This article originally appeared in The Hub.
By Shawn Whatley and Josh Dehaas, August 21, 2025
Inside a Facebook group for Canadians suffering from knee and hip pain, a woman asks whether anyone has had private surgery in another province. An Ottawa man says he went to Quebec. A Calgarian writes that he “paid for a knee in Toronto.” A Winnipeg woman says she went to Montreal. An Alberta resident explains he was able to get his privately in Alberta, but only because the clinic flew in a surgeon from out of province.
Why this nonsensical migration of patients and surgeons? Well, in Ontario, it’s illegal under the province’s health care laws for an Ontarian to pay privately for a hip or knee surgery, but above board for an Albertan who’s just visiting. In Alberta, the law makes it practically impossible for Albertan surgeons to provide private surgeries to Albertans by capping what they can charge, but they can charge whatever they want to Ontarians.
This absurd situation is just one example of how Canada’s health care laws–designed to crowd out private payment for health care–no longer make sense. Ontarians need to recognize that the world has changed since 1966, when Parliament passed the Medical Care Act, which uses federal funding to encourage provinces to adopt universal health care, and the updated version of the law, the Canada Health Act, 1984.
While we should be proud to have public health insurance, we need to stop being nostalgic for an era when that system functioned well. Times have changed. The old way of thinking no longer makes sense. We need private options to relieve congestion in the system–not unlike the private Highway 407 relieves congestion on the public 401.
It will only get worse if we don’t find new revenue for the system. Canada has grown much older since medicare was first rolled out. In 1966, the country’s median age was 25.4 years. Last year, the median age was 40.3 years. In 1970, the median life expectancy was 68.7 years for men. Now, life expectancy for men is 79.9 for men (and 84 for women). Back then, seniors represented 8 percent of Canada. Now, they represent 18 percent. In 2031, they’ll be 31 percent.
As the population continues to age, the demand for health care will only grow exponentially. Meanwhile, Canada’s hospital capacity has shrunk. In 1970, we had seven hospital beds per 1,000 population. Now we have 2.5 per 1,000 people.
Premier Ford’s plan to expand primary care, overseen by former Liberal Health Minister Jane Philpott, is a step in the wrong direction. This plan attaches patients to public clinics based on their postal code. It takes a page out of socialist Henry Sigerist’s 1947 panegyric to state medicine: Medicine and Health in the Soviet Union. Assigned care will not reduce waitlists or improve care if regulations and incentives remain largely unchanged.
To give Ford credit where credit is due, he does seem to recognize the need for more system capacity by extending public funding to create more privately owned clinics. Transitioning some services away from large hospitals, which have expensive unionized staff and administrative bloat, into more efficient, privately-run facilities is a smart move. Private facilities are incentivized to maximize efficiency, service, and quality, since they won’t attract customers or make a profit otherwise.
But private clinics won’t make much difference unless there is a new source of funding. They will only get that by allowing some people who want to pay for faster care to do so.
Ontario should repeal its law that blocks private payment for Ontarians, section 10 of the Commitment to the Future of Medicare Act, and secure a promise from the Carney government that they won’t punish the province by reducing their funding. Contrary to popular belief, the Canada Health Act does not require them to punish provinces that allow for private care, as long as they continue to provide a universal public system.
While ideologues argue that allowing private payment harms equality because wealthier people are “skipping the queue,” that argument doesn’t hold up, considering that the province only provides so much funding for operations, leaving surgeons to twiddle their thumbs when they could be privately operating on Ontarians. Operating on private patients would take those patients who opt to go private off the public waitlist, making it shorter for everyone else.
Critics also argue that ditching these laws would cause the best surgeons to flee the public system and opt to only operate on those who can afford to pay. If that’s genuinely one’s concern, why not regulate this by requiring surgeons who want to operate privately to only do so after they’ve maxed out the available operating time in the public system?
Critics also argue that we don’t have the nursing staff to provide private surgeries and procedures. What they might not realize is that nearly 40 percent of Canadian nurses leave the profession before age 35, often due to a lack of flexibility over their work schedules. Unlike hospitals that require 12-hour shifts, including nightshifts, private surgery centres can offer appealing eight-hour dayshifts to those nurses who would otherwise leave the profession. We suspect there would be far more nursing care to go around, not less.
Finally, critics argue that allowing private surgeries to locals would be a slippery slope to the dreaded “American-style health-care system,” where some people are bankrupted by the cost of care. What they don’t seem to realize is that private surgeries are available across Europe, which generally has stronger, better-performing, and more equitable health-care systems than Canada, in part because allowing some private payments takes financial pressure off the public system.
Incentivizing surgeons to build more private clinics and allowing them to take some private payment would be a win-win. While it’s true that some patients would be speeding toward surgery quicker than others, the rest of the patients would be moving faster, too.
Shawn Whatley is a contributor to Project Ontario, a physician, and a Munk Senior Fellow with the Macdonald-Laurier Institute.
Josh Dehaas is a contributor to Project Ontario and counsel with the Canadian Constitution Foundation.
