Fraser Institute
Time to finally change the Canada Health Act for the sake of patients
From the Fraser Institute
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.
Business
Canada’s recent economic growth performance has been awful
From the Fraser Institute
By Ben Eisen and Milagros Palacios
Recently, Statistics Canada released a revision of its calculations of Canada’s gross domestic product (GDP) in recent years. GDP measures the total production in an economy in a given year, and per-person GDP is widely accepted by economists as one of the most useful metrics for assessing quality of life. The new estimate places Canada’s GDP for 2024 at 1.4 per cent larger than previously reported.
By the standards of these sorts of revisions—which are usually quite small—the recent update is significant. But make no mistake, the new numbers do not change the fundamental story of Canada’s economic performance, which has been one of historically weak growth and stagnant living standards for an unusually long stretch of time.
Let’s get into the numbers (all adjusted for inflation, in 2017 dollars) with some historical perspective. The new figures put Canada’s per-person GDP estimate for 2024 at $59,529. By comparison, in 2019 per-person GDP was slightly higher at $59,581. This means there has been no progress at all in Canadian living standards as measured by per-person GDP over the past five years. Even with the revision, five years of flat living standards is an extraordinary result.
This is historically anomalous. From 2000 to 2018—a period that was itself not especially strong by the standards of earlier decades—per-person GDP still grew at a compounded annual rate of just under one per cent. In the 1990s, growth was faster still at roughly 1.8 per cent annually. In both periods, living standards were rising meaningfully, even if the pace varied. The fact that they have completely stagnated for five years is alarming, even if our GDP numbers aren’t quite as bleak as we believed a few weeks ago.
Some pundits determined to view all economic data through a political lens have emphasized that under the new revisions, the overall rate of per-person growth during Justin Trudeau’s time as prime minister is now approximately the same as what occurred during Stephen Harper’s tenure.
However, this is more relevant as a political talking point than an economic insight. The historical data show that at an average annual growth rate of just 0.5 per cent, the Canadian economy’s performance under Harper was weak by long-term standards. This is something that Trudeau himself recognized when he first sought high office, criticizing the Harper government for “having the worst record on economic growth since R.B. Bennett in the depths of the Great Depression.”
Trudeau was right back then that Canadian economic growth during the Harper era was historically weak. As such, a revision showing that Canada’s slow growth has approximately continued for the past decade is hardly cause for celebration. It simply underscores that both governments presided over a long period of weak productivity growth and very slow improvements in living standards—and that in recent years even that sluggish growth has given way to complete stagnation.
Of course, an upward revision to recent GDP calculations is welcome news, but it must not be allowed to distract policymakers or the public from the reality of Canada’s severe long-term growth problem, which in recent years has gone from bad to worse.
Community
Charitable giving on the decline in Canada
From the Fraser Institute
By Jake Fuss and Grady Munro
There would have been 1.5 million more Canadians who donated to charity in 2023—and $755.5 million more in donations—had Canadians given to the same extent they did 10 years prior
According to recent polling, approximately one in five Canadians have skipped paying a bill over the past year so they can buy groceries. As families are increasingly hard-pressed to make ends meet, this undoubtedly means more and more people must seek out food banks, shelters and other charitable organizations to meet their basic necessities.
And each year, Canadians across the country donate their time and money to charities to help those in need—particularly around the holiday season. Yet at a time when the relatively high cost of living means these organizations need more resources, new data published by the Fraser Institute shows that the level of charitable giving in Canada is actually falling.
Specifically, over the last 10 years (2013 to 2023, the latest year of available data) the share of tax-filers who reported donating to charity fell from 21.9 per cent to 16.8 per cent. And while fewer Canadians are donating to charity, they’re also donating a smaller share of their income—during the same 10-year period, the share of aggregate income donated to charity fell from 0.55 per cent to 0.52 per cent.
To put this decline into perspective, consider this: there would have been 1.5 million more Canadians who donated to charity in 2023—and $755.5 million more in donations—had Canadians given to the same extent they did 10 years prior. Simply put, this long-standing decline in charitable giving in Canada ultimately limits the resources available for charities to help those in need.
On the bright side, despite the worrying long-term trends, the share of aggregate income donated to charity recently increased from 0.50 per cent in 2022 to 0.52 per cent in 2023. While this may seem like a marginal improvement, 0.02 per cent of aggregate income for all Canadians in 2023 was $255.7 million.
The provinces also reflect the national trends. From 2013 to 2023, every province saw a decline in the share of tax-filers donating to charity. These declines ranged from 15.4 per cent in Quebec to 31.4 per cent in Prince Edward Island.
Similarly, almost every province recorded a drop in the share of aggregate income donated to charity, with the largest being the 24.7 per cent decline seen in P.E.I. The only province to buck this trend was Alberta, which saw a 3.9 per cent increase in the share of aggregate income donated over the decade.
Just as Canada as a whole saw a recent improvement in the share of aggregate income donated, so too did many of the provinces. Indeed, seven provinces (except Manitoba, Nova Scotia and Newfoundland and Labrador) saw an increase in the share of aggregate income donated to charity from 2022 to 2023, with the largest increases occurring in Saskatchewan (7.9 per cent) and Alberta (6.7 per cent).
Canadians also volunteer their time to help those in need, yet the latest data show that volunteerism is also on the wane. According to Statistics Canada, the share of Canadians who volunteered (both formally and informally) fell by 8 per cent from 2018 to 2023. And the total numbers of hours volunteered (again, both formal and informal) fell by 18 per cent over that same period.
With many Canadians struggling to make ends meet, food banks, shelters and other charitable organizations play a critical role in providing basic necessities to those in need. Yet charitable giving—which provides resources for these charities—has long been on the decline. Hopefully, we’ll see this trend turn around swiftly.
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