The Canadian mass media regularly speculates that medicare is broken and requires "radical" change. We are constantly reminded of this by the reporting of perceived crises, such as the Krever inquiry into tainted blood, Hepatitis B infections by transfusion, the "brain drain," Sudden Acute Respiratory Syndrome (SARS), waiting times for cancer treatment and many others.

Crowley suggested that public confidence in the Canadian system is at an all-time low, with design flaws considered the major cause of this phenomenon (Crowley 1999). The increased financial burden of publicly funded healthcare, plus purportedly low levels of public confidence in the system, led, in 2002, to two Canadian federal initiatives looking at healthcare delivery (Kirby 2002; Romanow 2002). At least one of these reports had as one of its major objectives "to increase the confidence of Canadians in the system" (Romanow 2002).

In late 1999, a World Values Survey compared trends in confidence in public and private institutions in most post-industrial societies, between 1980 and the mid-1990s. This showed that out of 17 countries only Iceland showed a trend toward improved confidence, while all other countries had a significant decline in confidence levels over that period (Inglehart 1999).

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