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June 27, 2023

From: Colin MacKenzie

To: Canadian healthcare watchers

Date: June 27, 2023

Re: Regent Debate Recap

The C.D. Howe Institute’s fourth Regent Debate was a rousing, elegant evening that featured four notable Canadians debating the question of the moment: Be It Resolved, Competition Will Save Canada’s Broken Healthcare System.

A preliminary vote by the 350 people in attendance showed slightly more than half supported the proposition, about one third were opposed and the rest unsure.

Then the debaters had at it, led off by former BC Premier Christy Clark, arguing in the affirmative. Ms. Clark’s argument was that more money is not the only answer to the crisis in the healthcare system, which she said is ranked tenth in a survey of 11 wealthy European and North American economies. And, she said, it is time to move beyond a system implemented in 1966.

“What needs to change? First, we need to stop thinking of healthcare reform as a binary choice. It’s not a choice between what we have now, or having a private, American-style system in which the rich get care and everyone else is forgotten.  

“Let’s stop comparing ourselves to the only system worse than ours and start asking ourselves what the nine better performers are doing and see what we can learn from them,” she said, arguing that the Western European mix of private and public delivers better outcomes.

In rebuttal, former NDP leader Tom Mulcair argued that current moves toward privately delivered healthcare – especially Ontario’s – are being rolled out hastily with little evidence-based analysis and in the face of Canada’s pandemic experience. Beyond that, he said, this nation’s record of enforcement of standards in existing private care is a cautionary tale.

“We don’t enforce in Canada, as we learned during the pandemic, whether it was the privately run Herron residence in Montreal where 47 seniors died in COVID’s first wave or in Bobcaygeon where another 29 people died in a private care facility. This was private care, but there was no enforcement because both provinces had actually reduced the number of people overseeing long-term care.

“And private care is not unimportant in these matters. Consider the Oxford University study published in the Lancet last summer. ‘Private sector outsourcing corresponded with significantly increased rates of treatable mortality,’ was the conclusion.”

For his part, Shaun Francis, chair and CEO of Medcan, opened with a list of government missteps, from the federal Phoenix payroll system, the ArriveCan app, F-35 jet acquisition and public transit.

“What do all of these stories have in common? All were the product of government monopolies,” he said.
“In some ways, as Canadians, we’ve learned to expect such mismanagement. Yet so many of us hang on to the illusion that the monopoly in the insurance and provision of Canadian health care is somehow different. Our steadfast belief in a health care monopoly has resulted in a broken and outdated system.

“And you can be a not-for-profit or a for-profit and still compete. In fact, when they compete, both get better. So this idea that you only can have one or the other, I think is a total fallacy.”

Dr. Danielle Martin, chair of the Department of Family and Community Medicine at the University of Toronto, in her remarks hailed Canada’s COVID response as world-class.

“(It) was built entirely on collaboration and co-ordination. Resolving to eliminate competition and work together was the key to every success we had,” she said, citing vaccine rollout, testing, inter-provincial cooperation and the swift response to the emerging crisis in long-term care homes.

“Competition, on the other hand, is what happened in New York City where, in the first wave, hospitals were overwhelmed with COVID patients while for-profit facilities up the street stood empty.

“Competition is also what happens in the most dysfunctional parts of our Canadian health systems, where value for money is most elusive and frustration is highest,” she said, listing drug prices and a confusing matrix of electronic health records.

After these opening statements, and a round of rebuttals, debaters fielded questions from an expert jury. Then finally, the question was put to the audience once more through an electronic vote. The negative side clearly persuaded the room.

See the full debate video posted on the C.D. Howe Institute website.

Meanwhile, the fifth Regent Debate is slated for this fall. Stay tuned for more details on this marquee C.D. Howe Institute event.

Colin MacKenzie is editor of the C.D. Howe Institute’s Intelligence Memos.

To send a comment or leave feedback, email us at blog@cdhowe.org.

The views expressed here are those of the author. The C.D. Howe Institute does not take corporate positions on policy matters.