By Shawn Whatley
April 16, 2025
Introduction
Canadian health care is ripe for major reform. In 1965–66, Canada experienced a paradigm shift – a “big bang” policy change. Since then, the core relationships between patient, state, medical profession, and labour remain the same. For 60 years, political actors have focused on policies that promise incremental change and avoid major reform. Medicare might be one of the most durable and change-resistant set of policies in Canada.
A few people have called for major health care reform based on market mechanisms aimed at expanding patient choice, improving access, and increasing the freedom of providers to innovate based on patient needs. But major reform requires more than a vision or detailed plan. Major reform only comes with change in the decision-making logic of the whole policy environment. We must address the policy logic that sustains the current paradigm or attempts at reform will fail.
Carolyn Tuohy, professor of political science at the University of Toronto, asked recently, “Why are ‘big’ policy changes launched at some times and in some jurisdictions and not others?” She argues that change starts with a combination of political will and political capacity. Political will pertains to whether those involved in the health care system are willing to risk change as part of a broader political agenda. Political capacity pertains to the ability of those involved in the system being able to “[mobilize] sufficient capacity.” However, will and capacity also require “windows of opportunity” to open – “accidents” of history. Change results from a combination of factors including assumptions, individuals taking action, capacity, and other elements that combine to create a new, “accidental logic” that animates change.
“The intersection of key elements of the policy framework can trigger unintended shifts in legitimating principles. This is true even in the case of the landmark ‘internal market’ reforms of 1989–90 under the Thatcher government in the United Kingdom. The concept of the transformation of the hierarchy of the National Health Service into an internal market became a defining feature of the reforms… But the designers of the reforms did not begin with a broad intention to create a ‘market’ as a matter of principle; rather, the concept ‘emerged’ as the by-product of policies designed to change the NHS’s dynamics, by giving more autonomy to the providers and introducing more incentives to efficiency.’” (Tuohy 2018, 553)
Major change is (most) often a by-product of political intention. Of course, it is a given that health care change involves political agency at every step. (In theory, politicians could decide to isolate themselves from health care organization, funding, delivery of patient services, and so on, but isolation itself is a political decision.) Voters experiencing challenges with patient care will insist that politicians opine and take action to change regulation, oversight, and management of service delivery. Politics and patient care are inherently entangled in all developed countries.
The most obvious source of entanglement relates to expenditures. The Canadian Institute for Health Information expects total health spending in Canada to reach $372 billion in 2024 – 12.4 per cent of GDP (the OECD average was 9.2 per cent in 2023) and 34.4 per cent of total spending by provincial and territorial governments – their largest expense. Health expenditures seem to grow in spite of creative attempts to curb them. Again, Carolyn Tuohy noted that between 1985 and 2013, the United Kingdom, the United States, the Netherlands, and Canada each saw increases in both total health expenditure as a percentage of GDP and the health share of total government expenditure, despite a wide range of policy approaches, including “market-oriented” change which sparked heated political debate about “privatization” in all four countries (Tuohy 2018, 559–560). Over the 28 years that Tuohy examined in her study, even the governments that aimed to shift services off public balance sheets still saw a relative increase in government spending on health care. Despite increased spending overall, Canada was the only country able to achieve a modest decrease in the public share of total health expenditure – a pyrrhic benefit that brought with it world-famous wait times ostensibly due to (over-) rationing.
Canada also stands out for being the only country to disavow market thinking for medical services. Thirty-two out of thirty-eight OECD countries have universal health care, and most of them also include elements whereby patients pay at the point of service, or have some choice, or experience other market mechanisms. What are recognized as obvious elements of patient care in other countries appear equally obvious guarantees of political failure in Canada. Canadians have been taught to see market thinking as a threat to universal access. Questioning the capacity of a single-payer, publicly funded approach seems to undermine the Canadian conviction that progressive taxation should cover the cost of care. As political economist and Macdonald-Laurier Institute Managing Director Brian Lee Crowley noted in his 2009 book Fearful Symmetry: The Fall and Rise of Canada’s Founding Values, Sir Wilfrid Laurier’s “most famous declaration about Canada’s values (‘Canada is free and freedom is its nationality’) is far more stirring than its modern equivalent: Canada is free health care and Medicare is its nationality.”.
