Is It Time For Two-Tiered Health Care In Canada? - March 28, 2026

Or Should Canadians Pay More In Taxes To Improve Healthcare?

A common complaint Canadians have is that the wait-times for non life-threatening healthcare services and treatments can be quite long, often too long. Three-plus hour wait-times in the emergency room; six months wait-times for an MRI; or, waiting several months for a heart procedure that’s been deemed “non life-threatening” by a doctor. These situations give the affected patients and their families much stress and reason to worry. Canadians across the country have been complaining about wait times and availability of services for years. To address these long-standing complaints about the Canadian medical system, is it time for Canada to adopt a two-tiered health care system? 

A Two-Tiered Healthcare System 

Healthcare in Canada is treated as an essential public service. The system is publicly funded and governed by the Canada Health Act, which requires provinces to provide medically necessary hospital and physician services to all eligible residents. All Canadians have universal access to essential medical care. You cannot be denied care based on income or health status.  The Canadian system is also less complex for both patients (fewer insurance claims to make) and healthcare providers (they get paid by the provincial and federal governments, as opposed to individual patients or their healthcare insurers).  However, under Canada’s current system, while medically necessary hospital and physician services are free, about two-thirds of Canadians have private insurance to cover costs not covered by the public system, such as drugs and dental care.

A two-tiered healthcare system could take on many forms but in essence it would allow Canadians to pay for expedited receipt of services, or to pay directly for services/treatments that aren’t covered under the public healthcare system. 

Critics of a two-tiered healthcare system will argue that private clinics and paid-priority services will allow the wealthy to jump queues, threatening the equal access afforded to all Canadians under the current system.  Critics will also argue that it draws resources away from the public system, increases wait times for the majority, and produces poorer overall health outcomes. 

The United States is generally considered to have a two-tiered health care system, characterized by a mix of public insurance for specific populations (Medicare/Medicaid - see definition below) and private insurance for others. This system often creates disparities in access and quality, where those with better insurance or higher income can access faster and more comprehensive care. The claim of better or more timely service for those with better insurance stems from the business aspect of healthcare in the United States, where healthcare providers charge more for their services when the patients have insurance.  I wrote about an example of this in one of my prior articles, which can be read here. In this article, I cite the example of a friend who sought a heart procedure in Florida and was initially told the hospital invoices an insurance company $450K for that procedure. After some negotiation he was able to get that procedure quote reduced to $19K. When I heard this story I was stunned, but apparently this type of haggling over medical bills is quite common under the two-tiered US system.  As a Canadian, having to pay $19K for a medical procedure was shocking in itself, let alone $450K as originally quoted. If a two-tiered system triggers this type of behaviour, we don’t need it in Canada.  However, this type of gouging could be prevented with better laws and regulations.  In fact each Canadian province and territory currently maintains its own distinct fee schedule or billing rates for physician services and hospital procedures, often established through negotiations with provincial medical associations. These schedules define the amounts doctors bill the public health insurance plan for services, ensuring that "medically necessary" care is covered. Since the Canadian medical system is already accustomed to standardized billing rates, a two-tiered healthcare system shouldn't result in gouging the way the American system does. The healthcare lobby is strong in the United States, as is the sentiment to protect capitalism at all costs, which results in healthcare being denied to some, or bankrupting others who can’t afford their medical bills, under the American system.  As mentioned above, healthcare is considered a universal right in Canada, and other countries around the world, so these worst case scenarios shouldn’t occur in Canada, but universal healthcare does come at the cost of longer wait times and certain services/medications being excluded. 

Note - Medicare is a US federal insurance program mainly for people 65+ or with disabilities, based on age/work history, while Medicaid is a US joint federal-state program for individuals with limited income and resources. Medicare requires premiums and deductibles, whereas Medicaid generally has little to no cost.

However…as a corollary to the story noted above about my friend, his underlying heart issue occurred and was initially treated in Ontario. He pursued and paid for treatment in Florida because he was told by his Ontario doctors that he’d have to wait several months for the heart treatment, because it was deemed “non like-threatening”. With his own funds, he availed himself of the two-tier system available in the US, and received expedited healthcare service.  As far as he knew he wasn’t bumping another patient from the queue.  

Or, are Canadians willing to pay more in taxes to put more money into the healthcare system, with the promise of shorter wait times and greater availability of services?

