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Matthew Lau: We should be free to choose in health care

Canadians should have access to any private options that people who work in health care are willing to supply

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A new Ipsos poll commissioned by the Montreal Economic Institute (MEI) reveals widespread discontent with Canada’s government-controlled health-care system. No fewer than 76 per cent of Canadians say it is too bureaucratic; 72 per cent believe private facilities would provide services more quickly than government-run hospitals; 60 per cent say government health-care spending in their province is unsustainable; 56 per cent want greater access to independent providers; and only 34 per cent say increased government spending has improved their province’s health care.

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Many of these poll results are not surprising: the poor performance of Canada’s government-controlled health-care system is well documented. A 2025 C.D. Howe Institute study compared Canada’s system with nine peers (Netherlands, United Kingdom, France, Australia, Germany, Switzerland, Sweden, New Zealand and the United States) and found “Canada ranks ninth out of 10 countries, performing below the international average in access to care, administrative efficiency and equity — and ranking last in timeliness.” Moreover, all 13 provinces and territories fell below the international average for overall health-care performance.

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Similarly, a 2025 Fraser Institute study comparing Canada with 30 other high-income universal health-care countries (which excluded the United States) concluded that while Canada ranked third out of 31 in health-care spending as a per cent of GDP, we were near the bottom for availability of doctors, care beds, MRI units and CT scanners. A key feature of Canada’s relatively costly and poorly performing system: unlike other countries with universal health care, Canada effectively disallows private insurance markets for medically necessary health-care services.

“Governments should not stubbornly cling to what isn’t working, but should instead look at what does work elsewhere and adopt it here,” MEI economist Emmanuelle Faubert said of the poll. “Canadians clearly want change, and policy-makers should listen to them.” That’s true but even if polls found most Canadians did not want change, policy-makers still ought to deliver it. The case for widening access to private health-care services does not rely on the majority of Canadians wanting it.

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Consider the ability to access other goods or services — for example, garlic. The right to eat garlicky food does not depend on the majority of Canadians wanting garlic in their food. Some people can have garlic, and others not. Those who like garlic should not be able to force it on those who don’t, and those who don’t like it should not be able to prohibit it. Everyone should be — in Milton and Rose Friedman’s famous phrase — “free to choose.”

The same principle applies to health care: people should be free to choose. Canadians should have access to any private options that people who work in health care are willing to supply. As in the case of garlicky food, whether most people want to use private health care or even want it to be available at all is irrelevant in determining whether it should be available. In fact, because garlic causes bad breath while private health care has no such negative externalities, the case for government restricting private health care is even weaker than that for restricting garlicky food.

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Although the economic or moral case for improved access to private health services should not rely on polls, strong support for it strengthens the argument that expanded access to private health care is politically feasible. According to the MEI-Ipsos poll, fully 83 per cent of Canadians believe patients stuck on waiting lists for too long should be reimbursed for treatment in a private facility.

Health-care wait times in Canada really are intolerable. According to the Fraser Institute’s annual survey, the average time between referral from a family doctor to seeing a specialist is 149 days for orthopedic surgery (followed by another 190-day wait before treatment). By contrast, a U.S. survey by AMN Healthcare found the average wait time to see an orthopedic surgeon is a mere 12 days. Similarly, Canadians wait on average 175 days to see a gynecologist, though the AMN survey found it took only 42 days in the U.S. The numbers are not strictly comparable since the AMN survey only covered 15 major urban centres. But, clearly, Canada lags far behind on timely health-care provision.

Canadian politicians should widen access to private health care — not because the majority of people want it but because it is the right thing to do. People should be free to choose something other than the failing government-controlled system.

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