Enough talk, we need to actually do something about Canadian health care

From the Macdonald Laurier Institute

By J. Edward Les for Inside Policy

Canada spends more on health care as a percentage of GDP than almost all other OECD countries, yet we rank behind most of them when it comes to outcomes that matter.

I drove a stretch of road near Calgary’s South Health Campus the other day, a section with a series of three intersections in a span of less than a few hundred metres. That is, I tried to drive it – but spent far more time idling than moving.

At each intersection, after an interminable wait, the light turned green just as the next one flipped to red, grinding traffic to a halt just after it got rolling. It was excruciating; I’m quite sure I spied a snail on crutches racing by – no doubt making a beeline (snail-line?) for the ER a stone’s throw away.

The street’s sluggishness is perhaps reflective of the hospital next to it, given that our once-cherished universal health care system has crumbled into a universal waiting system – a system seemingly crafted (like that road) to obstruct flow rather than enable it. In fact, the pace of medical care delivery in this country has become so glacial that even a parking lot by comparison feels like the Indianapolis Speedway.

The health care crisis grows more dire by the day. Reforms are long overdue. Canada spends more on health care as a percentage of GDP than almost all other OECD countries, yet we rank behind most of them when it comes to outcomes that matter.

And we’re paying with our lives: according to the Canadian Institute for Health Information, thousands of Canadians die each and every year because of the inefficiencies of our system.

Yet for all that we are paralyzed by the enormity and complexity of the mushrooming disaster. We talk about solutions – and then we talk and talk some more. But for all the talking, precious little action is taken.

I’m reminded of an Anne Lamotte vignette, related in her bestselling book Bird By Bird:

Thirty years ago my older brother, who was ten years old at the time, was trying to get a report written on birds that he’d had three months to write, which was due the next day. We were out at our family cabin in Bolinas, and he was at the kitchen table close to tears, surrounded by binder paper and pencils and unopened books about birds, immobilized by the hugeness of the task ahead. Then my father sat down beside him, put his arm around my brother’s shoulder, and said, “Bird by bird, buddy. Just take it bird by bird.”

So it is with Canadian health care: we’ve wasted years wringing our hands about the woeful state of affairs, while doing precious little about it.

Enough procrastinating. It’s time to tackle the crisis, bird by bird.

One thing we can do is to let doctors be doctors. A few weeks ago, in a piece titled “Should Doctors Mind Their Own Business?”, I questioned the customary habit of doctors hanging out their shingles in small independent community practices. Physicians spend long years of training to master their craft, years during which they receive no training in business methods whatsoever, and then we expect them to master those skills off to the side of their exam rooms. Some do it well, but many do not – and it detracts from their attention to patients.

We don’t install newly minted teachers in classrooms and at the same time task them with the keeping the lights on, managing the supply chain, overseeing staffing and payroll, and all the other mechanics of running schools. Why do we expect that of doctors?

Keeping doctors embedded within large, expensive, inefficient, bureaucracy-choked hospitals isn’t the solution, either.

There’s a better way, I argued in my essay: regional medical centres – centres built and administered in partnership with the private sector.

Such centres would allow practitioners currently practicing in the community to ply their trade unencumbered by the nuts and bolts of running a business; and they would allow us to decant a host of services from hospitals, which should be reserved for what only hospitals can do: emergency services, inpatient care, surgeries, and the like.

In short, we should let doctors be doctors, and hospitals be hospitals.

To garner feedback, I dumped my musings into a couple of online physician forums to which I belong, tagged with the query: “Food for thought, or fodder for the compost bin?”

The verdict? Hands down, the compost bin.

I was a bit taken aback, initially. Offended, even – because who among us isn’t in love with their own ideas?

But it quickly became evident from my peers’ comments that I’d been misunderstood. Not because my doctor friends are dim, but because I hadn’t been clear.

When I proposed in my essay that we “leave the administration and day-to-day tasks of running those centres to business folks who know what they’re doing,” my colleagues took that to mean that doctors would be serving at the beck and call of a tranche of ill-informed government-enabled administrators – and they reacted to the notion with anaphylactic derision. And understandably so: too many of us have long and painful experience with thick layers of health care bureaucracy seemingly organized according to the Peter Principle, with people promoted to – and permanently stuck at – the level of their incompetence.

But I didn’t mean to suggest – not for a minute – that doctors shouldn’t be engaged in running these centres. I also wrote: “None of which is to suggest that doctors shouldn’t be involved, by aptitude and inclination, in influencing the set-up and management of regional centres – of course, they should.”

Of course they should. There are plenty of physicians equipped with both the skills and interest needed to administer these centres; and they should absolutely be front and centre in leading them.

But more than that: everyone should have skin in the game. All workers have the right to share in the success of an enterprise; and when they do, everybody wins. When everyone is pulling in the same direction because everyone shares in the wins, waste and inefficiencies are rooted out like magic.

