A treatment room in the emergency department at Peter Lougheed hospital in Calgary, in 2023.Jeff McIntosh/The Canadian Press
Dr. Brian Goldman is an ER physician in Toronto and the host of White Coat, Black Art on CBC Radio One. His latest book is The Casino Shift: Stories from an ER on the Edge.
The history of publicly funded health care in Canada was written by people like Tommy Douglas and Emmett Hall. The future of health care in this country may well be written by Dr. Brian Day.
Three decades ago, Dr. Day opened the Cambie Surgery Centre in Vancouver, Canada’s first free-standing private hospital.
Since then, the veteran orthopedic surgeon has waged an often lonely campaign to bring some measure of private-pay health care to Canada. Along the way, he’s earned nicknames like “Darth Vader” and “Doctor Profit.”
As a staunch defender of publicly funded universal health care, I’ve been dismayed by dangerously overcrowded ERs and ever-lengthening waits for joint replacement (two years or more in some provinces) and other procedures.
Dr. Day first began publicly predicting the demise of Canada’s publicly funded health care system in the mid-1990s. During his tenure as president of the Canadian Medical Association from 2007 to 2008, he advocated against strict government health care monopolies. His recent book, My Fight for Canadian Healthcare: A Thirty-Year Battle to Put Patients First, makes it clear to me he was right all along.
In 2025, I interviewed Dr. Day, and among his main concerns were fixed budgets for health care. Currently, the provinces give hospitals a set amount of funds each year – and since hospitals cannot run deficits on a routine basis, they must stop providing services as soon as the money runs out.
That is the reason why operating rooms sit idle most nights and weekends. It’s the reason why orthopedic surgeons are underemployed and why new graduates often find themselves unemployed.
Alberta defends public-private health care model as experts say it could violate Canada Health Act
Canadians are increasingly fed up with this. Some are so desperate they fork over $30,000 to get a private-pay joint replacement, which is legal in Canada provided you have the surgery in a different province than where you reside.
To see a country that does things the right way, Dr. Day urged me visit Germany, where wait lists for surgery average three to four weeks. Last fall I visited the Charité – Universitätsmedizin Berlin. The hospital does more joint replacements a year than almost any other hospital in the world. It offers a seamless mix of public and private-pay health care. They deliver the same quality of surgery in both systems. The only difference is that private patients get a room that looks like a fancy hotel, and somewhat better and faster access to rehabilitation.
The government pays for each publicly funded joint replacement, and the extra cash earned through private patients subsidizes the hospital.
The system is so much more efficient that a private-pay knee or hip in Germany can be had for roughly half of the $30,000 cost in Canada.
To go this route, the provinces would need to train many more orthopedic surgeons than they do now. At present, there aren’t enough of them to work in both systems, and a private system would drain public hospitals of surgeons and other frontline health care providers.
On a per capita basis, Germany trains many more orthopedic surgeons than does Canada. Doctors in Germany must work a minimum of five years before being permitted to go private. A steady stream of young surgeons means the public system is always well staffed.
Opinion: An urgent prescription for our ailing Canadian health care system
The lack of an adequate number of surgeons in Canada is the central argument against the Health Statutes Amendment Act, 2025, which was passed by the Alberta legislature in December. The act permits “dual practice,” which means doctors could work in both the public and emerging private systems. Critics have said that “dual practice” will lead to longer waits in the public system.
Training more providers would fix that issue. As well, like Germany, the provinces would have to move from fixed budgets to handing over cash for each patient treated. Fees for private patients would lessen the burden on provincial coffers, and the provinces could also encourage competition by giving higher fees to hospitals that get better results.
As well, the Canada Health Act would have to be amended to allow Canadians to have private-pay surgery in the province in which they live.
I’m addressing here how to fix the gap in joint-replacement operations in Canada, but all of this can be applied to other kinds of health care services.
Private-pay medicine will come to Canada as a hodgepodge, by stealth or by open discussion. I prefer the latter, which is why I believe it’s time for Canadians to have an “adult conversation” about private health care.