At least two primary care clinics in Alberta recently came under fire for providing subscription-based programs, where patients pay out-of-pocket for physician services. The response from both the federal and provincial governments was entirely predictable—Ottawa pointed to a potential violation of the Canada Health Act (CHA) while noting it clawed back more than $13 million in health-care transfers to Alberta, followed by Premier Danielle Smith quickly making a strong statement against these practises while restating her commitment to the CHA.

But what many seem to have missed from these events is how the CHA, and the conditional federal cash transfers tied to it (an estimated $49 billion this year), has curtailed the ability of provinces to innovate and experiment with any meaningful health-care reform. Simply put, the CHA is not serving Canadians—including Albertans—well.

Canada’s health-care system offers less availability of physicians and diagnostic technologies—and some of the longest waits for access to emergency, primary, specialist and surgical care—compared to other universal access health-care countries in the world. Despite repeated claims from politicians and members of the media, this is not the result of underfunding. In fact, Canadians pay for the world’s most expensive universal access health-care system (as a share of the economy). In fact, countries such as Australia, France, Switzerland and Germany spend less than or a similar amount as Canada (as an age-adjusted share of their economy) but perform better on many measures of access and performance including the timeliness of medical services.

Why?

These countries have a very different policy approach where patients are free to use private clinics outside the universal system. The private sector is accepted as either a partner or pressure valve, and not perceived as a threat to universality. And each of these countries expect patients to share the cost of care (while offering protections for low-income and vulnerable populations).

Unfortunately for Canadians, according to the CHA, provinces must follow certain rules and restrictions to be eligible for federal transfers. For example, due to interpretations of the CHA, provinces have prohibited private contracts for medical services, even though the CHA doesn’t actually state this and Quebecers have been allowed limited private contracts thanks to a 2005 Supreme Court decision.

This federal restriction and oversight puts any provincial policy proposal or decision at risk. At a moment’s notice the federal government can rattle its financial sabre, and the provincial government (like the Alberta government last week) will quickly fall in line to protect its federal cash transfers, and both patients and providers are left stuck exactly where they were before.

Among the protectors of the failed status quo, there’s no debate about the merits of existing policy and how a new provider or change might be managed. There’s no discussion about the consequences of past policy choices and how other countries have successfully solved the same problems in their universal systems. There’s only a renewed commitment to the failed model in place today, with vague promises of improvement and ever greater spending.

Albertans and Canadians deserve better. Until the narrowness of the current debate changes, and until provinces are freed to implement proven policy reforms following the lead of other more successful universal access health-care countries without the threat of financial penalty, Canadians will remain trapped in a high-cost low-performance universal health-care system.