Contrast that to how hospitals are run, with scarcely anyone aware of the actual cost of the blood tests or CT scans they order or the packets of suture and gauze they rip open, and with the motivations of administrative staff, nurses, doctors, and other personnel running off in more directions than a flock of headless chickens. The capacity for waste and inefficiencies is almost limitless.

I don’t mean to suggest that the goal of regional medical centres should be to turn a profit; but fiscal prudence and economic accountability are to be celebrated, because money not wasted is money that can be allocated to enhancing patient care.

Nor do I mean to intimate that sensible resource management should be the only parameter tracked; patient outcomes and patient satisfaction are paramount.

What should government’s role be in all this? Initially, to incentivize the creation of these centres via public-private partnerships; and then, crucially, to encourage competition among them and to reward innovation and performance, with optimization of the three key metrics – patient outcomes, patient satisfaction, and economic accountability – always in focus.

No one should be mandated to work in non-hospital regional medical centres. It’s a free country (or it should be): doctors should be free to hang out their own community shingles if they wish. But if we build the model correctly, my contention is that most medical professionals will prefer to work collaboratively under one roof with a diverse group of colleagues, unencumbered by the mundanities of running a business, but also free of choking hospital bureaucracy.

I connected a couple weeks ago with the always insightful economist Jack Mintz (who is also a distinguished fellow at the Macdonald-Laurier Institute). Mintz sits on the board of a Toronto-area hospital and sees first-hand “the problems with the lack of supply, population growth, long wait times between admission and getting a bed, emergency room overuse,” and so on.

“Something has to give,” he said. “Probably more resources but better managed. We really need major reform.”

On that we can all agree. We can’t carry on this way.

So, let’s stop idling; and let’s green-light some fixes.

As Samwise Gamgee said in The Lord of the Rings, “It’s the job that’s never started as takes longest to finish.”

Dr. J. Edward Les is a pediatrician in Calgary who writes on politics, social issues, and other matters.

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To increase competition in Canadian banking, mandate and mindset of bank regulators must change

Published on December 7, 2025

Todayville

From the Fraser Institute

By Lawrence L. Schembri and Andrew Spence

Canada’s weak productivity performance is directly related to the lack of competition across many concentrated industries. The high cost of financial services is a key contributor to our lagging living standards because services, such as payments, are essential input to the rest of our economy.

It’s well known that Canada’s banks are expensive and the services that they provide are outdated, especially compared to the banking systems of the United Kingdom and Australia that have better balanced the objectives of stability, competition and efficiency.

Canada’s banks are increasingly being called out by senior federal officials for not embracing new technology that would lower costs and improve productivity and living standards. Peter Rutledge, the Superintendent of Financial Institutions and senior officials at the Bank of Canada, notably Senior Deputy Governor Carolyn Rogers and Deputy Governor Nicolas Vincent, have called for measures to increase competition in the banking system to promote innovation, efficiency and lower prices for financial services.

The recent federal budget proposed several new measures to increase competition in the Canadian banking sector, which are long overdue. As a marker of how uncompetitive the market for financial services has become, the budget proposed direct interventions to reduce and even eliminate some bank service fees. In addition, the budget outlined a requirement to improve price and fee transparency for many transactions so consumers can make informed choices.

In an effort to reduce barriers to new entrants and to growth by smaller banks, the budget also proposed to ease the requirement that small banks include more public ownership in their capital structure.

At long last, the federal government signalled a commitment to (finally) introduce open banking by enacting the long-delayed Consumer Driven Banking Act. Open banking gives consumers full control over who they want to provide them with their financial services needs efficiently and safely. Consumers can then move beyond banks, utilizing technology to access cheaper and more efficient alternative financial service providers.

Open banking has been up and running in many countries around the world to great success. Canada lags far behind the U.K., Australia and Brazil where the presence of open banking has introduced lower prices, better service quality and faster transactions. It has also brought financing to small and medium-sized business who are often shut out of bank lending.

Realizing open banking and its gains requires a new payment mechanism called real time rail. This payment system delivers low-cost and immediate access to nonbank as well as bank financial service providers. Real time rail has been in the works in Canada for over a decade, but progress has been glacial and lags far behind the world’s leaders.

Despite the budget’s welcome backing for open banking, Canada should address the legislative mandates of its most important regulators, requiring them to weigh equally the twin objectives of financial system stability as well as competition and efficiency.

To better balance these objectives, Canada needs to reform its institutional framework to enhance the resilience of the overall banking system so it can absorb an individual bank failure at acceptable cost. This would encourage bank regulators to move away from a rigid “fear of failure” cultural mindset that suppresses competition and efficiency and has held back innovation and progress.

