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EPOCH TIMES COLUMN: Danielle Smith (finally) delivers health care reform

Health-care reform is often considered the “third rail” of Canadian politics—a reference to an electrified line on train tracks best left untouched. However, a new survey suggests that the Canadian public is ready for reform, and it’s time for politicians to get on board.

Provincial health-care systems are in crisis. We have a persistent shortage of physicians, nurses who are fed up with working conditions, and ERs that face routine closure. The Fraser Institute reports median wait times for elective surgery hit an all-time high (30 weeks) last year, and freedom of information by SecondStreet.org revealed at least 15,000 patients died on waitlists in 2024.

It doesn’t have to be this way. The experiences of more successful universal health-care systems provide us with proven strategies to improve our system—and Canadians seem generally supportive.

SecondStreet.org and Leger polled Canadians on five policies that help better-performing health systems—such as Sweden, Switzerland, the Netherlands, France, Australia, Germany, and Japan—and the following is what Leger found.

Almost six in 10 Canadians (59 percent) support private partnerships—i.e., the government paying non-government clinics to provide services to reduce wait times for patients in the public system. This type of collaboration is already prevalent in provinces like B.C., Alberta, and Quebec, and was also a notable part of the Saskatchewan Surgical Initiative, which saw a 75 percent reduction the in the number of patients waiting more than three months (2010–14).

There was identical support for the idea of keeping the public system but allowing people to pay for private treatment if they cannot get timely care within the public system. This move would help take pressure off the public system, allowing it to focus on helping patients who don’t have the funds to pay for private treatment.

The highest level of support for both of these policies was in Quebec, where the almost one-in-five publicly funded day surgeries are performed in private surgical centres. The Supreme Court of Canada has already ruled that the provincial ban on private insurance for core health-care services was against the Quebec Charter of Rights.

But health-care reform goes beyond issues pertaining to the role of the private sector.

For example, the majority of respondents also support changing the way hospitals are paid. Most provinces currently fund hospitals based on “global budgets”—governments send an annual cheque at the beginning of the year that treats patients like costs eating into funds. By contrast, the vast majority of universal health-care systems have shifted towards paying hospitals according to the volume and complexity of care provided—e.g., providing, say, $15,000 each time a provider does a knee operation (with adjustments for medical factors). Fifty-six percent of respondents agreed that hospitals should be paid using this more modern approach to funding.

This also depoliticizes the entire public private debate with money simply following patients to where care is delivered.

Canadians are, however, still reluctant to introduce user-fees in our system, with only about 30 percent supporting a small fee when people use the system. This is unsurprising in light of the recent concerns with the cost of living. However, cost-sharing (with protections for vulnerable populations) is a core feature of most universal health-care systems around the world, including primarily tax-based ones like Australia, Sweden, and France.

Finally, respondents were asked about the opposite: financial incentives for patients who live healthy lives. Discussions about health-care reform in Canada primarily revolve around the supply of health-care services with little consideration for reducing demand for potentially preventable conditions. Meanwhile, organizations like the Chronic Disease Prevention Alliance of Canada estimate the cost of treating diet-related disease in Canada was approximately $26 billion in 2015. Respondents seem to intuitively understand this connection, with about half (50 percent) believing governments should offer financial incentives to reward those who live healthy lives. Understandably, seniors aged 55 and older were most likely to oppose government-provided health incentives.

With a health-care system that continues to lurch towards disaster, Canadians understand the importance of enacting reform grounded in the experiences of more successful universal health-care countries around the world. Unfortunately, it’s patients who have to pay the price for political inertia.

Bacchus Barua is the research director at SecondStreet.org, a Canadian think tank.

This column was originally published in The Epoch Times on December 3, 2025.
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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.