Thus, the political environment in Canada places an artificial constraint on potential health care solutions even before any consideration of particular policy problems. Political leaders must choose from a short list of safe policy options that do not threaten the status quo. In general terms, leaders can either promise new programs (increased spending), or they can promise better management (increased efficiency). Many leaders pursue both. In the pursuit of new programs and/or better management, campaign managers hunt for two or three practical, easily understood policy options that promise improvement, while avoiding upset to the status quo should they give the impression that they are trying to insert market mechanisms into medicare. Pursuing a short list of safe policy options decreases the risk of an election becoming a referendum on health care. (Politicians who promote tangible goals also appear courageous and accountable, which endears voters.)
This approach produces incremental change, at best. However, incremental change fails when Canadians need change at a scale and pace beyond what any government can fund or manage (see evidence of the need for growth below). In 2025, Canadians do not need political parties to focus all their energy on only two or three concrete policies; patient care needs are too broad and acute. New policies and pilot projects foster incrementalism, at best, or no change at all: we cannot implement all the pilot projects we have already on the go.
This leaves political leaders in a terrible bind. Voters cling to the belief that they will get free care when they need it despite performance measures that say otherwise. Most measures – for example, wait times, access to technology, hospital capacity, etc. – indicate that we cannot meet the needs of our current population, let alone those of tomorrow’s older, sicker population. This means that political leaders must project their commitment to voters’ (false) belief in a medicare system that promises care, while at the same time projecting an image that they can control or fix a reality that says otherwise.
In an ideal world, political leaders could bridge the gap between voters’ erroneous beliefs and a disappointing reality. But an ideal world does not exist. Elections pivot on sentiment, impressions, and false beliefs at least as much as on evidence and logic.
In any election for public or private office, a candidate must appeal to a bare minimum of shared opinion within the majority of constituents in question. Candidates who are determined to run on broadly unpopular positions end up assuming an outsider’s critic’s voice by default. Canadian parties that are focused on winning generally play it safe by sticking to 2 or 3 concrete policy ideas. By doing so, they eliminate the risk of offending the shared bare minimum of public opinion, but that stance also guarantees minimal change given the broad range of policy needs.
Instead, political leaders need an approach to health care that can survive (and win) elections; address urgent, broad-based shortages; and shift the assumptions of the current health care paradigm.
Canada needs a political platform for change that appeals to a shared bare minimum consensus on health care. However, recalling Tuohy’s notion of “accidental logics,” Canada does not possess the logic, or combination of factors, required to make change. Furthermore, the logic we need cannot be acquired by direct intention. It comes about, in part, by the accident of history – a by-product of our policy intentions. But this is not a cause for despair or policy nihilism. Instead, we need to adjust our approach to policy-making such that we build with accidents in mind. To borrow a term from economics, we aim to increase the likelihood of creating positive externalities. We should think in terms of finding wedges into the current paradigm or “logic” without causing panic among the voters. This requires a focus beyond policy incrementalism and towards change in the environment in which policy occurs – we need to help a new logic emerge.
A campaign for growth offers a way to shift the logic, address current gaps in patient service, and prepare the policy soil for large-scale change that Canada so desperately needs.
This piece argues that
1. Need: Canadians need more health care. In many cases, we could double current service levels and infrastructure and still fall below average levels available in other high-income countries in the OECD. Canada needs a time-limited vision for massive growth – a vision larger than any detailed plan could encompass.
2. Funding change: A vision for growth requires diverse sources of funding. At this point, discussions around diversification should emphasize a broad-based shared bare minimum of public opinion and avoid discussion of patients paying for care themselves (including co-pay, deductibles, user fees – anything that requires patients to open their wallets for care). The point of pursuing funding diversification is to shift the current “logic” of our policy environment – and not simply secure a new funding stream – that can fully meet all the needs created by growth. We want to “trigger unintended shifts in legitimating principles.” The process of funding diversification could start with a change in the current regulations around charitable donations and systems of group access. But this is only a start. Diversification itself will develop over time beyond charitable sources as new proposals surface and public sentiment changes. Again, the aim is to foster larger change that will result as a by-product beyond the initial intention.
3. Management reform: A time-limited vision for growth, with even small changes in funding, will spark management reform. This reform will be organic and driven by necessity as managers shift their focus from maintaining the status quo, single-payer approach towards a new mindset of addressing growth supported by multiple funding sources.
The needed change in health care is larger than any government can afford or manage. This article builds on a bare minimum of shared public opinion to offer a small but meaningful step – a wedge – towards more fundamental reform in the health care system.
