The truth of the matter is that allowing a private parallel health care sector to exist in Canada would mean faster access to higher quality health care for Canadians. It would in no way mean abandoning Canada’s universal approach to health care where Canadians have access to medical care regardless of their ability to pay. In the course of explaining why this is so, it is critical to understand the purpose a private parallel health care sector would serve.

Among the arguments for a comprehensive private system is that individuals work hard to earn more money so that they may enjoy a higher quality of life. Disallowing a private health sector, as Canada does, means denying people the right to spend their own earnings on goods or services such as health care that would benefit them. Simply put, a private-sector provider providing health services, that are also offered by the public insurer, allows individuals to use their own earnings in a way that benefits them the most, and allows private health care providers to tailor special services for those willing to pay for them.

Further, the monopolization of health care, which happens when the government supplier disallows private health care, means that individuals have no effective choice in the health care they receive. Without effective choice, health care delivery becomes a common, uncontested standard, leaving patients in a situation where they cannot protest for better quality by choosing to purchase health services from a different provider.

Given these basic purposes of privately funded care, understanding the effect on wait times from a private parallel health care sector is fairly straightforward. If an individual waiting for public care goes to the private sector and chooses to pay for their own care, there is one less person in the queue for the public insurance program to treat. If the demand for publicly funded care is otherwise unchanged, wait times fall as fewer patients are in the queue for public treatment.

The idea that this process would have Canadians abandon the publicly funded health care program en masse and then call for its destruction are unfounded at best: Canadians are proud of their universal access health care program and that program will continue be available and well funded for those who desire to use it. The difference is that it will no longer be the only choice out there.

And what of the evidence that supposedly shows Canada’s approach to be superior to other approaches? And the evidence that suggests privately funded care is harmful to the well being of individuals in the public system based on the experiences in the UK and/or Australia?

Contrary to what many claim, the UK experience is actually not one that discourages private competition. On the whole, the system actually produces shorter wait times in many instances than Canada’s (though wait times can be longer in certain areas) while our system costs a whopping 40% more than their system does. Part of the explanation to Britons getting the same or more while spending less is that private competition in financing is (and has always been) present there.

The experience in Australia is not much different. Australians also get shorter wait times than Canadians do and spend less on health care in total. Further, Australians not only have (and have always had) access to a privately funded health insurance sector, but are actually encouraged to purchase private health insurance through various public policies. Yes, there have been some studies showing that the expansion of private health insurance in Australia (not the creation) led to longer wait times. But there were also other studies showing the expansion of private health insurance coverage in Australia to have had the opposite effect on waiting times or no effect at all. Put simply, the evidence is not as clear or as one-sided as so many opponents of sensible reform suggest, and the fact that Australian’s enjoy shorter queues than Canadians while spending less on health care should give some insight to the benefits of competition in financing.

Yet another example demonstrating that a privately funded sector does not necessarily lead to longer queues in a public insurance program comes from Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland. These nations all have health expenditure performances that are similar to or lower than Canada’s. But they stand out among developed nations by having no queues for access to publicly insured/guaranteed care. Not one of these nations has managed this performance without a private parallel health care sector and the competition it creates.

Canadians should take careful note of the following facts when considering claims that introducing privately funded care would worsen the state of health care in Canada: Canada’s universal access health care program is the developed world’s third most expensive such program; is the only such program that disallows privately funded care; and it requires Canadians endure some of the longest queues for access to medically necessary care in the developed world. If allowing privately funded care necessarily lengthens queues, how is it that Canada has among the longest queues despite being the only nation to ban privately funded care?

Many will claim at this point that while privately funded health care may make sense for other nations, Canada’s lack of physicians means private health care will have a different impact in this great nation. They are wrong. Such a conclusion assumes that Canadian physicians are unable to provide more services than they currently deliver through the public program, which is simply not true. The reality is that despite the relative lack of physicians in Canada, many Canadian physicians spend a good deal of their time waiting for access to operating rooms or are unable to treat patients because of provincial quotas and limits. In other words, there are idle physician resources in Canada that the public system is simply unable or unwilling to employ. Thus, a system that permitted these physicians to practice in both the public and private parallel sectors would not rob the public system of resources but would instead increase the number of resources available to Canadians in total.

It should be noted that allowing physicians to practice in both public and private sectors simultaneously is not an unknown or unique practice among developed nations who maintain universal access health insurance programs. According to the Organisation for Economic Cooperation and Development (OECD), Denmark, England, Ireland, New Zealand, Norway, Spain, Sweden, Australia, Finland and Italy all allow physicians to practice in both public and private sectors. It should be noted that in some cases these physicians are subject to certain limitations. However, what is clear is that Canada would not be alone among developed nations in making more efficient use of highly trained resources like physicians through allowing dual practice.

The reality in Canada is that we are already paying for a world-class health care program, but are receiving anything but in return. Specifically, among the 28 most developed nations who seek to achieve the same goal as Canada, access to healthcare insurance regardless of ability to pay, Canada’s health care system ranks third in health care expenditures (age-adjusted share of GDP). At the same time, Canadians enjoy relatively poor access to physicians and medical technologies, while wait times for health care in Canada are not just unacceptably long but are among the longest in the developed world. That poor performance is the result of Canada’s unique approach to health care policy.

No single solution to all of Canada’s health care woes exists. However, in the interests of all Canadians, }we ought to be looking at what others are doing and adopt those policies that work best. Allowing patients to seek care on their own terms with their own resources when they desire to do is a proven policy that would improve the state of Medicare for all Canadians. Continuing to prohibit this option only serves to continue to shackle Canadians to a substandard health program that costs far too much for what it delivers.

links to other presentations by Nadeem Esmail

• Setting the Record Straight on Private Health Care