“I don’t know where it was going to end up,” says a Canadian-born doctor who has worked in the capital since the 1980s.
“I’ve seen all the signs that it was heading in the wrong direction.
Now I’m just hoping that maybe it doesn’t go down the wrong road.”
As a physician and former president of the Canadian Medical Association, Dr. Andrew Gaudreau has witnessed the country’s health-care system transform in recent years.
While it has benefited from government investment and expanded access to care, it has been overtaken by private insurance, a trend Dr. Gaudrey says is a consequence of an unsustainable growth model.
“We’re going through a very difficult period right now, in terms of the health care system,” he says.
“So I would say that I would expect a big change in Canada in terms [of] the system.”
Canada’s health care is now far more expensive than the United States, according to the OECD.
Its system of health insurance, Medicare and private insurance is also more fragmented than in the United Kingdom, which has more than 80 private insurers and a single system of publicly funded insurance for people with private insurance.
“There are a lot of countries that have private insurers,” says Dr. John Rabinowitch, an economist at the University of British Columbia who studies the health-insurance industry.
“The United States has a lot more private insurers, and Canada has a huge one.”
Canada is also one of only a handful of countries where the federal government provides health care to all Canadians.
It covers all Canadians regardless of age, race, marital status, marital or family status, and it covers all medically needy patients regardless of their ability to pay.
The federal government is also responsible for paying the costs of the private insurance system.
Health care is the biggest cost for the government.
Health-care spending accounts for a large part of all taxes and federal revenue.
The cost of the system is the largest share of the federal budget, according the OECD, which calculates its cost based on how much the government pays in taxes and how much it collects in health-related revenue.
That calculation is a rough estimate.
The OECD estimates the federal system will cost the federal treasury $14.2 trillion over the next decade.
That would be a record amount.
But the OECD doesn’t put a dollar figure on the cost of health care in Canada.
Instead, it calculates how much health-provider costs are covered by provincial, territorial and municipal governments and what those costs would be if they were paid directly by consumers.
That figure is more complex.
Health spending by the provinces and territories varies significantly.
In Ontario, for example, the federal Health Services Act requires that the provincial government provide coverage for all Canadians and that it covers medically needy people.
The Ontario Ministry of Health says the provincial system is in fact paying for about 50 per cent of health-inclusive care in Ontario, including in the most expensive regions.
But Ontario is the only province that covers medically-inclined patients in all provinces and the federal health-accounting system does not provide coverage to the provincial insurance system, so patients in Ontario are covered in the federal insurance system and provincial governments are not.
Dr. Rabinowsitch says the federal governments role is to pay the costs.
“If they’re going to be able to do it, they’re paying for it,” he said.
“In Ontario, if you’re 65 years old and you have $3,000 in private insurance and you get a catastrophic illness, you’re out of pocket.
If you get $5,000 private insurance in Ontario and you’re a 70-year-old with $5 million private insurance with the same catastrophic illness and you don’t have private insurance coverage, you still get to go to the emergency room.”
“The whole system is very broken.
It’s not sustainable.”
Dr. James P. O’Brien, a professor at the Canadian Institutes of Health Research who has studied the health of Canadians, said the federal-provincial system is “the most broken” system of care in the world.
It is, he says, unsustainable and “we need to fix it.”
Dr O’Brien points to a report from the Fraser Institute, a think tank, which concluded that a single-payer system is more efficient than a single employer-based system.
The Fraser Institute said a single payer system would have a net savings of $1 trillion a year.
That’s more than the cost to the federal and provincial budgets combined, says the Fraser report.
“A single-payer system has a net benefit to the economy in the short run but has a significant downside in the long run,” it said.
A single-province system would also reduce administrative costs, said Dr. O’ther, because there would be fewer bureaucrats to manage and fewer bureaucrats in charge of the medical-insuring system.
That could lead