He said private, for-profit services could help alleviate the pressure on publicly run facilities, reduce wait times and save money.

Critics of privatization claim it threatens to undermine the current system, where access to health care is not dictated by an individual's ability to pay.

The Conservatives also announced on Tuesday a plan to protect access to pensions when companies go through bankruptcy or restructuring. The proposal would bar executives from receiving bonuses during that process unless their workers' pension plan was fully funded.

"Canadian workers deserve better," O'Toole said. "It's time for the government to stand up for workers and secure Canadians' pensions."

The plan would also force companies to disclose the funding status of pensions, which the Conservatives say will increase transparency.

O'Toole must 'come clean' on health care views: Trudeau

O'Toole's health-care comments came a day after Liberal candidate Chrystia Freeland posted to Twitter a selectively edited clip of O'Toole speaking about health care. In the posted video, O'Toole said he would be open to more for-profit health care in Canada to help address some of the current system's failings.

Left out of Freeland's edited video montage was O'Toole's subsequent statement — that universal access to health services must be maintained. Twitter has since flagged the clip as "manipulated media."

Liberal Leader Justin Trudeau said Tuesday the edited clip accurately reflects O'Toole's attitude toward private health care.

"Erin O'Toole has clearly and directly said he is a long-standing believer in for-profit models of health care." Trudeau said. "He needs to come clean with Canadians on what exactly he means when he says that."

O'Toole hit back, saying that on Trudeau's watch, the private sector's role in health care has grown considerably.

In Quebec, for example, the province recently signed 20 contracts with private clinics to outsource some surgeries and reduce waiting times. Radio-Canada reported in February that some 20,000 surgeries in that province have been done at private clinics already.

Saskatchewan has outsourced some diagnostic imaging to private operators to reduce wait times for MRIs and CT scans. Under this so-called "two-for-one" initiative, for-profit clinics can charge patients for scans as long as they provide an equal number of scans to patients on the public waiting list.

In a 2016 letter, former federal health minister Jane Philpott said she wanted the province to put an end to encouraging private payment for medical scans — but the practice has continued.

Meanwhile, dozens of for-profit COVID-19 testing sites have popped up all over the country during the pandemic, offering a service that is also available at public clinics.

O'Toole said that, as prime minister, he would let this sort of "innovation" flourish but he'd "draw the line" at more radical reforms that would fundamentally alter the nature of the single-payer health-care system.

"Health care must be free for every Canadian. No one can ever be left behind, and all personal health decisions should be made by patients and their doctors, not insurance companies or anyone else," he said.

Provinces could face penalties for private care: Trudeau

Asked why Ottawa hasn't done more to rein in private elements like the Saskatchewan imaging program, Trudeau said the federal government could impose financial penalties on provinces that allow for the private delivery of services by curbing how much they get each year through the Canada Health Transfer.

"We will continue to stand up for a public, universal health-care system, unlike Erin O'Toole," Trudeau said.

He said Ottawa has had "discussions" with Quebec about its reliance on private operators for some surgeries.

Trudeau has promised $10 billion in new spending to clear surgical backlogs, hire 7,500 more doctors, nurses and nurse practitioners, and expand virtual options for primary care.

O'Toole vowed to boost the annual growth rate of the Canada Health Transfer to at least six per cent from its current rate, which is tied to how much the economy grows in a given year, with a floor of three per cent. The Conservatives say the more generous health transfer to the provinces would cost the federal treasury nearly $60 billion over the next 10 years.

"The COVID-19 pandemic has exposed the cracks in our health-care system and reminded us all of the need to strengthen it. Canada's Conservatives believe that the federal government should pay its fair share," the Conservative platform reads.

"Under the last Conservative government, federal transfers to the provinces grew at six per cent per year. Unfortunately, in 2017, the Trudeau government cut this in half, putting lives at risk."

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Trudeau said the Liberal party isn't interested in cutting a blank cheque for the provinces to do what they want on health care. Rather, Trudeau said, they want new federal money targeted to particular outcomes.

The two main parties have been trading barbs over health-care funding at a time when voters are telling pollsters it's one of the issues they care most about.

Campaign video flagged

On Sunday, Liberal candidate Chrystia Freeland posted to Twitter a selectively edited clip of O'Toole speaking about health care. In the video, O'Toole said he would be open to more for-profit health care in Canada to help address some of the current system's failings.

While willing to add more private elements to medicare, O'Toole said universal access remains paramount — a quote that was left out of Freeland's edited video montage. Twitter has since flagged the clip as "manipulated media."

The Conservative party's lawyers have asked Yves Côté, the commissioner of Canada elections, to investigate whether the "cynical motive to misinform" is a violation of the Elections Act.

Asked about the fracas over the manipulated video, Trudeau said the clip accurately reflects O'Toole position.

"What's really important here is, in the middle of a pandemic, O'Toole came out unequivocally in support of private health care, for-profit health care. We posted the interview in its entirety and I encourage all Canadians to take a look and see what Erin O'Toole has to say on the future of health care," he said.

In the 2020 video clip posted by Freeland, O'Toole said that to drive innovation in the sector, Canada "can't have just one old model that is increasingly becoming inefficient," and more "public/private synergies" are needed to improve health-care outcomes.

He also praised Saskatchewan's past decision to outsource some diagnostic imaging to private operators as a "brilliant move" because it reduced wait-times for MRIs and CT scans.

In a 2016 letter, former federal minister Jane Philpott said she wanted the province to put an end to encouraging private payment for medical scans — but the practice has continued.

O'Toole dodged questions Monday about what aspects of the health-care system he'd like to see in private hands. He was noncommittal when asked if he'd stop provinces from allowing private companies to offer more health-care services.

