The solution to Canada’s health-care woes? Build something new.

Posted on June 3, 2025 in Health Debates

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TheStar.com – Opinion/Contributors
June 3, 2025.   By Matthew Lister, Contributor

As Canada’s federal government works to dismantle interprovincial trade barriers, it is also a critical moment to rethink how we deliver and coordinate health care in this country.

Last year, I met a woman near Thunder Bay whose husband had waited 18 months for a knee replacement. Their anniversary trip had been cancelled for the second year in a row. They didn’t know when he’d be walking, and no one could say what to expect. Even his care team was frustrated. This example is all too common.

Canadians are accustomed to shortages, including closed emergency departments, lengthy surgical wait-lists, deferred procedures and uneven access to primary care. The supply and distribution network is not built for modern demand. That must change — not only for humanitarian, moral and legal reasons, but for economic ones as well.

The federal government has an opportunity to lead, not by centralizing control, but by empowering alignment. A single province can’t fix a national problem. But a coordinated framework, backed by Ottawa, can help remove long-standing barriers that prevent patients from getting care.

Our health system has acclimated to a scarcity mentality. If only we had more money, the thinking goes, we wouldn’t have wait lists or unaffordable medications. It is largely financed by income and payroll taxes. When the Canada Health Act was passed in 1984, there were six income-tax-generating Canadians for every senior. By 2035, there will be two. That demographic shift demands new, diversified revenue sources — not just higher taxes.

Canada should become a net provider of health services — one that serves its population comprehensively while developing a globally competitive health sector. For instance, instead of designing our health-care to meet the minimum need, let’s build excess capacity and use funds from international patients to subsidize our system. That income would come from out-of-country patients, not Canadians.

This would ease pressure on frontline workers, support thousands of new jobs and generate sustainable economic value, replacing a system straining under reactive taxation-based funding. More importantly, it would begin to resolve the wait-list and resource deficits that have grown steadily across the country over the past three decades.

Beyond funding, national coordination is overdue. Provinces maintain many identical policy and program functions, yet operate them in silos. This duplication adds cost, delays care and fragments service delivery. National alignment would not mean centralized control, but shared infrastructure and common tools, especially in areas such as scheduling and logistics. According to a national Ipsos survey conducted  in March 2024, most Canadians are open to travel for faster care if cost were no object, either out of province or out of country.

A coordinated national function — delivered provincially — could identify, pilot and scale proven solutions. High-performing tools could move beyond local boundaries. Some could even be commercialized globally, turning Canadian health-care problem-solving into exportable value.

Wait lists are expected to rise across primary care, diagnostics, surgery and long-term care over the next three to five years.  To manage this, provinces should coordinate and publish wait-list data and match it to available capacity.  Centralized monitoring is a practical first step.

More than 90,000 Canadians are projected to wait one to two years for orthopedic surgery, currently the longest wait times, according to The Canadian Institute of Health Information.  A short-term, innovative solution could help clear this backlog. Facilities across Europe and the Americas can deliver these procedures within weeks. Patients should not be expected to endure prolonged suffering or absorb the emotional and financial costs of long delays. If the Canada Revenue Agency expects taxes to be filed on time, essential services should meet comparable standards.

Governments collaborate internationally on wildfires, financial crime and national security. Health care deserves the same urgency and cooperation. Therefore, provincial governments must fund patient travel and  care elsewhere to meet clinical timelines, so be it. Accountability should go both ways.

Twenty years have passed since the Supreme Court of Canada’s Chaoulli decision, which found that denying an alternative to the public system when wait times are excessive violates the Charter of Rights and Freedoms. Yet the lines continue to grow.

Canada does not need to replace its health system. However, it does need to evolve into one that harmonizes operations across provinces, supports staff, and provides patients with real alternatives when local options fall short. A sustainable system won’t be built on rationing, complexity or territorial thinking. It will depend on scalable infrastructure, smart workforce planning and cross-border collaboration.

We should stop asking each province to solve system-wide problems on its own. A nationally aligned approach to capacity and access is long overdue. If we believe Canada is stronger when we work together, that principle should extend beyond trade and into the systems we count on most.

Matthew Lister is an independent health-system consultant who works across Canada and internationally with public and private health-care providers and governments.

 

https://www.thestar.com/opinion/contributors/the-solution-to-canadas-health-care-woes-build-something-new/article_e1ca429b-ec33-449d-a945-baed1a756193.html

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