The Washington PostDemocracy Dies in Darkness

Opinion What Alberta’s covid numbers tell us about the deficiencies of Canada’s health system

Protesters against covid-19 public health measures gather near a hospital in Calgary, Alberta, on Sept. 13. (Jeff McIntosh/The Canadian Press via AP)
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Canada and the United States are in equally morose moods about covid these days, but you can be excused for thinking something feels a bit off about this.

Canada’s case rates, after all, have remained lower than America’s for quite some time, a fact once endlessly emphasized as proof of Canadian cultural superiority. What has since become apparent, however, is that low cases are only as impressive as the health-care system’s ability to handle them — and on this front, the deficiencies of the Canadian system may be substantial enough to cancel out other sources of pride.

A look at two jurisdictions on both sides of the border provides a useful study.

In Canada’s recent general election, Prime Minister Justin Trudeau demagogued hard against the province of Alberta as a place getting covid-19 very wrong. In the United States, Republican-ruled states in the Deep South have been similarly highlighted by progressives as covid disaster zones. If we compare Alberta with perhaps the most quintessential Southern state, Alabama (which, coincidentally, has a similar-size population distributed in a similar rural-to-urban ratio), we certainly see both places producing equally depressing headlines: “ICU beds in Alabama called crisis situation” vs. “ICU doctors warn health system on ‘verge of collapse’ ” in Alberta.

These parallel failures are curious, given Alabama’s covid outbreak is much worse than Alberta’s. Beginning in mid-August, Alabama cases spiked to more than 4,000 a day and have only recently leveled to below 3,000. This is easily attributable to the fact that only 42 percent of Alabamans are fully vaccinated. Alberta, meanwhile, has a vaccination rate of 62 percent, and at worst, daily cases from mid-August onward have rarely climbed above 2,000.

Why, then, are both places perceived to be in equal states of “crisis,” producing such strikingly similar stories about overcrowded hospitals and nurses pushed to the brink?

The answer lies in the contrasting capacities of their dueling health-care systems. Though both jurisdictions have roughly the same number of hospitals, Alabama, with a population of 4.9 million, has 1,531 intensive-care unit beds, while Alberta, population 4.4 million, has only 370. (It’s worth noting that in hospital jargon, a “bed” is not just a physical cot but also a health-care worker able to tend to the person lying on it).

Alberta’s 106 hospitals are run by the provincial government through a centralized bureaucracy called Alberta Health Services, “Canada’s first and largest provincewide, fully integrated health system.” A significant chunk of that system’s $23 billion budget comes from the Canadian federal government, though Alberta believes that chunk should be much bigger. Alabama’s approximately 116 hospitals, by contrast, are run in a more balanced way, with a nearly equal proportion managed by the public, private and nonprofit sectors.

Now, with a median household income of just $51,113, Alabama is obviously quite a poor place, while Alberta brags of having a GDP per capita that’s “the highest of any state or province in North America.” Of all Canadian provinces, only Newfoundland spends more on health care. So when a state as poor as Alabama possesses a health-care system with a higher emergency capacity than Canada’s wealthiest province, clearly something has gone terribly wrong.

That something seems to be Alberta’s government-monopoly approach to health care, which has proved adept at delivering what government monopolies so often do: shortages born from government’s finite capacity to give everything to everyone. The Albertan government, after all, is not only obligated to run all the hospitals but is also mandated by Ottawa to provide public health insurance to all its citizens to cover all “medically necessary hospital and physician services on a prepaid basis.”

The rationing required to sustain this generosity — including an average 29.4-week wait for medically necessary treatment — can be shrugged off in good times, but during a crisis when enormous levels of care are required all at once, it becomes horrific. Even if we have no sympathy for Alberta’s current “pandemic of the unvaccinated,” the limitations of the province’s emergency health care (and those of other provinces, for that matter) would be just as disturbing in countless other contexts, including a different sort of pandemic, a terrorist attack or a natural disaster.

Polls routinely show health-care accessibility near the top of issues that matter to Canadian voters, which makes sense. Voters can read horror stories about Alberta ICU bed shortages then flip the page and see projections about deepening government debt and a ballooning Canadian population. Yet health care is also the topic least debated in Canadian politics, given the amount of mud that’s reliably thrown at any politician who so much as wheezes an observation that we could lessen the burden on the public system through a greater role for private care providers.

This tendentious tradition of pretending anyone with a problem with the status quo is a right-wing anarchist once seemed silly. Amid Alberta’s crisis, it now looks deadly.