A recent letter by five advocates for health-care reform, and the predictable meltdown in response by what Jason Kenney on X called the “braindead” Left, is just the latest round in the crazy carousel of this quintessentially Canadian debate.
The mildest suggestion that we might do something to fix our creaking 60-year-old system is met by the sort of tantrum that would do a toddler proud: tears, shrieks, howls, plugged ears, pounding fists. From the more coherent, we get clichés declared with the confidence of proofs. One appreciates what it must have been like to raise an innocent question about supply and demand at an early Congress of the Russian Communist Party.
Never mind that every one of our peer countries does things differently—and almost all of them do it better—because they believe our system is morally superior to the Americans, that’s good enough for these zealots for decline. When your horizon extends no further than North Dakota, being the second-worst health-care system in the developed world is good enough.
I won’t bore you again with the evidence. There have been countless articles about why Canadians should stop myopically comparing ourselves to the Americans and look at how they manage health care in the places we typically look to for inspiration like Denmark, The Netherlands, France, Australia, and New Zealand. I know, I’ve written some of them.
The good news is that it seems Canadians are slowly starting to come around. A poll earlier this year by the Montreal Economic Institute showed that more than half of Canadians—and two-thirds of Albertans and Quebeckers—favour more private health-care options.
Perhaps this is the generational shift that I once predicted would create more impatient patients demanding faster service and increased choice, or perhaps the real-world evidence of our system’s failings has, tragically, touched too many people to be ignored.
The next step in converting this majority support for change into a consensus is to dispel once and for all the two great myths of Canadian health-care reform, the two bogeymen that the supporters of the sclerotic status quo trot out to terrify the masses in the phrase: “two-tier, American-style health care.”
The first myth, that choice in health care and private insurance are “American” ideas, is already vulnerable. The MEI poll showed that although 80 percent of Canadians are unaware of how health care works in France and Sweden, 72 percent think we should emulate them. In other words, it’s a straightforward education problem.
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The emergency entrance of the Northern Lights regional health centre is seen in Fort McMurray, Alta., Tuesday, April 14, 2026. Jeff McIntosh/The Canadian Press.
The second myth is that we don’t already have “two-tier” health care in Canada. In fact, it’s much worse than that: by my quick count, Canada has at least 10 tiers of health care.
Tier 1: You can afford to go to the United States for treatment. This is the tier for those who have a research chair, if not an entire wing, named after them at the Mayo Clinic.
Tier 2: You’re a professional athlete. Do you think Connor McDavid would wait nine hours for treatment? Ismael Koné didn’t.
Tier 3: You can join an “executive” health-care clinic (and your province/city offers them). The choice of professionals in Vancouver, Calgary, Toronto, and Montreal.
Tier 4: You can afford non-U.S. health-care tourism. Mexico and Costa Rica are both popular choices. Our federal government even offers a guide.
Tier 5: You have employer health-care benefits and a health-savings account. This puts you ahead of Canadians who pay out-of-pocket for vision, dental, and other “non-essential” treatment.
Tier 6: Your injury is covered by workers’ compensation. Even provinces fighting to shut down private clinics use them to save on their own workers’ comp cases.
Tier 7. You work in the medical field or have a doctor in your family. Appointments magically open up when there’s a personal connection.
Tier 8: You live in a province or city with better health-care options. Quebec, for example, has a Supreme Court-granted exemption from parts of the Canada Health Act. The rural/urban disparity in health-care access is also glaring.
Tier 9: You have high social capital and a flexible job. Not everyone can afford to wait on hold for hours, follow up repeatedly, demand good service, and get time off from work for inconvenient appointments. If you do, you’ll get faster and better care.
Tier 10: Everyone else.
Next time someone raises the spectre of two-tier health care, tell them: two-tier? They wish! The more people see how broken our current system is, and the more they realise that the better alternatives are not American but Scandinavian and Australian, the closer we’ll be to overdue reform.
Howard Anglin is a doctoral student at Oxford University. He was previously Deputy Chief of Staff to Prime Minister Stephen Harper, Principal…
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The idealized vision of Canadian health care far outpaces the cold reality of lengthening wait times and poor performance, particularly compared to our international peers. Naysayers to reform like to invoke the bogeyman of “American-style, two-tiered health care” whenever criticisms against the system are made. But that supposes Canada doesn’t already essentially have tiered access to health care—there are, in fact, far more than just two.