Of all the quintessential questions facing Canadians today, universal healthcare continuing in its current state is one of the most pressing issues. It is also one of the most critiqued yet cherished of government programs. Some people miss the point and argue the system works well enough; it just requires greater funding by increasing our tax burden. Others say it is time for a revamping of universal health care after 60 years through the addition of a parallel, private/public P-2 system that should be without cost to the patient.
As we emerge from two years following the pandemic, it is clear that the system is now broken. In most provinces, cancelled surgeries, increasingly long wait times, strained primary care networks, an alarming lack of emergent care and serious staffing challenges have brought the issue to the forefront. Most Canadians hear daily about alarming waitlists, and nurses and doctors who leave their profession and relocate to other jurisdictions that have less government involvement.
Tommy Douglas’ and his cohort’s vision of a public healthcare system was first implemented in the 1960s. It is no longer functioning nor has it been practiced the way it was originally intended because of the elimination of a minimal quarterly co-pay. Times have changed in many ways, not the least of which is the large number of Baby Boomers reaching their 70s. The awareness that we spend approximately 80 per cent of our individual healthcare budget in the last 10 years of life is an important fact. Therefore, like everything else that evolves over time, public healthcare in Canada is long overdue for a rebuild.
Rebuilding public healthcare is a complex issue. Dr. M. Garth Mann, CEO of the Manor Village Life Centers, has devoted much time, effort and passion to suggesting a solution that will work effectively. Mann bought a parcel of land on the corner of Richmond and Victoria streets in London, Ont., and developed Canada’s first multi-use senior supportive centre combined with medical and allied medical offices plus dual surgical suites that were approved by College of Physicians and Surgeons of Ontario.
With the opening of this building called Advanced Medical / Surgical Operatory & Senior Center, the purpose was to exemplify and understand how the private sector could assist the healthcare requirements of a growing and aging populace. It is important to note that Mann is a staunch proponent of a public healthcare system that is supported by private industry. Today his team has proven in London that the private sector can contribute by meeting the needs of public healthcare affordably.
“Our London team is looking at it from the perspective of meeting the needs of the patient,” says Mann. ”If the private sector can intervene and improve the healthcare system where the public system can’t facilitate patient needs, then the public sector should welcome the opportunity for enhancing universal health care for Canadians.
“Our protocol is for a single health-care system in each province that is genuinely universal, not two-tiered,” says Mann. “The private sector would provide the required funding to develop and build the licensed chartered health services, typically in the form of day surgical facilities or other types of clinical care. It is simply not necessary that the public fund medical clinics, day surgical suites and enhanced senior supportive care facilities for long-term care.”
Mann sees hospitals been essential to treat acute care (emergencies), offer extended care for more complex surgical procedures, and act as research centres for new technologies and treatments. Hospitals funded by public taxes should not provide for long-term senior care or simple surgical procedures. Chartered private clinics would be licensed and registered through the provincial Colleges of Physicians and Surgeons, and skilled professionals employed by the Chartered Clinic would provide the facilities and the staffing resulting in a cost saving to the taxpayer.
“If we remove day surgeries from hospitals, wait times for approximately 73 per cent of all surgeries would be reduced,” Mann says. “This represents a huge use of hospital resources that could be offloaded to chartered surgical facilities.”
According to the Fraser Institute, Canada is near the bottom of the G20 list of countries when comparing costs related to value received for healthcare. For example, in Calgary, the average wait time for a hip replacement surgery so far this year is 73.6 weeks (almost a year and a half), and 93.8 weeks (almost two years) for a knee replacement surgery. In other Canadian cities, wait times can be even longer.
“Canada already has a two-tier system. Those that can afford to pay get their care in another province or country. This is something that regularly happens in what Mann describes as a two-tiered system. Governments suppress the facts that patients today, who can afford to pay, travel out of province or country and pay a huge fee for these surgeries,” he says. “Many Canadian patients have also learned that they can pay a substantial fee to be part of a healthcare group that helps circumvent waitlists and pushes the patient in for primary care quicker, versus spending the weekend at hospital emergency.”
Dr. Brian Day, founder of the Camby Clinic, challenged B.C.’s legislation, but the Supreme Court dismissed his challenge in July 2022. The B.C. Court of Appeal upheld the lower court’s finding that while long waits for treatment have denied some patients their Charter rights to life and security of the person, those violations are permitted under the principles of fundamental justice. The justices said the laws are meant to ensure equitable provision of health and prevent the creation of a two-tier system where access to potentially life-saving treatment depends on wealth. (In other words, Canadians who wait for required healthcare should expect they could die waiting.)
”Canadians need to better advocate for themselves instead of accepting the status quo,” Mann says. ”We already live in a country with two-tiered healthcare. You can be blind to the fact that it’s happening, but it’s there, and everyone knows it.”
“Our proposal is exactly the opposite. We don’t want a two-tiered system. We want a single system that is fair and equitable.”
“Chartered senior supportive care facilities for long-term care, including quality meals, activities and skilled staff, should likewise be provided and paid for through the private sector, with each province paying for the nursing and health component,” states Mann.
In London, the first two floors of the building focus on preventative health care for chronic health diseases as well as acute care, which includes a walk-in clinic and family doctors and specialists. Pharmacy, laboratory testing and cardio testing are standard tenancies, and they are especially busy along with dentistry, optometry, physiotherapy, plus two large day surgical suites.
The third and fourth floors provide skilled care for senior supportive living, assisted living, as well as memory care.
London, Ontario is an excellent model and Mann advocates for future Advanced Medical & Surgical Centers as superior for both the patient and the senior resident. It is also more efficient and cost-effective. “We have proven that costs can be reduced in comparison to in-hospital procedures and surgeries. This is how the private sector can reduce the cost of healthcare and expedite the process by partnering with the public sector.”
And indeed, cost is always paramount. In Alberta, the latest provincial budget allocates a whopping $22 billion for health operating expenses, an increase of $515 million from the 2021 budget forecast, and not including costs related to COVID-19. Healthcare spending continues to rise across the country, accelerated by an aging population.
Costs will only continue to rise, which is why Mann argues that a nominal quarterly co-payment should be re-introduced to offset rising healthcare costs, where provincial budgets are well above the mandated 35 percentile for universal healthcare.
The expansion of private facilities will also help ameliorate the staffing challenges being felt across the healthcare system. In Mann’s own experience, “people want choices as to where and how they practice. No one is finger-pointing. It is simply human nature that surgeons, specialists, doctors and nurses want to choose where and how they practice. It’s a far better system with choices. Patients should also have a choice as to how and where they receive healthcare.”
Mann also advocates for greater personal responsibility when it comes to preventable chronic health diseases. “Perhaps we need to reward people on their tax returns for working to be healthy, and our overall health-care costs paid by taxes will come down immensely,” he says.
In Alberta, the use of private chartered health facilities is on the rise, with the government announcing this year an increase in the share of surgeries delivered by such facilities from 15 to 30 per cent over the next few years. Ontario also recently announced it would invest more to increase surgeries in existing or new chartered clinics.
“It’s time that we stood up and asked our government and politicians to re-build universal healthcare,” Mann concludes. “Let’s start dealing with the issues and talk openly about it. Let’s resolve how we’re going to look after the citizens of this country who are paying a lot of money on taxes and not receiving adequate healthcare. Let’s do it efficiently in a way that we can provide the services without placing patients with intense pain on endless waitlists.”
Revolutionary thinking in the 1960s is what brought universal health care to Canada. Some 60 years later, fresh approaches are once again required to meet the healthcare needs for a much larger group of Canadians. The time is now to take up the challenge. Lives depend on it.
