Though vastly superior in both design and outcome to its American equivalent, Canada’s health care system has some obvious weaknesses. Originally established decades ago, it continues to have major gaps in coverage. Thanks to nationalized health insurance, a visit to a hospital or doctor’s office may cost nothing, but a prescription afterward must often be paid out of pocket. Dental, like pharmaceutical care, similarly remains a largely private market covered by a patchwork of means-tested and nonuniversal public programs that vary from province to province.

The real Achilles’ heel of Canada’s health care system, however, can arguably be traced to the cracks in existing public coverage. In advocating Medicare for All, critics of America’s current health care model have rightly argued that the mere existence of any private market would virtually guarantee a two-tiered system of care even if a public option were to be put in place. The same problem, albeit on a much smaller scale, exists in Canada, where private, for-profit clinics for some services have been allowed to proliferate by government policies.

As Andrew Longhurst observes in a recent study published by the Canadian Centre for Policy Alternatives, the outsourcing of care to private clinics often owes itself largely to myopic policymaking. “Severe pressure on our hospitals and a lack of physical space and shortages of health-care personnel,” Longhurst writes, “mean that outsourcing to private clinics is often viewed by governments of all political stripes as a politically expedient policy fix.” The implication, as his report demonstrates, is not only the continued undermining of efficient and effective public provision but also the growth of billing practices that are illegal under the Canada Health Act.