Higher Taxes For Shorter Wait Times And Better Access 

Below we’ll discuss some of the more highly-regarded healthcare systems around the world.  They tend to be funded by higher taxes and premiums. We’ll look at four such countries and comment on whether Canadians are supportive of higher taxes instead of adopting a two-tiered system. 

Taiwan is frequently ranked number one in the world for healthcare, particularly in the CEOWORLD magazine 2024 and 2025 Health Care Index, due to its high-quality infrastructure, skilled professionals, and accessible universal system. Other top contenders  include Netherland, Japan and Singapore, which are praised for high efficiency and strong patient outcomes. Source - International Citizens Insurance. These countries achieve these high rankings because they often share the following common characteristics: universal healthcare coverage, high investments in medical technology, a high density of qualified professionals, and excellent patient access. - Source - WellAway.

Are The Taxes Higher In These Countries?

Generally, yes, taxes or mandatory social insurance contributions are higher in the Netherlands and Japan to fund their universal healthcare systems, while Taiwan and Singapore achieve high-quality care through higher-efficiency healthcare business models. 

Some specific commentary about these top healthcare systems in the world:

• The Netherlands combines public and private systems. Residents pay mandatory, high premiums to private insurers (around $115–$150/month), but these are heavily supplemented by government tax subsidies. Tax Impact: Top income tax rates are high, reaching ~49.5%, which funds social services including healthcare. 

• Healthcare Outcome: Highly rated for access and quality, with lower out-of-pocket costs than the U.S. Source - Commonwealth Fund 

• Japan uses a Social Health Insurance (SHI) system. It is funded through mandatory payroll contributions and taxes. Tax Impact: Often considered a "moderate-tax" country compared to Europe, but higher than the U.S., taxpayers pay substantial social insurance premiums. Healthcare Outcome: Provides very good public service for a moderate tax rate, with very low out-of-pocket spending for patients. Source - PubMed Central 

• Taiwan operates a single-payer National Health Insurance (NHI) system. Tax Impact: Surprisingly, Taiwan has a relatively low tax-to-GDP ratio compared to many developed nations. Its system is funded by payroll premiums rather than high income taxes. Healthcare Outcome: Ranks #1 in the 2026 Health Care Index by providing comprehensive coverage to everyone, with only 6.4% of its GDP spent on health. Source - Commonwealth Fund 

• Singapore focuses on personal responsibility through the "S+3Ms" framework: Subsidies, MediSave (mandatory savings account), MediShield Life (low-cost insurance), and MediFund (government safety net). Tax Impact: Singapore has low income tax rates (top personal rate of 24%) and a low corporate tax rate of 17%. Healthcare Outcome: It is a low-tax "paradise" that achieves world-class healthcare by keeping costs low through competition and discouraging over-consumption.  Source - Commonwealth Fund 

Paying higher taxes in exchange for better healthcare is certainly one approach, but as we can see from the analysis above it’s not the only way.  

Public opinion among Canadians expresses a reluctance to raise taxes to pay for better healthcare.  An average family’s contribution to the system is already approaching $19,000 annually as of 2025,  nearly double the same cost in 1997, a cost that has risen significantly faster than income. Source - The Fraser Institute. Canadians would rather see efficiencies in the Canadian medical system, and less spending on overhead and management, before they agree to pay more in taxes. 

I have one other story to share, in support of a two-tiered healthcare system.  A friend from Ottawa was recently visiting Arizona with her daughter, who is a doctor in Canada.  My friend travels with a blood pressure machine and did a regular measurement of her BP. She found her BP to be high and was planning to have it looked at when she returned to Canada. Her daughter indicated it could take a while to get the necessary appointments, and wasn’t comfortable having her mother, my friend, with high blood pressure for an indefinite period of time.  So, the daughter went online, found a local doctor who makes “house calls”, and arranged for an appointment later that same day.  The local doctor came by, examined my friend and diagnosed that there was nothing seriously wrong with her, but prescribed some medication to bring her high blood pressure under control.  My friend filled the prescription at a local pharmacy and was/is doing fine.  The cost of the “house call” was $400.  A premium fee paid for expedited service, but it brought peace of mind to my friend and her family.  The doctor didn’t drop any other patients or cancel any scheduled procedures, to see my friend.  No other patient was bumped for this premium service.  One could argue that $400 for a “house call” is excessive, but with the regulated billing rates we already have in Canada, and with doctors having the opportunity to make extra income in their spare time, why not introduce a two-tiered system of healthcare in Canada. The Canadian Medical Association ranks Canada’s healthcare as seventh out of the top ten countries.  We can do a lot better than that!