Canadians will soon be privy to yet another round of pointless discussions on health care between the provinces and the federal government. Both sides are convinced that more money is the solution to what ails us; they just can’t seem to decide how it should be spent or by whom. Even worse, neither side seems to be dealing with the current state of health care.

Consider this: When compared with the other 27 developed nations that guarantee access to health care for their populations, Canada has some of the longest waiting times, mediocre health outcomes, and terrible access to doctors and technology. At the same time, Canadians (on an age-adjusted basis) pay for the most expensive universal access health care system in the developed world (we’re tied with Iceland).

While Canadians are already paying for a world-class health care system, and not getting anything close to one in return, Canada’s elected officials are about to busy themselves debating just how much more money and government control are needed to cure medicare. They have yet to realize, however, that a multi-billion dollar commitment by the federal government and a new federal drug program, no matter how large, will not solve the fundamental problems plaguing medicare. The health care system’s greatest fault is that it is a massive, centrally controlled government bureaucracy. And in the true tradition of government bureaucracies, it consumes increased funding with almost no change in the functioning of the system or the outcomes from it.

And as this pointless provincial-federal debate rages on, the real solutions to medicare’s problems are already being successfully employed in nations that are doing a better job than Canada at delivering universal access health care to individuals and families. Those countries: Australia, Austria, Belgium, France, Germany, Japan, Luxembourg, Sweden, and Switzerland either manage better health outcomes from health care, or manage to deliver universal access to care without significant waiting times, or, in the cases of France and Japan, do both.

What may come as a surprise to some, particularly those elected officials involved in this very public debate, is that none of these countries manages this superior performance by employing a Canadian-style health system. Each of these countries has several features that distinguish their health system from our own. Features that would dramatically improve the delivery of health care in Canada, and that may even lead to a less expensive health care system overall.

In each of these countries, patients are free and able to access a private care centre, both within the public health care envelope and through their own devices. These countries focus on the appropriate, timely, and efficient delivery of services, and not on who ultimately delivers them. As a result, all of these countries enjoy the cost savings and improvements in the quality of care and efficiency that innovative and competitive private health providers create. In addition, and very much unlike Canada, patients in these countries are not prisoners of the bureaucratic will and are free to choose when and where they will receive health care, even if the government is unwilling to offer it.

The third, and equally important, difference in policy between these countries and our own is the existence of user fees for publicly insured services. Such fees can lead to dramatic reductions in health expenditures as patients who are required to directly fund even a small portion of their health care will make more informed decisions about when and where it is best to access the health care system. According to research and international evidence, user fees lead to a more efficient use of resources and make patients no worse off in terms of health outcomes as long as low-income individuals are exempted.

The problem with current and upcoming debates between the provinces and Ottawa is that they have little substance and hold even less promise for Canadians. No matter the outcome of these debates, the health care system will remain as it is: a very expensive system with miserable access and mediocre outcomes. Improving medicare will require an informed and honest debate about what really works, a debate the provincial and federal government have yet to consider, and are not likely to have later this month. Such a discussion would inevitably lead to the recognition that we need to reform how we deliver health care not how much we spend on it.