While O'Toole voiced support for a reworked medicare while running for the party's leadership last year, the Conservative party's election platform makes no mention of a new role for the private sector.

"Let me be perfectly clear, I 100 per cent support our public and universal system and I always have. It's been the backbone that we've relied on throughout the pandemic," O'Toole told reporters at a campaign event in Ottawa.

Rather than cut health care, O'Toole said, he'd pump billions into the public health-care system through "stable and predictable" new funding allotments that are larger than what the Liberals have promised.

"What is very disappointing is in an election that was called by Mr. Trudeau amidst a fourth wave, he's dividing and misleading Canadians on a daily basis. With their social media, they're importing American-style misleading politics. I think Canadians deserve better than that," O'Toole said, while announcing a new Conservative policy that would require some federally regulated employers to include worker representation on their boards of directors.

O'Toole's plan to spend more was criticized by People's Party Leader Maxime Bernier, who said the Conservatives are "promising more billions in new spending and targeted tax measures funded by borrowed money — just like the Liberals." 

Bernier said that, if elected, he would dramatically curb federal spending, end all COVID-related support programs and get back to a balanced budget in just four years' time.

"Instead of buying votes with borrowed money, a responsible government should aggressively cut spending, balance the budget as quickly as possible, and then lower taxes in a prudent manner to put money back into Canadians' pockets," he said.

NDP Leader Jagmeet Singh said it's hypocritical for Trudeau to criticize O'Toole when the Liberal government has done nothing to reverse privatization in the long-term care sector, which was hit hard by COVID-19 in the early days of the crisis.

"Justin Trudeau likes to campaign on private health care during election time, but he just voted to let corporations profit off health care for seniors. If he's really against private health care, why does he think it's good enough for our seniors?" Singh said, referencing a non-binding motion the NDP tabled in Parliament earlier this year.

"Justin Trudeau says the right thing about access to doctors, but his record shows that he has no intention of following through. People who don't have access to doctors can't afford Justin Trudeau's empty promises anymore."

At his campaign stop in Montreal, Singh announced that an NDP government would end all federal subsidies to the oil and gas sector and instead spend $500 million to support "Indigenous-led stewardship programs" focused on protecting the country's land, water and forests.

Some New Brunswick doctors are overbilling medicare and not facing any penalties, according to the auditor general.

Sixteen doctors were paid more than $1 million in 2011, more than double the amount budgeted by the Department of Health for the average annual earnings of a specialist, Kim MacPherson states in her 2012 report, released on Tuesday.

In some cases, doctors double billed, charging both Medicare and the province's WorkSafeNB for the same service, the province's chief financial watchdog found.

There are no deterrents to wrongful billing, said MacPherson.

She is calling on the department to enforce existing legislation and have clearly documented procedures.

"There should be consequences when a doctor repeatedly submits inappropriate claims," she said.

Although the Medicare Act authorizes the department to revoke a doctor's billing privileges for the offence, it has never done so, MacPherson found.

The department does not issue fines or charge any interest either, she said.

Other findings of the report include:

• Only a portion of payments to doctors are audited
• Monitoring is "inadequate"
• Recovery of overpayments is low
• Public reporting of remuneration is incomplete and misleading

"The observations on payments to doctors are intended to highlight unusual items that, in our professional opinion as auditors, may warrant further investigation by the department," the report said.

Ophthalmologist paid nearly $1.7M

Medicare payments to some doctors appear high, compared to budget estimates, MacPherson said, noting 16 doctors were paid more than $1 million each in 2011.

One ophthalmologist received the most at nearly $1.7 million, which is almost $1 million more than the average for that specialty.

The top-billing general practitioner was paid $1.3 million, which is far higher than the average $255,000 for these doctors.

MacPherson also singles out radiologists, five of whom billed Medicare more than $1 million. She recommends the health department take "immediate action" to require radiologists to submit information on patients, diagnosis and treatment with their bills.

There were 219 doctors paid more than $500,000, while 826 received more than $300,000.

By comparison, the Department of Health had budgeted for general practitioners to earn an estimated $291,418 annually, while the average specialist would earn an estimated $420,977 each year.

"Given this, we believe remuneration greater than these figures should be considered high," the report states.

"We believe the department should identify doctors with high medicare earnings and doctors with earnings significantly higher than their specialty average; their earnings should be reviewed to determine reasonableness and audited if suspect."

Lack of auditing, monitoring

Only 53 per cent of medicare payments to doctors are currently audited, said MacPherson.

"The fee-for-service payments system is based upon the honour system," with only a portion of those payments audited, she said.

Meanwhile, radiology, salary and sessional payments are not audited at all.

"We believe although it may be more difficult to audit some types of medicare payments, given the magnitude of the payments involved, alternate audit methods should be pursued so all types of payments (100 per cent) are included in the audit population," the report said.

Monitoring of payments also needs improvement, said MacPherson. As it stands, there is no monitoring of radiologist remuneration and monitoring of fee-for-service payments, and payments to salaried doctors is "lacking," she said.

Make earnings public

MacPherson also recommends the Department of Health publicly report the total remuneration for each doctor to allow for public scrutiny and proper accountability — even if it requires changes to legislation.

"Medicare has a huge impact on the lives of all New Brunswickers," she said.

Medicare expenditures in 2011 were $553 million, representing 22.3 per cent of the Department of Health's expenditures.

The average annual recovery for inappropriate payments between the fiscal years 2002 and 2011 was $72,581, she said. The Medicare Audit Plan 2012-13 projects recoveries of $3.21 million.