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Endless spending increases will not fix Canada’s health-care system

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From the Fraser Institute

By Mackenzie Moir and Jake Fuss

Canada’s health-care system ranked as the most expensive (as a share of the economy) among 30 universal health-care countries. And despite these relatively high levels of spending, Canada continues to lag behind its peers on key indicators of performance.

In February 2023, the federal government announced the money they send to the provinces for health care would increase, yet again. Despite being billed as a fix for health care, these spending increases will not actually provide any relief for Canadian patients.

The Canada Health Transfer (CHT), the main federal financial tool for funding provincial health care, has increased from $34.0 billion in 2015/16 to $52.1 billion this year (2024/25), a 53.1 per cent increase in about a decade. Moreover, the federal government has committed to increases in the transfer at a guaranteed 5 per cent until 2027/28.

This latest increase in the CHT, however, is only one part of the $46.2 billion in new money being doled out over the next 10 years. More than half (roughly $25 billion) is currently being given to provinces who’ve signed up to work towards a number of “shared priorities” with Ottawa, such as mental health and substance abuse.

Clearly, the federal government has decided to substantially increase health-care spending in more than one way. But will it produce results?

These periodic “fixes” occasionally championed by Ottawa every few years are nothing new. And unfortunately, the data show that longstanding problems, including long waits for medical care and doctor shortages, will persist even though Canada is certainly no slouch when compared to its peers on health-care spending.

recent study found that, when adjusted for differences in age (because older populations tend to spend more on health care), Canada’s health-care system ranked as the most expensive (as a share of the economy) among 30 universal health-care countries. And despite these relatively high levels of spending, Canada continues to lag behind its peers on key indicators of performance.

For example, Canada had some of the fewest physicians (ranked 28th of 30 countries), hospital beds (ranked 23rd of 29) and diagnostic technology such as MRIs (ranking 25th of 29 countries) and CT scanners (ranking 26th out of 30 countries) compared to other high-income countries with universal health care.

It also ranked at or near the bottom on measures such as same-day medical appointments, how easy it is to find afterhours care, and the timeliness of specialist appointments and surgical care.

And wait times have been getting worse. Just last year Canada recorded the longest ever delay for non-emergency care at 27.7 weeks, a 198 per cent increase from the 9.3 week wait experienced in 1993 (the first year national estimates were published).

But it’s not just the health-care system that’s in shambles, despite our high spending. Our federal finances are, too. Years of substantial increases in federal spending have strained the country’s finances. The Trudeau government’s latest budget projects a deficit of $39.8 billion this year, with more spent on debt interest ($54.1 billion) than on what the federal government gives to the provinces for health care.

Again, these periodic injections of federal funds to the provinces to supposedly fix health care are nothing new. Ottawa has relied on this strategy in the past and wait times have grown longer over the last three decades. Endless increases in spending will not fix our health-care system.

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This Sunday, June 8, is Tax Freedom Day, when Canadians finally start working for themselves

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From the Fraser Institute

By Milagros Palacios, Jake Fuss and Nathaniel Li

This Sunday, June 8, Canadians will celebrate Tax Freedom Day, the day in the year when they start working for themselves and not government, finds a new study published by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

“If Canadians paid all their taxes up front, they would work the first 158 days of this year before bringing any money home for themselves and their families,” said Jake Fuss, director of fiscal studies at the Fraser Institute.

Tax Freedom Day measures the total annual tax burden imposed on Canadian families by federal, provincial, and municipal governments.

In 2025, the average Canadian family (with two or more people) will pay $68,266 in total taxes. That’s 43.1 per cent of its annual income ($158,533) going to income taxes, payrolltaxes (including the Canada Pension Plan), health taxes, sales taxes (like the GST), property taxes, fuel taxes, “sin” taxes and more.

Represented as days on the calendar, the total tax burden comprises more than five months of income—from January 1 to June 7. On June 8th—Tax Freedom Day—Canadians finally start working for themselves, and not government.

But Canadians should also be worried about the nearly $90 billion in deficits the federal and provincial governments are forecasting this year, because they will have substantial tax implications in future years.

To better illustrate this point, the study also calculates a Balanced Budget Tax Freedom Day—the day of the year when the average Canadian finally would finally start working for themselves if governments paid for all of this year’s spending with taxes collected this year.

In 2025, the Balanced Budget Tax Freedom Day won’t arrive until June 21. “Tax Freedom Day helps put the total tax burden in perspective, and helps Canadians understand just how much of their money they pay in taxes every year,” Fuss said. “Canadians need to decide for themselves whether they are getting their money’s worth when it comes to how governments are spending their tax dollars.”

Tax Freedom Day for each province varies according to the extent of the provincially and  locally levied tax burden.

2025 Provincial Tax Freedom Days

Manitoba                                    May 17
Saskatchewan                            May 31
British Columbia                       May 31
Alberta                                         May 31
Prince Edward Island               June 2
New Brunswick                          June 4
Ontario                                        June 7
Nova Scotia                                June 10
Newfoundland & Labrador     June 19
Quebec                                        June 21

CANADA                                    June 8

 

Canadians Celebrate Tax Freedom Day on June 8, 2025

  • In 2025, the average Canadian family will earn $158,533 in income and pay an estimated $68,266 in total taxes (43.1%).
  • If the average Canadian family had to pay its taxes up front, it would have worked until June 7 to pay the total tax bill imposed on it by all three levels of government (federal, provincial, and local).
  • This means that Tax Freedom Day, the day in the year when the average Canadian family has earned enough money to pay the taxes imposed on it, falls on June 8.
  • Tax Freedom Day in 2025 comes one day earlier than in 2024, when it fell on June 9. This change is due to the expectation that the total tax revenues forecasted by Canadian governments will increase slower than the incomes of Canadians.
  • Tax Freedom Day for each province varies according to the extent of the provincially levied tax burden. The earliest provincial Tax Freedom Day falls on May 17 in Manitoba, while the latest falls on June 21 in Quebec.
  • Canadians are right to be thinking about the tax implications of the $89.4 billion in projected federal and provincial government deficits in 2025. For this reason, we calculated a Balanced Budget Tax Freedom Day, the day on which average Canadians would start working for themselves if governments were obliged to cover current expenditures with current taxation. In 2025, the Balanced Budget Tax Freedom Day arrives on June 21.

