still, unfortunately, our health care system no longer embodies the principles of equality, respect, politeness, safety, and peace that we hold dear.

You may also be familiar with our Prime Minister’s fondness for dressing up and doing shirtless yoga poses. Aside from hockey, poutine, and maple syrup, few things were more emblematic of Canada than our universal health care system.

Universal health care means that all medical services are covered for everyone, without discrimination based on race, financial status, or social connections. It also means that no one should have to go bankrupt to access medical care or avoid treatment due to financial reasons, which is a problem that is all too common in the United States.

Unfortunately, our system has lost a lot of its universality today.

Not all health care services are covered by the public system, such as dental, vision, and long-term care, which are self-pay services.

Not all Canadians have equal access to health care services, with some populations, like First Nations and certain regions, experiencing greater barriers to care.

Not all Canadians have equal access to high-quality care, with some patients experiencing great disparities in the quality and outcomes of the medical services they receive.

Not all Canadians have equal access to timely care, with extremely long wait times for medical appointments or surgeries.

Not all Canadians have equal access to health care providers, with shortages of physicians, nurses, and other professionals across the nation.

Not all Canadians have access to innovative treatments and technologies, with some patients unable to access the latest medical advances.

Not all Canadians have equal access to comprehensive and coordinated care, with a lack of integration and coordination among different levels of care.

Not all Canadians have equal access to patient-centered and personalized care, with limited attention to patients’ unique needs and preferences.

Not all Canadians have equal access to health information and education, with limited support for patients to make informed decisions about their care.

Not all Canadians have equal access to health services in other countries when not available or accessible at home, with limited provisions for cross-border health care.

How did this happen?

Poor planning led to an enormous imbalance between demand and supply of health care services, and poor leadership are to blame. It is worth wondering if voters actually interact with hospitals at all.

There were attempts at rationing care to decrease spending (fewer medical services rendered meant less spending by the single-payer system), but that obviously resulted in a sicker population, requiring more care, not less, months-long waiting lists even for urgent care, endemic staff shortages, and outdated equipment.

In addition, life expectancy has increased from 75 to 81 over the last forty years, while the number of births per woman has dropped from 1.74 to 1.4. This means that Canada, like most western countries, is dealing with an aging population that is not being replaced.

As five million Canadians will turn 65 this decade, the 2020s will be the one that sees the last boomers retire. Among them, many physicians as about 20 percent of doctors in Canada are 65 or more. Our country will soon be facing an exodus of physicians due to retirement, on top of the burnout epidemic, just as health care demand is rising.

Studies also show that younger physicians, both male and female, do not work the same hours or deliver the same amount of medical services as their predecessors did in the past. As a consequence, Canada is headed for a perfect storm due to a severe imbalance between supply and demand.

We are aware that the U.S. health care system is failing too, as it has become unaffordable for too many people, who can’t access medical care even when they have insurance. Most Americans get insurance coverage through their employer, which limits choices, and many defer treatments because of underinsurance, hefty copays, and out-of-pocket deductibles and expenses. People also put off preventive care for the same reasons, which will result in more medical expenses down the line.

A growing number of our American friends who are looking for solutions seem to support a single-payer system, like ours, as Bernie Sanders suggested. My advice is: Don’t look to the north for inspiration. We messed up. There are better models, like in Switzerland, that allow private health insurance, but if a person cannot afford to pay, the government pays the premium for them.

Canadians tend to be grateful they don’t have the American system, but also do not speak up loud enough to push for better. Universal? I don’t think so.

Jean Paul Brutusis a hand surgeon.