Canadians cherish public health care. It’s part of our national identity; a social contract that ensures we’ll be cared for when we’re vulnerable, regardless of the size of our bank account.

It’s an affirmation of our collective commitment to equality and justice.

But our health care system is in crisis.

Emergency rooms are being overwhelmed, health care workers are burning out, millions of Canadians lack access to a primary care provider, and patients are facing massive backlogs for surgeries, diagnostics, and other procedures.

Although the COVID-19 pandemic has undeniably placed enormous strain on our health care system, it didn’t cause the current crisis—it just exposed it. In fact, its roots can be traced back to decades of poor policy choices and federal underfunding by successive Conservative and Liberal governments.

When our health system was first created, it was based on a 50/50 cost sharing partnership between Ottawa and the provinces. But over the years, the federal government’s contribution has declined to just 22 percent.

This has profoundly shifted the fiscal burden for health care delivery and exacerbated pressures caused by an aging population, digital disruption, and increasingly expensive treatments and pharmaceutical drugs.

The results of this are clear to see on the frontlines of care.

Where Canada used to have 6.9 hospital beds per 1,000 people, we now have just 2.5. Millions of Canadians can’t access a family doctor, the primary portal into our health care system. And Canada now ranks near the very bottom of the OECD in the number of physicians per capita and wait times for essential care.

Tommy Douglas warned Canadians about the threat posed by this “subtle strangulation” strategy. He understood that opponents of public health care would attempt to starve our system of resources to lay the groundwork for private, for-profit care.

Unfortunately, his prediction appears to be coming to fruition. Across Canada, Conservative premiers are exploiting the current crisis to pursue privatization.

Alberta Premier Danielle Smith has brazenly called for patients to “fundraise” for their own health care needs. Her government is implementing a health savings accounts, a Trojan horse to inject user-fees and private care into Alberta’s health system.

In a recent throne speech, Manitoba Premier Heather Stefanson announced her government’s intention to seek out private partnerships to deliver health care.

And Ontario Premier Doug Ford has revealed plans to divert funding from his province’s hospitals towards for-profit surgical clinics. This move is expected to benefit clinic owners with a windfall of over $500 million annually.

This is a frontal assault on our public health care system. It must be stopped in its tracks.

Experts have denounced this approach as a false solution that will exacerbate the current crisis. In an exhaustive review of the evidence presented in Cambie Surgeries Corporation v. British Columbia in 2022, the BC Court of Appeal unanimously ruled that allowing more private care in a parallel system is more expensive, fundamentally unfair, and ultimately counterproductive.

In short, privatization will mean line-skipping for the rich, a drain on workers from the public system already short of staff, and longer wait times for everyone else. For-profit delivery will drive up costs in the short-term and make us dangerously vulnerable to corporate ransom.

To date, the federal Liberals have demonstrated a troubling lack of concern in the face of this privatization agenda. Prime Minister Justin Trudeau has even called Ford’s for-profit clinics scheme an example of “innovation.”

This should come as no surprise. While the Liberals may claim to defend public health care, their record demonstrates otherwise.

After promising to negotiate a new Health Accord in 2015, the Trudeau government instead adopted the same health transfer formula of Stephen Harper. And they have allowed flagrant violations of the Canada Health Act to go unchecked across the country.

For example, the government of Saskatchewan has been openly flouting the Act with its private-pay MRI policy since 2016. Although former federal Health Minister Jane Philpott initially ordered the province to put an end to the policy, the Trudeau Liberals have failed to crack down ever since. Unsurprisingly, and no doubt buoyed by this lack of federal resolve, Alberta soon followed suit.

New Brunswick has also repeatedly violated the Act by failing to provide adequate access to abortion services. This has elicited hardly a peep from Ottawa.

And by limiting annual federal transfer increases to three percent when the need just to tread water is 5.2 percent, the federal government has baked in a recipe for systemic decay.

Indeed, the federal government’s eroding share of health care spending, coupled with its lackluster enforcement of the Act, has severely weakened its ability to influence our country’s health care system. Former Parliamentary Budget Officer Kevin Page has noted that it is “difficult to imagine the preservation of the principles of the Canada Health Act without more federal skin in the game.”

There is a better way.

The Supreme Court of Canada has been clear that health care is shared jurisdiction. This means the federal government has a central role to play in ensuring care is available to all. Although the provinces are responsible for the direct administration of most medical services, the federal government can use its spending power, grounded in sections 91 and 106 of the Constitution, to set conditions and criteria for federal health transfers through the Canada Health Act.

Canadians need their federal government to champion public health care instead of standing back while Conservative premiers and others seek to systematically dismantle it. They need national leadership, a full financial partnership, and an unwavering commitment to equity and service quality.

The prescription is clear.

Ottawa must be willing to come to the table with significant, stable, new funding for health care. It must consistently and strongly enforce the principles of the Canada Health Act where access to care is based on need, not wealth. And equally, the provinces and territories must accept accountability measures and be willing to share data and best practices.

Above all, a basic rule for any additional federal health care transfers must be that public dollars go to public care.

In the coming sitting of Parliament, New Democrats will use every tool at our disposal to push for immediate federal action to address Canada’s health care crisis and combat privatization. We will also continue our fight for expanded public coverage through pharmacare and dental care.

Through our Confidence and Supply Agreement with the government, the NDP forced the Liberals to agree to provide additional ongoing investments in the immediate future to address pressures on Canada’s health care system. NDP leader Jagmeet Singh has issued an unambiguous warning to the Liberals that our party is prepared to withdraw from the agreement if they fail to honour their commitments.

Canadians deserve a health care system that is world-class, timely, and accessible for all. New Democrats will continue to press for a new health accord that protects, strengthens, and expands public health care across Canada.

We know we can deliver it, but we can’t do it alone.

It’s time for all Canadians who value public health care to take a stand and make their voices heard.

Don Davies is the federal NDP’s health critic and a Member of Parliament for Vancouver Kingsway.