From the Fraser Institute

By Nadeem Esmail and Tegan Hill

The Smith government may soon allow Albertans to privately purchase diagnostic screening and testing services, prompting familiar cries from defenders of the status quo. But in reality, this change, which the government plans to propose in the legislature in the coming months, would simply give Albertans an option already available to patients in every other developed country with universal health care.

It’s important for Albertans and indeed all Canadians to understand the unique nature of our health-care system. In every one of the 30 other developed countries with universal health care, patients are free to seek care on their own terms with their own resources when the universal system is unwilling or unable to satisfy their needs. Whether to access care with shorter wait times and a more rapid return to full health, to access more personalized services or meet a personal health need, or to access new advances in medical technology. But not in Canada.

That prohibition has not served Albertans well. Despite being one of the highest-spending provinces in one of the most expensive universal health-care systems in the developed world, Albertans endure some of the longest wait times for health care and some of the worst availability of advanced diagnostic and medical technologies including MRI machines and CT scanners.

Introducing new medical technologies is a costly endeavour, which requires money and the actual equipment, but also the proficiency, knowledge and expertise to use it properly. By allowing Albertans to privately purchase diagnostic screening and testing services, the Smith government would encourage private providers to make these technologies available and develop the requisite knowledge.

Obviously, these new providers would improve access to these services for all Alberta patients—first for those willing to pay for them, and then for patients in the public system. In other words, adding providers to the health-care system expands the supply of these services, which will reduce wait times for everyone, not just those using private clinics. And relief can’t come soon enough. In Alberta, in 2024 the median wait time for a CT scan was 12 weeks and 24 weeks for an MRI.

Greater access and shorter wait times will also benefit Albertans concerned about their future health or preventative care. When these Albertans can quickly access a private provider, their appointments may lead to the early discovery of medical problems. Early detection can improve health outcomes and reduce the amount of public health-care resources these Albertans may ultimately use in the future. And that means more resources available for all other patients, to the benefit of all Albertans including those unable to access the private option.

Opponents of this approach argue that it’s a move towards two-tier health care, which will drain resources from the public system, or that this is “American-style” health care. But these arguments ignore that private alternatives benefit all patients in universal health-care systems in the rest of the developed world. For example, Switzerland, Germany, the Netherlands and Australia all have higher-performing universal systems that provide more timely care because of—not despite—the private options available to patients.

In reality, the Smith government’s plan to allow Albertans to privately purchase diagnostic screening and testing services is a small step in the right direction to reduce wait times and improve health-care access in the province. In fact, the proposal doesn’t go far enough—the government should allow Albertans to purchase physician appointments and surgeries privately, too. Hopefully the Smith government continues to reform the province’s health-care system, despite ill-informed objections, with all patients in mind.

Nadeem Esmail

Director, Health Policy, Fraser Institute

Tegan Hill

Director, Alberta Policy, Fraser Institute

From the Fraser Institute

By Jake Fuss and Grady Munro

Based on the rhetoric, the Carney government’s first budget was a “transformative” new plan that will meet and overcome the “generational” challenges facing Canada. Of course, in reality this budget is nothing new, and delivers the same approach to fiscal and economic policy that has been tried and failed for the last decade.

First, let’s dispel the idea that the Carney government plans to manage its finances any differently than its predecessor. According to the budget, the Carney government plans to spend more, borrow more, and accumulate more debt than the Trudeau government had planned. Keep in mind, the Trudeau government was known for its recklessly high spending, borrowing and debt accumulation.

While the Carney government has tried to use different rhetoric and a new accounting framework to obscure this continued fiscal mismanagement, it’s also relied on an overused and misleading talking point about Canada’s debt as justification for higher spending and continued deficits. The talking point goes something like, “Canada has the lowest net debt-to-GDP ratio in the G7” and this “strong fiscal position” gives the government the “space” to spend more and run larger deficits.

Technically, the government is correct—Canada’s net debt (total debt minus financial assets) is the lowest among G7 countries (which include France, Germany, Italy, Japan, the United Kingdom and the United States) when measured as a share of the overall economy (GDP). The latest estimates put Canada’s net debt at 13 per cent of GDP, while net debt in the next lowest country (Germany) is 49 per cent of GDP.

But here’s the problem. This measure assumes Canada can use all of its financial assets to offset debt—which is not the case.

When economists measure Canada’s net debt, they include the assets of the Canada Pension Plan (CPP) and the Quebec Pension Plan (QPP), which were valued at a combined $890 billion as of mid-2025. But obviously Canada cannot use CPP and QPP assets to pay off government debt without compromising the benefits of current and future pensioners. And we’re one of the only industrialized countries where pension assets are accounted in such a way that it reduces net debt. Simply put, by falsely assuming CPP and QPP assets could pay off debt, Canada appears to have a stronger fiscal position than is actually the case.

A more accurate measure of Canada’s indebtedness is to look at the total level of debt.

Based on the latest estimates, Canada’s total debt (as a share of the economy) ranked 5th-highest among G7 countries at 113 per cent of GDP. That’s higher than the total debt burden in the U.K. (103 per cent) and Germany (64 per cent), and close behind France (117 per cent). And over the last decade Canada’s total debt burden has grown faster than any other G7 country, rising by 25 percentage points. Next closest, France, grew by 17 percentage points. Keep in mind, G7 countries are already among the most indebted, and continue to take on some of the most debt, in the industrialized world.

In other words, looking at Canada’s total debt burden reveals a much weaker fiscal position than the government claims, and one that will likely only get worse under the Carney government.

Prior to the budget, Prime Minister Mark Carney promised Canadians he will “always be straight about the challenges we face and the choices that we must make.” If he wants to keep that promise, his government must stop using a misleading measure of Canada’s indebtedness to justify high spending and persistent deficits.

Jake Fuss

Director, Fiscal Studies, Fraser Institute

Grady Munro

Policy Analyst, Fraser Institute