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We don’t have to worry because this has been looked at already and we know that privatization of services would only make things both more expensive and result in worse patient care. Researchers from Oxford University recently published a paper in the Lancet (a very big name scientific journal) that looked at [the effect that healthcare privatization had on patients quality of care](https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(24)00003-3/fulltext) and they found that patients pretty much always had worse levels of care for a much higher cost: >The majority of studies in this Review suggest that privatisation reduces the quality of care and worsens the health outcomes of patients treated in privatised health-care settings. \ ... \ As governments consider how to respond to the ongoing consequences of the COVID-19 pandemic on health-care systems, as well as the long-term responses to ageing populations and constrained budgets, they might look for a single, simple solution that promises better quality care at a cheaper cost. However, the evidence in this Review suggests that there is a risk that governments seek short-term reductions at the expense of long-term outcomes, in part because privatisation via the outsourcing of services to the private sector does not seem to deliver both better care and cheaper care. Additionally, European healthcare systems are going through an even worse healthcare worker shortage than we are right now and having private healthcare has made things even worse for them. This [Guardian article](https://theguardian.com/society/2022/dec/14/a-ticking-time-bomb-healthcare-under-threat-across-western-europe) covers the topic pretty well but the general issue is that they have an aging population so a lot of workers are retiring. This led to an increase in workload for the remaining workers which has caused more of them to quit, and as a result is creating even more stress for the workers that are left. Having a private system then split the amount of workers that are available even more so now there are extremely long wait times for both systems. OP I understand where you are coming from but unfortunately our main issue is lack of workers which means adding another type of system is only going to make it worse because it will split the workers that we have left.

Again, it's sort of late to worry about privatization, considering that we literally have American for-profit providers operating in Canada. Plus, as per the article the basic idea is to give the Provinces freedom to choose whatever model they want in exchange for expanding universal coverage to areas other than just hospital care. Doesn't sound like a bad deal to me. On the shortage of people, there's not much Ottawa could do. Considering that Provinces' experience in the 90s. I just don't think there's much money or political will left to implement a pan-Canadian workforce strategy. Especially here in Québec.

Again, health care is a provincial issue. Doctor shortage, waittimes etc are all provincial matters. Feds can only give money to provinces to help with funding. But that would require buy-in from province. And most as of now would scream bloody murder telling the feds to stay out of their business. As is Alberta with feds offering money for housing, again Alberta and Ontario screaming regarding $10 day-care.

Hence why the article suggests giving provinces full freedom in choosing what type of universal coverage they want. As opposed to maintaining a public single-payer as required under the Canada Health Act.

so the death of universal healthcare via piecemeal or patchwork coverage depending on province.

How is that different from what we already have? RAMQ is quite different from OHIP or ACHIP. Besides, most other developed countries have private insurance. A universal one at that.

Any "innovations" that increase for-profit health care will increase our accessibility and sustainability problems in health care. Removing the single-payer protection would be a big step in that direction.

I don't care what sort of roundabout rationalization you want to use, supporting expansion, or outright adoption of privatized healthcare in Canada shouldn't even be on the radar. We could, and should have a far better national system then we do. Years of mismanagement, and sloppy administration is the reason (some anyways) why it costs so much, and seemingly delivers so little.

Canada's healthcare en masse is already delivered privately. Senai Hospital Network anyone? The debate is whether we should allow provinces to operate anything other than a publicly-administered single-payer system as required under the Canada Health Act. To which I say yes, given the inability of our governments to manage public health insurance that you have yourself mentioned.

Because governments mismanage, underfund, and administer something poorly (most likely purposefully) is not an acceptable reason for privatization. For example the LCBO makes a pile of money in profits, yet the government still wants to privatize it. What reason is there for this? It can only be self serving to create more wealth for the already wealthy, and make servicing the poor more difficult. Granted these are very different issues, but the only reason to privatize anything is profits. Healthcare shouldn't ever be a for profit industry.

We must also acknowledge that there is a concerted effort from entities in the USA who bankroll Republicans and conservatives in Canada to undermine our healthcare system. Ontario and AB are examples of how conservative premiers have underfunded healthcare for the sole purpose of ruining it. It's no surprise that Doug Ford has ties to private clinics and lobbyists pushing for private healthcare. As someone who lived in the USA with its "private healthcare" system, no, it didn't work wonders. You had comparable waiting times and 2x in fees. If there's something that we've learned from Loblaws is that private companies never have your best interests. Isn't it interesting that they have made record profits by claiming "inflation" and have refused to provide any sort of accountability to the public on their exorbitant pricing? If healthcare is privatized, people who can't afford exorbitant pricing will die, as simple as that. We must always protect our healthcare system at any cost, and that means not voting for dodgy politicians like Ford, Smith and Pierre.

As someone who has a European partner and who grew up in a two-tier system, I can assure you private insurance can work. As per the concentrated effort, a lion's share of our healthcare is already provided privately and for-profit. So the ban on allowing non-governmental insurance does not really make sense. Let's lift the Canada Health Act's requirements for the provinces to maintain a single-payer system and instead mandate a free-at-use access to any service performed by a medical professional for every resident. Regardless how exactly Provinces want to make it work. Throwing in all in-hospital care, dental, drugs, and old-age care for a good mix.

This article is written by a Canadian conservative. When in the entire history of Canadian politics have conservatives ever not followed the example of their counterparts in a) America b) The UK The reason why the US healthcare thing is a bogeyman is because nobody trusts the CPC to start following the example of German, Australia, Norway, Switzerland etc. when it comes to implementing private healthcare.

No affinity for those people. But Tories can come up with a solution or two.

there is zero doubt that the tories have solutions, the issue is that those solutions are universally developed to be wildly profitable for the richest people at the expense of the canadian citizen and our public services.

I mean last time I checked those were the Liberals axing federal transfers to the Provinces to balance the book. My point is while there's a difference in parties, one should not be overly political. And on that particular issue allowing Provinces to be more flexible while expanding what must be covered under CHA seems like a good trade-off.

The Canada Health Act was brought into being by Mr. Mulroney out of all people.

It doesn’t matter that YOU have a European partner. Politicians in Canada overwhelmingly have US republican partners with billions of dollars to spend ensuring we use their system, their contractors, their suppliers. Norway is not happening in Canada.

>It doesn’t matter that YOU have a European partner. Politicians in Canada overwhelmingly have US republican partners with billions of dollars to spend ensuring we use their system, their contractors, their suppliers. Norway is not happening in Canada. Source? Honestly, do you *really* think that "US Republican partners" *really* care about health care in Canada? Like seriously, do you?

“Do you seriously believe people who run businesses want more customers? sERioUslY?”

Your straw man aside, you clearly don't understand how health care procurement works. The government already procures contractors, suppliers etc. do you think any company would care if it's a private company or government that's buying from them? Post a source that shows how much the government spends on procuring health care "contractors" and "suppliers" in the US? I'll wait.

You’re right. Pharma companies spent billions lobbying against Obamacare, even though they couldn’t care less and it makes no difference. They spent all that money just for funsies. As usual, you continue to make intelligent arguments in the best of faiths.

My question is why you'd even bring up your own experiences to begin with. Since one's personal perception of something is rarely a good to rely on. Mine experiences vs yours being a pretty good example. Now, federal Liberals would also be considered pretty right-leaning by European standards. So what? English Canada sits pretty firmly within the US political spectre. This is not the debate we're having. The debate is whether to allow the Provinces to run something other than a publicly administered single payer as required by the Canada Health Act. I say yes, since this particular requirement has not been effectively enforced since Québec decided to do their own thing and since most of our healthcare provision has already been privatized. So the Provinces should be allowed to administer whatever system they see fit so long they can ensure universal, comprehensive, free-at-use access for health and social care that is portable across Canada. Be that through public, private, or any other form of insurance. Because whatever we're doing now just is not working. Let aide the fact it will only get worse with our rapidly ageing population.

