The Canadian single-payer health-care system is one of the greatest victories of Canadian workers. However, after decades of clawbacks, millions of Canadians do not have a family doctor. The system is far from “universal”. Even prior to the COVID-19 pandemic, the Canadian health-care system had major problems that contributed to inadequate and delayed medical care. COVID only made things worse.
In 2019, 5 million Canadians had no family doctor, and of those with a family doctor only one in three would be able to make a next-day appointment. Family doctors identify issues needing urgent attention, provide referrals for chronic or more specialized problems, and support the well-being of entire communities. Many Canadians have been forced to rely on walk-in clinics even though they are no substitute for an ongoing doctor-patient relationship. Even accessing care using a walk-in clinic can be difficult when waiting rooms are full and patients can wait for hours to see a doctor.
These accessibility problems are not limited to seeing a family doctor. One study found that the typical Canadian waits 11 weeks to see a specialist doctor (Liddy et al., 2020). The right-wing Fraser Institute found that in 1993, the wait time was 3.7 weeks, whereas it has grown to 10.5 weeks in 2020. Waitlists for specialists are so long that it has prompted a lawsuit asking for the creation of a private system on the side so that rich people can jump the queue. In B.C., the Supreme Court was needed to quash an attempt to subvert the single-payer model in 2020. The proposal that partial privatization can relieve pressure on the public system is a scam. It only diverts resources away from the public system to funnel them into something capitalists can profit from. The capitalists create the problem by underfunding medical care, and then pretend to have a solution. Instead of further chipping away at public health care, we need to adequately fund the system.
Another consequence of severe underfunding is that doctors are being forced to work at an extreme pace. Emergency room doctors sometimes do not have the time to assess patients before requesting CT scans and bloodwork. Radiologists are reading enormous volumes of imaging, unheard of in decades past. Operating rooms are running long hours just to catch up with the enormous backlog of surgeries that were delayed by COVID.
In a rational system, public health care would be considered a common good; something that improves not just the individual’s quality of life, but society as a whole. That health care is put under such stress shows that capitalism is far from rational. To the bosses, health care is an expense needed to make sure workers are just healthy enough to work. Health care is like any other investment to a capitalist. It is most profitable to run it nonstop 24/7 to get the most bang for their buck. Training doctors is very expensive and time-consuming. To ensure capitalists get the most for their investment, the work of doctors has been gradually but surely intensifying. The sweatshop character of medical work has consequences on the quality of care and on patients’ outcomes, with one study finding that doctors were prone to medication errors when they had self-reported higher workloads and had a greater number of patients.
To promote doctors to work faster and longer, the fee-for-service payment model has been deployed throughout most medical practices. That means that doctors get paid more if they see more patients. This leads to family doctors rushing to assess patients with complex medical histories in only 10 minutes. Doctors in private practice are essentially small businesses who have to pay for their own operations. Like other small businesses, they face the prospect of being crushed by the pressures of the economic crisis. From the point of view of workers, this leads to a drop in the quality of care.
Socialist solution
To end the doctor shortage and to provide genuinely universal health care, it is not enough to simply increase funding to health care. So long as capitalism exists, so will the incentive to turn every sphere of life into a means for profit, and the threat to health care will never subside. We need to massively expand our single-payer health-care system, provide free schooling for health-care professionals, end the fee-for-service model that leads to lower-quality care, and increase the salaries of the vast majority of doctors. But the only way to secure these gains for the future is to eliminate capitalism in favour of a system that is truly rational and operates in the interests of all—socialism.
Liddy, C., Moroz, I., Affleck, E., Boulay, E., Cook, S., Crowe, L., Drimer, N., Ireland, L., Jarrett, P., MacDonald, S., McLellan, D., Mihan, A., Miraftab, N., Nabelsi, V., Russell, C., Singer, A., & Keely, E. (2020). How long are Canadians waiting to access specialty care? Canadian Family Physician, 66(6), 434–444.
