The Canada Health Act has become the electrified third rail in Canadian politics – untouchable legislation that is failing us.
This antiquated piece of legislation is not only out of step with modern medicine but also actively obstructing progress. The result? A health-care system on life support, languishing in pain, and a country unwilling to acknowledge the political cowardice of all stripes that sustains this status quo with palliative care medicine. This guarantees a frightening, disabling death of health care without any chance of recovery.
Politicians love to trumpet the phrase “universal healthcare,” but that’s not what we have. What we actually have is a doctor-and-hospital system that ignores the full spectrum of health-care practitioners capable of delivering care.
Mental health? Unless you’re lucky enough to see a psychiatrist after a ridiculously long wait, you’re paying out of pocket for therapy. Need physiotherapy after surgery? Better hope you’ve got insurance. Nurse practitioners or pharmacists? Sidelined by regulations that treat them like second-class primary care practitioners.
Thankfully, there are glimmers of progress. In January, the federal government acknowledged that nurse practitioners will be able to bill provincial health plans, a crucial step in leveraging their expertise. Similarly, pharmacists are seeing their scope of practice slowly expand, allowing them to prescribe medications for minor conditions in several regions. The Canada Dental Care Plan is another example of addressing gaps, extending coverage to millions who previously went without.
But these steps, while commendable, are only a start. How is it acceptable in a country as wealthy as Canada that access to care still depends on who you see, where you live and what you can afford? The Canada Health Act – unchanged since 1984 – is a relic, a Dead Sea Scroll that prioritizes the optics of “free” health care over actual health outcomes. The refusal to recognize the realities of modern medicine isn’t just an oversight, it’s a moral failure propagated by every stripe of politician.
We are stuck with this broken system because politicians on all sides are terrified of modernizing it. The Canada Health Act has been elevated to untouchable status, a political landmine no one dares to reform for fear of being branded a privatizer or a heretic to Canadian values. Meanwhile, the provinces and federal government bicker over funding and jurisdiction like children arguing over Pokémon cards, leaving patients as collateral damage.
We’re asking for common-sense changes that prioritize patients over politics.
This paralysis is particularly maddening because the solutions are obvious. We’re not asking for miracles here. We’re asking for common-sense changes that prioritize patients over politics: expanding access to licensed allied health professionals working in a patient family home model team; integrating digital health from primary to tertiary care and across all provinces; and funding a broader range of services so people don’t have to choose between their health and their wallet. No matter what propaganda is spewed, health care in Canada requires both your credit card and your health card. And, it seems, your credit card more and more.
In a nation in which emergency departments (EDs), hallways and now parking lots are overflowing, more and more EDs are closing and family doctors are becoming extinct, why are we still treating pharmacists, psychologists, nurse practitioners, chiropractors and physiotherapists as second-class providers? These are highly trained professionals who could drastically reduce wait times and improve outcomes if only we let them. But no, we cling to a 40-year-old framework that’s as outdated as corded rotary phones. It’s absurd.
Even the simplest reforms, like funding psychologists or physiotherapists under public health plans, are mired in political inertia. If we really cared about access, what are we waiting for? A complete collapse of the system?
Newsflash: We’re already there. I am fed up with excuses, with politicians seemingly accepting that waiting and waiting for minimal health care is a true badge of being Canadian.
Let’s be clear: this isn’t about dismantling universal health care. It’s about delivering on its promise. A modernized Canada Health Act could:
- Expand the scope of care: Recognize and fund the full range of health-care practitioners who can safely and effectively deliver services.
- Eliminate out-of-pocket inequities: Stop forcing patients to pay for essential services like mental health therapy and physiotherapy.
- Leverage technology: Embrace digital health tools to connect patients with providers faster and more efficiently.
- Prioritize outcomes over ideology: Shift the focus from protecting the old model to achieving better patient results.
These changes aren’t radical; they’re reasonable. What’s radical is continuing to deny patients the care they need because politicians are too afraid to challenge the sacred status of the Canada Health Act. Its original intent may have been noble, but its rigid framework has become a barrier to the very universality it is supposed to uphold.
It’s time to stop treating the Act as a symbol and start treating it as what it is: A tool that needs updating. Because the real symbol of Canadian health care shouldn’t be a piece of legislation, it should be a system that works for everyone.