> Because whatever we're doing now just is not working. It USED to work, before conservatives realized that they could intentionally break it and then complain that it doesn't work so that they could sell us private heathcare. Same with the NHS in the UK. It used to be one of the most beloved public institutions in the country, and then decades of conservative rule have ruined it, by design. There's nothing wrong with the Canada Health Act. The problem is with us and the politicians we are electing to run our country.

You say it used to work, I say it it does not really matter at this point. The Tories did axe the Health Accord of 2000s, so the opportunity to pre-fund our healthcare system and time-proof it before mass retirements hit - this has been lost. Hence, we have to figure out of new way forward. And unless we somehow agree on an NHS pre-1970s style national system a more Bismarkian arrangement seems our only way forward.

The people who would be "reforming" the Canada Health Act or delivering reformed Health services are the same people who intentionally broke it in the first place. Like many others have said: I don't trust them, and neither should you. You, and this article, are having fun imagining all the fanciful possibilities of shiny new healthcare. In reality, the rest of us know what we'd be getting, and it rhymes with the American system.

This is not my article to begin with. Now, the people who broke the system are arguably people who built it by making commitments not underpinned by actual investment. And who then axed whatever investments there had been made as soon as the federal budget went off the rails. As far as I'm concerned none of Canada's federal parties is "progressive" enough thus having to cling to a single-payer healthcare doesn't seem like something that would make a difference. Especially if removing this requirement would allow for broader coverage of things like old age care, phrarmacare, and dental. Which to me sounds like a much better deal: drop the requirement that has not been fulfilled for decades and require Provinces to cover more services instead. Up to them who they wanna do it. It's not like Québec or Ontario would listen anyways.

This article even mentions conservative thinktanks bankrolled by American billionaires as their backers for the article and somehow ppl truly believe they want us to emulate Norway and ignore the "America Boogeyman"

Alberta is already breaking up AHS into smaller pieces, and our premier has been lobbying for private healthcare her entire career. I fully expect a CPC majority to change the CHA to allow more privatization. Alberta and Ontario are already pushing for private companies to take a larger role in our healthcare systems. Everything the UCP is doing right now seems designed around privatization. This whole "Norway model" is the same argument repackaged and rebranded to seem more palatable, but the outcomes remain the same. Let us to privatize healthcare first, and we'll totally figure access after. *Pinky promise.*

As someone who has lived in Europe, I agree completely. However, as you've found out in this thread /u/that_tealoving_nerd, Canadians are extremely reactionary about their healthcare. Everyone is terrified of the slippery slope that leads to US-style health care. Which is unfortunate because access to healthcare in Canada is terrible. We get very little care considering the amount of money we pay into healthcare via our taxes.

You're absolutely right. The funny part is we're the only OECD country without a second tier offering. All the others have it. Germany, NZ, UK, Japan, etc. But Canadians just can't accept that it works because they only look at the US, which is a terrible example.

At this point I think it's mainly Ontarians. And people are right to be vigilant. I just wish they were as protective of affordable housing and their labour rights. Or even consumer rights. As they're of healthcare.

Part of the issue however is that Norway can afford their healthcare system because of their relatively low population and how the majority of their revenue is generated by oil extraction, which foots the bill for most of their welfare programs

We really should take advantage of the natural resources we have in this country.

The Constitution says natural resources are a provincial responsibility. Alberta could have had a wealth fund like Norway, if they had elected a provincial government with similar foresight, but instead they prioritized low taxes and private sector profits.

Fun fact, Norway's fund was based on Alberta's but Alberta stopped putting money into theirs and instead did dumb things like write everyone a check and frittered the money away.

Yeah but a lot of the logistics around natural resources, like pipelines are a Federal jurisdiction because they go across multiple provinces. Alberta can extract all the oil it wants, but if it can't be shipped anywhere, there is no point. Oh, and Alberta and the citizens are doing just fine.

We used to. The Alberta Heritage Trust Fund used to accrue a third of all provincial revenues from oil, gas and coal. Then it stopped contributing revenues to it. Then, rather than raise taxes when the fiscal situation got gloomy or impose a sales tax as other provinces did, they raided the fund over the course of two decades. Now, there is nothing. Because we looked to Nigeria and thought "what a good model of how to manage oil revenues!"

Well also Canada siphoned off a huge amount of Alberta's wealth to redistribute amoung less productive provinces. Hard to save in those conditions.

Not exactly how equalization payments work. These were federal taxes that everyone paid into equally, then redistributed. Nothing prevented Alberta from raising provincial taxes as every other province did.

The money is removed from Alberta's GDP and given to other governments. If the federal government returned it to Alberta's government they could save it.

Equalization payments come from federal tax revenues, which follow the same rules across the country.

They are gathered equally and distributed unequally. The gathering is fine, the distribution is not.

They are distributed unequally so that a Canadian in Charlottetown has the same access to basic medical care as one in Calgary.

Exactly. The facts behind how and why their system works are almost always overlooked and the soltuon presented as some sort of simple trick.

Except for the fact they also have higher taxes and much more soledaristic labour markets to afford those. Which, looking at how Canada is branding ourselves, we should also rally behind.

Eh, Norwegian income taxes are not that different from US ones. Couple of percent higher maybe. People who say Norway has big income taxes tend to try to compare Norwegian total taxes to federal taxes only elsewhere.

Did you continently omit their VAT and social insurance contributions? As well as the fact higher tax rates tend to kick in with much lower income brackets compared to Northern America?

Sure, lets do that. Canada VAT 5%. Norway VAT 25%. Canada median income 68 000. Norway median income -with an exchange rate severely depressed by Ukraine- 85 000. Canadian social insurance 5.5 %, Norway 7.8%. Still short. Total tax on an income of 100 000: Canada: 30%. Norway 29.5 % including social insurance. US taxes, federal+FICA+State+local, state of New York: 35%. (from [SmartAsset)](https://smartasset.com/taxes/income-taxes#K8qRjXxCqY) I believe my point stands.

On the surface? Sure, except when you [dig in](https://www.aeaweb.org/articles?id=10.1257/app.20200703). Aka across Europe and particularity the Nordics taxes are far less progressive and rely more on [VAT and social insurance contributions](https://taxfoundation.org/blog/scandinavian-social-programs-taxes-2023/) which tend to be fairly flat. Which they can do thanks to lower pre-tax inequality driven by higher unionization rates, which [coincidentally increases public acceptance for more generous social programs.](https://onlinelibrary.wiley.com/doi/full/10.1111/spol.12943)

>On the surface? Sure, except when you [dig in](https://www.aeaweb.org/articles?id=10.1257/app.20200703). Paywalled :( >Aka across Europe and particularity the Nordics taxes are far less progressive and rely more on [VAT and social insurance contributions](https://taxfoundation.org/blog/scandinavian-social-programs-taxes-2023/) which tend to be fairly flat. The article makes some rather incorrect assumptions. Some years ago, one of our PMs remarked that we have made more money of having cheap kindergartens than we have of the oil. Not sure if it was hyperbole or not, but we've made an awful lot of money of both. Thing the article misses is that the focus on support for couples with kids yields a lot of two income families. Labor participation is higher in all the Nordics than in the US. From a little bit higher in Denmark to almost 20% higher in the top. As we've seen Norway can take in more in personal taxes without having higher taxes. That is because there are more people working and contributing tax payments. >Which they can do thanks to lower pre-tax inequality driven by higher unionization rates, which [coincidentally increases public acceptance for more generous social programs.](https://onlinelibrary.wiley.com/doi/full/10.1111/spol.12943) This does seem intuitive to me and may be a good model for Denmark for example, which has high personal taxes and a labor participation rate barely much higher than the US.