    Milagros Palacios

    Director, Addington Centre for Measurement, Fraser Institute

    Jake Fuss

    Director, Fiscal Studies, Fraser Institute

    Nathaniel Li

    Senior Economist, Fraser Institute

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Fraser Institute

Health-care lessons from Switzerland for a Canada ready for reform

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From the Fraser Institute

By Yanick Labrie

Last year marked the 40th anniversary of the Canada Health Act, long considered a pillar of national identity. But today, that symbol is showing signs of strain. Despite record government spending, health-care wait times have reached historic highs—more than 30 weeks on average for planned treatment—and access to care continues to deteriorate. Fewer than one in five Canadians now say the system works well.

While political leaders tinker at the margins, countries such as Switzerland have taken bold steps to build universal health-care systems that are more responsive, more flexible and, above all, more accessible.

Switzerland achieves universal health coverage through a fundamentally different and patient-centered model. Instead of relying on a government monopoly, the Swiss health-care system is organized around principles of regulated competition. Forty-four private non-profit insurers offer standardized basic coverage, and every resident must enroll. But unlike in Canada, Swiss patients are free to choose their insurer and switch plans twice a year. This freedom of choice drives insurers to innovate, tailor benefits, and ultimately improve service.

Switzerland’s universal system is also more comprehensive than Canada’s. It covers not only hospital and physician services, but also prescription drugs, mental health care and certain long-term care services. At the same time, patients can choose from a variety of plan designs, which have varying deductibles and premiums, and manage care based on their preferences.

By contrast, the Canadian system offers virtually no choice. The government enrols every citizen in the same plan, with the same benefits, on the same terms. The Canada Health Act, the federal legislation meant to promote equity, prohibits flexibility. It’s a lowest-common-denominator model—rigid, bureaucratic and unresponsive to patient needs.

Nowhere is this clearer than how we access care. In Canada, patients must go through a family doctor—compulsory gatekeeping—before seeing a specialist. But six million Canadians don’t even have a family doctor. For them, this requirement isn’t just inconvenient, it’s a dead end. The result is long delays, lost diagnoses and growing public frustration.

Conversely, the Swiss model prioritizes adaptability, driven by the power of patient choice and regulated competition among insurance providers. Because residents can switch insurers twice a year and select among different care models, insurers are incentivized to innovate and respond to evolving needs. As a result, patients can choose from a variety of insurance plans: a standard model with no gatekeeping; managed care with family doctors; pharmacy-based coordination; telemedicine-first plans, or other models. And they don’t have wait long. According to the latest survey from the Commonwealth Fund, 76 per cent of Swiss residents are able to obtain a medical appointment with a doctor or nurse within five days, compared to only 46 per cent of Canadians.

In addition to expanding patient choice, these different plan options help insurers control costs by reducing unnecessary consultations and hospitalizations. Studies show that such models can lower the cost of care by up to 34 per cent without compromising quality while also discouraging unnecessary treatments or hospital visits. And these plans encourage health-care providers to focus on prevention and chronic care management, ultimately improving efficiency and outcomes while the savings allow insurers to reduce premiums and control long-term spending. In fact, despite offering greater choice and a broader package of health-care services than Canada, real health-care spending (per person) in Switzerland has grown by less than 2 per cent annually since the mid-1990s compared to 2.7 per cent in Canada.

These Swiss facts, which are likely music to the ears of Canadians, raise a key question: how much do Swiss citizens pay out-of-pocket for health care?

While Swiss residents do share some costs through deductibles and co-payments, these costs are capped and vulnerable populations (children, pregnant women, low-income people, etc.) are exempt.

In 2022 (the latest year of available data), average annual out-of-pocket spending per insured person in Switzerland was 581 Swiss francs, equivalent to C$792. For people who don’t require much care, the costs are much lower or non-existent. And nearly 28 per cent of the population receives subsidies to cover their premiums.

Of course, many Canadians assume our system as “free,” forgetting that it’s funded through general taxation. They also tend to overlook our significant out-of-pocket costs not covered by the public system (prescription drugs, mental health care, long-term care, etc.).

Nevertheless, Canada can’t simply copy-and-paste the Swiss model. The Canada Health Act currently prohibits co-payments and mandates uniform public insurance. But that doesn’t mean we have nothing to learn. Switzerland shows that universality isn’t incompatible with choice and competition. In fact, these goals can strengthen each other. When patients have freedom of choice, a health-care system becomes not only more efficient but also more responsive to their needs and preferences. In other words, it becomes a true health-care system.

Canada’s health-care debate has long been framed as a rigid dichotomy between a government monopoly and a privately-funded system where any reform is seen as a threat to universality. This mindset has stifled innovation and made it harder to build a system that is both universal and responsive. Switzerland points the way forward, with a model that reconciles equity, choice and adaptability in ways Canadian policymakers can no longer afford to ignore.

Yanick Labrie

Senior Fellow, Fraser Institute
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