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Fraser Institute

It’s budget season—but more money won’t solve Canada’s health-care woes

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From the Fraser Institute

By Mackenzie Moir

In light of regular reports of hallway health care, regular closures of emergency rooms, and the longest wait times for care on record, it’s understandable that Canadians want dramatic improvements to their health-care system. For governments, particularly during budget season, improvement often means an increase in spending.

However, Canada already ranks among the most expensive universal health-care systems in the world. In 2022 (the latest year of comparable data), and after adjusting for population age in each country, Canada ranked fourth-highest for health-care spending as a share of the economy (11.5 per cent). For per-person spending, Canada ranked ninth. In other words, whichever way you look at it, Canada ranked among the top-third of spenders among 31 universal health-care countries.

That’s a lot of money. But what do Canadians get in return?

Canada ranked near the bottom (28th of 30) on the availability of physicians. Canada also had some of the fewest hospital beds and diagnostic equipment (including CT scanners and MRI units) per person.

Moreover, among nine universal health-care countries surveyed by the Commonwealth Fund, a health-care research organization, 65.2 per cent of Canadian patients reported waiting more than one month for a specialist appointment (8th worst out of 9 countries) compared to 35.7 per cent in top-ranked the Netherlands.

We see the same thing for patients trying to access timely non-emergency surgical care. In Canada, 58.3 per cent of patients reported waiting more than two months (9th worst of 9 countries), far more than in the Netherlands (20.3 per cent), Germany (20.4 per cent) and Switzerland (21.1 per cent).

While Canada clearly struggles on measures of availability and timely access to medical resources, it reported mixed results in other areas. For example, Canada performed well on measures of heart attack survival (ranked 8th of 26). And while Canada had average performance for stroke survivability, it remained a bottom of the barrel performer on safety measures such as obstetric trauma during birth (23rd of 23).

With relatively fewer key medical resources and long waits for non-emergency surgery, patients in Canada face major challenges. And this budget season, while governments may be keen to simply spend more, in reality Canadians do not currently receive commensurate value for their health-care dollars. Without fundamental reform, based on the experiences of other more successful universal health-care systems, it’s unlikely we’ll see improvement.

Mackenzie Moir

Mackenzie Moir

Senior Policy Analyst, Fraser Institute

Automotive

Canada’s electric vehicle industry faces multiple threats

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From the Fraser Institute

By Joseph Fournier

While Trump’s trade war continues to grab all the headlines, Canada’s electric vehicle (EV) industry may be steaming toward an iceberg, due mainly to shifts in policy south of the border.

Specifically, the Trump administration has withdrew from the Paris Agreement (and its net-zero 2050 framework) and eliminated the U.S. EV mandate, which required upwards of 56 per cent of new vehicles sold in the United States. to be EV and 13 per cent be plug-in hybrids by 2032. These moves represent an existential threat to Canada’s EV investments and the viability of the large EV battery plants under various stages of planning and construction in Ontario and Quebec.

Indeed, the Trudeau government, along with the Ontario and Quebec governments, negotiated several significant battery manufacturing deals, which included subsidies and construction funding totalling $4.6 billion for the Northvolt AB plant near Montreal, $13.2 billion for the Volkswagen plant in Saint Thomas, Ontario, $15 billion for the Stellantis plant in Windsor, Ontario and $1.6 billion for the Japanese battery company Asahi Kasei plant in Port Colborne, Ontario. (Although both Northvolt AB and Stellantis are reconsidering their EV battery investments in Canada—Northvolt AB is approaching bankruptcy and Stellantis thinks that current federal subsidies are insufficient to justify its investment.)

According to the Parliamentary Budget Officer, taxpayer subsidies (a.k.a. corporate welfare) for these deals will cost Canadians up to $44 billion between 2022/23 and 2032/33. In the U.S., EV sales in 2024 were 1.2 million (7 per cent of auto total sales) buoyed by an EV tax credit of US$7,500 per new vehicle, which translates into US$9 billion in EV consumer subsidies that year alone.

All of this raises the question: can the EV industry stand on its own without massive subsidies from taxpayers?

In 2023, of the two largest EV producers (Tesla and Ford), only Tesla would break even without the EV tax credit subsidies. According to Reuters, Tesla earned approximately US$8,300 in profit per EV in 2023, and of the 1.8 million Tesla vehicles produced globally, only 400,000 were produced in the U.S. Meanwhile, even after the subsidies, Ford lost US$64,700 per EV in 2023 and US$32,700 in 2024. (It’s also worth noting that Ford, with the second-highest EV production in the U.S., produced a mere 72,000 vehicles in 2023.)