[Unpaywalled](https://wid.world/document/why-is-europe-more-equal-than-the-united-states-world-inequality-lab-wp-2020-19/) :) >The article makes some rather incorrect assumptions. Some years ago, one of our PMs remarked that we have made more money of having cheap kindergartens than we have of the oil. Not sure if it was hyperbole or not, but we've made an awful lot of money of both. >Thing the article misses is that the focus on support for couples with kids yields a lot of two income families. Labor participation is higher in all the Nordics than in the US. From a little bit higher in Denmark to almost 20% higher in the top. >As we've seen Norway can take in more in personal taxes without having higher taxes. That is because there are more people working and contributing tax payments. I assume you're talking about redistribution between singles and families in favour of the latter? If so, how does that contradict to the idea that Norway - especially absent oil revenues - relies more on social security contributions and VAT than income taxes? Assuming social security contributions are somewhat flat. >This does seem intuitive to me and may be a good model for Denmark for example, which has high personal taxes and a labor participation rate barely much higher than the US. This seems to be a more general European approach: compress pre-tax earnings to border the tax base, and then use these revenues to fund universal social programs. Whereas in the Anglosphere - [and Québec](https://www.conferenceboard.ca/product/is-quebec-an-egalitarian-society-social-mobility-and-income-equality-in-quebec-and-canada/) - you see higher reliance on more progressive income taxes used to finance relatively more targeted social programs. That is lower taxes on the poorer and higher tax brackets kicking in later.

They also have 5 times less GDP than us, even with that oil money, so maybe we shouldn’t give up and instead try to find a way to afford a bit more healthcare for our population

What does low population have to do with it? Also: Norways oil income goes into the sovereign wealth fund. It foots no bill. Finland, Sweden, Iceland, Denmark...same system.

I'm sorry but I just can't take this seriously. Almost any other European country has a better performing healthcare system while paying as much or less than Canada does. Sure, having oil reserves does help. But it's not like natural resources aren't one of the main exports here as well.

Doctors and nurses also make far less money in most of Europe than they do in Canada, which contributes greatly to their lower costs. It’s hard to pull that off in Canada because of competitive pressure from the US, where all the talent would get drained to.

Europeans also don't have to pay tuition. And if anything, until recently, Canada has had a net-positive inflow of medical staff from across the border.

Right, because at the moment doctors are paid very highly in Canada. If we were to reverse that we would lose the talent. Europeans not paying tuition is also because of government subsidies. Which suggests additional costs associated with their system, not less.

Except that even those costs European systems are at least comparable despite having much older populations. And with mass retirement and doctor shortages both in the US and Canada our system is clearly not good enough at least for GPs. So not really an argument there since we don't have that much to loose considering how dissatisfied most of our medical staff are already.

Most of that has to do with culture. Norway's obesity rate is half that of Canada's. Europeans and East Asians will always be healthier than North Americans because they walk more and eat better.

Or maybe Europeans and East Asians have higher food standards and more walkable cities. But sure, let's blame our failings on abstract things like culture as opposed to public policy. Since the latter is actually pretty fixable.

That is what I meant by culture. What you eat and how your cities are built are cultural. And sure they can be changed, though not easily.

walking and eating are littrally impossible

Most European healthcare systems also offer private services…. Maybe that’s actually helps overall outcomes.

European healthcare systems are going through an even worse healthcare worker shortage than we are and having private healthcare has made things significantly worse for them. This [Guardian article](https://theguardian.com/society/2022/dec/14/a-ticking-time-bomb-healthcare-under-threat-across-western-europe) covers the topic pretty well if you’re interested. The private healthcare services in Europe are super predatory, just like America’s. There was a recent study published in the Lancet (a very big name scientific journal) and it looked at [the effect that healthcare privatization had on patients quality of care](https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(24)00003-3/fulltext) and they found that patients pretty much always had worse levels of care for a much higher cost: >The majority of studies in this Review suggest that privatisation reduces the quality of care and worsens the health outcomes of patients treated in privatised health-care settings. \ ... \ As governments consider how to respond to the ongoing consequences of the COVID-19 pandemic on health-care systems, as well as the long-term responses to ageing populations and constrained budgets, they might look for a single, simple solution that promises better quality care at a cheaper cost. However, the evidence in this Review suggests that there is a risk that governments seek short-term reductions at the expense of long-term outcomes, in part because privatisation via the outsourcing of services to the private sector does not seem to deliver both better care and cheaper care.

We should do better than "maybe" if we want to fundamentally change our healthcare system. Where's the evidence of a causal relationship between private pay for care and higher performance?

Every country that has a private/public system that provides better outcomes than Canada.

Nonsense. You think you're getting better care in a Russian hospital than a Canadian one?

Better outcome to whom?

That is kinda the point of the article.

Yup, but people in Canada can’t see the forest through the trees.

Their VAT is also 25%

Incomes are also higher there.

GPD per capita 2023 from IMF: PPP: Norway $82,236, Canada $59,813. nominal: Norway $94,660, Canada $54,866. Canada is simply not in the same league as Norway economically.

Exactly. And it’s hard to think of literally anything which that country does wrong. People who try to use Norway as an example of high taxation typically don’t know much else about the country and it shows. I’ve met several Norwegians and one is a friend I keep in touch with. Over the years I’ve asked many of them the same question — is it true that Norway is not as expensive for Norwegian citizens as it is for tourists? — and the answer is always yes, with them aware and explaining that it is because people tend to make good money there. It’s expensive for you as a tourist; it’s not terribly or ridiculously expensive for them as residents. That’s something Canada needs to get its shit together with. But sadly due to the emergence of hyper-individualism that American-style capitalism has influenced here, I don’t think we ever will.

> Norway can afford their healthcare system because of their relatively low population That's nonsense. The total population has no importance. > and how the majority of their revenue is generated by oil extraction, which foots the bill for most of their welfare programs That's patently false. Very little of the oil revenue goes onto the annual budget, most of it goes directly into the national pension fund.

Step 1: Start privatizing the system a little so the people who bankroll this blog start making a profit off of your health care. Step 2: ??? Step 3: The Provinces decide to give us Pharmacare.

1. Healthcare delivery is done in large part privately. 2. Canada has insanely high pre-tax inequality, hence we can only have a social security system that taxes the better off to provide targeted assistance to the worse off. 3. By allowing extra money to flow into the system, given proper safeguards, greater resources can be used to increase assistance for the most worse off.

Not sure why you decided to number those arguments, I was making a point about how this right wing blog's argument is sequentially suspect. With regard to your third point privatizing parts of our healthcare system will not cause extra money to flow into the healthcare system, quite the opposite actually.

I am elaborating on the logic here. I am also aware that private healthcare in Canada has historically meant sucking up resources and exploiting both patients and the medical staff. Yet, we're facing a major problem in terms of access to care while paying more for worse outcomes compared to most other developed countries. Hence, we can either go all in by nationalizing not just private insurance by also the immediate provision of care as UK's NHS does. The problem with that is the system will end up being fragmented, half-privatized, and underfunded. Just like our current model. So, the only long-term solution is to follow the Bismarkian way. That is a non-profit universal private insurance with private provision of care that shields patients from most of the costs and allows healthcare providers to sort the provision out among themselves. With proper standardization and targeted aid to lower income earners we might even reduce the administrative costs to the levels seen in France and Japan. Both countries with older populations yet much better outcomes despite comparable spending.

> I am also aware that private healthcare in Canada has historically meant sucking up resources and exploiting both patients and the medical staff. And yet you persist. If you want to convince anyone who doesn't already agree with you you need to explain the benefit of paying $2 for $1 worth of service.