Why the current approach is failing
The current approach of policy shortlists and incremental change fails in large part because the approach itself is incoherent. Its inability to meet current needs or to change the logic of the present health care paradigm will be discussed in the sub-sections that follow.
Incoherence
The search on the term “Canadian health care system” on PubMed, which hosted by the NIH National Library of Medicine in the United States, produces 4,717 articles on the topic published since 2019, and 20,253 published articles overall. The same search term in Google Scholar returns 19,400 results since 2019, with 3,650,000 overall. If we were building a traditional policy platform, we would input multiple search terms into several search engines. Then we would parse the list to find unique ideas with the best supporting evidence. It seems reasonable to expect our search to reveal several thousand solid policy ideas.
Given a buffet of policy ideas bigger than anyone could ever sample, effective policy groups operating inside the archipelago of healthcare stakeholder organizations must limit themselves to approximately three policy ideas. They focus public-relations and government-relations efforts on those three issues for a period of several years. The pick-three approach works well for individual organizations within the health care system (e.g., unions, professional associations). They can devote resources to changing public sentiment and (ideally) legislation related to specific issues to demonstrate measurable value for members or shareholders.
Voters have ranked health care as one of their top-three concerns for decades, but health care drops out of the top three, and often well below fifth place, when it comes to having an impact on how they will vote. The pick-three approach decreases the risk, for political parties, of an election becoming a referendum on health care; the approach guarantees that health care will never become a ballot concern. It allows parties to say something about health care without saying much of any substance. This applies especially to Conservative parties. Ginny Roth, political commentator and national practice lead at Crestview Strategy, addressed this tendency to avoid hard topics. “When Conservatives are losing, sometimes it’s tempting to opt out of the policy conversations that we think we are losing on. Provincially, this always happens: ‘Don’t talk about health care and education. Conservatives lose when we talk about health care and education.’”
Non-transferable
Political parties use the same pick-three approach to build platforms that promise to “fix” specific issues. For example, political parties promise access to a family doctor, increased funding to provinces by boosting Canada Health Transfer (CHT) payments, or the creation of a national pharmacare program.
However, the pick-three approach is incoherent. Political priorities and patient-care priorities only align if particular health policies can be packaged into easily understood messages to be used in a political environment. This leaves out all of the more challenging and less easily understood, but still critical, policy issues.
Furthermore, the concepts and thought processes used in health policy do not translate into political theory and practice. Health policy and politics are separate social domains. Daniel Bell, former Harvard professor and author, argued that the “techno-economic” social domain (e.g., health policy) operates on the concept of functionality structured around bureaucracy, whereas politics pivots on the concept of legitimacy structured on democracy (Bell 1996, 11). In other words, the pure policy domain is governed by the logic of what may work best to deliver efficient service delivery in a bureaucracy (e.g., market mechanisms in health care), but the political domain is governed by the logic of voter preferences legitimizing certain policy decisions (‘free’ healthcare available to all ‘equally’). When there’s a mismatch between the logics of different social domains, it can be challenging to use the language and reasoning of one to persuade those who are operating on the logic of the other. Thus, it makes no sense to expect the ideas and arrangements in health policy (such as market mechanisms) to be equally viable in the political domain, regardless of how much evidence or how many arguments support it in the policy world. Even if a particular health policy seems safe enough to include in a political platform because of its policy merits, it remains out of place with the political domain itself.
Risk
Finally, choosing a short list of safe, fixable ideas might decrease election risk, but it carries inherent risk after the party forms government. Too often, promises ignore the broader system and fail to deliver the “fix” they promised. The most famous example is Prime Minister Paul Martin’s 10-year, $41.3 billion agreement in 2004 that promised a health care “fix for a generation.” But Martin’s fix did not help as much as hoped, nor last a generation as planned. Unfortunately, this lesson has only been applied to funding fixes; the quest to “fix” using other policy ideas remains. We should remain skeptical of any approach that promises concrete solutions for complex problems.
Health care reform as a by-product of growth
Canada needs a platform for change that appeals to a bare minimum of shared public opinion about health care itself – things such as universality, comprehensive care, and portability – while calling for broad-based change that avoids sending the majority offside. To wit, debate about access (user fees, self-pay, and “private care”) falls beyond the shared bare minimum of public agreement and seems wise to avoid in a political campaign.