While Ford still plans to make EVs, it recently announced plans to shift production at its Oakville, Ontario factory from electric sports vehicles to gas-powered pickup trucks. The news came shortly after General Motors announced it would trim its forecast of EVs produced in 2024 by 50,000.

Clearly, U.S. legacy automakers are worried about overproducing against sluggish consumer demand, knowing that their profitability and fiscal viability resides in their internal combustion engine vehicle production lines. Numerous large European automotive manufacturers also saw a decline in EV sales in 2024 and are re-investing in their combustion engine production lines to protect profits.

Finally, beyond only EVs, Canada’s automotive manufacturing sector is in decline. Between 2014 and 2023, automotive production fell from 2.4 million to 1.5 million vehicles while automobile imports increased from $57 billion to $82 billion. Of the 1.5 million vehicles produced in Canada in 2023, 88 per cent were exported to the U.S., leaving the industry highly vulnerable to shifts in American policy (which currently include President Trump’s threat of a 100 per cent tariff on automobile exports).

The iceberg is in view. The new Carney government and our provincial governments must take stock of the decline in the automotive manufacturing sector, its near total dependence on U.S. exports, and uncertain government-driven EV investments. And they should ask if the push to electrify the automotive manufacturing base is in the long-term best interests of Canadians.

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Business

Canada’s finances deteriorated faster than any other G7 country

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From the Fraser Institute

By Jake Fuss and Grady Munro

Some analysts compare Canada’s fiscal health with other countries in the Group of Seven (G7) to downplay concerns with how Canadian governments run their finances. And while it’s true that Canada’s finances aren’t as bad some other countries, the data show Canada’s finances are deteriorating fastest in the G7, and if we’re not careful we may lose any advantage we currently have.

The G7 (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States) represents seven of the world’s most advanced economies and some of Canada’s closest peer countries. As such, many commentatorsorganizations and governments use Canada’s standing within the group as a barometer of our fiscal health. Indeed, based on his oft-repeated goal to “build the strongest economy in the G7,” Prime Minister Carney himself clearly sees the G7 as a good comparator group for Canada.

Two key indicators of a country’s finances are government spending and debt, both of which are often measured as a share of gross domestic product (GDP) to allow for comparability across jurisdictions with various sized economies. Government spending as a share of GDP is a measure of the overall size of government in a country, while government debt-to-GDP is a measure of a country’s debt burden. Both the size of government in Canada and the country’s overall debt burden have grown over the last decade.

This is a problem because, in recent years, government spending and debt in Canada have reached or exceeded thresholds beyond which any additional spending or debt will most likely harm economic growth and living standards. Indeed, research suggests that when government spending exceeds 32 per cent of GDP, government begins to take over functions and resources better left to the private sector, and economic growth slows. However, the issues of high spending and debt are often downplayed by comparisons showing that Canada’s finances aren’t as bad as other peer countries—namely the rest of the G7.

It’s true that Canada ranks fairly well among the G7 when comparing the aforementioned measures of fiscal health. Based on the latest data from the International Monetary Fund (IMF), a new study shows that Canada’s general government (federal, provincial and local) total spending as a share of GDP was 44.7 per cent in 2024, while Canada’s general government gross debt was 110.8 per cent of GDP. Compared to the G7, Canada’s size of government ranked 4th highest while our overall debt burden ranked 5th highest.

But while Canada’s size of government and overall debt burden rank middle-of-the-pack among G7 countries, that same study reveals that Canada is not in the clear. Consider the following charts.

The first chart shows the overall change in general government total spending as a share of GDP in G7 countries from 2014 to 2024. Canada observed the largest increase in the size of government of any G7 country, as total spending compared to GDP increased 6.34 percentage points over the decade. This increase was nearly three times larger than the increase in the U.S., and both France and Italy were actually reduced their size of government during this time.

The second chart shows the overall change in general government gross debt as a share of GDP over the same decade, and again Canada experienced the largest increase of any G7 country at 25.23 percentage points. That’s considerably higher than the next closest increases in France (16.97 percentage points), the U.S. (16.36 percentage points) and the U.K. (14.13 percentage points).

Simply put, the study shows that Canada’s finances have deteriorated faster than any country in the G7 over the last decade. And if we expand this comparison to a larger group of 40 advanced economies worldwide, the results are very similar—Canada experienced the 2nd highest increase in its size of government and 3rd highest increase in its overall debt burden, from 2014 to 2024. Some analysts downplay mismanagement of government finances in Canada by pointing to other countries that have worse finances. However, if Canada continues as it has for the last decade, we’ll be joining those other countries before too long.

Jake Fuss

Director, Fiscal Studies, Fraser Institute

Grady Munro

Policy Analyst, Fraser Institute
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