Josh Dehaas: Let's keep those 'medical tourism' dollars in Canada

Canadians are already paying for private care. They're just doing it in the United States.

By: Josh Dehaas

In response to Trump’s trade war, many Canadians have taken an “elbows up” approach to spending on vacations in the U.S. They’re choosing to spend more of their savings here at home than in the Great Satan land.

This makes perfect sense. So why not make it possible to do the same with health care?

In most of Canada, if you need an MRI or a knee replacement, your only choice in most provinces is to suffer on a waiting list. The median wait time last year for an MRI was 57 days. The median for a knee replacement was 151 days. These are bleak numbers, but they actually badly understate the difficulty in accessing these tests and procedures — one must first get a requisition for a scan or the order for the surgery to even get on those wait lists, and that process can also take months. Sometimes years.

Meanwhile, just a few hours from Toronto in Buffalo, N.Y., you can get scanned within days, and operated on within weeks.

Many Canadians do just that, sucking money out of Canada. Why not let these Boomers spend those dollars here instead, where they can create Canadian jobs and generate revenue in Canada’s economy? A simple reinterpretation of the Canada Health Act to allow some procedures to be purchased here could inject many millions into Canada’s economy. Alberta is poised to try this with Bill 11. Prime Minister Mark Carney can help by making clear that he doesn’t intend to punish provinces by cutting transfers if they make these common-sense reforms.

Many Canadians fear that allowing more choice will drain resources from the public system. In fact, the opposite is true. Consider MRIs. Canada ranks 34^th out of 37 wealthy countries for MRI units per capita due to government rationing. If private-pay options were available, there would be more money to buy machines, paid for primarily by people who would otherwise be spending their money in the U.S. or other medical-tourism destinations.

There would also be more money to pay radiologists and technicians. Right now, shortages exist in this area, but only because of government rationing. If private payments were allowed, the job market would respond accordingly over time. Commentators who claim otherwise are ignoring the basic reality of supply and demand.

Another common retort is that opening up choice would cause the public wait lists to grow, at least until the market responds. This is not true — if the rules are designed right. As surprising as it may sound, many surgeons are currently unable to get enough publicly-funded operating room time in hospitals to fill their days. Allowing them to charge for surgeries in private ORs when they can’t get space in public hospitals wouldn’t cause waitlists to grow, because they’re not able to operate full-time as it stands. To allay any such concerns, provinces can do as Alberta’s minister has said they plan to do, putting conditions on surgeons to only allow taking private payments after they’ve devoted a certain amount of care to patients on public waitlists.

It’s a popular misconception that the 1984 Canada Health Act prevents Prime Minister Carney from allowing this type of change. It doesn’t. The act was designed to force provinces to provide universal care in exchange for federal funding, in part by banning “extra-billing,” and giving Ottawa the authority to withhold funds from provinces that allow extra billing to take place. Extra-billing is defined in the act as “billing for an insured health service rendered to an insured person by a medical practitioner or a dentist in an amount in addition to any amount paid or to be paid for that service by the health care insurance plan of a province.” This means that doctors can’t double-dip by charging the public plan to provide a surgery or scan and then also charging a patient or insurer an extra fee on top of that.

The federal government has misinterpreted extra billing, often with provinces turning a blind eye, to mean charging any amount that is higher than what the provincial plan pays or would pay, even when the province is not being charged. As a result, in 2023, the Trudeau government fined those provinces that experimented with allowing private diagnostic scans $76 million, claiming this was extra billing.

Punishing provinces for letting patients leave the government waiting list to get care is cruel and counterproductive. Mr. Carney could reverse the Trudeau-era interpretation of extra billing tomorrow, giving the green light to provinces that want to cautiously liberalize the market while still protecting public care, as Alberta intends to do.

And he should. There’s not much Canada can do about Trump’s tariffs, but we can create new economic growth — and a healthier society with less avoidable pain and suffering — by liberalizing health care.

Josh Dehaas is Counsel with the Canadian Constitution Foundation, a non-profit that protects rights and freedoms in Canada including healthcare liberty.

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