Business
Canada’s health-care system is not ‘free’—and we’re not getting good value for our money
From the Fraser Institute
By Nadeem Esmail and Mackenzie Moir
In 2025, many Canadians still talk about our “free” health-care system. But in reality, through taxes, we pay a lot for health care. In fact, according to the latest data, a typical Canadian family will pay $19,060 (or about 24 per cent of their total tax bill) for health care this year.
Given the size of that bill, it’s worth asking—do Canadians get good value for all those tax dollars? Not even close.
First, Canadians endure some of the longest wait times for medical care—including primary care, specialist consultations and non-emergency surgery—among developed countries with universal health care. In fact, the wait in Canada for non-emergency care is now more than seven months from referral to treatment, which is more than three times longer than in 1993 when wait times were first measured nationally.
Why the delays?
Part of the reason is the limited number of medical resources available to Canadians. Compared to our universal health-care peers, Canada had some of the fewest physicians, hospital beds and medical technologies such as MRI machines and CT scanners.
And before you wonder if $19,000 per year isn’t enough money for world-class universal coverage, remember that Canada has one of the most expensive universal health-care systems in the developed world, which means Canadians are among the highest spenders on universal health care yet have some of the worst access to health-care services.
Fortunately, countries such as Switzerland and Australia, which both provide far more timely access to high-quality universal care for similar or even lower cost than Canada, offer lessons for reform. Compared to Canada, both countries allow a larger degree of private-sector involvement and, perhaps more importantly, competition in their universal health-care systems.
In Switzerland, for instance, health insurance coverage is mandatory and provided by independent insurers that compete in a regulated market. Swiss citizens freely choose between insurers (which must accept all applicants) and can even personalize some aspects of their universal insurance policy. Patients also have a choice of hospitals, more than half of which are operated privately and for-profit.
In Australia, citizens can purchase private insurance, which covers the cost of treatment in private hospitals. Higher income Australians are actively encouraged to purchase private health insurance and even have to pay additional taxes if they do not. Some 39 per cent of hospitals in Australia are private and for-profit, providing care to both privately and publicly insured patients.
Vitally, competition between private health-care businesses and entrepreneurs in both countries (and many others including Germany and the Netherlands) has helped create a more cost-effective and accessible universal health-care system. Back here in Canada, the lack of private-sector efficiency, innovation and patient-focus has led to the opposite—namely, long waits and poor access.
Health care in Canada is not free. It comes with a substantial price tag through our tax system. And the size of that bill leaves less money for savings and other things families need.
Getting better value for our health-care tax dollars, and solving the longstanding access problems patients face, requires policy reform with a more contemporary understanding of how to structure a truly world-class universal health-care system. Until that reform happens, Canadians will continue to be stuck with a big bill for lousy access to health care.
Business
Parliamentary Budget Officer begs Carney to cut back on spending
PBO slices through Carney’s creative accounting
The Canadian Taxpayers Federation is calling on Prime Minister Mark Carney to cut spending following today’s bombshell Parliamentary Budget Officer report that criticizes the government’s definition of capital spending and promise to balance the operating budget.
“The reality is that Carney is continuing on a course of unaffordable borrowing and the PBO report shows government messaging about ‘balancing the operating budget’ is not credible,” said Franco Terrazzano, CTF Federal Director. “Carney is using creative accounting to hide the spiralling debt.”
Carney’s Budget 2025 splits the budget into operating and capital spending and promises to balance the operating budget by 2028-29.
However, today’s PBO budget report states that Carney’s definition of capital spending is “overly expansive.” Without using that “overly expansive” definition of capital spending, the government would run an $18 billion operating deficit in 2028-29, according to the PBO.
“Based on our definition, capital investments would total $217.3 billion over 2024-25 to 2029-30, which is approximately 30 per cent ($94 billion) lower compared to Budget 2025,” according to the PBO. “Moreover, based on our definition, the operating balance in Budget 2025 would remain in a deficit position over 2024-25 to 2029-30.”
The PBO states that the Carney government is using “a definition of capital investment that expands beyond the current treatment in the Public Accounts and international practice.” The report specifically points out that “by including corporate income tax expenditures, investment tax credits and operating (production) subsidies, the framework blends policy measures with capital formation.”
The federal government plans to borrow about $80 billion this year, according to Budget 2025. Carney has no plan stop borrowing money and balance the budget. Debt interest charges will cost taxpayers $55.6 billion this year, which is more than the federal government will send to the provinces in health transfers ($54.7 billion) or collect through the GST ($54.4 billion).
