It is important to remember that universal Canadian Medicare legislation was not crafted to destroy private funding and provision of health services. It was crafted to create something – a system of publicly funded insurance, based on fair and admirable principles, to ensure that no Canadian would ever face catastrophic financial loss due to illness or injury. And it was good.

However, Medicare was created in simpler times for health care. The average population age was younger, drugs were fewer and less expensive, expensive medical technology was only in its infancy, people weren’t getting hip replacements, and CT and MRI scanners didn’t exist.

We now live in a time when the Canadian tax coffers aren’t large enough to pay for sweeping, all-inclusive coverage for every procedure, medical device, drug and professional intervention available – all delivered with optimal speed. Consequently, the system restricts and rations services while many politicians and self-serving groups work hard to cover up Canada’s own “big lie”; this country never invented universal health care, nor does it have the best healthcare system in the world.

Fortunately we also now live in the internet era, and Canadians are quickly realizing the truth. Two years ago, if you asked a person on an 18 month wait list for a surgical procedure how long they thought someone in (say) France waited, they would have likely said 18 months - or longer. They now realize that there are no wait lists to speak of in France – despite lower per capita healthcare costs.

The baby boomer generation is now entering the stage of life that consumes an ever-increasing amount of healthcare services. Through their taxes they have been paying some of the largest premiums in the world for public health insurance for most of their working lives. Yet they are now being denied services they need. They now know that an MRI or surgery should not take months or even years - and that 5 minutes with a family doctor isn’t good primary health care.

A very large number of Canadians now know what they should be expecting by “first world” standards, and they have money. We should be thankful that they are only asking that they be given the right to use that money (which, for emphasis, is in addition to what they have already paid to support Medicare) to take care of themselves and loved ones in the best and most timely way possible. It could be worse. No doubt that it will be worse if we don’t quickly do something about it.

So, back to the question. Purely on the grounds of humanity and fundamental freedoms, people should be able to use after-tax dollars to purchase health services that are already covered under Provincial health insurance plans if the public system isn’t providing the right care for them. The Supreme Court of Canada agrees.

Having said this, I believe very strongly that we need to begin working hard and immediately at eliminating the need for privately provided essential medical services. We may not have the best healthcare system in the world, but we can. We have the important advantage of being one of the last countries in the world that delivers essential health services almost exclusively through a public system – and so we have many countries to look to for guidance. Many mistakes have been made and we can learn from them. More importantly, most have re-invented their healthcare systems for the better.

It always bothers me when some person or group with a strong ideological position points to a flaw in the health system of one of the countless countries that have private healthcare running alongside universal public healthcare. It’s bad enough that the countries they invariably point to (e.g. Britain, Australia, New Zealand) have better performing systems than Canada, but it’s as if they are saying that Canadians aren’t smart enough to learn from other people’s mistakes. When they’re really desperate, they imply that advocates of new private options in Canada wish for a U.S. style health system. I have never heard anyone in Canada advocate for a U.S. style health system. Everyone agrees that it is worse than ours on most measures, and its multi-payer administration model is a hugely expensive monster.

I am a proud Canadian. My pride doesn’t have many roots in the quality of our healthcare system, and only a few more from hockey. But it does have strong roots in the values that formed the foundation of Medicare, which I don’t think are compromised by taking a new look at how we deliver essential healthcare to all Canadians.

At the risk of over-simplifying a very complex issue, it is my view that we can reverse the erosion of public healthcare in Canada by focusing on 3 fundamental areas:

(1) Redefinition of Essential Medical Care

The foundation of Medicare was a simple and very noble idea. No Canadian, regardless of their financial position, would ever experience catastrophic financial loss due to illness or injury. Yet every day in Canada, people experience this. Some examples might be the family of an autistic child, a person in need of an expensive drug or a new and “unapproved” cancer therapy, or someone whose has lost their livelihood because surgery couldn’t be performed quickly enough. At the same time, people will moan about the prospect of a $25 user fee to help control demand for certain services – even when the poor are protected. We need to take a long look at what we are prepared to pay for (for everyone) out of the public purse, and what we need to leave up to private insurers – ensuring that no Canadian ever experiences catastrophic financial loss due to illness or injury. We need to remember how Medicare all started and be realistic about what we can afford for everyone.

(2) A New Funding Model

From a financial perspective, Hospitals and other publicly run healthcare facilities look at patients as costs. Under the global funding budgets of virtually all public facilities, administrators would be far happier if no one showed up. When too many people show up, well, that’s a whole new problem. Beds close, operating room time for surgeons is cut back, nurses and other workers stay home and supplier orders are cancelled. The rationing begins. If we began funding facilities based on the volume of care they provide, countless problems would be solved. Most importantly, patients would come first as they begin to be looked at quite differently as sources of revenue for clinical programs.

Too few people know that there are enough Canadian physicians, surgeons and nurses in the world to eliminate wait lists and generally improve healthcare standards across the entire spectrum. The problem is that we don’t having enough working professionals here. Countless nurses have left the profession because they cannot get consistent, agreeable, full time work. Countless physicians have left the country (or clinical work altogether) because they do not get enough time to provide proper care or keep their skills sharp. Being able to cut back nursing and doctor time is one of the most effective “levers” that a health administrator can pull to control costs.

(3) Transition from Illness Care to Health Care

Compounding the problem of an aging population is that the population that is aging grew up when it was the norm to smoke, drink, have a rich desert after every meal and eat lots of red meat and exciting new processed foods. An apple a day was good enough to prevent disease.

One of the very real hopes we have in achieving a financially sustainable universal healthcare system in the future is to take everything we now know about prevention and make sure that our children and grandchildren don’t make the same mistakes.

It is ironic that we refer to our “medical” system as a health care system when a pitifully small amount of money and effort is spent on preventing illness and injury. There is ample evidence that the public health system will reap huge regards in cost savings if we can treat surgical and diagnostic patients more promptly and provide timely medical interventions. Most importantly, if we provide an environment of superior education and financial support for a reduction in chronic diseases that often stem from poor lifestyle choices, then we will have eliminated one of the largest costs within the current system.

It is not the role of government to hand-hold its citizen’s through life and provide all of the personal professional support that someone may need to overcome all educational, physical or emotional impediments to a healthy lifestyle, but it needs to provide an ever-increasing budget for public health education (with particular emphasis on children) in addition to its current funding for preventive measures. The fantastic inroads that have been made with smoking cessation are a testament to what can be done.

In short, we must give our citizens the fundamental right to take care of themselves and pay out-of-pocket for any insured medical service that is currently being delivered in a sub-optimal or untimely way. However, we must all work hard to eliminate the need for privately provided essential medical services as soon as we can.