The pandemic has pushed Canada’s health-care system to its limit and highlighted something critical. If we want to remain proud of it, we must end our emotional attachment to it and fix it. This may mean making hard decisions.

This emotional attachment may be part of the reason that both elected officials and citizens alike feel comfortable with spending increasing amounts of money on the system, even if we do not fully understand its impact.

There have been numerous pre-existing issues and warning signs that we ignored prior to the pandemic. As the strain on our health-care system from the pandemic lessens, with 81 per cent of Canadian vaccinated with two doses, and with health care remaining a top issue on the political agenda, we have an excellent opportunity for reform.

Our system faces serious issues such as high elective care wait times, inaccessible services and health-care disparities for Indigenous populations. These issues are caused by disintegration of the public health capacity in recent years; a lack of a methodology and strategy for health-care funding (also known as “tinkering at the margins”); and not having enough traceability, or transparency, in our funding mechanisms.

A racial justice agenda for medicare

Most Canadians want higher health transfers, mostly without conditions

To answer the question of how we got here, we should revisit the creation of our modern system. Throughout the mid-1900s, the Canadian health-care system began to grow and advance, leading to increased costs and the belief that health care was “a social good [and] not merely another purchasable commodity.”

After years of debate, the Canada Health Act was passed in 1984, which outlined the foundation for Canada’s new universal and publicly funded health-care system (medicare). In 2016, total health spending was $228.1 billion (with 70 per cent of funding from public sources and 30 per cent from private insurance or individual spending).

In recent decades, federal and provincial administrations have disintegrated the authority and autonomy of our public health officers and systems through a variety of actions. These issues have been noted by numerous authorities (such as the final report from the advisory panel on federal support for fundamental science or the Naylor Report in 2016, and the Canadian Journal of Public Health in 2017). While the federal government followed some key recommendations relating to budget investments in 2019 to spend more on “fundamental science,” research suggests that increased funding and investment does not always lead to better outcomes.

While increasing budgetary provisioning as a solution seems appealing to some, there is little to no evidence or research into how to effectively fund public health. Additionally, we lack budgetary visibility into how the federal and provincial governments spend on varying jurisdictions and priorities.

Simply put, we have very little knowledge of how to spend well. This relates back to the issue of “tinkering at the margins.” It also leads us to the question of why there has not been more of a push for change. We think there are two reasons.

First, due to a lack of budgetary transparency on health care in the provinces and territories, it is difficult for both citizens and their elected officials to scrutinize current practices or to suggest reforms. This is due to an immense lack of monetary traceability and “systematic tracking” of public health budgets across Canada. Even if Canadian citizens wanted to scrutinize the public health system, accurate data would not be there to do so.

The second reason relates to the pride that Canadians feel for our health-care system. As demonstrated by numerous public polls, health care is a priority issue. During the 2021 federal election, improving access to health care was ranked in some polls as the second most important issue to Canadians. Independent of national pride, health care is important to our everyday well-being.

However, it is important to remember that since the mid-1900s, the country has looked at health care as a social good, and not merely another commodity. This implies that in addition to the practical aspects of health care (survival and health), there is also an emotional aspect for Canadians.

The emotional attachment is prominently demonstrated in surveys where universal health care is listed as the number one source of both collective and personal pride in Canada. This means that health care is ranked higher than the Canadian flag, the national anthem, the armed forces or multiculturalism.

While we should take pride in our universal health-care system, it is important that we do not let our pride become acquiescence, thus allowing the issues to deepen.

How do Canadians push for change and a better system? We can start by better understanding how and where our money is spent through pushing for democratic traceability and transparency.

Sometimes the best way to maintain our pride is to take a step back and recognize our shortcomings. Are there institutional reforms that could save us money and improve our system?

The only way to find out is to look at health care objectively, reflect on our system, and most importantly reflect on our emotional attachments to our system.