Not Universal Enough

In Canada, prohibitive costs mean that one in ten prescriptions are not filled. Many more patients attempt to cut their pills in half for the same reason. This is because Canada is the only Organization for Economic Cooperation and Development (OECD) member country with universal health care that does not include coverage for prescription drugs.

As a result, after making use of the country’s universal physician services, many Canadians are unable to follow through with the advised treatment due to the cost of medications. When people do not take their medication, their health deteriorates and many end up back in an emergency room needing care for easily preventable illnesses. By the government’s own reckoning, these backend costs saddle the system with over a billion dollars in extra health care spending each year.

Canadians spend the third highest amount per capita on prescription drugs in the world. It is only in comparison to the cost of pharmaceuticals in the United States that Canada’s drug prices could appear reasonable. When matched up against the rest of the Global North, Canada’s drug costs are outrageous. Estimates show that universal pharmacare would not only make Canadians healthier, but would also lower spending on prescription drugs by over 4 billion dollars per year due to the ability to purchase in bulk and use generic drugs.

Dental care is also excluded from Canada’s universal health care system. One in three Canadians lack dental insurance and over one in five avoid the dentist each year due to financial constraints. Without access to dental care, people go without preventative services and early interventions, leaving small problems to fester until pain and infection occurs.

Lack of access to dental care results in poor oral health, the consequences of which extend beyond the mouth. Poor oral health has been associated with the following health conditions: cardiovascular disease, diabetes, having a low-birth-weight infant, aspiration pneumonia, erectile dysfunction, osteoporosis, metabolic syndrome, and stroke. Having missing teeth or visible decay can affect employability, further exacerbating the cycle of poverty for those who lack access to care.

Consequences

The pain of a toothache is excruciating. As a dentist, I have seen countless people who have tried to extract their own teeth. Allowing dental infections to go untreated can become fatal when they spread to the brain or compress the airway. A Sioux First Nation’s person recently died from the complications that arose from a dental infection.

Visits to the ER for dental pain cost over $150 million per year, while people are still left in need of treatment from a dentist. ER visits are also made by people who cannot fill their prescription or cannot not access mental health services. There are better places than the emergency department to treat these people, and many of these emergencies would not happen if people had proper access in the first place.

Compared to other countries, provincial and federal governments in Canada are uniquely bad at helping those without access to dental care. Canadian government spending accounts for only 5 percent of dental spending — which is even lower than in the United States, which spends 10 percent — and well behind the UK’s 46 percent and Japan’s 75 percent.

Because Canadians rely primarily on work related insurance and out of pocket payments to access these services, financial downturns result in people losing access to care. During the COVID-19 pandemic, millions of Canadians became unemployed and lost their work-related benefits as well as disposable income to pay for these services. This very recent history illustrates the precarious nature of work-related health insurance.

Access to work-related benefits have been worsening for years — they were getting worse well before the pandemic. Many older people are retiring and losing work-related benefits. The increasing number of workers in the precarious gig economy, which does not provide benefits, is also increasing the number of people without proper health care access.

The result of millions of Canadians being unable to access necessary medical services is a less healthy country. Undue stress is consequently placed on the existing health care system. The COVID-19 pandemic, and the attendant financial downturns, have only exacerbated this problem. And, of course, this is exactly when the health care system has been needed most.

A Window of Opportunity

A report from earlier this year found that Canada had the worst record among wealthy nations for COVID-19 deaths in long-term care (LTC) facilities. This resulted in hundreds of thousands of seniors ending up in ICUs. The problem was exacerbated by the poor performances of private LTC facilities — the death rates in for-profit LTC facilities were several times higher than their nonprofit counterparts.

The cost-cutting efforts of private LTC facilities resulted in understaffing, insufficient PPE, and multiple residents being crammed into small rooms. The money-grabbing miserliness of LTCs led to the deaths of thousands and burdened an already stressed health care system. Canada needs to bring all its LTCs under public control.

There have been few better windows of opportunity to expand Canada’s universal health care system than the one right now. In the 1960’s, universal health care was achieved during back-to-back Liberal minority parliaments that were propped up by the NDP. With the 2019 and 2021 federal elections yielding similar results, the NDP is in a very strong position to push the Liberals to expands the health care system. A new Canada Health Act can be created that outlines the criteria provinces must meet in order to be eligible for the transfer payments needed to fund the new programs. It is simply a matter of political will.

In 1964, the Royal Commission on Health Services stated that a universal health insurance plan for physicians’ services should be established immediately, but that additional services could be included at a later date. Now, over half a century later, these additional services are long overdue.

The expansion of universal health care in Canada to include dental care, prescription drugs, long-term care, vision, hearing, and mental health would increase the health of the population and free up resources within our existing health care system. Universal health care systems tend to cost less than private American-style systems, while achieving better results. To quote Emmett Hall, the head of the 1964 Royal Commission on Health Services: “The only thing more expensive than good health care is no health care.”