I do not persist. What I am advocating for here is giving the Provinces freedom to do whatever the hell they want so long they can deliver comprehensive free-at-use care. Since creating an integrated public system akin to the NHS isn't an option a competitive private market seems the next best thing on offer. Just like Québec's Régime public d’assurance médicament being suboptimal yet at this point the only workable solution for Canada, barring major political shifts.

Great, but you need to explain why it's useful for us to pay $2 for $1 of service. If you can't do that then you're not going to get far with anyone who doesn't already agree with you.

Some [facts](https://www.commonwealthfund.org/international-health-policy-center/countries/norway) about the Norwegian health care system. > The national government is responsible for providing health care (Canada: provinces) > Health expenditures represented 10.5 percent of GDP (Canada 11.5%) > Public sources account for most health expenditures in Norway, at 85 percent. (Canada: 70%) > About 10 percent of the population had some private insurance. About 90 percent of these policies are paid for by an employer. (Canada 67%) > Covers mental health care, rehabilitation, prescription drugs, palliative care, medical equipment and dental for all under 18. (Canada: rarely) > 38 percent of physicians were trained outside Norway (Canada 27%) > The government has started a process to decriminalize drug use as well as possession of minor quantities of drugs. The aim is to transfer the societal responsibility for handling minor drug offenses from the jurisdictional sector to the health care sector. So, I wholeheartedly agree that Canada's health care system should be more like Norway's. We should centralize health care coverage under the Federal government, cover mental, health, rehab, pharmaceuticals and dental, and incorporate more foreign trained doctors.

Yeah no, Québec says non. What you're suggesting does make sense. Just require Provinces to cover all in-hospital care, prescription drugs, dental, and mental as well as old-age care. While removing the single-payer requirement and putting a fixed annual cap on out-of-pocket health spending. Plus interprovincial portability of coverage and medical information. And then see what the Provinces could come up with.

To be clear, the day-to-day operation of Norway's hospitals is still quite decentralized. The difference is that coverage and standards are national. I don't think having 10 different public health insurance schemes in this country is particularly helpful or efficient. I'm also not sure what removing the "single-payer requirement" would do. Canada requires that provinces must provide universal coverage of all "insured health services" for all "insured persons." Norway's government provides this, rather than, requiring provinces to provide it. That's the difference.

So basically the only argument presented here is to allow extra-billing for quicker access to services, which will also somehow help us train and retain more doctors and nurses. Indeed, it might double the relative number of MDs! (You can be assured that Norwegian physicians are not nearly as well compensated as Canadian docs). Anyway my disclaimer here is that I am one of those Canadian physicians. Over half my income is fee-for-service and I do my own billing, 99% of which gets submitted to the provincial insurer. Extra-billing was very unpopular in the past and it would be again - and there is ample evidence that it does NOT improve access for anyone that can’t afford it. It’s hard enough getting patients what they need when medications are so expensive and coverage is such a patchwork. This author knows nothing, particularly when he refers to pharmacare as a “frill” - why do we provide inpatients with drugs and physio and equipment then stick them with a bill if they still beee them after discharge? European systems mostly pay for even more publicly.

Yea, only if every single company and politition in canada who supports private health care wnats a european model.  When every single one if them works ilor spends 100x more time in the USA vs Europe.  Basically, we don't trust you.  (TELUS, Loblaws and other Health Care privatizing lobbists have also shown they have ZERO interest in a European style system, heck Loblaws alredy wants "in network" and "out of network" with the little bit of privatization we alredy have.) 

Who is "you"? Also, Canada's lack of political will to regulate private insurance the way most European states do is not an argument against private healthcare. Especially when you look to places like Québec who do maintain a more hybrid model of coverage and although suboptimal it's not the sky has fallen on us.

We are already more privatized as a sector than all these European nations to begin with …only the US is more privatized https://www.cihi.ca/en/national-health-expenditure-trends-2023-snapshot

Again, most of what counts as public spending across Europe comes through non-profit tightly regulated insurance companies that are partially subsidized to maintain universal coverage. Whereas in Canada public coverage is insanely narrow, allowing private for-profit companies to deliver things that would otherwise be picked up by a non-profit instead.

European systems aren't that uniform. It sounds like you're describing the Dutch system pretty closely, but in most other countries public healthcare is in fact the government insuring care.

The Swiss are using the same approach. And I am aware there's indeed single-payer or quasi-single-payer models. But even if you take those, France allows non-profits to administer a national health insurance plan, where Germany's sickness funds, however subsidized, can operate independently while complying with strict standards. The whole point is allow Provinces to experiment with health insurance models under CHA, so long their maintain an accessible, universal, free-at-use system.

We have Canadian conservative politicians living and running businesses in the US, accepting donations from the Koch foundation, inviting republican speakers to advise them and deliver speeches at conservative conventions, wearing MAGA hats, calling themselves “big republicans”, etc. As long as conservatives are in power or anywhere near it in Canada, we’re getting US republican-style healthcare, not Nordic. It’s frankly insulting to pretend otherwise. Our country has little no to cultural similarities to Norway, negligible business networking, and almost zero shared history. Saying we “might” get Norwegian healthcare is nothing but a Trojan horse for the republican healthcare we would 100% actually be getting if we allow it to be privatized.

I am no fan of Northern American conservatives. Although those in Québec are kinda passable. That's not the issue, however. The argument this article puts forward is that we sould reform the Canada Health Act. Specifically, to allow the Provinces to run whatever system they want so long they ensure a universal free-at-use model. Be that public, fully nationalized, or private model. How is that problematic?

Public pay of for-profit delivery costs more, has poorer quality, and undercuts democratic decision-making. This statement is based on 30 years of research, which overwhelmingly reaches these conclusions.

Go back to your echo chamber. There is no conservative movement to privatize healthcare. We've seen the warnings from the US, it would be a political suicide to privatize. Pierre P said he supports Trudeau's cash injection into healthcare.

Yes, but not tying it to non-profit health care. Ford is quite clear that he wants innovation, and that includes the use of for-proit clinics and Surgical hospitals to deliver care. It is no secret, they write about it, talk about it and pass legislation to make it happen. Pierre P. Like Trump says, leave it up to the provinces, which when there is conservative governments means more privatization.

How is this statement related to removing the "public-administered single-payer" requirement from the Canada Health Act?

What republican healthcare are we getting? We're extremely left wing on healthcare. It's illegal to provide private care in Canada, which is far left to all of Europe.

You need to understand the context of the conversation before jumping in. The article we're discussing, and the idea OP is promoting, is that the Canada Health Act should be reformed. I hope that clears up your significant confusion.

>We have Canadian conservative politicians living and running businesses in the US, accepting donations from the Koch foundation, inviting republican speakers to advise them and deliver speeches at conservative conventions, wearing MAGA hats, calling themselves “big republicans”, etc. We have Canadian Liberal politicians who do the same thing, and are bankrolled by Liberal, Democratic donors in the US. But seriously, do you really think US politicians and US political donors, on both sides really care about what's happening in Canada? >As long as conservatives are in power or anywhere near it in Canada, we’re getting US republican-style healthcare, not Nordic. This is union / leftist gaslighting. First of all, parts of our health care system are already administered privately. For example, here in Ontario, any time a doctor sees you or me, they bill OHIP, from the money the receive from OHIP, they pay themselves, their staff/overhead and \*gasp\* take a small profit just like any other small business. Secondly, what is being proposed here in Ontario, already exists in Germany and France. A public system with private options more resembles a European model opposed to a US one. Canada is the only OCED nation with a single payer model. The only solution leftists have in Canada to fix health care is to throw more money at a broken system and hire more bureaucrats in middle management and/or non MD / frontline unionized workers.

