an old-school doctor. Over a decades-long career, he’s worked nights and weekends and, on his rare vacations, even taken his computer with him to track patients’ test results. In 2019, at 71 years old, he finally began planning to retire from his Saskatoon family practice. He knew he’d have to find more than one replacement for his patients, however—young doctors want a life outside the office, and they couldn’t be expected to put in the hours he did.
All that is changing. Confidence in the publicly funded system has fallen dramatically, the result of decades of political neglect and the aftermath of a crushing pandemic. The Commonwealth Fund, an organization that studies health care around the world, recently ranked Canada 10th of 11 OECD countries in health-care performance, ahead of only the U.S.—even though Canada spends more than the OECD average on health care.
In 1959, Douglas’s government announced phase two: universal physician care, a move that met with instant opposition from physicians themselves. Many of Saskatchewan’s doctors were British expats who’d fled their own country after it created the National Health Service, which made many doctors public-sector employees. They had no interest in seeing the same happen in Saskatchewan, as Douglas’s plan proposed.
The costs kept escalating. Measured in 2022 dollars, national health expenditures surpassed $100 billion in 2001, $141 billion by 2005 and $248 billion by 2017. In part this was because the population had aged dramatically; when the Medical Care Act passed in the ’60s, the median age in Canada was about 26. By 2016 it was 41, but our funding system was the same one created decades earlier for a younger, smaller population. Medical technology had also advanced—and become more expensive.
In 2007, patients complained that Day’s clinic extra-billed them, charging for services that were publicly insured, in contravention of the CHA. Other patients complained that the clinic had overcharged them for services where the fees were set by the province, even for doctors like Day who’d opted out of Medicare. The B.C. Medical Services Commission began an audit of his clinic. But in 2009, Day sued the Commission, beginning what became a 14-year legal battle.
Private care was already creeping in around the edges when the COVID-19 pandemic began and put unprecedented strain on the public system. First, waves of patients hammered emergency departments and intensive care units. Health systems nationwide were working beyond capacity, and so were the people staffing them. Doctors and nurses put in extra hours, showing up to work even when they had to push through crowds of anti-vaccine protesters outside hospitals.
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