Parallel private debate

Some politicians and think tanks have proposed removing barriers to the existence of a parallel private healthcare system. Others note that such systems act to erode cost control and impede equity. Though polling suggests support for such reforms has been increasing, it has yet to be adopted as official policy by any of the main federal political parties.
There are no barriers under the Canada Health Act to private clinics, although provincial governments may or may not permit them. Individual physicians can and do operate private clinics, but there are disputes as to whether surgical procedures can be performed. Two related issues have obstructed the growth of such clinics. One is regulatory - hospital-based quality assurance often failed to encompass them. This gap has been filled in most provinces, but sometimes only after celebrated incidents in which patients died in unregulated clinics, including one physician who performed cosmetic surgery in an Ontario hotel room. The second is economic - there may be no way for physicians to recoup the additional costs of running a surgical facility from their fees. Here, provinces can choose to offer 'facility fees' to these clinics, but doing so has often been contentious, particularly if hospitals felt that these costs would be better devoted to allowing them to increase their operating room time.
Note that uninsured persons can pay for care (including medical tourism), and that insured persons can still pay for uninsured services. These are both niche markets.
Opponents of Medicare often raise issues such as long wait times, a 'brain-drain' drawing qualified professionals away from Canada to other jurisdictions where working in the health care field is more profitable, and impairment of the Canadian health care system due to budget cuts. Fox News ran a story in 2007 reporting that during a period of above average numbers of births, at least 40 Canadian mothers of premature babies had to travel to the U.S. for treatment due to insufficient capacity for premature babies in British Columbia neonatal units. Nonetheless, Canada's Medicare system covered the health care costs of those mothers affected.
In 2003, the Government in Canada spent $2,998 USD per capita on healthcare as compared to $5,711 USD per capita in the United States, while almost every Canadian citizen is fully covered. In the United States a high percentage of the population is uncovered or only marginally covered, despite higher proportional spending along with large private investment.
The lack of competition has given healthcare unions a monopoly on essential services, thus ensuring a very strong bargaining position. Nova Scotia is currently debating healthcare legislation aimed at removing the threat of striking healthcare workers and replacing it with binding arbitration.
Proposed reforms
One proposed solution for improving the Can the rise of neo-conservative economic policies in Canada and the associated reduction in welfare state expenditure (particularly in the provinces) from the 1980s onwards as the cause of degradation in the system. In fact, there is evidence that the percentage of total government expenditures spent on healthcare has been increasing, in part due to a higher percentage of older Canadians.
Other critics of healthcare state that increased funding will not solve systemic problems in the healthcare system including a rising cost of medical technology, infrastructure, and wages. These critics say that Canada's proximity to the United States causes a "brain drain" or migration of Canadian-trained doctors and nurses (as well as other professionals) to the United States, where private hospitals can pay much higher wages and income tax rates are lower (partially because health care is not covered through taxation). Some of these critics argue that increased privatization of healthcare would improve Canada's health infrastructure. Others argue vehemently against it.
Critics of greater privatization state that healthcare should be kept public, (public in funding only, as most services are provided by the private sector including doctors who in most cases are private corporations) in part because it separates Canadians from Americans by mandating equality and fairness in health care. This is in contrast to other states where doctors are on a per capita based salary. In this sense the Canadian Healthcare system is merely a publicly funded where services are provided by a mixture of public and private entities, which most Canadians appreciate and desire. Changing the system to eliminate the balance between public and private service providers to a completely public system is one such alternative.