I recently attended a lunch about the “Cambie Clinic” case, an ongoing constitutional challenge to British Columbia’s public healthcare monopoly. One of the guests, a former premier of a large province, was asked why he didn’t encourage more private healthcare options when he was in office. His answer was candid: it wasn’t worth the risk. It’s hard to fault him. Fealty to the Canadian public healthcare monopoly has been a political shibboleth for two generations.
But is it still?
Time has a way of showing that political wisdom is just political fashion. When the Canadian public healthcare system was born, Crown corporations were in vogue. Airlines, utilities, telecoms, and energy companies were state enterprises and privatization was the hobby horse of bespectacled Hayekians and “nature, red in tooth and claw” capitalists. The years passed and opinions changed. Pierre Trudeau created Petro-Canada in 1975; twenty-six years later Brian Mulroney sold its shares on the open market.
Recent surveys of Canadians show a growing awareness of the problems of healthcare delivery and cost. Polls show that a consistent, if small, majority of Canadians believe we should have the right to purchase private healthcare if we cannot receive timely access to treatment in the public system. There is good reason to believe this number will continue to increase, and that openness to private options within a universal healthcare system will come from both ends of the age spectrum.
Baby boomers are now entering their decades of maximum healthcare consumption and the Canadian system will not be able to accommodate their demands without either substantial tax increases, which they oppose, or more severe rationing of service. How will the “me” generation take to being told they must wait 18 months for a knee surgery so they can resume hiking and biking their way through active retirement?
Jaime Watt, executive chairman of public-strategy firm Navigator Ltd., wrote last October in the Toronto Star that his opinion research confirms that “[b]aby boomers don’t believe the system is sustainable” and that they agree that introducing more private options into our public healthcare system “is inevitable and makes sense, so long as the universality and equality of access remained in place.”
At the other end of the spectrum, the millennial generation has been raised in a world of choice and customization unimaginable before the Internet. This is the generation that took the idea of curation out of dusty museums and now expects individually selected workouts, menus, and wardrobes. “Disruptive” technologies like Airbnb, Uber, and food trucks allow them to bypass their parents’ passive reliance on hotels, taxis, and restaurants. Twenty-somethings decide what’s for dinner by opening an app on their phone and choosing from fifty national cuisines literally at their fingertips. The world is not merely their oyster, it’s a rotating selection of Malpeques, Kusshis, Beausoleils, and Hog Island Sweetwaters. When they encounter our state healthcare monopoly and its long queues for one-size-fits-all care, it will feel like being teleported back to the 1970s, and not in a fun, “retro” way.
A just-released poll by the Manning Centre supports this intuition. Even though millennials are less likely than older Canadians to have experienced the frustrations of health-care rationing, when asked to choose between a “two-track system, government and private” and a “one-track, government run system,” voters aged 15-34 preferred the two-track system by 46% to 39%, with 15% undecided. That’s not quite a majority yet, but it shows a new generational openness to change.
With pressure for health-care choice coming from both sides of the generational divide, our political leaders will face unprecedented service expectations just as our public system reaches its financial breaking point. Egocentric boomers and spoiled millennials may provoke eye-rolls from their respective older generations, but their impatience may be what it takes, finally, to shift Canada’s anachronistic public healthcare monopoly to the complementary public-private model that produces better results in Australia, New Zealand, and Europe.
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