Time to finally change the Canada Health Act for the sake of patients

Back in 1984, the Canada Health Act (CHA) received royal assent and has since reached near iconic status. At the same time, under its purview, the Canadian health-care system has become one of the least accessible—and most expensive—universal health-care systems in the developed world.

Clearly, policymakers should reform the CHA to reflect a more contemporary understanding of how to structure a truly world-class universal health-care system.

Consider for a moment the remarkably poor state of access to health care in Canada today. According to international comparisons of universal health-care systems, we endure some of the lowest access to physicians, medical technologies and hospital beds in the developed world. Wait times for health care in Canada also routinely rank among the longest in the developed world.

None of this is new. Canada’s poor ranking in the availability of services reaches back at least two decades. And wait times for health care have nearly tripled since the early 1990s. Back then, in 1993, Canadians could expect to wait 9.3 weeks for medical treatment after GP referral compared to 30 weeks in 2024.

This is all happening despite Canadians paying for one of the world’s most expensive universal-access health-care systems. And this brings us back to the CHA, which contains the federal government’s requirements for provincial policymaking. To receive their full federal cash transfers for health care from Ottawa, provinces must abide by CHA rules and regulations. And therein lies the rub.

We can find the solutions to our health-care woes in other countries such as Germany, Switzerland, the Netherlands and Australia, which all provide more timely access to quality care. Every one of these countries requires patient cost-sharing for physician and hospital services, and private competition in the delivery of universally accessible services with money following patients to hospitals and surgical clinics. And all these countries allow private purchases of health care, as this reduces the burden on the publicly-funded system and creates a valuable pressure valve for it.

Unfortunately for Canadians, the CHA expressly disallows requiring patients to share the cost of treatment while the CHA’s often vaguely defined terms and conditions have been used by federal governments to discourage a larger role for the private sector in the delivery of health-care services. At the same time, every new federal commitment to fix health care means increased provincial reliance on Ottawa. In 2024-25, federal cash transfers for health care are expected to total $52 billion, which means there’s $52 billion on the line for perceived non-compliance with the CHA. In short, this is why the provinces beholden to a policy approach that’s clearly failing Canadians.

So, what to do?

For starters, Ottawa should learn from its own welfare reforms in the 1990s, which reduced federal transfers and allowed provinces more flexibility with policymaking. The resulting period of provincial policy innovation reduced welfare dependency and government spending on social assistance (i.e. savings for taxpayers). When Ottawa stepped back and allowed the provinces to vary policy to their unique circumstances, Canadians got improved outcomes for fewer dollars.

We need that same approach for health care today, and it begins with the federal government reforming the CHA to expressly allow provinces the ability to explore alternate policy approaches, while maintaining the foundational principles of universality.

Next, the federal government should either hold cash transfers for health care constant (in nominal terms), reduce them or eliminate them entirely with a concordant reduction in federal taxes. By reducing (or eliminating) the pool of cash tied to the strings of the CHA, provinces would have greater freedom to pursue reform policies they consider to be in the best interests of their residents without federal intervention.

After 40 years, it’s high time to remove ambiguity and minimize uncertainty—and the potential for politically motivated interpretations—of the CHA. If federal policymakers want Canadians to finally have access to world-class health care, they should allow the provinces to choose their own set of universal health-care policies. The first step is to fix the 40-year-old legislation that has held the provinces back.

Nadeem Esmail

Senior Fellow, Fraser Institute

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Automotive

EV fantasy losing charge on taxpayer time

Published on May 30, 2025

Todayville

From the Fraser Institute

By Kenneth P. Green

The vision of an all-electric transportation sector, shared by policymakers from various governments in Canada, may be fading fast.

The latest failure to charge is a recent announcement by Honda, which will postpone a $15 billion electric vehicle (EV) project in Ontario for two years, citing market demand—or lack thereof. Adding insult to injury, Honda will move some of its EV production to the United States, partially in response to the Trump Tariff Wars. But any focus on tariffs is misdirection to conceal reality; failures in the electrification agenda have appeared for years, long before Trump’s tariffs.

In 2023, the Quebec government pledged $2.9 billion in financing to secure a deal with Swedish EV manufacturer NorthVolt. Ottawa committed $1.34 billion to build the plant and another $3 billion worth of incentives. So far, per the CBC, the Quebec government “ invested $270 million in the project and the provincial pension investor, the Caisse de dépôt et placement du Québec (CDPQ), has also invested $200 million.” In 2024, NorthVolt declared bankruptcy in Sweden, throwing the Canadian plans into limbo.

Last month, the same Quebec government announced it will not rescue the Lion Electric company from its fiscal woes, which became obvious in December 2024 when the company filed for creditor protection (again, long before the tariff war). According to the Financial Post, “Lion thrived during the electric vehicle boom, reaching a market capitalization of US$4.2 billion in 2021 and growing to 1,400 employees the next year. Then the market for electric vehicles went through a tough period, and it became far more difficult for manufacturers to raise capital.” The Quebec government had already lost $177 million on investments in Lion, while the federal government lost $30 million, by the time the company filed for creditor protection.

