Alberta’s movement toward a two-tier health-care system is concerning. By allowing physicians to bill both publicly and privately (patient-paid care), the province is gambling with its citizens’ money. If Canada determines Alberta’s new regulations fall outside of the Canada Health Act (federal legislation mandating access to health care without cost to patients), Alberta will be subject to reductions in their federal health-care funding. This won’t impact the province financially as an entity, because the public will be picking up the tab that Canada will no longer be paying for their health care. It will, however, impact individual citizens and, sadly, this is not a level playing field.
A two-tier system reinforces the ridiculous belief that some bodies are more deserving of care than others. Women’s bodies aren’t included in research; Indigenous bodies were used for research without consent; trans bodies have law written to exclude their medical care; and for decades medical practitioners were taught that Black bodies don’t require treatment for pain. These are just a few examples of categories of patients; some are entitled to care, some are not. Alberta has just taken regulatory steps to define who fits into which category. Surprise, surprise: the wealthy are coming out on top.
From a strategic perspective, Alberta putting two-tier health care on the books wasn’t smart. Most regions of Canada have quietly had long-standing access to privatized care. Formalizing it through provincial law may reassure for-profit medical clinics that they can operate with stability in Alberta, but there are two potentially costly downfalls: one, the federal government will have to respond to Alberta’s new legislation (noting the Supreme Court of Canada’s 2023 Cambie Surgeries decision, which denied the legality of two-tier health care); and two, that if or when the feds do declare it improper, Alberta may be liable for any losses those clinics claim.
From a practical perspective, regardless of the apples-to-oranges comparisons being made to countries with successful multi-tier healthcare systems, two-tier healthcare under the current Canadian framework means less people will get access to care. Doctors, who are backlogged and under-compensated, will shift to the for-profit system. People who can afford to will jump the queue and get a disproportional amount of care, because the for-profit system will tell them they need more and more tests. People who cannot pay (by far, the majority) will lose access to physicians and have longer wait times if they are able to obtain referrals to specialists or for tests. It’s not a practical system; it’s a preferential system designed to further line already deep pockets and to widen the divide between the deserving and not.
From a human perspective, health care shouldn’t depend on wealth. People will undoubtedly justify their choice to pay for care, and, if you’re an individualist, someone who puts themselves before or above others, the justifications will sound… justifiable. I understand that people aren’t always selfless, that health anxiety is a real thing, and that it’s human nature to want to save yourself. A community-minded person, someone who values all people equally, will see few excuses to pay for health care in Canada. Doing so jeopardizes the greater system only to benefit the people who can afford the luxuries that make illnesses easier to endure.
The one-level medical system in Canada isn’t—obviously—at peak functioning. But I don’t fault the system. It could work to serve all people equally the way it’s designed. However, doctor shortages, cost-prohibitive equipment, and problematic big pharma policies, among many other factors, limit the operational efficacy of the system.
BC needs to do something, but two-tiered healthcare isn’t it.