Harrison Ruess: Canadian health care desperately needs an HBO moment

Why is Canadian health care the greatest in the world? It isn't.

By: Harrison Ruess

The Newsroom was an HBO show that was on the air for a few years starting back in 2012. It was created by Aaron Sorkin (The West Wing) and starred Jeff Daniels as a centre-right television news anchor.

In the show’s opening scene, Daniels’ character is on a college campus auditorium stage participating in a panel discussion alongside a Democrat and a Republican. As the scene proceeds, a college student named Jenny comes up to the open mic and asks the three panellists to explain, “in one sentence or less, (hah!) why America is the greatest country in the world.”

Without hesitation the Democrat says, “diversity and opportunity,” while the Republican offers, “freedom and freedom.” Daniels’ character, after the moderator prods him for giving non-answers, goes on one of the better fictional political television tirades. In it, he runs through various statistical measures — life expectancy, household income, infant mortality, literacy, etc. — that demonstrate there’s no evidence to support the premise of Jenny’s question.

(It really is a great scene and you should watch it. Warning though: there are a couple f-bombs … it was HBO after all.)

Now, you’ll be forgiven for asking why you’ve just read three paragraphs about the opening scene from an American TV show that aired a decade ago. Here’s why: go watch that opening scene again, but this time whenever you hear the word “America,” replace it with the words “Canadian health care.”

Really, go do it. I’ll wait.

Does that version hit a little closer to home?

Millions of Canadians are extremely proud of our health-care system. They defend it and are utterly convinced of its greatness. They react with hostility to any hint of change.

But on what basis could Canada make a claim to health-care greatness?

According to OECD data, on life expectancy Canada ranks 16th. On mortality rates from avoidable causes, we’re 23rd. On cancer survival rates we range from 13th down to 18th, depending on the cancer type. On the number of one-year-olds vaccinated for diphtheria, tetanus and pertussis, we rank an abysmal 37th (even the U.S. is higher here at 27th. Gulp.). One area where we do rank closer to the top is spending as a proportion of GDP, where we sit at seventh. 

In modern parlance of TL;DR, what the OECD data says is that Canada spends a disproportionately large amount of money to get strongly mediocre health outcomes.

For an overall picture we can look at the World Health Organization’s ranking system, which measures, “responsiveness (both level and distribution), fair financing, and health inequality, in addition to the more traditional goal of population health.” Here, Canada ranks 30th overall.

“But…” I’m sure you’re about to say… “Canada has universal health care!” 

Yes. And that’s good. But the shortfall of that argument is that dozens of other countries have universal health care and many also have far better overall outcomes. In short, universal health care access is not a unique feature in Canada. For instance, a few notable countries from the WHO’s top 10 include France, Italy, Singapore, Spain, Austria, and Japan. These are hardly countries that let citizens go bankrupt or die in the streets when they need health care.

So why are we so darned committed to defending the Canadian status quo?

I genuinely can’t make sense of it. Canadians are smart, sensible people. We want the best for ourselves and our children. But at the same time, we have a very long history of refusing to change and improve our health care despite every piece of evidence that says we desperately must do better. The COVID pandemic has made this especially clear over the last couple years, but none of this is new.

As Robyn Urback recently asked in the Globe & Mail, “When do we admit Canada’s health-care system just isn’t working?” and as Matt Gurney pondered on TVO, “When can we start trying to make it [better]?”

Despite all the gloom recently, I am genuinely hopeful the answer to both these questions can be “now.”

If there is any piece of good that may come out of COVID, perhaps it will cause enough Canadians to wake up to the fact that the status quo simply cannot hold on any longer. Our hospitals operate at or near capacity at the very best of times. We are ill-equipped to handle minor health crisis like annual flu seasons, to say nothing of a global pandemic like COVID. Protecting our dangerously fragile system is why we’re some of the most locked down people on the entire planet right now.

With the optimism that maybe we can finally have a real conversation about improving Canada’s health care, I propose three ground rules to start the discussion:

First, we all agree that we’re compassionate, patriotic Canadians and together we understand that our health-care system must do better. Every piece of data on this point is clear. It is not un-Canadian or uncaring to want our country to be as good as it can be. On the contrary: what is un-Canadian and uncaring is continuing to insist that our fellow citizens — including health-care workers themselves — suffer through a system that clearly isn’t up to snuff.

Second, we all agree that nobody (literally: nobody) is seriously proposing that we recreate the U.S. health-care system in Canada. As bad as Canada ranks (#30), the U.S. is ranked by the WHO even lower (#37). The Americanization argument is a strawman that only attempts to scare Canadians, stall progress, and defend our failing status quo. 

Third, we all agree to the (obvious) fact that there are numerous countries on our planet other than Canada and the United States. Admittedly, this is related to the first two ground rules, but it’s worth saying explicitly: we must move beyond rooting all our health-acre debates in a “Canada vs. U.S.” framing — neither system is one worthy of bragging rights. There are many health-care systems and models in the world that we can look to for inspiration. Twenty-nine of them objectively perform better than ours, generally without spending much, if any, more money (in relative terms) than we do. Let’s have a mature discussion about which elements of the very best performing systems we can adopt for Canadians.

With our lives literally on the line, I hope this isn’t all too much to ask.

I’ll end my piece as Jeff Daniels’ character ended his: “The first step in solving any problem is recognizing there is one. (Canadian health care) is not the greatest in the world anymore.”

If we can make the admission, we can get on with fixing it.

Harrison Ruess is a campaign director and political advisor in Ottawa. This essay is submitted as an individual. No, he doesn’t work for HBO.

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