From the Fraser Institute

By Jake Fuss and Grady Munro

From 2014 to 2024, gross government debt (including federal, provincial and local governments) increased from 85.5 per cent of the economy (measured by GDP) to 110.8 per cent—a larger increase than any other G7 country. When debt grows faster than the economy, government finances are unsustainable.

Ahead of the Carney government’s long-awaited first budget scheduled for Nov. 4, a recent CBC commentary described the long-standing debate about the federal deficit and the state of federal finances as “something of a phoney war.” And that calls to balance the budget—expressed today and over the last decade—have lacked any serious discussion about the trade-offs between allowing deficits to persist versus balancing the budget.

While there’s certainly something to be said about the political theatre that regularly dominates the House of Commons—which we agree focuses too often on scoring political points instead of adequately assessing the merits of policy—it’s wrong to downplay concerns about the state of federal finances. Such concerns aren’t “phoney.”

Consider this. From 2014 to 2024, gross government debt (including federal, provincial and local governments) increased from 85.5 per cent of the economy (measured by GDP) to 110.8 per cent—a larger increase than any other G7 country. And federal gross debt increased from 53.0 per cent of the economy in 2014/15 to a projected 70.0 per cent in 2024/25. When debt grows faster than the economy, government finances are unsustainable. And the Carney government seemingly plans to continue this same approach.

In other words, the government plans to continue to spend more than it collects in revenue, continue to run massive deficits, and continue to rack up large amounts of debt.

Why should Canadians care?

Because the costs of government debt land squarely on their backs. For example, when government debt levels rise, the cost of debt interest often also rises. This year the federal government will spend a projected $54.5 billion on debt interest costs—equivalent to what it sends to the provinces for health care. Moreover, when governments borrow money, they can help drive up the cost of borrowing by increasing demand for the limited pool of savings that both government and the private sector compete for—making it more expensive for a family to take out a mortgage or businesses to attract investments. And to pay for today’s debt accumulation, governments in the future may raise taxes—a burden that will fall disproportionately on younger generations.

Again, given this alarming deterioration in the state of government finances over the last decade and the costs it imposes on Canadians, there’s nothing disingenuous about calling for more fiscal discipline from Ottawa.

Of course, getting federal finances back in order is no small task—the Trudeau government’s forays into areas of provincial jurisdiction (which carry huge price tags), combined with Carney’s massive new spending commitments for defence and other programs, mean the government cannot balance the budget without significant trade-offs. In the past, the federal government has overcome similar fiscal circumstances by committing to balance the budget and outlining a clear plan to achieve this goal. The Carney government should heed these lessons and apply them in its upcoming budget.

Jake Fuss

Director, Fiscal Studies, Fraser Institute

Grady Munro

Policy Analyst, Fraser Institute

From the Frontier Centre for Public Policy

By Ian Madsen

Doctors waste millions of hours on useless admin. It’s enough to end Canada’s doctor shortage. Ian Madsen says slashing red tape, not just recruiting, is the fastest fix for the clogged system.

Doctors spend more time on paperwork than on patients and that’s fueling Canada’s health care wait lists

Canada doesn’t just lack doctors—it squanders the ones it has. Mountains of paperwork and pointless admin chew up tens of millions of physician hours every year, time that could erase the so-called shortage and slash wait lists if freed for patient care.

Recruiting more doctors helps, but the fastest cure for our sick system is cutting the bureaucracy that strangles the ones already here.

The Canadian Medical Association found that unnecessary non-patient work consumes millions of hours annually. That’s the equivalent of 50.5 million patient visits, enough to give every Canadian at least one appointment and likely erase the physician shortage. Meanwhile, the Canadian Institute for Health Information estimates more than six million Canadians don’t even have a family doctor. That’s roughly one in six of us.

And it’s not just patients who feel the shortage—doctors themselves are paying the price. Endless forms don’t just waste time; they drive doctors out of the profession. Burned out and frustrated, many cut their hours or leave entirely. And the foreign doctors that health authorities are trying to recruit? They might think twice once they discover how much time Canadian physicians spend on paperwork that adds nothing to patient care.

But freeing doctors from forms isn’t as simple as shredding them. Someone has to build systems that reduce, rather than add to, the workload. And that’s where things get tricky. Trimming red tape usually means more Information Technology (IT), and big software projects have a well-earned reputation for spiralling in cost.

Bent Flyvbjerg, the global guru of project disasters, and his colleagues examined more than 5,000 IT projects in a 2022 study. They found outcomes didn’t follow a neat bell curve but a “power-law” distribution, meaning costs don’t just rise steadily, they explode in a fat tail of nasty surprises as variables multiply.

Oxford University and McKinsey offered equally bleak news. Their joint study concluded: “On average, large IT projects run 45 per cent over budget and seven per cent over time while delivering 56 per cent less value than predicted.” If that sounds familiar, it should. Canada’s Phoenix federal payroll fiasco—the payroll software introduced by Ottawa that left tens of thousands of federal workers underpaid or unpaid—is a cautionary tale etched into the national memory.

The lesson isn’t to avoid technology, but to get it right. Canada can’t sidestep the digital route. The question is whether we adapt what others have built or design our own. One option is borrowing from the U.S. or U.K., where electronic health record (EHR) systems (the digital patient files used by doctors and hospitals) are already in place. Both countries have had headaches with their systems, thanks to legal and regulatory differences. But there are signs of progress.

The U.K. is experimenting with artificial intelligence to lighten the administrative load, and a joint U.K.-U.S. study gives a glimpse of what’s possible:

“… AI technologies such as Robotic Process Automation (RPA), predictive analytics, and Natural Language Processing (NLP) are transforming health care administration. RPA and AI-driven software applications are revolutionizing health care administration by automating routine tasks such as appointment scheduling, billing, and documentation. By handling repetitive, rule-based tasks with speed and accuracy, these technologies minimize errors, reduce administrative burden, and enhance overall operational efficiency.”

For patients, that could mean fewer missed referrals, faster follow-up calls and less time waiting for paperwork to clear before treatment. Still, even the best tools come with limits. Systems differ, and customization will drive up costs. But medicine is medicine, and AI tools can bridge more gaps than you might think.

Run the math. If each “freed” patient visit is worth just $20—a conservative figure for the value of a basic appointment—the payoff could hit $1 billion in a single year.

Updating costs would continue, but that’s still cheap compared to the human and financial toll of endless wait lists. Cost-sharing between provinces, Ottawa, municipalities and even doctors themselves could spread the risk. Competitive bidding, with honest budgets and realistic timelines, is non-negotiable if we want to dodge another Phoenix-sized fiasco.

The alternative—clinging to our current dysfunctional patchwork of physician information systems—isn’t really an option. It means more frustrated doctors walking away, fewer new ones coming in, and Canadians left to languish on wait lists that grow ever longer.

And that’s not health care—it’s managed decline.

Ian Madsen is a senior policy analyst at the Frontier Centre for Public Policy.