The Myth of Universal Health Care

Despite our illusions, Canada’s system is neither comprehensive nor equally accessible. What would it take to reform it?

BY NADINE CARONDANIELLE MARTIN 
ILLUSTRATION BY PETE RYAN

Updated 9:46, Jan. 11, 2021 | Published 14:10, Dec. 8, 2020

[Excerpts] ERYN DIXON had enough to manage as it was. At the age of forty-five, with profound disabilities related to multiple sclerosis, Dixon was living in Almonte Country Haven, a long-term care facility on a grassy hill in eastern Ontario. Then, in March, she contracted COVID-19. As she lay unconscious and unresponsive, struggling on oxygen, her father, Rick, was told to say his final goodbyes. Against the odds, Dixon pulled through, but more than a third of her facility’s residents weren’t so lucky.

Hers is just one of so many stories that we have been reading and watching and hearing for months—a catalogue of media reports every day, documenting COVID-19’s progression through our communities and the various ways it takes its toll.

As COVID-19 took hold around the world in the spring, Canada prepared for one very specific kind of tragedy: the kind we saw unfold in Italy and in New York, one where hospitals were overwhelmed and ventilators in short supply. Thanks to good timing, hard work, and an economic shutdown that will have ripple effects for years, we have so far avoided that particular calamity. But, as Dixon’s, Punian’s, and Bernadel’s stories reveal, there are many kinds of tragedies: as a country, we were too slow to realize that there were—and are—other pandemic disasters happening all around us. The stories of COVID-19-affected Canadians are also stories about Canada and our health care systems—about which kinds of tragedies we go to great lengths to avoid and which we allow to persist.

By comparison with the death count unfolding south of our border, many Canadians have felt very proud of how our country and its health systems—thirteen provincial and territorial systems, with some areas of federal responsibility as well—rose to meet the initial crisis of the pandemic. Canadian medicare has always meant more than a set of public insurance programs: we are prouder of it than we are of ice hockey or the maple leaf. The notion that access to health care should be based on need, not ability to pay, is a defining Canadian value, surviving along the longest shared border in the world with the country that hosts the most expensive, inequitable, profit-driven alternative imaginable. That difference in values is often emphasized in our political rhetoric, as when Jean Chrétien would say, “Down there, they check your wallet before they check your pulse.”

We are two doctors working in very different environments and very different medical disciplines, and we have been seeing COVID-19 reinforce some basic lessons about Canada’s health care. First, our systems’ preexisting cracks become chasms when subjected to major shocks. Second, a conversation about health care that is divorced from the social factors that help determine how healthy you are is not really a meaningful conversation at all. And, third, perhaps the only lesson that should qualify as news: when they feel they have no alternative and the need is sufficiently great, governments, private-sector players, and individual people can make tremendous changes in very short order.

HEALTH CARE SYSTEMS exist to prevent and treat illness. What this means, as a matter of medical practice and health policy, is a matter of enormous ongoing debate. When Tommy Douglas implemented public health insurance in 1947, his Saskatchewan government focused first on covering hospitals and later on medical care—at that time mainly defined as physician services. This model spread across the country in the decades that followed, with the support of the federal government and its spending power.

Douglas dreamed of moving to a second stage of medicare, in which coverage would be much broader and the prevention of disease a bigger focus. That dream was never realized, and there are whole swaths of health care that are not included in our universal system at all. Instead, an ongoing emphasis on doctors and hospitals has led many observers to characterize Canada’s so-called universal health care coverage as “narrow and deep.” What we do provide (services like primary and specialty medical care, diagnostics, surgery) tends to be high quality; our health care system strives for equal access to care particularly by ensuring there are no financial charges for these services. If you are seen by a doctor or admitted to the hospital, if you need a CT scan or a blood test, if you require a biopsy or a specialist assessment, you will be well taken care of and never see a bill. But, if you are among the 20 percent of Canadians lacking adequate drug coverage and you walk out of your doctor’s office with a prescription for medication to treat your diabetes or high blood pressure or infection or depression, you may be on your own. If you require therapy with a psychologist for anxiety, or physiotherapy for your sports injury, or a root canal, your access will depend on your ability to pay.

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