OP-ED: Why healthcare can’t be governed by politics

"Illness doesn’t wait for budgets to pass, mandates to change, or governments to turn over. But healthcare delivery in Canada is repeatedly shaped by those cycles."

Source: Adobe Stock

Author: Ingrid Gahsner

Every election cycle in Canada, healthcare returns to the centre of political debate. Provinces campaign on promises to reduce wait times, expand services, recruit staff, or fix a system under strain. Federally, parties pledge new funding, targeted agreements, and renewed commitments to universal care.

And yet, with every provincial and federal cycle, the conversation resets, while the underlying problems remain unchanged.

This isn’t because governments don’t care about healthcare. It’s because the system is governed in a way that no longer matches how care is actually delivered or what the public now expects from it.

Healthcare is one of the few public systems where outcomes are time-sensitive, clinically complex, and deeply personal — yet it is governed almost entirely through political cycles designed for short-term accountability and visible wins. The result is a system that is constantly re-announced, re-prioritized, and re-branded, but rarely stabilized.

Politics runs on electoral timelines. Healthcare does not.

Illness doesn’t wait for budgets to pass, mandates to change, or governments to turn over. But healthcare delivery in Canada is repeatedly shaped by those cycles. Every provincial election brings new priorities, new targets, and new approaches to delivery. Federal elections often bring new funding frameworks or bilateral agreements, each with their own conditions, timelines and objectives.

Over time, this has created motion, but no progress.

Canada is also unusual in how healthcare is structured because, while universal healthcare exists in many countries, Canada is virtually unique in delegating the delivery of medically necessary care entirely to the provinces, while the federal government limits its role to funding and national principle setting.

In most peer countries, national governments play a direct role in delivery standards, workforce planning, and system coordination. But in Canada, that responsibility was deliberately divided from the beginning.

From day one, the federal government chose to fund healthcare and establish national principles through the Canada Health Act, while intentionally avoiding responsibility for how care would be delivered. Provinces were granted autonomy over organization, capacity, compensation models, and care pathways, with minimal federal involvement beyond enforcing visible billing violations.

That structure made political sense at the time, but over the last four decades this structural divide created fragmentation because no single body was ever tasked with managing healthcare as a system.

As a result, healthcare has become permanently exposed to political incentives. Delivery decisions are shaped by electoral priorities. Funding announcements favour visibility. Structural reform, which requires continuity, coordination, and long planning horizons, is repeatedly deferred in favour of short-term measures that fit political timelines.

This is not a partisan critique. Governments across the political spectrum operate within the same framework and face the same incentives. The issue is not ideology; it is governance design.

Healthcare professionals experience the consequences directly. Clinicians are expected to deliver consistent, high-quality care within structures that are anything but consistent. Burnout is not simply the result of workload; it is the result of working inside a system that is continually reorganized without resolving its foundational constraints.

Patients experience the effects differently, but just as clearly. Access becomes unpredictable. Pathways vary. Options narrow as delays grow longer. The system remains universal in principle, but reliability erodes in practice as each province delivers care differently.

This is not how other critical systems are governed.

Banking and monetary policy, for example, are not managed by elected officials responding to election cycles. Central banks operate independently, with clear mandates, transparent measurement, and insulation from day-to-day political pressure. That independence exists because stability matters more than politics.

Healthcare shares those same characteristics and arguably carries higher stakes. Yet it continues to be governed as a political file rather than as essential national infrastructure requiring continuity, expertise, and long-term planning.

This does not mean I’m suggested we remove healthcare from public accountability. It means redefining how accountability is exercised.

Healthcare delivery requires a non-partisan governing framework, an independent authority or regulator, mandated to manage access standards, capacity planning, workforce alignment, and system performance nationally across jurisdictions. Governments would continue to fund healthcare and define its values. But delivery, the mechanics that determine whether patients actually receive care, would no longer reset with each election.

This is not a call to dismantle universal healthcare. It is a call to modernize and restructure how it is governed.

As long as healthcare delivery remains fragmented and shaped primarily by political incentives, access will continue to fluctuate and reform will remain reactive. If universal healthcare is to function as intended, it must be managed as the essential system it is, through non-partisan, clinically grounded governance that ensures access is shaped by need, not politics.

Ingrid Gahsner is a Healthcare Access Risk Consultant and author of Off the Waitlist: A Practical Strategy for Canadians Who Can’t Afford to Wait.