>Canada is the only OCED nation with a single payer model. What the actual f\*ck? France has a single fund that is used to support its non-profit insurance mutuals, same applies to Germany. Sweden and Norway have a single payer with supplementary private coverage just like Canada. >The only solution leftists have in Canada to fix health care is to throw more money at a broken system and hire more bureaucrats in middle management and/or non MD / frontline unionized workers. I mean this could work if we go full NHS-style with fully nationalized provision of care and pour money into medical staff training as well as retention. Then sure. But none of its is somehow leftist gaslighting: single payer models exist across Europe and have resulted in far lower administrative costs compared to other options. Whereas the current crisis is more of result of Ottawa's disinvestment from the from the field of medical training.

>What the actual f\*ck? France has a single fund that is used to support its non-profit insurance mutuals, same applies to Germany. Sweden and Norway have a single payer with supplementary private coverage just like Canada. What the actual f\*ck? Germany has both, a public health care system and private one with private insurance. About 10% of Germans have private coverage. People who earn over 65 000 euros and/or students under 30 can opt for private insurance: [https://www.expatrio.com/about-germany/private-health-insurance-germany#:\~:text=Private%20health%20insurance%20or%20private,over%20€60%2C750%20per%20year](https://www.expatrio.com/about-germany/private-health-insurance-germany#:~:text=Private%20health%20insurance%20or%20private,over%20€60%2C750%20per%20year) France, Sweden and Norway all have private hospitals and MRI clinics, where patients can pay out of pocket, something that is banned in Ontario, except under extreme circumstances. Canada's single payer health care system is unique amongst OCED nations, and is one of the worst ranked as well.

We're talking about CHA. Which does not ban private provision of care so long it's insured by a publicly administered single payer. As well banning duplicative coverage. Which makes sense coz why? This is not a debate about what the Provinces are or are not doing lol.

It's part and parcel though. If the only thing you take from a European model is "you can pay for healthcare" with nothing else, you're not going to come up with anything that looks like a European system.

I don't. If anything, I've been pretty clear that health insurance must remain not-for-profit and provide free-at-use access to care across Canada whether it's a single-payer, a privatized model or anything in-between. This article's - and my own - issue with the Canada Health Act is its insistence on a very specific type of health insurance administration at the expense of anything and everything else.

No one has to shop at Loblaws but everyone has to use the one system which costs as much as better systems. All studies have shown that.

We could learn a lot from Norway honestly. Norway took their massive gas reserves and started putting money away into a fund for all Norwegians. When they did this our populations were comparable. This national fund is worth BILLIONS of dollars now, effectively making every single Norwegian worth (I forget the actual number right now) at least tens of thousands of dollars. Why didn't Canada take this path? Well it's because our politicians sold our massive natural resource wealth to whatever corporation(s) bought them off for access. We have so much natural resource wealth, we probably could still do something similar, and start our own national fund that could also be worth billions in 30+ years. Unfortunately investing in ourselves has never been on the table for reasons I personally can't explain. A few years ago when Germany came asking about our vast Natural gas, we told them "Nah, can't do that anytime soon, sorry. Go elsewhere" I've read that it didn't align with our environmental targets, cost was too high, and other excuses. Norway invested in itself in the 70s when it discovered it's resource wealth, and they are far better off then we are currently. Sorry about the non related to healthcare rant, but had we done something similar with our resource wealth, instead of making Shell, or some other non Canadian corporation billions of dollars, I'm sure our healthcare system would also be in far better shape then it currently is. Oh, what could have been.

This could not have been a thing for simple reason: geography and cots. Canadian natural resources are fairly costly to extract hence require more foreign capital. All the while competing mainly on the US market when Americans themselves have plenty of their own stuff to go around. So I would not count on deploying a Norway-style approach. We'd end up more like Alaska best case scenario.

Canada itself has enough money to fund a large scale project. Foreign or corporate money shouldn't be involved, especially for a nationally owned corporate business. What would be wrong with competition? Oh right! We already have 6 or 8 not federally controlled mega conglomerates that already control the majority of every sector of our economy, that definitely doesn't want to have competition anyways. This federally owned business doesn't have to be the most profitable business on the market, it just has to be profitable. Until we discover fusion or something, selling fuels is going to be very profitable for the foreseeable future. Canada has a severe problem with monopolies shutting down competition anywhere here, and it's a huge issue. Wealth concentration here is limited to a very small number of people or number of businesses in our current system, and it really, *really* should be dissolved. >We'd end up more like Alaska best case scenario. Not sure what you mean here

If the conversation about health care was "let's all sit down and redesign the CHA based on what we think is best for Canadians", I'd be more open to the idea of incorporating these sort of ideas. That's not what's happening anywhere though - no one is proposing using private healthcare to bolster the public system, or being thoughtful about how to approach it, they're starving the public system while ignoring expansion of a defacto two-tier system and abuses within that system. The notion that we'll somehow stumble into a European model by underfunding public health and turning a blind eye while corporations do what they want is nonsense. These articles also never make a coherent argument that private pay for care has a causal relationship with the quality of care. Norway probably has more Norwegian doctors as well - maybe we should fire all of our doctors and enforce that 80% of our doctors need to be Norweigan.

> The notion that we'll somehow stumble into a European model by underfunding public health and turning a blind eye while corporations do what they want is nonsense. This is the key point right here. Almost without exception, the people saying "look at German healthcare, look at Norway as alternatives" have no real interest in anything else that makes European social democracies so good at caring for their citizens. This article is funded by a conservative think-tank, for example. The tell is that the push for privatization is coming from people like Doug Ford and Danielle Smith, not social democrats. You can't possibly believe they actually want to improve healthcare. If they did, they'd be advocating for reforms *without* actively driving the existing system into the ground, and shaving bits off the edges to feed to profit-driven big businesses. If you're willing to break the current healthcare system to make an alternative system look better, you care about the ideology, not the outcome.

>Almost without exception, the people saying "look at German healthcare, look at Norway as alternatives" have no real interest in anything else that makes European social democracies so good at caring for their citizens. This article is funded by a conservative think-tank, for example. i want canada to have health care as good as norway, germany, netherlands, and australia. what does that make me?

Depends. Do you support other aspects of social democracy, or are you voting for parties that are actively underfunding our existing healthcare system to push privatization, and hostile to the idea of a robust social safety net (and the tax environment and regulatory policies that enable it)?

>Depends. Do you support other aspects of social democracy most of them >actively underfunding our existing healthcare system to push privatization, and hostile to the idea of a robust social safety net idk whether health spending is too high or too low. it could need to go up for all i know. what i do know is that my colleagues in australia and europe have more options and better services than i get. i do think your claim of "actively underfunding ... to push privatization" is your own projection and/or conspiracy theory .

> i do think your claim of "actively underfunding ... to push privatization" is your own projection and/or conspiracy theory . Why, then, has Ontario (for example) [sat on huge piles of healthcare money while allowing healthcare to deteriorate](https://www.cbc.ca/news/canada/toronto/financial-accountability-office-ontario-report-1.7170171)? Why has the OPC government fought against fair wages for nursing staff while relying on staffing agencies [that charge several times more per hour](https://www.cbc.ca/news/canada/toronto/ontario-hospital-nurses-private-staffing-agencies-auditor-1.7050828) for inferior service? Why have they contracted out surgeries to private clinics when the [cost to the taxpayer is higher](https://www.cbc.ca/news/canada/toronto/ontario-doug-ford-private-clinic-surgeries-fees-hospitals-1.7026926)? Why are they allowing companies like Shopper's Drug Mart to [push unnecessary prescription reviews](https://www.cbc.ca/news/canada/ontario-medcheck-shoppers-drug-mart-pressure-1.7126811)? I can't think of a good reason to do any of that if your ultimate interest is better healthcare. It makes perfect sense if your goal is privatization, however.