We need a political platform that offers hope, improves care, and sparks change without forcing voters to give up too much of what they find familiar.
Governments should pursue a vision of broad-based growth in patient care, while remaining agnostic about management of the growth or the method(s) by which growth is achieved. This vision could be term-limited, perhaps 5 to 10 years. During the period of growth, governments must resist the impulse to manage and plan. The vision should centre on inspiration, not detailed management.
The need for growth
It’s important to note, introducing data invites debate about the data, which risks immobilizing decision-makers. The point of offering the following data is to support voters’ sense that Canadians do not have access to enough care, not to open a paralyzing debate.
A. Wait times and access to care:
i. “Only 15% of patient requiring palliative care receive services in the year before death.”
ii. Only 59 per cent of patients received knee replacements in Canada within the 26-week benchmark in 2023 (21 per cent in Prince Edward Island).
B. Hospitals:
i. The OECD average is 4.1 hospital beds per 1,000 population. Canada has 2.59 and Ontario 2.23. Only Sweden has fewer beds per 1,000 population.
ii. Overcrowded hospitals decrease patient flow. Current occupancy rates in Canada are often over 100 per cent, but we know that 80–85 per cent occupancy maximizes flow.
iii. The Financial Accountability Office of Ontario report on hospital spending: 2.5 per cent average annual growth in funding for health care versus a 3.6 per cent annual growth in spending on health care between 2021–22 and 2027–28.
C. Spending:
i. Canada spends less on hospitals than the OECD average. In 2020, the average “voluntary/household out-of-pocket” spending on hospitals in Canada was $164 versus $203 in the OECD. The average government spending on hospitals was $1,694 per household in Canada that year compared with $1,877 in the OECD.
ii. With 15.3 million households in the country in 2021, Canada would need to increase voluntary/household spending by $600 million and government spending by $2.8 billion to meet the OECD average (an increase of $222 per household in total spending),
iii. “Of 34 selected OECD countries, 20 spent more on hospitals than Canada on a per person basis.”
D. A 2023 Fraser Institute report compared Canada to 30 other high-income OECD countries with universal care systems. Canada was:
i. 1st place for spending as a share of the economy
ii. 28th place for number of doctors
iii. 23rd place for the number of care beds
iv. 25th place for the number of MRI units
v. 26th place for the number of CT scanners
vi. Last place (30th) for surgical wait times
Growth is not a new idea
For much of the twentieth century, the federal government focused on growth, which translated into building all sorts of things – railways, roads, bridges, ports, the postal service, the number of radio shows, the travel industry, and much more. Political leaders had their collective foot firmly on the gas pedal. They had more of a venture capital mindset than a managerial one. Government saw itself as governing the growth of the country.
In health care, the federal government provided incentives for the expansion of hospitals and hospital services with its 1948 National Health Grant Program. In 1957 the federal Hospital Insurance and Diagnostic Services Act further encouraged growth by matching provincial spending on hospital services. The Medical Care Act, 1966 [MCA] also focused primarily on funding medical services. However, the MCA also marked a pivot in federal thinking away from an emphasis on incentives to build and towards more rigorous criteria on how provinces could qualify for funding.
By the time government passed the Established Programs Financing Act in 1977, political leaders had lost all interest in funding growth. The federal government wound down the open-ended stimulus of 50:50 cost sharing with provinces, shifted its focus to making costs predictable, and turned federal attention towards maintaining medicare.
The final turn in federal thinking came in 1984 with the adoption of the Canada Health Act. With it, the federal government took the exact opposite stance it had taken during the growth years of 1948–1966. By 1984, federal leaders had moved their collective foot from the gas pedal to the brake. The feds became the primary restrictor of health care growth instead of an enabler of it. This led to provinces cutting hospital beds and services in the 1990s. As Michael Decter, former Ontario deputy minister of health, said, “We took tens of thousands of hospital beds out of the system – closed hospitals. We did that with very little real insight into the impacts.” In 1993, when the Fraser Institute began reporting on wait times, the wait time to see a specialist was 9.3 weeks. In 2024, the wait to see a specialist increased to 30 weeks – the longest on record. Regrowth eventually returned in the early 2000s in terms of increased funding and expanded services, but it was managed growth such that today medicare runs on a raft of formal and informal agreements, practices, restrictions, and policies. Non-legislative, extra-legal governing structures now curtail behaviour with the force of law. (For an extended discussion, see my 2020 book, When Politics Comes Before Patients.)
