opinion: canada risks sliding into the u.s. path of healthcare denial
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a loss of funding for healthcare in canada would mean less support and resources for people in need. this could happen if provinces decide to cut costs from the system.
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millions of americans are about to lose access to healthcare. if you don’t think that could ever happen in canada, think again.
hospital and doctor visits are free to canadians and protected by federal legislation. but determined provincial governments could find ways to chip away at canadian’s access to vital services.
new provincial legislation is needed to secure funding for healthcare services enshrined in the federal canada health act.
in the united states, president trump’s signature legislation reduces subsidies for states to provide health insurance to low-income americans. according to the non-partisan u.s. congressional budget office, more than 10 million americans are expected to lose their health insurance. without health insurance, millions of americans will lose their access to hospitals, doctors and drugs, and be pushed to emergency departments as their only source of healthcare.
ontario, quebec, british columbia and alberta governments each spent in excess of $30 billion on healthcare for their residents in 2024 according to the canadian institute for health information. this is a veritable pot of gold for governments looking to plug huge holes in budgets, especially in provinces hard hit by tariffs.
like what is underway in the u.s., is it possible that a determined provincial government could start a war with its own publicly provided healthcare system in the name of fiscal restraint?
it could happen.
as canadians are seeing in the u.s., the traditional way of doing things can be challenged and upend norms.
the federal canada health act mandates that provinces are financially obligated to fund hospital care, physician services and advanced diagnostics. importantly, however, the act is vague regarding specifics. it does not specify the rate at which funding must be provided to hospitals, advanced imaging clinics or physicians to guarantee access to residents.
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provincial governments could dramatically cut funding to their health systems under this current federal legislation.
massive funding to healthcare systems would target the most costly services first: hospitals, physicians and drugs. the impact could cause canadians to have healthcare delayed, modified or even denied.
hospitals unwilling to abandon their communities would prioritize life-saving care by reducing or eliminating less urgent or elective care. some hospitals would likely need to close or merge to reduce capital expenses. thousands of jobs would be lost. similar to the u.s., emergency departments would fill up with non-emergency cases.
cuts to physician payments would result in physicians moving into private practice or leaving canada for greener pastures, reigniting a brain drain of seasoned experts to more secure or more lucrative settings in unaffected provinces or other countries.
given the vague language of the canada health act regarding funding levels, the federal government would have few levers in response to breaches of the legislation. if the federal government were a willing corroborator in under-funding healthcare, provinces’ health systems would unravel even more quickly.
seniors, people with disabilities and the working poor could find more drugs uninsured by government-funded programs and see deductibles rise.
sure, provincial governments might topple for reshaping the health system landscape and reducing services canadians have been getting for free. but before they topple, the changes they legislate might be hard to unwind especially if their budget shortfall is real and significant.
so, what can be done to buttress core healthcare services for canadians?
new provincial legislation to future-proof provincial governments’ obligation to pay fairly for healthcare services prescribed in the canada health act is needed to further ensure the right of all canadians to access hospitals and doctors without additional out-of-pocket costs.
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experts attribute part of canadians’ longevity to access to free healthcare and less severe poverty among seniors. the risk of not taking strong steps to secure access to healthcare could open the doors to healthcare systems that undermine our health and wellbeing.
jason m. sutherland is the ubc professor of health services and policy and director of the centre for health services and policy research in the school of population and public health at the university of british columbia.
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