Absolutely excellent article. I remember at the beginning of COVID listening to one of Trudeau’s daily? broadcasts..the horrendous truths about LTC facilities were beginning to emerge…and he refused to consider amending the CHA to bring LTC under the act, and hence try and control the damage. He was terrified (IMHO) of “upsetting” the provincial premiers who want absolute control of healthcare in their provinces. So look where we are; they have control and we are broken due to their selfishness and desire to stay in power. No-one cares about the citizens of this country as we age and need more than ever a comprehensive care system available to all. Absolutely shameful.
Constant expansion of funding for health care services just means inflating the volume of services used and money that goes into the pockets of health care providers.
What’s ignored in the article:
– overuse/underuse of services: We need to embrace Choosing Wisely programs to make sure resources are used appropriately.
– accountability: providers (especially physicians) are simply not accountable. If a patient is enrolled with a primary care physician, the physician gets paid but a patient may need to wait weeks for an appointment. That’s not about over worked physicians … that’s about how a physician chooses to manage their practice. Or one physician orders a test, and another physician orders the same test because they like to have it done on their machine or at their lab.
– self-interest: our system is structured around providers, not patients, who are self-interested in maximizing income, minimizing work. Providers often overcomplicate the system, don’t deliver on obligations contracted with government.
Some good (and difficult to swallow) points! How would you re-balance the accountability/self-interest problem? There seems to be a lack centralized planning of resources to improve efficiency. I often see patients get repeated consultations for the same problem because the consultation report is not available (or it not particularly helpful). One efficiency I wish could to be actualized is a province wide EMR/referral system/pharmanet. Another common problem seems to be frequent no-shows and misuse of services (ie. ED to renew a prescription) and I wonder about some policy to encourage judicious use of care by patients themselves (ie. a co-pay for no-shows).
The greatest failing of Canadian medicare is failure of governments to control allocation. The fee-funds are allocated between services and specialties by the provincial medical associations, so they favour their members who are best at lobbying and organising, not societal needs. They also follow patterns across the southern border. This is why orthopedic surgeons ophthalmologists and dermatologists do well, while family physicians, especially rural family physicians, psychiatrists and pediatricians do badly. New graduates choose to go into the high-income specialties, not where they are needed. Governments need to take control of the public money and redirect it: not only to fee-for service, but also to other ways of ensuring the population gets the services it needs.
There is an army of trained physicians who cannot practice in Canada due to misguided past policies of reducing the number of physicians trained in Canada. Canadian citizens who have trained abroad are denied entry back into Canada to work as doctors by protectionist policies that promote and prioritize the interests of graduates from Canadian universities. This is a many layered issue but that is the bottom line. If those doctors, who have financed their own training, were given easier access back into Canadian health care, a lot of care problems co you d be solved.
I suspect the policies of the past were during a time of slower population growth and a healthier/younger population, but times have changed over the past decade. I think part of the struggle with re-entry into Canada is that residency training is a finite resource, and its quite difficult to increase access due to limits in training sites/supervisors/cases. Although CMGs should get first dibs given the investment already made by the gov (and have completed a high-quality, often more-competitive, local training).
Hi Dr. Abdulla, thanks for the article.
I strongly disagree with expanding scope of care. We can incorporate mid-level providers (ie. NPs and PAs) within family health teams under MD supervision as you described while maintaining current scope of practice. The US is a cautionary tale for the over-utilization and increased scope of care of mid-level providers. To be frank, the rapid expansion of full-practice autonomy mid-levels has been a complete mess. There is evidence that mid-levels cost the system more per patient, making more unnecessary referrals and investigations, and often over-prescribing. We should not have a “race to the bottom” of qualifications in order to solve the primary care shortage like the US, which would ultimately lead to second-class care to vulnerable populations that do not have access to team/MD care. We need to work as a team instead and not make the same mistakes we see in the US.
Thank you for your perspectives. Look at this reference and let me know what you think:
https://www.canada.ca/en/health-canada/services/health-care-system/health-human-resources/workforce-education-training-distribution-study.html
Thanks for the reference, Dr. Abdulla, but I might be missing what you’re referring to here. I can see that there is an increase in the amount NPs and the suggestion that NPs may be used to address the primary care gap (mind you, the citations are from nursing associations and nurse unions). Unfortunately, this report does not address the quality of care (or cost) concerns that we have seen if we saddle ourselves to the US model for increased scope of practice and increasing utilization of mid-levels.