Last year, Ford Motor Co. delayed production of an electric SUV at its Oakville, Ont., plant and Umicore halted spending on a $2.8 billion battery materials plant in eastern Ontario. In April 2025, General Motors announced it will soon close the CAMI electric van assembly plant in Ontario, with plans to reopen in the fall at half capacity, to “align production schedules with current demand.” And GM temporarily laid off hundreds of workers at its Ingersoll, Ontario, plant that produces an electric delivery vehicle because it isn’t selling as well as hoped.

There are still more examples of EV fizzle—again, all pre-tariff war. Government “investments” to Stellantis and LG Energy Solution and Ford Motor Company have fallen flat and dissolved, been paused or remain in limbo. And projects for Canada’s EV supply chain remain years away from production. “Of the four multibillion-dollar battery cell manufacturing plants announced for Canada,” wrote automotive reporter Gabriel Friedman, “only one—a joint venture known as NextStar Energy Inc. between South Korea’s LG Energy Solution Ltd. and European automaker Stellantis NV—progressed into even the construction phase.”

What’s the moral of the story?

Once again, the fevered dreams of government planners who seek to pick winning technologies in a major economic sector have proven to be just that, fevered dreams. In 2025, some 125 years since consumers first had a choice of electric vehicles or internal combustion vehicles (ICE), the ICE vehicles are still winning in economically-free markets. Without massive government subsidies to EVs, in fact, there would be no contest at all. It’d be ICE by a landslide.

In the face of this reality, the new Carney government should terminate any programs that try to force EV technologies into the marketplace, and rescind plans to have all new light-duty vehicle sales be EVs by 2035. It’s just not going to happen, and planning for a fantasy is not sound government policy nor sound use of taxpayer money. Governments in Ontario, Quebec and any other province looking to spend big on EVs should also rethink their plans forthwith.

Kenneth P. Green

Senior Fellow, Fraser Institute

Business

Switzerland has nearly 65% more doctors and much shorter wait times than Canada, despite spending roughly same amount on health care

Published on May 30, 2025

Todayville

From the Fraser Institute

By Yanick Labrie

Switzerland’s universal health-care system delivers significantly better results than Canada’s in terms of wait times, access to health professionals like doctors and nurses, and patient satisfaction finds a new study published by the Fraser Institute, an independent, non-partisan Canadian policy think-tank.

“Despite its massive price tag, Canada’s health-care system lags behind many other countries with universal health care,” said Yanick Labrie, senior fellow at the Fraser Institute and author of Building Responsive and Adaptive Health-Care Systems in Canada: Lessons from Switzerland.

The study highlights how Switzerland’s universal health-care system consistently outperforms Canada on most metrics tracked by the OECD.

In 2022, the latest year of available data, despite Canada (11.5 per cent of GDP) and Switzerland (11.9 per cent) spending close to the same amount on health care, Switzerland had 4.6 doctors per thousand people compared to 2.8 in Canada. In other words, Switzerland had 64.3 per cent more doctors than Canada (on a per-thousand people basis).

Switzerland also had 4.4 hospital beds per thousand people compared to 2.5 for Canada—Switzerland (8th) outranked Canada (36th) on this metric out of 38 OECD countries with universal health care.

Likewise, 85.3 per cent of Swiss people surveyed by the CWF (Commonwealth Fund) reported being able to obtain a consultation with a specialist within 2 months. By comparison, only 48.3 per cent of Canadians experienced a similar wait time. Beyond medical resources and workforce, patient satisfaction diverges sharply between the two countries, as 94 per cent of Swiss patients report being satisfied with their health-care system compared to just 56 per cent in Canada.

“Switzerland shows that a universal health care system can reconcile efficiency and equity – all while being more accessible and responsive to patients’ needs and preferences,” Labrie said.

“Policymakers in Canada who hope to improve Canada’s broken health-care system should look to more successful universal health-care countries like Switzerland.”

Building Responsive and Adaptive Health Care Systems in Canada: Lessons from Switzerland

Canada’s health-care system is increasingly unable to meet patient needs, with wait times reaching record lengths—over 30 weeks for planned care in 2024—despite significantly rising public spending and growing dissatisfaction among patients and providers nationwide.
Swiss health care outperforms Canada in nearly all OECD performance indicators: more doctors and nurses per capita, better access to care, shorter wait times, lower unmet needs, and higher patient satisfaction (94% vs. Canada’s 56%).
Switzerland ensures universal coverage through 44 competing private, not-for-profit insurers. Citizens are required to enroll but have the freedom to choose insurers and tailor coverage to their needs and preferences, promoting both access and autonomy.
Swiss basic insurance coverage is broader than Canada’s, including outpatient care, mental health, prescribed medications, home care, and long-term care—with modest, capped cost-sharing, and exemptions for vulnerable groups, including children, low-income individuals, and the chronically ill.
Patient cost participation (deductibles/co-payments) exists, but the system includes robust financial protection: 27.5% of the population receives direct subsidies, ensuring affordability and equity.
Risk equalization mechanisms prevent risk selection and guarantee insurer fairness, promoting solidarity across demographic and health groups.
Decentralized governance enhances responsiveness; cantons manage service planning, ensuring care adapts to local realities and population needs.
Managed competition drives innovation and efficiency: over 75% of the Swiss now choose alternative models (e.g., HMOs, telemedicine, gatekeeping).
The Swiss model proves that a universal, pluralistic, and competitive system can reconcile efficiency, equity, access, and patient satisfaction—offering powerful insights for Canada’s stalled health reform agenda.