For a response to this article, see “Why we do not need to nationalize health care in Canada” by Ashley Holloway, published in Canadian Dimension on January 13, 2023.

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The time has come to nationalize health care in Canada.

The experience of the pandemic has provided ample evidence that the provinces are wholly incapable of handling major public health emergencies. Indeed, the cumulative effect of decades of provincial budget cuts, downsizing, mismanagement, and a corporate ‘do more with less’ mentality (coupled with exorbitant executive compensation has strained our health care system to the breaking point. Canadians have consistently paid more for over three decades—both in taxation and out-of-pocket expenses—for a hodgepodge of health insurance schemes with diminishing returns.

Far from being a universal health care system, there are considerable disparities in health care access and outcomes between provinces, within provinces, from region to region, and between cities and income levels (and depending on whether you’re Indigenous).

Canadians notoriously lack access to family physicians and there are near chronic shortages for some specialists. There are insufficient spaces in our universities and colleges for the number of Canadians seeking education in health sciences, such that Canadians have to go abroad for their training (in turn creating a brain drain that further exacerbates the overall staffing problem). Burnout is as high as it has ever been and will likely get worse in the coming year with the anticipated new waves of COVID-19 mutations and the ‘trickle-down’ effects this will have on the health system in general.

We have no universal coverage for oral health, despite a limited effort to provide as much from the current government, and are lacking in mental health coverage as well. Long-term care facilities, in poor state before the pandemic, were the first components of the broader health care system to collapse with the onset of COVID-19.

Not only do we lack universal pharmaceutical coverage, we further lack the ability to manufacture essential pharmaceuticals—a capability we once had and lost in the 1980s thanks to then-popular privatization schemes. Today we lack the ability to supply hospitals with medications as foundational as low-strength pain relievers, and are forced to queue up with other nations to bid on vaccines and protective equipment, as we did during the early stages of the pandemic. Our hospitals are routinely over capacity, their workforces taxed to the limit, and outcomes and patient experiences are depreciating. In the last four decades, hospital capacity in Canada has decreased from seven beds per 1,000 people to less than three.

No Canadian province currently serves as a guiding light for any other when it comes to health care, some are simply less bad than others. It begs the question: why should health care be a provincial responsibility in the first place? Irrespective of tradition, our current health care system—wherein the provinces and territories come up with their own designs for ‘universal’ health insurance according to federal guidelines—doesn’t make much sense, particularly given that Canadians so often believe we have a national system that those opposed to it decry its failures as another example of the failures of federalism. We could arguably rid ourselves of considerable unnecessary bureaucratic duplication were we to create a truly national health service administered directly by the federal government.

Paradoxically, Canada’s health care system—despite its many flaws—continues to be well-regarded by a super-majority of Canadians. It is one of the few things that truly unites us as a country, and one of the few things we still find a sense of national pride in, despite the fact that the system we have isn’t national at all.

A unified, federally-managed health care system would be one less thing for provincial governments to worry about, and could be pitched as a move towards ‘smaller government and lower taxes’ to the very premiers who have advocated for health care privatization to achieve the same goal. If nothing else, such a proposal would likely expose the truth of the matter: small government advocates are really only interested in positioning themselves to take advantage of privatization efforts. What province has proposed increasing taxation to better fund their health care systems?

The federal government also has an arguably stronger incentive to improve health care access nationwide, where artificial provincial borders wouldn’t constrain accessibility. Canada’s major cities, with unique health care needs and resident populations whose needs are often ill-represented by populist provincial governments, could be arguably better served by a federal system rather than the status quo.

Similarly, a nationalized system would ensure Canadians could receive health care anywhere in the country, irrespective of their province of origin. Though this is supposed to be the case—your provincial health insurance card is supposed to get you service anywhere in Canada—there seem to be a growing number of cases in which this requirement isn’t being respected.

There are other advantages as well, namely that a federal health care system—particularly one that would expand to address current deficiencies—would benefit from a state-run facility to manufacture essential pharmaceuticals, vaccines, and personal protective equipment (of which, excess production could be sold to the private sector or foreign nations, the profits from which could, in turn, be re-invested back into the health care system). There would also be the advantage of coordinating the national health service with the national public health policy and disaster assistance initiatives. The disadvantages of our current system were made evident throughout the pandemic, as federal guidelines were ignored or undermined by provincial governments that ‘re-opened’ or dropped mask mandates too quickly, prompting the endless pandemic that now threatens the very foundations of health care in Canada.

More funding is in all likelihood necessary, but this should occur in relation to clearly articulated service, outcome, and accessibility improvement goals, as well as improved overall accountability. Provincial demands for more money without more oversight are senseless; we shouldn’t spend less on health care, we should spend less on middlemen.

Of all the potential issues that would spur a showdown between Ottawa and the provinces, health care is probably the one area where the federal government would be at a distinct advantage. Aside from the fact that health care has broad national support, no province leads the others in effective health care services. The effort to determine, on a national scale, how much we wish to improve health care would be a unifying, nation-building effort in its own right. Moreover, a nationalization effort would be advantageous to the provinces in that they could lower provincial taxes and eliminate a large portion of each province’s bureaucracy, resulting in considerable potential savings). Further still, the potential pension fund that could be created for this massive new federal workforce could itself become a major future source of development capital.

As it stands, roughly 30 percent of Canada’s total annual health care spending comes from private insurance, and there are many who would like to see this number increase substantially. It is well known that Canada’s health care system is considered a threat to the private health insurance providers who stand in the way of the United States developing its own universal health care system. American health insurance providers and Big Pharma want nothing more than for Canadians to abandon their health care system, for their benefit.

We have a strong foundation on which to build, but ultimately the people of Canada need to advocate both in favour of a better system and against any effort to dismantle it. The coming year will likely bring new challenges that will further degrade the quality of health care in Canada, and this in turn will only serve to encourage those who advocate privatization. This must be resisted at all costs.

Let this be the year we fight for truly universal health care in Canada. We deserve nothing less than the very best system we can imagine.

Taylor C. Noakes is an independent journalist and public historian from Montréal. In addition to writing regularly for Canadian Dimension, he contributes to the Toronto Star, Jacobin, Cult MTL, The Maple, DeSmog, and the Montréal Review of Books, among others. He holds an MA in Public History from Duquesne University and has worked on the restoration of playwright August Wilson’s childhood home. He is also a frequent contributor to the Canadian Encyclopedia, and once debated several Canadian prime ministers at once on matters of foreign policy.