On healthcare, you don’t know what you got ‘til it’s gone

The federal election is looming and health care—top of the mind to many voters—is not being addressed much by the candidates in this campaign and was barely discussed in the leadership debates last week. Nurses are invisible. We are quietly keeping the ship afloat, but are at risk of drowning.

So what’s at stake here? Why are nurses and others who work in health care sounding an alarm?

Make no mistake, public health care in Canada is in crisis because it’s being funded without accountability. Public funds are being diverted to private, for-profit agencies and public-private partnerships. Nursing services, for example, are being contracted out to private agencies — and some physician services are as well. These agencies strain the public system because they cost more than our universal system does, yet we foot the bill.

They also channel staff away from our public system. Nurses are tired of working forced overtime and being chronically understaffed and denied time away from work. Private companies pay more and offer flexibility in scheduling. No wonder nurses are leaving.  We need to stop using private-agency nurses and instead channel that money to pay and support nurses in the public system. 

If we can retain nurses in the public system by paying and treating them well, this will transform into more staff and safer workloads. Retention is key. We can’t afford to lose anyone else. Using private agency staff decreases the incentives of management of the public system to hire, retain and properly compensate permanent nursing staff in the public system.

If the public system is left to further crumble, those who can afford it will become more willing to pay for timely care that should be free for everyone. Enter for-profit outsourcing of medical imaging, lab work and diagnostics, as well as private, for-profit clinics. This draws even more people and services out of our public system, creating longer wait times, backlogs and shortages. For-profit clinics and outsourced medical services are creating a two-tier system where those who can pay get access to a service. It also diverts human and supply resources from our public system. We have to recommit to preserving and protecting public health care before it’s too late. Once privatization creeps in, it’s hard to shake it.

We are in a crisis and a turning point in the future of public health care for Canada. 

So what exactly is at stake?

Canada Health Act

The Canada Health Act was passed unanimously by the Canadian Government in 1984. It establishes the core principles that provinces and territories have to abide by to get funding: public administration, comprehensiveness, universality, portability and accessibility. The Act is there to “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”

Provinces and territories are responsible for administering health care but the federal government plays a key role in allocating funding and setting national standards. It transfers funds to provinces and territories and ensures that the Canada Health Act is met. 

There have been some important changes to the Canada Health Act recently. In January, the federal government clarified the Act to expand coverage to healthcare professionals (like nurse practitioners) that provide services previously offered only by physicians. This is important for the principle of universality, because it means there has to be public funding for what is now an out-of-pocket private nurse practitioner clinic system. We are awaiting Newfoundland and Labrador’s plan on this. How it plays out depends largely on who we elect, and their views of, or blindness to, nurse practitioners.

Pharmacare

In October 2024, the federal government approved the Pharmacare Act, which currently  provides free coverage for diabetes medication and supplies, as well as contraception. Contraception being free is a basic human dignity. Women must control when, if, and with whom they have children. The newer long-acting contraceptives are the most effective, easy-to-use, and are of course expensive. Cost cannot be the reason someone doesn’t access birth control. Women’s right to choose is under threat in many countries and this is a good first step to protecting it here at home.  

Diabetes is rampant in Newfoundland and Labrador and comes with a lifetime of monitoring and controlling blood-sugar levels. The easiest medications and monitoring systems are expensive and unaffordable to many. Untreated diabetes causes a litany of  medical issues, including kidney failure, vision problems and heart disease. Managing diabetes is cheaper than treating its many complications. Free drugs and supplies are a good first step here.

The Liberal government brought in this legislation under pressure from the federal NDP. The Conservative Party voted against it, with Pierre Pollieve calling it “radical”. Canada is the only country with free public health care that doesn’t also have free prescription drugs as well. There is a hitch, of course. The Liberals have promised to expand pharmacare to include other drugs, if they are elected. The NDP has promised the same. Interestingly, most provinces, including Newfoundland and Labrador, still have to sign reciprocal agreements with the federal government on pharmacare. Pharmacare is at risk, depending on election outcomes.

Behind the rhetoric and promises, nurses, nurse practitioners and physicians are holding the system together. So where are our voices in the lead-up to this critical election?

I care for people who can’t afford their prescription medications, so they either take them inconsistently or not at all. I see people prescribed medication based on affordability, not efficacy. The best drugs and equipment are out of reach for many who need them most. Pharmacare is a step in the right direction and has to be expanded to include all prescribed medications and equipment. There has been an anti-pharmacare lobby backed by pharmaceutical companies and insurance companies. The Conservative Party has said this Act will prohibit people from having their own private health insurance. This  isn’t true. The Act offers free pharmaceuticals to covered drugs but does not prevent anyone from having their own insurance as well.

Dental care

Last May the Canadian Dental Care Plan was brought in by the Liberals, again under pressure from the NDP. Canada is one of only a few countries with universal health coverage that doesn’t provide dental care. The cost of a dentist is prohibitive to many. I care for people with dental infections and issues that could be prevented with regular preventative care. Treating complicated dental infections is much more expensive than preventing them with regular cleaning and checkups. The federal dental care plan has its critics because it’s not universal. It is only for people who don’t have insurance and requires that people have filed their taxes, something we know many of the most marginalized don’t do. It also requires that net family income is less than $90k. While that may seem reasonable, a deeper look reveals the threat of tying access to income.  Finally, the dental plan is being phased in by age. Right now it is available to people under 18 and over 65. Coverage for the final cohort of 18-64 year olds is something the Liberals plan to introduce in May, after the election. The NDP has said the same. The Conservatives voted against the dental care plan but have said that, if elected, those with it won’t lose it.

What’s the solution?

We have to reframe health care spending as an investment instead of an expense.  In terms of bang for your buck, it’s more cost effective to prevent diseases than to treat them. Public health care is also an industry that provides decent jobs. Investing in health care in an investment in our communities — but investing isn’t enough. We have to know where our public health dollars are going and commit to stopping them being channelled to for-profit agencies. Universal health care means it’s ours, and we all have a stake in it.

We need to promote and defend our public system. We need to expand and protect pharmacare and dental care. We also need to include long-term care in the Canada Health Act.

Speak to your candidates at the door. Ask questions. Because how you vote matters, now more than ever.

The Independent’s 2025 federal election coverage is made possible with support from the Covering Canada: Election 2025 Fund.