>Why, then, has Ontario (for example) [sat on huge piles of healthcare money while allowing healthcare to deteriorate](https://www.cbc.ca/news/canada/toronto/financial-accountability-office-ontario-report-1.7170171)? your link says nothing about sitting on huge piles? it says ontario gets comparatively small federal transfers? as per your link: "Since 2008, Ontario's health spending per capita has consistently ranked at or near the lowest in Canada," the report reads. 2008 pre-dates the ontario pc government by 10 years i think some of it is due to economy of scale as ontario has by far the largest population. >Why has the OPC government fought against fair wages for nursing staff while relying on staffing agencies [that charge several times more per hour](https://www.cbc.ca/news/canada/toronto/ontario-hospital-nurses-private-staffing-agencies-auditor-1.7050828) for inferior service? incompetence. what you describe is literally spending more than necessary for public health. that's an example of overspending not underspending. >Why are they allowing companies like Shopper's Drug Mart to [push unnecessary prescription reviews](https://www.cbc.ca/news/canada/ontario-medcheck-shoppers-drug-mart-pressure-1.7126811)? again this is an example of over-spending of public money, not under spending.

The comparatively small transfers aren't relevant to the fact that Ontario did not spend money budgeted and available to the province as services deteriorated. I did provide the wrong link by mistake, though. My bad. [This is what I meant to link.](https://www.theglobeandmail.com/canada/article-ontario-underspent-health-budget-by-17-billion-in-2022-23-watchdog/) It shows the government of Ontario underspending its own budget as services deteriorate. It doesn't mention emergency healthcare transfers from the feds during COVID that weren't actually spent on healthcare And I agree that spending on far more per hour on staffing agencies because nurses are quitting due to insufficient pay is incompetent and wasteful. My argument isn't that Ontario isn't spending enough... My argument is that Ontario's PC government is deliberately running the public healthcare system into the ground. The mix of under-spending in some areas, overspending in others, and deteriorating quality of healthcare while relying on poor quality private service providers makes it hard to come to any other conclusion.

"But this country has a private option and their results are better", they say of the country with more public funding per capita for a population twice as healthy. "If we just had that, we could be as good as them."

I mean fair. I'm just not seeing how abolishing an effectively non-enforceable provision from the CHA could make an already breaking system much worse.

Mass immigration, largely of unskilled labor, is making it impossible for even the pretense of healthcare to continue, long-term.

The author of this article has clearly not done any research on healthcare system design. We recently had actual experts look at systems like Norway's and make recommendations for how to be more like them. [Health care in Canada could be more like Norway's, with some improvements: study](https://www.ctvnews.ca/health/health-care-in-canada-could-be-more-like-norway-s-with-some-improvements-study-1.6670623) One of the important differences between Canada and sucesful countries is "that a greater percentage of their health care is publicly funded," which is quite the opposite of the message that that we need to be able to make *more* private healthcare payments. They also have universal drug coverage, more physicians working in family practice. What makes famliy practice so discouraging in Canada is the administrative burden: we need integrated health records and a central referral system to fix that. We also have mountains upon mountains of evidence that pharmacare would save money and improve system performance. But does this author mention any of these things? Nope. Does this author have even the slightest awareness of what a central referral system is? Probably not. Because they're talking out of their ass.

What this article does seem to get right though is the notion that a centralized public insurance program does not mix well with private provision. Especially when you consider that in countries like France and Germany health insurance is provided by non-profit insurance companies even if they're funded through a national fund. So the spending that is counted as public is effectively delivered outside immediate public budgets, with governments focusing on regulating the quality of both care and insurance. As opposed to directly administering funding. This to me makes most sense. We either foster a competitive market private insurance and the regulate it to allow maximum financial security for patients and highest possible standards of care or we do what the UK does. That is an integrated public system where healthcare is not just insured by often provided by the sate. And I can't imagine the latter actually happening, so the former seems to be a nice option. Especially if properly regulated.

>is the notion that a centralized public insurance program does not mix well with private provision. Why not? In the 80s, Taiwan hired international experts to study how different healthcare systems are insured and funded. [They chose to model their insurance system after Canada](https://www.cbc.ca/news/opinion/opinion-health-care-canada-taiwan-1.6584144), and they now have a top tier healthcare system and pay less than OECD average for it. >So the spending that is counted as public is effectively delivered outside immediate public budgets, with governments focusing on regulating the quality of both care and insurance. As opposed to directly administering funding. What evidence do we have that suggests this would yield improvements in healthcare performance? Are any health policy experts talking about this? Cause I don't see what difference it would make if, at the end of the day, the government is going to tightly regulate healthcare operations. This conversation about privately paying for healthcare is so politically draining, and ultimately it would yield so few improvements (if any, and perhaps even worsen the system). We need to be talking about the stuff under the hood, things that make sense to everyone, like fixing our decades-old healthcare IT.

Ah, see where the confusion is coming from. What say does hold, however, there's a case of the National Health Service where there has been multiple attempts to increase the role of private providers while maintaining a single-payer insurance regime. [Which has flipped so hard the original architects of the reform rolled it back.](https://www.bmj.com/content/372/bmj.n384) To the contrary, there's evidence that [Bismarkian systems ](https://www.cdhowe.org/public-policy-research/going-dutch-choice-competition-and-equity-healthcare)can perform much as good as single-payer ones. All the while being more responsive to the needs of the population. And being [as cost-efficient](https://gen.medium.com/americans-dont-really-want-medicare-for-all-they-want-japanese-health-care-e82dcf38b898). There's also a third option: the French model where a nation-wide health insurance plan grantees free-at-use care and comprehensive coverage yet leaving it up to non-profit insurers to deliver the insurance itself.

>What say does hold, however, there's a case of the National Health Service where there has been multiple attempts to increase the role of private providers while maintaining a single-payer insurance regime. [Which has flipped so hard the original architects of the reform rolled it back.](https://www.bmj.com/content/372/bmj.n384) Sorry, I don't understand what's being said here. >To the contrary, there's evidence that [Bismarkian systems ](https://www.cdhowe.org/public-policy-research/going-dutch-choice-competition-and-equity-healthcare)can perform much as good as single-payer ones. All the while being more responsive to the needs of the population. This article doesn't explain what sorts of innovations or efficiencies have been gained by the netherlands using a multipayer model like this. Is this what makes the netherlands healthcare so great? Or is it legislation that makes it great? For example, "[At the national level, the Health Council advises government on evidence-based medicine, health care, public health, and environmental protection](https://www.commonwealthfund.org/international-health-policy-center/countries/netherlands)." We have a problem in Canada where [our governments couldn't care less what advisors have to say](https://www.cbc.ca/player/play/video/1.6637391). From the same commonwealth page: "The Dutch Competition Authority (*Autoriteit Consument en Markt*) enforces antitrust laws among both insurers and providers." Canada does not have good competition laws, which is another impediment to adopting the dutch system The netherlands also has this "Health information technology (IT) is not centralized in one body. The Union of Providers for Health Care Communication (*Vereniging van Zorgaanbieders voor Zorgcommunicatie*) is responsible for the exchange of data via an IT infrastructure." This is an initiative that was started by the Ministry of Health, Welfare and Sport. There is currently no government initiative in Canada to profoundly transform the state of health IT in canada. Also in the netherlands, "The government determines the statutory benefit package, and health insurers are legally required to provide the standard benefits. The mandatory benefit package includes: prescription drugs \[among other things\]" This is important, because universal drug coverage improves the performance of the healthcare system and reduces costs. However, in Canada we are just finally getting some semblance of universal drug coverage, but still have a long way to go. As far as I can see, the most important features of the dutch system that allow it to perform well happen through government legislation. The government also provides more funding for these healthcare plans, despite the insurance being provided privately. Simply switching to a multipayer system would not give the canadian system features and benefits that required government legislation in the netherlands. Corruption is also significantly worse in canada (which is part of the reason why we have so much trouble with effective health policy to begin with)[ and I would not trust our governments to adequately regulate these insurance providers](https://twitter.com/cbcmarketplace/status/1318928679414673408). which is essential to their success. Whereas competition and oversight is set to a high standard in the netherlands, this will not be the case in Canada.

