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Health care is inefficient, but not because of public spending

Canada spends fewer public dollars on health care than many other OECD countries

Canadian Politics

Doug Ford’s strategy is clear: defund health care, generate public resentment over its inefficiency, and then privatize.

While unfavourably comparing Canada’s health care system to those in Cuba and North Korea, Ford announced plans to further privatize Ontario’s health sector, regurgitating well-worn conservative rhetoric that public spending, which is apparently wasteful and out of control, is to blame for the system’s inefficiencies.

Of course, the fact that Cuba has the highest doctor-to-patient ratio in the world and has secured some important gains such as not-for-profit, made-in-Cuba COVID vaccines goes unmentioned. Nevertheless, one can understand what Ford means: public health care is communism, and communism is evil. Therefore, privatization equals freedom.

The problem is that public spending is not what makes Canadian health care inefficient. In fact, Canada spends fewer public dollars on health care than many other Organization for Economic Co-operation and Development (OECD) countries. Per capita, the United Kingdom, Germany, Sweden, France, and New Zealand all allocate more public funding to health care than Canada—an average of 73 cents per dollar, with the other 27 cents covered by out-of-pocket spending or private insurance (at the high end, Sweden and Germany cover 84 percent).

By contrast, Canada covers 70 cents out of every dollar with public funds. This comes to 10.7 percent of GDP, lower than France, Germany, and Sweden. Meanwhile, Canada’s “public” health care system does not offer dental or universal public drug coverage, vision care, or physiotherapy. Canada also has a lower doctor-to-patient ratio and lower per capita hospital spending than the OECD average.

Additionally, tax cuts have eaten into government revenues that could have gone toward properly funding the health care system. Since the 1980s, the corporate tax rate has been slashed from 36 percent to 15 percent; income tax for the highest income earners has fallen from 43 to 33 percent; and only 50 percent of capital gains are taxed as opposed to 75 percent decades ago.

Meanwhile, Canadian governments have continued to search for ways to decrease rather than increase public health spending. The Ford government is leading this charge. While attempting to limit wages for public sector employees with Bill 124, the Ontario government has looked for ways to “identify efficiencies, savings, and value creation” in the province’s health care system. In one recent case, the Ford government met with corporate lobbyists from an “Uber for health care workers” app, a move that would turn affected workers into “independent contractors” without benefits, legal protections, or union rights.

At the same time, internal documents reveal that the Ford government knows its actions are responsible for the province’s shortage of health care workers. Briefing notes prepared for Sylvia Jones after she was appointed minister of health in June 2022 stated that “concerns about wage disparity via Bill 124” were partly to blame for “retention issues” at Ontario health care facilities. Separate notes admitted that “Wages and working conditions continue as key drivers of attrition,” and “wage disparities are also causing (health-care staffing) shortages in home care.” The COVID-19 pandemic worsened these issues, while also doubling the amount of patients waiting “longer than recommended” for surgeries to 105,000.

Now, Ontario health care has a turnover rate of 15 percent, with the Ontario Nurses’ Association claiming that the government will need to hire 47,000 more employees just to keep up with turnover, let alone staff the facilities at adequate levels.

For its part, the Ontario government refuses to publicly say how many health care workers the province needs to fill staffing shortages. Responding to an access to information request, the Ford government withheld those statistics under Section 18 of the Freedom of Information and Protection of Privacy Act on the grounds that revealing such information may be “injurious to the financial interests of the Government of Ontario.” Global News was told that the government withheld this information because it may give health care workers more leverage when negotiating contracts in the future.

The Ford government has made many cuts to public spending in the past, and its 2022-2023 budget indicated $859 million in reductions to health care funding. And yet, Ford continues to blame the public sector while employing conservative tropes to label universal health care an oppressive communist policy when the solution is obvious: increase government revenues through taxation and spend that on health care.

A government that defunds public health, placing even more stress on overworked and understaffed facilities as a way to justify privatization, is simply cruel. And yet, this is what the Ford government is doing in Ontario. If implemented, its strategy may serve as a model for other conservative governments in Canada, including those in Manitoba and Saskatchewan, where similar right-wing tropes are often deployed to discredit socialized medicine.

Owen Schalk is a writer based in Winnipeg. He is primarily interested in applying theories of imperialism, neocolonialism, and underdevelopment to global capitalism and Canada’s role therein. Visit his website at


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