The Weekly Wrap: Alberta is right to reform our failing health-care status quo

Yet in the face of overwhelming evidence of these systemic failures, there are still those who cling to the status quo in the name of equality. The idea that people could pay for health care is so offensive, they’d rather that we all suffer equally together. It’s a kind of egalitarianism run amok. These opponents of reform often accuse proponents of private options of being ideologues. But this is precisely backwards. It’s dogmatic to observe the systemic failings of the status quo—to acknowledge its rationing, its backlogs, its dysfunction—and still oppose even modest changes designed to improve access. At some point, the refusal to adapt becomes a kind of faith-based politics: an insistence that equality demands uniform suffering rather than better outcomes. Notwithstanding their predictable criticisms, allowing physicians to work in parallel public and private streams isn’t a threat to the principle of universality. Quite the contrary. It’s a way to fulfill it. Universality must mean more than equal access to wait lists. The Smith government’s proposal represents a pragmatic adjustment that will, over time, expand the supply of services and better align capacity with need. It could facilitate more private capital for facilities and technologies. It could attract physicians from elsewhere who are motivated by a system that recognizes their time and effort. And it could enable a more efficient allocation of scarce public resources by shifting certain services out of the government queue and freeing up space for others. There are, of course, trade-offs to consider. The premier has already indicated for instance that any such model would likely include expectations of meaningful physician participation in the public system. That’s reasonable. And no one seriously argues that private provision alone would be a panacea. It should be paired with broader reforms, including liberalizing the number of medical education slots at the province’s major universities and creating clearer pathways for internationally trained physicians to practice in Canada. But the fact that reforms come with trade-offs is by no means an argument against them. There are always trade-offs. And the current trade-offs of the single-payer model are far worse. The notion of “single payer” is even a bit obscuring these days. Canadians already pay for health care in countless ways. They pay for dental care, vision care, mental-health counselling, prescription drugs, and a wide array of diagnostic services. They pay out-of-pocket for physiotherapy, chiropractic treatment, and fertility services. And increasingly, they pay by travelling outside their province—or even outside the country—for care they cannot get at home. The idea that private payment is morally unacceptable collapses under the weight of its own exceptions. And this is the core perversity of the status quo: For instance if you cross a provincial boundary, you are free as a consumer to purchase health services. But not in your home province. In what other sector would we tolerate a model in which people are forced to leave their community—and often their country—to access services that are perfectly legal to obtain elsewhere? Alberta’s expected reform builds on successful health-care models around the world. High-performing universal systems—from France to the Netherlands to Australia—pair public financing with private delivery, parallel options, and patient choice. They recognize that universality doesn’t require exclusivity, and that equal access isn’t undermined by allowing additional supply. In this sense, what Alberta appears poised to do aligns with the practice of virtually every successful universal model in the world. It reflects the simple insight that allowing more care, more providers, and more options is preferable to rationing. And it takes seriously the idea that access to health care must be real rather than merely theoretical. The premier and her government should be commended for facing these realities squarely. At a moment when the system’s flaws have become unavoidable, they are preparing to advance a proportionate and structural policy response. Opponents will, of course, oppose. That is to be expected. But the government shouldn’t relent in doing the right thing. Alberta is moving toward a system that is more modern, more flexible, and more aligned with international best practice. If successful, it will raise a question for every province still clinging to the failed status quo: How long must Canadians wait—sometimes literally—before reform finally becomes more important than ideology?