An Op-ed on Alberta’s move to a Dual Health System
By Masanjay Kromah
Alberta’s move toward a dual health care system raises a question that goes beyond whether patients should have the option to pay for private care. What happens when not everyone has the same ability to choose?
The idea behind dual health care practice is simple. “Dual practice gives you another way to access eligible surgeries while maintaining access to publicly funded care,” The Government of Alberta explains on their website. “Albertans can continue to receive care through the public health system, and may also choose to pay for eligible private surgeries if they do not want to wait.” But choice only means something when people actually have the resources to exercise it. That is where I see privilege entering the conversation. Money is an obvious factor; someone with a high income may be able to pay for private treatment, while someone living paycheque to paycheque may have no alternative but to remain in the public system. But financial privilege is not the only advantage — Having stable housing, transportation, documentation, time, and familiarity with Canadian institutions can also determine how easily someone moves through the healthcare system.
I was reminded of this during an interview with a friend who is pursuing a career in medicine. Her family came to Canada as refugees, and she does not have an original birth certificate. Although she is now a Canadian citizen, navigating documentation and health-care institutions remains difficult. She told me that going to the hospital can bring anxiety, particularly because of her family’s experiences. Her father’s health issues make those barriers even more personal. Her experience made me think of the fact that systems can be technically available to everyone while remaining easier to navigate for some people than others. For immigrants, refugees, people experiencing homelessness and low-income Albertans, adapting to another layer of healthcare may require resources they simply do not have. Instead of narrowing inequality, a system divided between public and private care could potentially make existing divisions more visible and wider.
When adapting to a new system becomes a condition for receiving care, the burden falls most heavily on those with the least power to adapt. The dual health care practice should not stop at efficiency, wait time or individual choice. A new care system should not be judged by how well it serves people who already have options. It should be judged by how it treats the people who have the fewest options. If Alberta is going to create a new system, perhaps the responsibility should not simply be placed on Albertans to adapt to it. The system should be designed to accommodate the realities of the people it’s meant to serve… Otherwise, “choice” risks becoming another world for privilege.
