Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ digital
    • Subscribe to CMAJ print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ digital
    • Subscribe to CMAJ print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Instagram
  • Listen to CMAJ podcasts
Editorial

It's time to take back the health care debate

Matthew B. Stanbrook, Amir Attaran, Ken Flegel, Noni MacDonald, Barbara Sibbald, Sharon Straus and Paul C. Hébert
CMAJ November 06, 2007 177 (10) 1157; DOI: https://doi.org/10.1503/cmaj.071476
Matthew B. Stanbrook MD PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Amir Attaran LLB DPhil
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ken Flegel MDCM MSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Noni MacDonald MD MSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Barbara Sibbald BJ
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sharon Straus MD MSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Paul C. Hébert MD MHSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading
  • © 2007 Canadian Medical Association

Nearly everyone would agree that Canada's health care system needs substantial improvements. However, as we listen to debates over proposed solutions, we find it frustrating to hear the issue inevitably and exclusively defined for us as a war of public against private.

Instead of taking sides, we at CMAJ demand to know why every discourse on health care reform must inevitably degenerate into ideological warfare. We contend that the public–private framework is an artificial, self-serving distraction that stands in the way of real change.

Canadians are more concerned about the outcomes of their health care than the mechanisms that deliver it. Our system is already a mix of public and private. We have been falsely led to believe that solutions depend upon the victory of one ideology over another. They do not.

We must take back the health care debate and re-focus it to address the truly unacceptable aspects of the status quo. For example, why do millions of Canadians lack regular access to a primary care provider or adequate mental health services? And why does access to some life-prolonging cancer drugs depend on which province Canadians call home? These are the kinds of problems that should arouse the attention and concern of those who seek health care reform. In contrast, wait times for a few elective procedures, although an important issue for many, do not deserve to be the sole focus of resources and attention.

The solution begins with establishing standards that ensure high-quality care across a broad spectrum of health interventions and services, and universal access to all evidence-based essential services. And given the sizeable investment this requires, the health care system must be publicly accountable for delivering results.

These problems and their solutions are neither inherently public nor private. Yet, the perception of an irreconcilable conflict between public and private health care is being actively maintained by both sides of the debate because it serves the self-interest of the actors. Advocates for private health care play the role of the self-appointed heroes of Canada's health care system, and advocates for the public system play the staunch defenders of a Canadian value. These roles give politicians a reliable campaign platform and allow medical entrepreneurs to profit from the debate by cherry-picking and delivering high-volume, easily standardized clinical services, such as joint-replacement surgeries and magnetic resonance imaging. In so doing, they evade responsibility for articulating a compelling vision of how the health care system as a whole will benefit from allowing private-sector involvement. Maintaining the debate frees both sides from the burden of actually achieving meaningful solutions. Regardless of whether advocates support private delivery of certain clinical services, such as CMA's new president Brian Day, or oppose it, such as the Canadian Health Coalition, placing the focus on ideology rather than outcomes is a calculated diversion.

Health care stakeholders, including the general public, should no longer accept being manipulated into a debate that leads nowhere. Instead, we should hold both public and private health advocates' feet to the fire. If Canadians are asked to support an increased role for the private sector in health care, we need to hear more than rhetoric about the private sector's competitiveness and efficiency being the simple solutions to our complex problems. Elsewhere, increased private-sector involvement has invariably meant increased system complexity, greater difficulties with allocation and oversight, and higher administrative costs. Private health advocates must address the issue of how a drain of health care personnel from the public to the private tier can be avoided in the face of already limited and insufficient human resources — without off-loading responsibility for such problems to the public system. And they need to address the fact that many of the businesses providing private health care services clearly violate the core value of equity in the Canada Health Act.

Equally, if Canada is to continue to exclude private delivery models, it should do so because the public system provides better care to more people while being more cost-effective rather than because we have been conditioned to fear that any circumstance in which the terms “private” and “health care” are permitted to be combined will immediately turn us into the United States.

At both the federal and provincial levels, we rely on our leaders to establish and ensure compliance with national standards in a wide range of important health care needs. Courageous federal politicians could use their fiscal leverage to bring our de facto 14-tier health care system up to these standards. We need much greater investments in health care and, in exchange for increased funding, much greater public accountability for the health care system. Politicians who maintain the public–private rhetoric while failing to achieve any meaningful change can be penalized by being denied the privilege of governing us. The debate is ours to control if we care enough to do so.

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 177 (10)
CMAJ
Vol. 177, Issue 10
6 Nov 2007
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
It's time to take back the health care debate
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
It's time to take back the health care debate
Matthew B. Stanbrook, Amir Attaran, Ken Flegel, Noni MacDonald, Barbara Sibbald, Sharon Straus, Paul C. Hébert
CMAJ Nov 2007, 177 (10) 1157; DOI: 10.1503/cmaj.071476

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
It's time to take back the health care debate
Matthew B. Stanbrook, Amir Attaran, Ken Flegel, Noni MacDonald, Barbara Sibbald, Sharon Straus, Paul C. Hébert
CMAJ Nov 2007, 177 (10) 1157; DOI: 10.1503/cmaj.071476
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Ideology and the Canadian health care system
  • Google Scholar

More in this TOC Section

  • Addressing fragmented early pregnancy care in Canada
  • New CMAJ article type aims to help physicians support their patients
  • Time to treat the climate and nature crisis as one indivisible global health emergency
Show more Editorial

Similar Articles

Collections

  • Topics
    • Health care coverage
    • Health policy

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected]

CMA Civility, Accessibility, Privacy

 

Powered by HighWire