“Carney isn’t balancing anything when he borrows tens of billions of dollars every year,” Terrazzano said. “Instead of applying creative accounting to the budget numbers, Carney needs to cut spending and debt.”
Business
Carney government needs stronger ‘fiscal anchors’ and greater accountability
From the Fraser Institute
By Tegan Hill and Grady Munro
Following the recent release of the Carney government’s first budget, Fitch Ratings (one of the big three global credit rating agencies) issued a warning that the “persistent fiscal expansion” outlined in the budget—characterized by high levels of spending, borrowing and debt accumulation—will erode the health of Canada’s finances and could lead to a downgrade in Canada’s credit rating.
Here’s why this matters. Canada’s credit rating impacts the federal government’s cost of borrowing money. If the government’s rating gets downgraded—meaning Canadian federal debt is viewed as an increasingly risky investment due to fiscal mismanagement—it will likely become more expensive for the government to borrow money, which ultimately costs taxpayers.
The cost of borrowing (i.e. the interest paid on government debt) is a significant part of the overall budget. This year, the federal government will spend a projected $55.6 billion on debt interest, which is more than one in every 10 dollars of federal revenue, and more than the government will spend on health-care transfers to the provinces. By 2029/30, interest costs will rise to a projected $76.1 billion or more than one in every eight dollars of revenue. That’s taxpayer money unavailable for programs and services.
Again, if Canada’s credit rating gets downgraded, these costs will grow even larger.
To maintain a good credit rating, the government must prevent the deterioration of its finances. To do this, governments establish and follow “fiscal anchors,” which are fiscal guardrails meant to guide decisions regarding spending, taxes and borrowing.
Effective fiscal anchors ensure governments manage their finances so the debt burden remains sustainable for future generations. Anchors should be easily understood and broadly applied so that government cannot get creative with its accounting to only technically abide by the rule, but still give the government the flexibility to respond to changing circumstances. For example, a commonly-used rule by many countries (including Canada in the past) is a ceiling/target for debt as a share of the economy.
The Carney government’s budget establishes two new fiscal anchors: balancing the federal operating budget (which includes spending on day-to-day operations such as government employee compensation) by 2028/29, and maintaining a declining deficit-to-GDP ratio over the years to come, which means gradually reducing the size of the deficit relative to the economy. Unfortunately, these anchors will fail to keep federal finances from deteriorating.
For instance, the government’s plan to balance the “operating budget” is an example of creative accounting that won’t stop the government from borrowing money each year. Simply put, the government plans to split spending into two categories: “operating spending” and “capital investment” —which includes any spending or tax expenditures (e.g. credits and deductions) that relates to the production of an asset (e.g. machinery and equipment)—and will only balance operating spending against revenues. As a result, when the government balances its operating budget in 2028/29, it will still incur a projected deficit of $57.9 billion when spending on capital is included.
Similarly, the government’s plan to reduce the size of the annual deficit relative to the economy each year does little to prevent debt accumulation. This year’s deficit is expected to equal 2.5 per cent of the overall economy—which, since 2000, is the largest deficit (as a share of the economy) outside of those run during the 2008/09 financial crisis and the pandemic. By measuring its progress off of this inflated baseline, the government will technically abide by its anchor even as it runs relatively large deficits each and every year.
Moreover, according to the budget, total federal debt will grow faster than the economy, rising from a projected 73.9 per cent of GDP in 2025/26 to 79.0 per cent by 2029/30, reaching a staggering $2.9 trillion that year. Simply put, even the government’s own fiscal plan shows that its fiscal anchors are unable to prevent an unsustainable rise in government debt. And that’s assuming the government can even stick to these anchors—which, according to a new report by the Parliamentary Budget Officer, is highly unlikely.
Unfortunately, a federal government that can’t stick to its own fiscal anchors is nothing new. The Trudeau government made a habit of abandoning its fiscal anchors whenever the going got tough. Indeed, Fitch Ratings highlighted this poor track record as yet another reason to expect federal finances to continue deteriorating, and why a credit downgrade may be on the horizon. Again, should that happen, Canadian taxpayers will pay the price.
Much is riding on the Carney government’s ability to restore Canada’s credibility as a responsible fiscal manager. To do this, it must implement stronger fiscal rules than those presented in the budget, and remain accountable to those rules even when it’s challenging.
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