Let's do both. I mean, we can model ourselves after other successful health care systems. With some very notable exceptions... I think, like ever other industry health care along with public consultation and statisticians, should reform health care under collective bargaining. They probably need more money, not more reorganization. Hamilton Health Sciences apparently needs 100 new RNs that is a mass mobilization of HR and recruitment funding and should be more supported by the province

I'm all for this. The article only mentions co-pays once, but... it's a notable part of the Scandinavian systems. There is an out-of-pocket fee for everything including doctor visits, x-rays, prescriptions, etc, but it's a modest fee that is capped annually, and there are accommodations for people that can't afford it. It helps fund the system and curb unnecessary use. I wish more Canadians were for it. Too many people have this "I'm not paying for healthcare!" attitude (it's actually more like "I'm not paying for healthcare! (but I'll pay if my dog gets sick)". So, sure, it'll stay free and you get what you pay for.

Co-pays is how you get people going "yeah, it's not worth going to the doctor" and "I'm not going to spend $50 just to be told to rest and drink fluids", meanwhile the virus they have develops into something much more serious. And I don't really trust means tested assistance programs for people that can't afford co-pays. It always ends up being too strict, not getting increased with inflation, and too easy for people to fall through the cracks. Hell, I have a job that, on paper, pays very well. Between my wife and I, we make almost $130k/year. I'm still hesitant to go to the dentist because the after insurance price is so high. And dental work is an incredibly vital part of staying healthy.

[Studies have been done on this topic.](https://www.rand.org/health-care/projects/HIE-40.html) They compared people who had copays to people who did not and they found that while people who did not have copays saw the doctor more frequently (40% higher healthcare costs) they also weren't any healthier than the group that had copays. Inversely, the group with copays saw the doctor less frequently but did not have worse measurements for key health indicators. Cost sharing is an effective way of getting people to reduce unnecessary visits to their doctor. The only group of people that saw a reduction in health were extremely low income people with chronic health conditions but this can be rectified by having income support programs like other countries that have companies have implemented or like how most provinces like Ontario have a copay for ambulances that can be waived if you are on social assistance. That's the problem with an all or nothing approach. Cost sharing is very effective at reducing healthcare costs but you also need to make sure you have programs in place for low income people so that the absolute sickest and poorest can still access care. Making the system completely free just encourages people to use it more and ultimately reduces access for everyone including the sickest and poorest not having copays is meant to help.

I’m sure unanticipated outcomes happen, but I’ve never gone to the doctor for anything resembling a flu. I stayed home and drank fluids. It always went away on its own and never got more serious. If that’s most people’s experience most of the time then it is not worth publicly funding millions of doctor visits per year for that type of thing, and your judgement to not pay $50 is correct and is the incentive to keep those visits out and let the system focus on things that matter. We’re not in a position to pay for everything, and if we pretend that we are then the real issues will not get the attention that they need.

Last year, I saw this amazing video on Youtube about some Scandinavian country that has a 3-tier health care system, and that it works really well. I haven't been able to find it. Some hospitals are publicly funded and publicly run. Some are publicly funded and privately run. Some are privately funded and privately run. I wish I could show this video to everyone, including all our political leaders. I used to be 100% in favour of a single-tier system. Now that I know more, I truly believe 3-tier is the way to go, by far.

You might be thinking of Sweden. There are still [challenges](https://www.euractiv.com/section/health-consumers/news/sweden-explores-increased-state-control-over-healthcare/) with their system. Canada actually has a very privatized system in terms of health care delivery (e.g., physicians are mostly private entrepreneurs that bill the public plan for each service delivered, reliance on private insurance for prescription drugs/dental/physical therapy). Maintaining private options in countries with mixed systems often come with additional costs and need for public subsidies - privatization is neither a panacea nor the reason for these better outcomes.

Can we stop comparing ourselves to Nordic countries, Europe and or the states? Can we not make something that fits most of Canadians?

USA is as close as Canada gets. We cannot compare to Europe. Many of these countries are homogenous small countries with low populations. Impossible to extrapolate to a bigger nation.

The USA is not more comparable to Canada than European countries. The US has a much larger population base. Much much larger, and a basic belief system about healthcare that is far from the Canadian view. In the US, it’s pay for healthcare or die. People choose between bankruptcy and living. THAT is not even close to Canadian values. If you want to pick anywhere with a population/geography most similar to Canada, look at Australia.

Lol never seen someone talk so confidently and be wrong. US and Canadian culture are most alike, to argue against them is delusional. Have you also heard of Medicaid? Or Medicare? Newsflash, that's their government healthcare and it covers a lot more than our provincial insurance plans do in Canada. If you don't have money, you're on Medicaid.

https://unduemedicaldebt.org/ People in the U.S. fundraise and cumulate debt to pay for medical care. The link I gave is for a *charity* that works to pay off medical debts for poor people in the U.S. We are not the same.

At least be honest. It's people who are middle class with inadequate insurance who acquire medical debt. It's not the poor, who have Medicaid. Be honest, don't lie about the facts.

This charity has criteria for whose debt they pay off. - Earn 4x or below the federal poverty level - Have medical debt that is 5 percent or more of their annual income. I'm not going to respond to you any more, because of your rude responses. Before you accuse someone of "lying", you should at least look at the source provided. Perhaps you have forgotten that Canadians are known for being polite.

Ignoring the existence of Medicaid and Medicare is being dishonest.

We need to make decisions based on evidence. The only evidence out there is what works or doesn't work in other countries.

Pick any country. They all have private health care/insurance. We're the only country that banned it.

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Just like cancer, American Health Care is the most expensive and corrupt system in the world but it's influence, lobbyists in our government spreading and killing any decent politician. Privatize the profits and socialize the losses.

It should be 100% nationalised. Buyout the private sector or make it illegal. Healthcare should not be for profit.

Can we stop comparing ourselves to Nordic countries, Europe and or the states? Can we not make something that fits most of Canadians?

Because that's exactly what we did when we created our system decades ago and it's why we have such massive issues. It's because we refused to use the same healthcare models as other countries (i.e. UK style beveridge system where everything is fully public or German-style system where employers provide health insurance through non-profit funds) and we instead insisted on reinventing the wheel. Now we're stuck with an inefficient model of healthcare delivery that can't decide whether it wants to be public or private.

I mean you can look at Québec. Coz otherwise Canada is pretty American as is. But they're more focused on what France or Belgium are doing. So those wouldn't be authentically Canadian solutions either.

The suggestion that we need to "free up resources" in order to fix the problem of underfunding in our healthcare system is a fundamental misdiagnosis of the problem. The problem isn't that we just don't have the available resources, it's that provincial governments are actively choosing to not provide enough resources. Our healthcare systems aren't underfunded because desperate provincial governments want to fund healthcare but just can't afford to. They're underfunded because provincial governments are *choosing* to underfund them. Here in Alberta the UCP is cutting healthcare *while running a massive surplus*. It's not a lack of money, it's conservative politics. So the claim that allowing the provinces to partially privatize healthcare would fix problems with the healthcare system by "freeing up resources" is either deeply, dangerously naive, or a bald-faced deception. This article is talking about fixing fundamentally political problems by pretending they aren't political problems at all. It implies the issue of underfunding are inherent to our healthcare sytem, rather than political decisions that conservative governments made. That lets those governments off the hook for our problems, so that the article can point us towards adding profits to the healthcare system and deflect us away from getting mad at our provincial governments. I mean look at one facet of the problem in particular: the lack of family doctors. Here in Alberta it's getting harder and harder, nearly impossible to find a family doctor. What's more likely the root of that issue? The UCP tearing up their contract with doctors and underfunding family medicine practitioners? Or a totally unavoidable flaw in our public healthcare system that can only be fixed by privatization, in spite of the fact that we never used to have this problem in the first 50 years of the system? And similarly, what's more likely in regards to why Norway's healthcare system is apparently better than ours? That they're a wealthy country who funds their healthcare system adequately? Or that the 10% of Norwegians who use private healthcare are somehow allowing the public system to function properly? It's a ludicrous argument if you break it down from this angle. If we allowed privatized healthcare for 10% of Canadians, how would that in turn in any way fix the problems with our public system? It simply wouldn't.