Practical application
What might a return to massive but unmanaged growth in the health care system actually look like? What are the issues we might consider?
Too often in the past we have funded growth. This is not the same as giving incentives for growth. According to Decter, directly funding growth tends to grow doctors’ and nurses’ salaries, not clinical services. We can think of growth as akin to trying to turn a giant flywheel. What can we do to get the flywheel moving? What will give positive feedback and make the flywheel turn faster? Simply injecting a large amount of funding won’t turn any flywheels. It gets soaked up by the current state, greasing old wheels that never say, “Enough!”
Furthermore, growth cannot be about doing more with less. That approach simply presupposes that there is a plan for how people should do more with the same or fewer resources. We need something more basic: a vision for more while keeping an open mind about how; an aim to find creative incentives; a concept for removing barriers to growth. We need a push for growth itself; not a push for a plan. We should provide incentives for growth such that those who grow the most get even more incentives.
We need government to think more in terms of how to inspire or spark change instead of trying to create specific change itself. For example, what might happen if 50 per cent of the CHT was tied to growth for a period of 5 to 10 years? We saw what similar thinking did with welfare reform in the 1990s. As Crowley noted in his 2020 book, Gardeners vs. Designers: Understanding the Great Fault Line in Canadian Politics, “This combination of reduced transfers plus the freedom of provinces to design their own welfare system unleashed a wave of exceptionally innovative welfare reforms across the country.”
We should put plans for broader system reform on hold for now. Instead, we should aim to inspire creative destruction within the system we have.[1] This requires that we accept and encourage people who have a mindset focused on innovation. Let them drive the bus. These are people who love to launch new projects, expand, and grow. They think differently from managers and become frustrated with committees, planning, and regulatory oversight. These are the people we need to unleash for the next 5 to 10 years. We should simply describe a vision for more care and then let people come forward with ideas to implement the vision. Note that governments do not excel at implementation; they lack the tools required. Furthermore, career civil servants do not have an entrepreneurial mindset, and the few who do soon learn to operate within a managerial mindset. Civil servants are expert managers of things that exist. They weigh new ideas based on how well the idea fits with the current thinking and management. Starters and builders do not start with management in mind, whereas civil servants do.
Finally, we should emphasize growth outside the current care envelope, for example, growth outside the hospital campus. Hospitals struggle with the administrative apparatus they have already built: much, but not all, of it in response to regulatory requirements. The apparatus becomes like a giant train of supplies and attendants that accompany royalty wherever it goes. There is no question that hospitals need to grow also, but we should put special emphasis on growth beyond current hospital models.
How do we pay for it?
Several specific opportunities to reform the federal government’s approach to funding health care already exist. For example, in 2010 Ken Boessenkool explored opportunities to fix the fiscal imbalance by returning the GST to provinces in exchange for CHT payments. In 2011 Jason Clemens argued that health care would benefit from the same approach that was successfully applied to welfare reform. In 2019 this author applied Boessenkool’s proposal as a means to add governance clarity and to assign accountability for medicare performance and reform. Each of these are big-picture reforms. They expand concepts that warrant attention and implementation. However, they would not work well in a political campaign; they require specialized knowledge and go beyond the “shared bare minimum consensus” required for electoral success and focus on reform of the federal government’s “functional rationality” (i.e., bureaucracy). These are not the kinds of concepts that resonate with voters.
Furthermore, emphasizing precise processes for payment has the same effect as creating a detailed plan for growth. In order for a vision for growth to work as a lever for reform, the only restriction on funding reform should be to avoid individual patient self-pay. Beyond that one restriction, we should explore as widely as possible changes to charitable funding, group/co-operative funding, prepayment, and more. The best ideas will come from those working in the sector and those who have experience working elsewhere. We should aim to simply offer a place to start.
For example, we might explore deregulation of charitable giving. Hospital foundations can only use charitable donations for capital costs, not operational expenses. Were the government to allow funding of operational costs, it would shift managers’ focus (and behaviour). Donors would be eager to have a whole ward open and staffed in their name – it would allow access for them when they needed it. If too many small hospitals would miss out on the innovation, we might consider a 2:1 foundation funding for partner hospitals. Large downtown hospitals have more donations than they know what to do with (large wards sit empty due to rules against operational costs), while some small hospitals have no foundation at all. The government could adjust deduction limits on charitable donations. Donations are only tax deductible up to the top marginal tax rate. We could double their impact by making donations fully tax deductible for donations towards growth in clinical services during a specified growth term. We might simplify the process of creating and approving new charitable entities focused on clinical services in order to encourage the expansion of this funding approach. Communities could be encouraged to create their own, local charitable organizations to fund medical services much the same as hospital foundations do now.
