The following article is a response to “Why we need to nationalize health care in Canada” by Taylor C. Noakes, published in Canadian Dimension on January 2, 2023.
In a recent article published by Canadian Dimension, Taylor C. Noakes eschews the idea of increased privatization in favour of a national health care system with federal oversight. This proposed system would include the provision of oral and pharmaceutical services, which are currently not included, and transfer the administrative woes of managing the system from the hands of the provincial and territorial governments into those of Ottawa. I would wager that in doing so, the current less-than-perfect system in place would, in fact, become an even greater disaster.
The construct of our current system is defined by the Canada Health Act (CHA), the federal regulation that dictates the ins and outs of the publicly funded system. This document outlines who gets money and how they get it. There are five principles of the Act (public administration, comprehensiveness, universality, portability, and accessibility), the criteria of which must all be met for provinces and territories to collect transfer payments for the provision and administration of medically necessary health care to their respective (eligible) residents.
The term “medically necessary” isn’t specifically defined in the CHA for good reason; the needs of the population change according to the differences in geography, demographics, economy, and culture of each province and territory, all of which are inherently tied to care-seeking behaviours and thus, health. As such, it is at the discretion of the provinces and territories to decide what is deemed medically necessary in terms of these factors. While this may seem somewhat reckless in some respects, the need for this flexible definition is evidenced by the different care needs of the primarily aged population living in British Columbia, compared to the needs of those living in the North, or even those in Ontario with their population largesse. Ultimately, the term medically necessary determines what is covered by the public system versus what is not. Two words with the power to change lives.
To coordinate a consensus under a nationalized system has the capacity to exacerbate (and perpetuate) the social inequities that currently exist, particularly where marginalized populations are concerned.
Under the current system, the provision of health care, including dental and vision care for veterans, serving members of the Canadian Armed Forces, federal inmates, and Indigenous and Inuit communities falls under federal responsibility. With this in mind, we are able to examine how health care in Canada might look for all Canadians under federal oversight.
For starters, the federal government’s current track record for keeping promises, such as the recent decision to purchase F-35 fighter jets, a move the Liberal government campaigned against in the 2015 election, is certainly lacking, leaving one with little faith in maintaining a comprehensive and consistent system. Likewise, the de-prioritization of delivering adequate and timely access to health care services to Indigenous peoples and those living in Canada’s North is reprehensible. Dental care for federal inmates continues to be insufficient, affecting incarcerated individuals even after their release, compounding the challenges in rehabilitation. Ottawa’s failure to meet the basic needs of the population, such as the persistent non-potable water and sanitation issues in northern Canada, or through offering medical assistance in dying (MAiD) to Canadian veterans are likewise condemnable.
While I have offered only a few examples, actions consistently demonstrated by the federal government in terms of its failed ability to meet the needs of the populations it is obliged to care for is a good indication that nationalizing our health care system is not a viable solution. Putting our health care system solely in the hands of the federal government will not solve surgical wait list issues, our slow recovery from the pandemic and its aftereffects, or our lack of family doctors that challenge our system in every province and territory, and it would be foolish to think otherwise.
While Canadians are quick to suggest a system overhaul, the complexities involved in doing so in a timely and efficient fashion would be no less problematic than trying to separate the cold water from the hot in the bathtub. Our health care system does not operate in a silo and is intimately connected to our education, employment, child care, transportation and immigration systems, our economy, and our cultural diversity. Our health care system involves all levels of our government, from the provision of municipal services, such as emergency medical services personnel and hospital planning, our provincial governments who advocate for population needs and provide oversight, and our federal government, which has ultimate oversight and deep pockets. Making a change in one area will effect changes in all other areas of the system.
While I do not purport to have the answer to solving our much-beleaguered health care system, I do know as Canadians, we should be criticizing the government’s actions; it helps keep our elected officials accountable and ensures our voices do not go unheard. Criticisms generate dialogue, and dialogue has the capacity to spur innovation. I also know that the grass isn’t always greener on the other side.
Residing in Mohkinstsis, Ashley Holloway teaches health care leadership at Bow Valley College in Calgary. She is a nurse with a Master of Public Health, a graduate diploma in Global Leadership, with further studies in intercultural communication and international development. Ashley’s work has appeared in the Calgary Public Library Short Story Dispenser, The Nashwaak Review, The Globe and Mail, Magna Publications, The Prairie Journal, Alberta’s CARE Magazine, Flash Fiction Magazine, with regular contributions to Lead Read Today; forthcoming publications include Flash Fiction Magazine (TBD), and WELL READ Magazine (March 2023). Ashley has co-authored two books (Create & Curate: 500 Ideas for Artists & Writers, 2023; and How (Not) to Lead, 2023) and reads manuscripts, writes book reviews, and provides editorial feedback for Unleash Press. Her work has been nominated for the Pushcart Prize.