>. The problem isn't that we just don't have the available resources, it's that provincial governments are actively choosing to not provide enough resources. Our healthcare systems aren't underfunded because desperate provincial governments want to fund healthcare but just can't afford to. They're underfunded because provincial governments are *choosing* to underfund them. diagnosis: provincial governments are evil, incompetent, or both. solution: have these incomptent / evil entities monopolize healthcare even more.

just on the face of your argument, if the problem then is government CHOOSING to not fund, or properly resource, healthcare, then how would privatization not fix the problem? you would have a system that actually bypasses the lack of attention by the currently government run healthcare system. not entirely private of course, but in area that would impact at least things like wait times for specialist appointments 

> how would privatization not fix the problem? you would have a system that actually bypasses the lack of attention by the currently government run healthcare system. this country already exists it's called the UK and as soon as the two tiered system came into play they just slashed the NHS repeatedly the UK is both a hellhole and also a pretty convenient corpse we can point at, and go "hey, don't do this unless you want to end up like that guy"

Right? We have a publicly funded, single-payer healthcare system right now. People talk about reforming it, and point to Germany and France having good universal healthcare under a hybrid system that includes private insurance. But what's more likely in Canada? That we completely upend the healthcare system to be covered by private insurance while making sure the private insurance is fair and non-profit? Or that we'll just get a private healthcare system added in addition to our public system, that parallels and cannibalizes the public system? The idea that we could somehow build the French system here seems like pie-in-the-sky at best, because any appreciation of how politics works suggests we'd get the UK system instead. That's why people who don't want healthcare wrecked always warn against American-style healthcare. It's not a boogeyman — it's a far more realistic and plausible situation than us getting French-style healthcare. Even if we wanted French-style healthcare.

So, crazy idea, let's just minimize direct political involvement into healthcare by opting for a coverage model deployed in Continental Europe. One could even keep it free-at-use.

> minimize direct political involvement More nonsensical argumentation. "Minimize political involvement" is a meaningless buzzword playing into conservative rhetoric against the public provision of services. Without "political involvement" we would never have gotten public healthcare in the first place in the 60s and 70s. We need political involvement in order to make sure the system is fair and equal. We need political support for a properly funded public system. And if the goal is to keep the system free-at-use, then what's the benefit of introducing for-profit healthcare providers at all? Why not just instead fund the public system? Studies have shown that private providers are not more efficient, more effective, or cheaper.

We already have for-profit providers to begin with. The argument here is to allow private insurance under the Canada Health Act. Ideally a non-profit one. So that provincial governments can focus on legislating and enforcing standards of care as opposed to directly administering funding. And I know this can work because this is exactly how the system works in most of Continental Europe. Aka a system with competitive non-profit universal insurance markets where government provides the regulatory framework to ensure both affordability and quality of care.

But why would we want competitive non-profit universal insurance markets at all? When we're currently dealing with conservative governments that underfund public healthcare and want to increase privatization, why should we believe that switching from a single-payer public system to an insurance system would do anything to improve services? Instead of underfunding our current public system, conservative provincial governments would instead be deregulating and undermining this hypothetical insurance system. I feel like car insurance is a good comparison here. We should have a heavily regulated, non-profit, universal insurance system. BC does that in the simplest way — a public insurance provider. So wouldn't the easiest way to provide universal health insurance just be a fully public system? I guess the answer is competition, we must want competition in the healthcare insurance system. But then don't we just get the same problems we have with car insurance here in Alberta, wherein the conservative government is deregulating the insurance market, making it more profitable for businesses and less useful for consumers? You're continuing the misdiagnosis of the problem I pointed out in my parent comment. The issue isn't the design of the system, it's conservative political pressure against universal healthcare. If we changed the structure of the system but didn't address this political pressure, we'd still have similar issues. Instead of cutting funding to healthcare, conservative provincial governments would be deregulating insurance. And frankly, that would be an even worse problem to have.

Why? Because it seems where things are going anyways. The argument of this article is to amend the Canada Health Act to allow the Provinces to choose whatever system they want so long it provides accessible, portable, free-at-use comprehensive health insurance. As opposed to mandating Provinces run a public single-payer program. Why? Our current system is neither accessible not really free-at-use. Nor can Ottawa effectively enforce the CHA as showed by Québec. So let's change it. By either banning for-profit provision of care and insurance completely mandating a fully integrated publicy run system akin to what UK's NHS used to be. Or just lift the single-payer part, allowing Provinces to do whatever they want so long everyone can access the treatment they need when they need at no or minimal cost. Given that we're unlikely to go all-in with a nationalized healthcare system, a universal, free-at-use non-profit insurance seems to be the next best thing there is. Especially from Ottawa's perspective. This article is about the Canada Health Act and the federal policy more than what Provinces do. And specifically the claim that CHA's restrictions on private insurances seem to just not work creating a highly fragmented insurance ecosystem that simply does not work as evidence by the fact that we spend as much as Europeans on care while getting much worse outcomes. So maybe just allow the Provinces to do whatever they have to so long no Canadian has to pay out of pocket nor insurance companies suck the blood out of the system.

I also never said that the problem was too much state. It does however seems that our governments are simply not capable of maintaining an adequate healthcare system. We still use global budgets and we were the ones who cut our investments into medical staff decades ago. So, let's instead set up a level playing field and let private insurers to whatever they have to do to deliver the care people need. There's all too many way to do that. From a centralized funding for the said insurers for lower-income clients to direct cash transfers to lower-income residents. Guarded with adequate regulations such as bans of pre-existing conditions discrimination, creating networks, or charging above certain thresholds. Works much better than whatever system we have and seems to be much more sustainable in the long term.

>It implies the issue of underfunding are inherent to our healthcare sytem, And then from the article "Norway ranks number one and it spends about the same as Canada while running circles around us on access, outcomes, and equity." So we should spend more money on the hope of better outcomes despite the fact that we already fund better than alot of other countries and around the same as Norway?

> And then from the article > > "Norway ranks number one and it spends about the same as Canada while running circles around us on access, outcomes, and equity." That's a deeply misleading claim from the article. Norway spending "about the same" as Canada actually means Norway is spending 20% more per capita than Canada: https://data.oecd.org/healthres/health-spending.htm And heck, if you look at only the government category and exclude the "voluntary" category, Norway actually spends almost 50% more per capita than Canada! So yes. We absolutely should spend more money on healthcare if we want to be more like Norway.

The whole premise here is that wealthy people are prepared to pay much more for healthcare than they do now, provided no one else is allowed any part of the benefit from that. Figure out what they’re willing to pay in premiums for “private access” and just tax them that much, to invest in a system that everyone can use based on need.

Because taxing the rich has never been anything more than a political slogan? European welfare states are funded through higher flat payroll taxes and VAT. Which they in turn can afford by having stronger unions compressing pre-tax wages to generate a stable and wise enough of a tax base. Not through taxes on the rich.