While many other countries incorporate private insurance and clinics into their systems to spur competition and shorten wait times, Canada is the only country in the world whose residents are banned from accessing private medical insurance or paying out of pocket for publicly insured services, even when faced with life-threatening delays. My patient asked why private insurers that provide coverage for people with severe dental pain can’t cover those with severe hip pain—and why he couldn’t seek care at a private clinic. “It doesn’t make sense,” he remarked. I agreed. By waiting, he faces serious risks to his health. He is now planning to undergo surgery at a private facility in the U.S. at a cost of at least $40,000. This will alleviate his pain and drastically improve his quality of life. He’s lucky that he can afford that option.

Orthopaedic patients aren’t the only ones going years without treatment—people are also waiting for cardiac appointments, cancer care, life-saving surgeries. Remarkably, the Canadian government allows many patients to suffer and even die each year while waiting for care. Government data reveal that at least 75,000 people have died on public surgical and diagnostic wait lists in the last six years. Canadians often suffer serious pain, limited activity, drug dependence and depression as they serve out a life sentence imposed by the state.

Like most doctors in Canada, I believe that if the public system could provide patients with timely care, there would be no need for a private option. But medicare in Canada has been on a downward spiral for 30 years—and the government can no longer hide behind its good intentions. When I first started working in Canadian medicine in the 1970s, all patients received timely care, and Canada had the second-highest physician-to-population ratios in the world; a recent OECD ranking now places us 35th. There were also plenty of nurses and hospital beds, while today, Canada ranks 31st in hospital beds per capita. Jeffrey Turnbull, a major supporter of medicare and past president of the Canadian Medical Association, summed it up succinctly back in 2010: “You can’t be cured by an idea. You can’t be made healthy by a theory. The system needs to work in practice. And, right now, today, in too many places across Canada, health care isn’t working nearly well enough.” And it’s only getting worse.

The Canada Health Act mandates that every Canadian should have access to medically necessary care, but that system is failing on every front, leaving hundreds of thousands of people suffering. How is this justifiable in a free and democratic society? Shouldn’t Canadians’ constitutional right to life, liberty and security protect them from this serious risk to their health?

These questions formed the foundation of the legal challenge I launched 16 years ago, arguing that laws restricting private health care were unconstitutional. In all other countries—including places like Sweden, Switzerland, Germany and Australia—it’s legal for patients to use private insurance to get faster care at private clinics or hospitals. Their systems, which include a mix of private and public facilities, benefit from competition and choice, shortening wait times for everyone and improving results. I lost my battle in the courts in 2023, but I continue to advocate for the Canadian health-care system. As I argue in my recent book, My Fight for Canadian Healthcare, the goal is not to privatize public care but to add new options that will make our existing system more efficient. For decades, private health care has been maligned as the antithesis of Canada’s ideals, a stain on our sacrosanct vision of a universal public system, an irreversible slide into a morass of greed and opportunism. It might actually be a solution to many of our problems.

I was born and raised in a bombed-out house in Toxteth, the poorest area of postwar Liverpool. I was one of just three students from my primary school class who went on to grammar school: the Liverpool Institute High School for Boys. Paul McCartney and George Harrison were my schoolmates, and I sometimes shared the bus with them. Without my school, the Beatles might never have existed: a classmate of Paul’s introduced him to John Lennon. My friends and I often went to see early Beatles performances at the Cavern Club.

I started medical school in the mid-’60s and moved to Canada in 1973. My professors in London had suggested I spend a year abroad. “Anywhere will do,” they said. I’d recently learned to ski and was somewhat addicted, so I chose Vancouver. Within a day of my arrival, I decided to stay, training in orthopaedic surgery at the University of British Columbia. At that time, care was delivered promptly, and if we needed more operating time, the hospital provided it. No one had to wait. But that golden period did not last.

In 1984, the Canada Health Act was passed, suppressing private competition in our health-care system and banning doctors from charging patients for publicly insured services. That meant private insurance could cover things like eye exams, dental care and physiotherapy, but not medically necessary care like GP appointments or hospital visits. I have never had a problem with that concept. But politicians didn’t consider how they would finance their plans. The legislation made hospitals dependent on government dollars alone. Neither the provincial nor the federal governments could afford to fund them adequately. Emmett Hall, the famed constitutional lawyer and one of the fathers of medicare, once said, “I hope that we do not freeze our principles in legislation or bureaucracy such that we cannot adapt to a future of medicine none of us can imagine.” That’s exactly what happened.

Starting in the mid-1980s, federal funding to hospitals declined precipitously from 50 per cent of total spending to 25 per cent. Innovation stalled, services shuttered and public hospitals closed. The ones that remained were on fixed budgets and therefore unable to fund the escalating costs caused by the pressures of an aging population and advances in medicine. The following decade, hospital beds in Nova Scotia decreased by a third, while Ontario got rid of 20 per cent of its hospital beds. Even emergency........

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