But that credo is false. Health care is far from free. Those government funds must come from somewhere — and that somewhere is the pockets of taxpayers. The average Canadian pays roughly $16,000 in taxes each year to support our health care system. (That’s on top of the substantial dollars we shell out for medications, physiotherapy, counseling, dental work, and a host of other health services.)

And the system we pay for isn’t much of a system. More than six million Canadians don’t have a family physician. Canadian emergency departments are utterly swamped by patients looking for care. Meanwhile, wait times for services ranging from MRIs to cancer care to orthopedic surgery stretch into oblivion. Things have gotten so bad that jurisdictions like British Columbia are paying to send busloads of patients to the U.S. for radiation therapy it has no hope of providing itself.

The care in Canada, if you can get it, is excellent. Canadian health care professionals are among the most highly skilled in the world. The problem is that there aren’t nearly enough of them, and they labour in a grossly inefficient bureaucracy-choked system hopelessly married to a failed model of health care delivery.

To say the system is in trouble is like saying the Titanic had a small leak. A functioning universal health care system would dole out actual health care in a timely and competent manner to all citizens who need it, which it most assuredly does not do. What we have instead is a universal waiting system — a system in which patients suffer and die while waiting in vain for care.

And yet Canadian medical leaders continue to double down on this colossal mess of a “system.” Case in point: last week the Canadian Medical Association released the preliminary results of a months-long consultation with “the public, physicians, people with lived experience and others to gain a better understanding of what people across the country think about the state of health care in Canada and what mix of public and private health care funding is most appropriate.”

I — anyone, really — could have saved them the trouble. Because what we think — what we know — is that the system is completely kaput. And we want solutions; we want action, not another report destined to collect dust from the moment it’s issued.

Not that the CMA doesn’t have recommendations. They’ve got plenty: twenty-two in all. The main takeaway, unsurprisingly, doubles down on the gospel that no one must “pay” for care. Here’s Dr. Kathleen Ross, CMA president:

“I don’t want anyone to have to pay out of pocket to have their kid’s sore ear looked at.”

It’s a curious statement given that the CMA’s survey suggests that physicians as a group are entirely conflicted on this issue, due to the outrageous bottlenecks currently bedeviling the system.

The depressing reality is that if your four-year-old is screaming in pain from her sore ear at 10 p.m. on a Friday night, you’ve got precious few options for medical advice outside of joining the queue jammed into your local emergency department waiting room.

One option that has become available in recent years, fueled by the realities of the COVID-19  pandemic, has been consultation with virtual care providers. Instead of packing your crying child into the car and driving on snow-packed roads to an ED, then paying for parking before waiting for five hours amidst a crowd of coughing children sharing their cooties, in advance of finally seeing a physician for 10 minutes of consultation before driving home bleary-eyed and exhausted at 4 a.m. — instead of all that, it’s been possible in some jurisdictions to consult instead by videoconference with a physician. It’s the same 10 minutes of advice, but from the comfort of your living room. It’s been an excellent option, one that helps to fill the substantial gaps in primary care. Multiple companies stepped in to provide the service.

But that option is increasingly imperiled.

In the aftermath of the pandemic, governments have been reluctant to continue supporting virtual care.  Ontario, for example, after initially providing remuneration of $80 per virtual care visit to doctors, slashed that fee to twenty bucks — essentially destroying the platform’s viability for physician providers. 

There are other ways that healthcare professionals are providing alternatives outside of the broken system. To address increased wait times and increased public appetite for healthcare options, for example, nurse practitioners in Ontario have begun opening private care clinics to meet demand. Since NPs aren’t mentioned in the Canada Health Act — the profession barely existed in 1984, when the Act was adopted — it’s been permissible to charge subscription and/or per-visit fees to patients accessing their services.

But that’s wholly unacceptable to the CMA. Recommendation #2 from last week’s report:

“Governments enforce the Canada Health Act prohibition against user fees by clamping down on jurisdictions that allow the charging of membership fees, user fees or bundled payments for persons to access publicly insured primary care. This will ensure primary care remains universally accessible in keeping with Canada’s long-standing value of equitable care.”

Federal Health Minister Mark Holland, in response to a plea from Ontario for a national crackdown on ancillary charges, has promised to issue a decree on the question of out-of-pocket fees charged by non-physician primary care providers. Three guesses as to how he’ll rule.

It’s all emblematic of the blinkered approach that governments and the CMA continue to take amidst the smouldering wreckage of our primary care system. Instead of welcoming needed innovation and expanding options for beleaguered patients, they remain welded to the failed approaches of the past. 

I daresay that we’re all in favour of ensuring universal access to good quality care. But by choking off access to virtual care and other such innovations, government and medical leaders are ensuring only that we remain equally miserable while we wait, and wait, and wait.

Dr. J. Edward Les is a Calgary pediatrician and was CEO of former pediatric virtual care company, Virtual Kids