The Canadian “universal access” public healthcare system (medicare) is “crumbling,” according to one insider. Another commentator has described it as “threadbare.” The wait time to see a specialist in Canada is now the longest among the OECD countries: 27.7 weeks. Six and a half million Canadians are unable to find a family physician. Besides primary care physicians, there are shortages of specialist doctors, nurses, hospital beds, and diagnostic imaging equipment (such as MRI scanners).
In the most recent survey, 42% of Canadians say they would pay to get medical care in the United States if necessary – because they are desperate, in pain and not wanting to die while waiting for treatment.
All this indicates that the medicare system is no longer sustainable, given its ballooning costs that come with an aging, longer-living population and little incentive for operational efficiency and innovation. Increasing taxes to fund medicare (the usual solution) cannot continue indefinitely as the proportion of the productive-age population continues to shrink. User fees could offer some relief, except they are illegal in Canada. Patients cannot be billed directly; paying for healthcare is a collective taxpayer responsibility.
A recent poll shows that almost two thirds of Canadians now support some private healthcare delivery options, such as private clinics, as long as they are publicly funded. But many still remain suspicious of privately funded, for-profit health care, despite medicare’s problems.
Why should Canadians embrace private health care as a moral alternative to medicare, as citizens of most other countries do?
The moral argument for private health care is the same as for a free market in any industry, from food products to pharmaceuticals to energy and beyond. A free market for production and trade leaves people free to think and act, which is essential to our flourishing. Because we lack automatic knowledge about how to survive and thrive, we must think, and act accordingly, to solve the problems our existence and flourishing pose. We must think to produce food, to discover and produce medicines and energy that protecting and maintaining our lives require.
Such thinking and action requires freedom from coercion by governments or others– as the history of human progress shows. Significant human achievements, from medical discoveries to technological innovations, have all been made under conditions of relative freedom (while authoritarian regimes have produced none).
Unlike medicare, private, free-market health care is free from coercion. The government could not nationalize medical insurance companies, dictate what doctors earn, or force taxpayers to bear everyone’s healthcare costs. Under private health care, entrepreneurs would be free to start companies to provide health insurance or healthcare services. Doctors and other providers would be free to set the terms and prices of their services, and patients would be free to choose and pay for the health insurance and services that best meet their needs.
In a private, free-market system, the profit motive attracts many providers who would compete for customers by offering high-quality services at prices their customers are willing and able to pay. Such a system is based not on coercion but on voluntary trade which makes it fair: people trade value for value, and no-one is made to sacrifice for the sake of others. It leads to win-win outcomes for all.
Patients benefit because there will be supply to meet their demand: a variety of products and services (including insurance) at various price points from which they choose the ones they want (and can better afford without the ever-increasing tax burden).
Instead of seeing patients as winners, critics of private health care often paint it as a scare scenario where private health care providers (hospitals, clinics, doctors, other professionals) pursue profits by denying services or harming patients. The scenario is absurd because in a competitive system with legal protection of individual rights profits cannot be obtained and sustained by such methods.
The very small percentage of people who could not afford to pay for health care or insurance would depend on private charity, and the quality of care would be protected, not only through competition and rights-protecting laws, but by private third-party licensing/certification.
Healthcare professionals (doctors, nurses, and others) benefit from private health care because competition among providers would enable them to negotiate fair compensation and working conditions, which in turn would attract more professionals to health care and eliminate staff shortages and burnout.
The private healthcare providers (hospitals, clinics, professional practices) and medical insurance companies benefit by profiting from the quality and competitive pricing of their services.
I have outlined the moral case for private health care based on human flourishing. Yet, envisioning how such a system would work may be difficult. While no entirely private healthcare system exists (because the requirements of human flourishing are poorly understood), there are many examples around the world of private healthcare systems operating in parallel with a publicly funded system.
Embracing private health care is necessary to avoid a complete collapse of Canada’s current underfunded and overburdened medicare. If we want a well-functioning, sustainable health care system for all, we need a switchover to private health care, implemented gradually to allow all parties time to adjust.
Photo by Hush Naidoo Jade Photography on Unsplash
Jaana Woiceshyn teaches business ethics and competitive strategy at the 
One Response
First, you should not use the word ‘medicare’ as that is the US system paid from the proceeds of payroll deductions in employment, as CPP and the US equivalent are. (‘Medicaid’ OTOH is a charitable system in the US, paid by taxpayers in general. There are also charitable programs operated by states.
I note that:
– government involvement pushed prices up in the US.
– regulation of providers also pushes prices up
(Bureaucracy being part of both.)
That harms people of income at the low side of ‘middle class’, who could otherwise afford good insurance.
I note that a century ago there were a great many charities in New York City, people do help.
British Columbia’s system lacks price feedback, decades ago recipient of care would receive a statement of what had been paid for their care, and an invoice for their share (a small ‘deductible’). That mailing was discontinued to save pennies, then later the small deductible was eliminated in political pandering.