Again, adjusting our approach to charitable donations is only one option (among many) to address health care funding. It is not a solution for fixing all funding shortfalls. But it is a lever or wedge that could drive broader reform. We saw how the Pay for Results (P4R) program in Ontario, which started in 2008, drove significant change in many hospitals. The opportunity for hospitals to earn even $100 to $400 per patient drove many (though not all) hospital managers to refocus their attention on wait times and patient flow. Overall, it led to a 28 per cent reduction in wait times during the first two years, with larger reductions in specific cases.
Management reform
Management changes little, if at all, by direct intervention. As mentioned above with P4R in Ontario, profound management changes can occur rapidly in response to often minor changes in its environment. However, management exists within a system of constraints. Managers can only perform as well as their institutional constraints allow. In health care, constraints steal time and resources away from patient services, which in turn drives growth in administrative costs. Canadian spending on health administration grew from $6.1 billion in 2014 to $11.4 billion in 2024. The growth in administrative requirements also affects clinicians. In Ontario, physicians must now spend 19 hours per week on administrative tasks. In some jurisdictions, primary care physicians must spend two hours of time with their electronic health record for every one hour spent on direct patient care.
Constraints are always built to achieve or protect some end: quality, safety, risk, and so on. But when managers must attend to thick and detailed departmental policy manuals, extensive rules and regulations, aggressive labour groups, intrusive (inexperienced) boards of directors, and adversarial media outlets, managers will not be able to focus on patient care. And these constraints are only those arising from within a manager’s own institution. Managers also have to attend to outside constraints such as ministry directives, comments made by the provincial or federal minister of health, public health directives, professional regulations, and much more. They must perform inside these constraints while staying vigilant about activists and media outlets eager to promote and leverage poor performance outside the norm. By necessity, managers spend most of their time trying to avoid insulting or provoking decision-makers in veto positions. This is why simply moving services out of hospitals affords a 20 to 40 per cent savings for the identical services, while maintaining or improving the quality of those services. Independent health facilities have (for now) a tiny fraction of the constraints imposed in the hospital environment. Many highly regulated industries exist in Canada, but none compare to the level, degree, and diversity of constraints present in Canadian hospitals.
Absent (minor) funding reform, any change in management mindset faces opposition from the status-quo tendency to operate in deference to whatever the sole funder wishes. Management always aims to satisfy the wishes of those who fund it.
Conclusion
Canadian health care is ripe for a large-scale change. Canadians need more care – more than any government can fund or manage on its own. Even so, government plays an irreplaceable role in establishing the health care policy environment – shifting the “logic” – in which patient care takes place. Political leaders should adopt a broad-based, time limited, robust vision for growth in clinical services based on a shared bare minimum of public consensus. They should avoid planning and management. Let the builders build.
Even a time-limited vision for growth will require diverse sources of funding. Again, those funding mechanisms should not be dictated; innovation should be encouraged, creativity rewarded, and only self-pay kept off the table. Changes to charitable donations offer a place to start. Openness to other options such as community funding, group funding, and direct primary care also seem wise. They could each offer ways of breaking into the rigid status quo, if considered carefully.
Finally, governments should avoid detailed programs and attempts to manage outcomes. Managers never change simply because a new program becomes popular. They only change when their environment changes. The biggest environmental changes relate to funding diversification.
Growth runs in the Canadian DNA; it is not foreign; it is just as much a Canadian concept as many others. We need a new time of enthusiastic, robust growth. We need to embrace the means of change if we hope to meet the needs of patients in the future.
About the author
Dr. Shawn Whatley is a physician and author of the recent book, When Politics Comes Before Patients – Why and how Canadian Medicare is failing. He is also the author of the highly praised book on how to fix emergency wait times in Canada, No More Lethal Waits. He has extensive experience in health care administration and medical politics. Whatley is a past president of the Ontario Medical Association (OMA).
[1] Note that “creative destruction” does not mean tearing down. It means innovation that maintains aspects of old functionality but surpasses the current status quo by offering new functionality to a broader base.
