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Why we’re fighting against two-tiered health care

This month pro-medicare allies in Nova Scotia are fighting against two-tiered health care being promoted by the NS College of Physicians and Surgeons. This fight is not unique to Nova Scotia, provinces across the country are finding ways to decrease the portion of their budget that they spend on medicare.  The Ontario Health Coalition organized an incredible fight against increasing privatization in April, New Brunswick labour is fighting massive privatization of cleaning services like laundry,  while the British Columbia Health Coalition and Canadian Doctors for Medicare are fighting for-profit health care in court, and that’s just to name a few.

What is it about private, for-profit, health care that concerns the pro-medicare community so much? Is it the inequality it creates between the 1% and the 99%? Is it the fear of adopting an American-style health care system? Is it the loss of a public system that we fought hard to win?

In this blog I intend to lay out five reasons why all Canadians should be concerned about private, for-profit medicare. These reasons are:  

  1. Private clinics increase wait times for the 99%

  2. Private clinics provide inferior quality of care

  3. Private hospitals are less efficient

  4. Public-Private-Partnerships cost more, deliver less

  5. Patients pay more through taxes and out-of-pocket

Wait times

We talk a lot about wait times in Canada and for good reason. For many procedures and in facilities like Emergency Departments wait times are far too long. The right-wingers use this as the reason for privatization and Conservative think tanks like the Fraser Institute cite models from random European countries as the solution.

There are several problems with this. The first is that most European models actually have more public health care than we do. Europe tends to have an 80-20 split with 80% of health care being provided publicly and 20% delivered privately. In Canada, we have a 70-30 split. We have fewer public health care services than most European countries.

Secondly, privatizing health care will actually lengthen wait times. According to the Wait Times Alliance (WTA), a group of physicians and physician organizations that examine wait times in Canada, the major causes of increasing wait times are: a shortage of acute care beds, not enough community care resources, and the inefficient use of existing infrastructure.

Solutions to long wait times are in the public health care system. We need more acute care beds, more community health centres, we should use our existing infrastructure and operating rooms more efficiently and we need pan-Canadian strategies for areas like aging and dementia, says the WTA.

The privateers argue that if we created a two-tiered health care system, we’d remove the richest Canadians from public health care waitlists and allow them to pay for their services in a private clinic. The problem is that we also remove our much needed health care providers creating a shortage of medical personal. Health care practitioners in the public system see many more patients than those in the private system. By seeing more patients, wait times for everyone are shorter. By removing those in-demand health care professionals and capping how many people they see in a day, you lengthen wait times for the 99%.

For more information on how private clinics lengthen wait times for all of us, read How Private Clinics Lengthen Wait Times for all of us

Private clinics provide inferior quality of care

Several studies have shown that public health care doesn’t just cost less; it provides us with safer care. In a study comparing for-profit and not-for-profit clinics, PJ Deveraux et al found a higher risk of death for patients in private, for-profit hospitals.  

An Ontario-based study in 2007 found that patients in private colonoscopy clinics were three times more likely to have an incomplete colonoscopy than those at an academic hospital.

Private care is the least efficient model

According to the World Health Organization, $300 billion is lost annually because of hospital inefficiency with for-profit private hospitals rating lowest in efficiency and public hospitals rating the most efficient (Etienne et al. Health Systems Financing: The Path to Universal Coverage, 2010. P. 68). We should save money by keeping hospitals public and putting the $300 billion we’ll save back into patient care.

Public-Private-Partnerships cost more and deliver less

There are lots of examples of public-private-partnerships that have gone well over estimated costs and in the end cost much more money that if they were built by the government (and then we’d also own them). In health care, one of the most talked about cases was the Brampton Hospital in Ontario. It’s known for being built 129 beds short and $300 million over the original estimated cost.

Patients pay more through taxes and out-of-pocket

All residents of Canada pay for their medically necessary (as defined by the Canada Health Act) health care through their taxes. However, we often hear the argument that Canadians should be allowed to also pay for these services out-of-pocket. Dr. Brian Day, owner of a private surgical centre in BC and the plaintiff in an upcoming court battle is an example of why the right is pushing so hard to get patients paying out of pocket. In 2012, a provincial audit of just 30 days found that Day’s clinic charged patients $500,000 in illegal fees and $66,000 where he actually billed both the medicare system AND the patient for the same service. Two-tiered health care makes lots and lots of money. It allow health care practitioners like Day to exploit the system and make twice the amount of money as they did before.

Wendy Armstrong in a study for The Consumers Association of Canada (Alberta) found that: “In Calgary, where 100% of publicly insured cataract surgery is contracted out to private clinics, patients must pay an average fee of $400 dollars (up to $750) for an optional “foldable” implant in order to obtain what is promoted to be better and/or safer care.In Lethbridge and Lamont where all cataract surgery is performed in a public hospital and there are no private clinics, these foldable implants are routinely provided at no cost to patients for a wholesale price of less than $100 dollars.” Public health care costs all of us less, with fewer out-of-pocket fees and tax dollars that stretch further through bulk purchasing.


There are many reasons why a two-tiered health care system is wrong for Canadians. Private health care costs more and delivers fewer services at a lower quality. The evidence from studies in Canada and abroad shows that two-tiered health care creates longer wait times for the 99% and less equality for everyone.

In 1984, when Canada adopted the Canada Health Act we banned extra billing and user fees. We fought hard to win this system not so many years ago, in fact many Canadians remember a time before medicare. We managed to create a progressive system based on our values of equality and justice. Canadians need to remain vigilant in their support for public health care. Capitalists and the 1% are going to try to take that away, they always will because there is profit to be made in health care. We need to fight hard to save what we’ve built and to continue building it. There are still many programmes in health care (like pharmacare, dental care, home and community care) that would benefit from public expansion of health care. We need to work on phase two of medicare to create a more just and affordable system.

Further reading:

Private care offers less:


Brampton Hospital- Over budget with fewer beds


Dr. Profit and the coming court battle:


Forbes gives us a look into how private hospitals make their money