Canada should also reduce the compliance burden imposed on banks by the many and varied regulators to reduce barriers to entry and expansion by domestic and foreign banks. These agencies, including the Office of the Superintendent of Financial Institutions, Financial Consumer Agency of Canada, Financial Transactions and Reports Analysis Centre of Canada, the Canada Deposit Insurance Corporation plus several others, act in largely uncoordinated manner and their duplicative effort greatly increases compliance and reporting costs. While Canada’s large banks are able, because of their market power, to pass those costs through to their customers via higher prices and fees, they also benefit because the heavy compliance burden represents a significant barrier to entry that shelters them from competition.

More fundamental reforms are needed, beyond the measures included in the federal budget, to strengthen the institutional framework and change the regulatory mindset. Such reforms would meaningfully increase competition, efficiency and innovation in the Canadian banking system, simultaneously improving the quality and lowering the cost of financial services, and thus raising productivity and the living standards of Canadians.

Lawrence L. Schembri

Senior Fellow, Fraser Institute

Andrew Spence

Alberta

A Memorandum of Understanding that no Canadian can understand

Published on December 6, 2025

Todayville

From the Fraser Institute

By Niels Veldhuis

The federal and Alberta governments recently released their much-anticipated Memorandum of Understanding (MOU) outlining what it will take to build a pipeline from Alberta, through British Columbia, to tidewater to get more of our oil to markets beyond the United States.

This was great news, according to most in the media: “Ottawa-Alberta deal clears hurdles for West Coast pipeline,” was the top headline on the Globe and Mail’s website, “Carney inks new energy deal with Alberta, paving way to new pipeline” according to the National Post.

And the reaction from the political class? Well, former federal environment minister Steven Guilbeault resigned from Prime Minister Carney’s cabinet, perhaps positively indicating that this agreement might actually produce a new pipeline. Jason Kenney, a former Alberta premier and Harper government cabinet minister, congratulated Prime Minister Carney and Premier Smith on an “historic agreement.” Even Alberta NDP Leader Naheed Nenshi called the MOU “a positive step for our energy future.”

Finally, as Prime Minister Carney promised, Canada might build critical infrastructure “at a speed and scale not seen in generations.”

Given this seemingly great news, I eagerly read the six-page Memorandum of Understanding. Then I read it again and again. Each time, my enthusiasm and understanding diminished rapidly. By the fourth reading, the only objective conclusion I could reach was not that a pipeline would finally be built, but rather that only governments could write an MOU that no Canadian could understand.

The MOU is utterly incoherent. Go ahead, read it for yourself online. It’s only six pages. Here are a few examples.

The agreement states that, “Canada and Alberta agree that the approval, commencement and continued construction of the bitumen pipeline is a prerequisite to the Pathways project.” Then on the next line, “Canada and Alberta agree that the Pathways Project is also a prerequisite to the approval, commencement and continued construction of the bitumen pipeline.”

Two things, of course, cannot logically be prerequisites for each other.

But worry not, under the MOU, Alberta and Ottawa will appoint an “Implementation Committee” to deliver “outcomes” (this is from a federal government that just created the “Major Project Office” to get major projects approved and constructed) including “Determining the means by which Alberta can submit its pipeline application to the Major Projects Office on or before July 1, 2026.”

What does “Determining the means” even mean?

What’s worse is that under the MOU, the application for this pipeline project must be “ready to submit to the Major Projects Office on or before July 1, 2026.” Then it could be another two years (or until 2028) before Ottawa approves the pipeline project. But the MOU states the Pathways Project is to be built in stages, starting in 2027. And that takes us back to the circular reasoning of the prerequisites noted above.

Other conditions needed to move forward include:

The private sector must construct and finance the pipeline. Serious question: which private-sector firm would take this risk? And does the Alberta government plan to indemnify the company against these risks?

Indigenous Peoples must co-own the pipeline project.

Alberta must collaborate with B.C. to ensure British Columbians get a cut or “share substantial economic and financial benefits of the proposed pipeline” in MOU speak.

None of this, of course, addresses the major issue in our country—that is, investors lack clarity on timelines and certainty about project approvals. The Carney government established the Major Project Office to fast-track project approvals and provide greater certainty. Of the 11 project “winners” the federal government has already picked, most either already had approvals or are already at an advanced stage in the process. And one of the most important nation-building projects—a pipeline to get our oil to tidewater—hasn’t even been referred to the Major Project Office.

What message does all this send to the investment community? Have we made it easier to get projects approved? No. Have we made things clearer? No. Business investment in Canada has fallen off a cliff and is down 25 per cent per worker since 2014. We’ve seen a massive outflow of capital from the country, more than $388 billion since 2014.

To change this, Canada needs clear rules and certain timelines for project approvals. Not an opaque Memorandum of Understanding.