The well-connected find ways to jump the health-care queue while everyone else waits months for treatment

The Manitoba Auditor General made headlines in 2017 when a report revealed that athletes, politicians, health-care workers and donors were receiving diagnostic scans within days of their request, while the average Manitoban waited upwards of 23 weeks.

The report exposed something uncomfortable that Canadians continue to grapple with: Canada already has a two-tier health-care system, one for those with wealth and connections, and one for everyone else. Hardly a surprise. Systemically inadequate capacity inevitably breeds informal and unfair workarounds.

Yet, in the name of preserving equity, most provinces prohibit the very solutions that higher-performing universal health-care systems use to improve patients’ access to care.

The Manitoba report was hardly an isolated incident. Across Canada, long wait times continue to define the patient experience, while concerns about preferential access and unequal treatment resurface whenever health-care capacity falls short of demand.

As of 2025, CIHI data show that only 68 per cent of Canadians received hip replacements and 61 per cent received knee replacements within the national benchmark of 26 weeks. Canadians are also waiting longer for MRI and CT scans than before the pandemic, even though the number of procedures being performed has risen substantially. The problem is no longer simply a pandemic backlog. It is a structural shortage of capacity.

Canada’s restrictive approach has delivered neither the standard of care patients expect nor the equity it promises.

If we want different outcomes, we need to do things differently. Countries like Australia and Denmark offer clear solutions. Both guarantee universal, tax-funded coverage for medically necessary care. Everyone is covered. No one is left out. But unlike most Canadian provinces, they have harnessed private alternatives rather than prohibiting them.

Both countries allow patients to purchase duplicate private health insurance that covers services already included in the public plan. While individuals with duplicate insurance benefit directly, its greatest value is expanding health-care capacity and reducing wait times across the entire system.

In Australia, private insurance diverts patients away from public hospitals to the country’s 647 private facilities, which accounted for 40 per cent of all hospital admissions in 2024. This additional capacity eases pressure on the public system and shortens wait times for patients who rely on it most.

Denmark takes a similar approach. When the public system cannot treat patients within clinically recommended time frames, the government refers patients to one of 19 private hospitals for timely care. As private infrastructure expanded alongside private insurance, average surgical wait times across the country fell by more than one-third.

Canada could adopt a similar model. Patients whose surgeries are not performed within nationally recommended benchmarks could be referred to accredited private surgical centres at no cost to the patient.

But that approach depends on expanding private capacity. Those benefits cannot be fully realized without investment in private infrastructure that increases the health-care system’s ability to treat more patients.

Duplicate insurance makes that possible by making private care more accessible through affordable monthly premiums, starting at $84 in Australia and $65 in Denmark. A larger insured patient pool makes it commercially viable to build, staff and equip new facilities.

In turn, that additional investment expands the overall capacity of the health-care system rather than simply shifting patients from one queue to another.

Private facilities increase the volume of care available by increasing the number of hospital beds and operating rooms. They also expand the clinical workforce by attracting and retaining physicians while creating additional residency training sites to support the training and graduation of more doctors. Those benefits extend beyond privately insured patients by increasing the system’s overall ability to deliver timely care.

The Manitoba Auditor General’s report showed what happens when demand consistently exceeds capacity. Canada can continue pretending the system is equitable while unofficial queues and preferential access persist. Or it can learn from countries like Australia and Denmark, which have strengthened universal care by allowing complementary private options.

Maintaining the ban on duplicate insurance does not protect equity, and removing it would not create a two-tier system. It would help fix the one we already have.

This isn’t about giving the wealthy more options. They already have options. This is about the millions of Canadians who have no connections to skip the line, no means to pay out of pocket, and whose governments have left them waiting longer for care with no meaningful alternatives.

Conrad Eder is a policy analyst at the Frontier Centre for Public Policy focusing on Canadian health and fiscal issues. He is an alumnus of the Fraser Institute and Montreal Economic Institute, and holds degrees from Laurentian University and Carleton University.