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
Clean energy transition price tag over $150 billion and climbing, with very little to show for it
 
														From the Fraser Institute
By Jake Fuss, Julio Mejía, Elmira Aliakbari, Karen Graham and Jock Finlayson
Ottawa and the four biggest provinces have spent (or foregone revenues) of at least $158 billion to create at most 68,000 “clean” jobs since 2014
Despite the hype of a “clean” economic transition, governments in Ottawa and in the four largest provinces have spent or foregone revenues of more than $150 billion (inflation-adjusted) on low-carbon initiatives since 2014/15, but have only created, at best, 68,000 clean jobs, according to two new studies published by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.
“Governments, activists and special interest groups have been making a lot of claims about the opportunities of a clean economic transition, but after a decade of policy interventions and more than $150 billion in taxpayers’ money, the results are
extremely underwhelming,” said Elmira Aliakbari, director of natural resource studies and co-author of The Fiscal Cost of Canada’s Low-Carbon Economy.
The study finds that since 2014/15, the federal government and provincial governments in the country’s four largest provinces (Ontario, Quebec, Alberta and British Columbia) combined have spent and foregone revenues of $158 billion (inflation adjusted to 2024 dollars) trying to create clean jobs, as defined by Statistics Canada’s Environmental and Clean Technology Products Economic Account.
Importantly, that cost estimate is conservative since it does not account for an exhaustive list of direct government spending and it does not measure the costs from Canada’s other six provinces, municipalities, regulatory costs and other economic
costs because of the low-carbon spending and tax credits.
A second study, Sizing Canada’s Clean Economy, finds that there was very little change over the 2014 to 2023 period in terms of the share of the total economy represented by the clean economy. For instance, in 2014, the clean economy represented 3.1 per cent of GDP compared to 3.6 per cent in 2023.
“The evidence is clear—the much-hyped clean economic transition has failed to fundamentally transform Canada’s $3.3 trillion economy,” said study co-author and Fraser Institute senior fellow Jock Finlayson.
State of the Green Economy
- The Fiscal Cost of Canada’s Low-Carbon Economy documents spending initiatives by the federal government and the governments of Ontario, British Columbia, Alberta, and Quebec since 2014 to promote the low-carbon economy, as well as how much revenue they have foregone through offering tax credits.
- Overall, the combined cost of spending and tax credits supporting a low-carbon economy by the federal government and the four provincial governments is estimated at $143.6 billion from 2014–15 to 2024–25, in nominal terms. When adjusted for inflation, the total reaches $158 billion in 2024 dollars.
- These estimates are based on very conservative assumptions, and they do not cover every program area or government-controlled expenditure related to the low-carbon economy and/or reducing greenhouse gas emissions.
- Sizing Canada’s Green Economy assesses the composition, growth, share of Gross Domestic Product (GDP) output, and employment of Canada’s “clean economy” from 2014 to 2023.
- Canada’s various environmental and clean technology industries collectively have accounted for between 3.07% and 3.62% of all-industry GDP over the 10-year period from 2014 to 2023. While it has grown, the sector as a whole has not been expanding at a pace that meaningfully exceeds the growth of the overall Canadian economy, despite significant policy attention and mounting public subsidies.
- The clean economy represents a respectable and relatively stable share of Canada’s $3.3 trillion economy. However, it remains a small part of Canada’s broader industrial mix, it is not a major source of export earnings, and it is not about to supplant the many other industries that underpin the country’s prosperity and dominate its international exports.
Alberta
B.C. would benefit from new pipeline but bad policy stands in the way
 
														From the Fraser Institute
By Julio Mejía and Elmira Aliakbari
Bill C-69 (a.k.a. the “no pipelines act”) has added massive uncertainty to the project approval process, requiring proponents to meet vague criteria that go far beyond any sensible environmental concerns—for example, assessing any project’s impact on the “intersection of sex and gender with other identity factors.”
In case you haven’t heard, the Alberta government plans to submit a proposal to the federal government to build an oil pipeline from Alberta to British Columbia’s north coast.
But B.C. Premier Eby dismissed the idea, calling it a project imported from U.S. politics and pursued “at the expense of British Columbia and Canada’s economy.” He’s simply wrong. A new pipeline wouldn’t come at the expense of B.C. or Canada’s economy—it would strengthen both. In fact, particularly during the age of Trump, provinces should seek greater cooperation and avoid erecting policy barriers that discourage private investment and restrict trade and market access.
The United States remains the main destination for Canada’s leading exports, oil and natural gas. In 2024, nearly 96 per cent of oil exports and virtually all natural gas exports went to our southern neighbour. In light of President Trump’s tariffs on Canadian energy and other goods, it’s long past time to diversify our trade and find new export markets.
Given that most of Canada’s oil and gas is landlocked in the Prairies, pipelines to coastal terminals are the only realistic way to reach overseas markets. After the completion of the Trans Mountain Pipeline Expansion (TMX) project in May 2024, which transports crude oil from Alberta to B.C. and opened access to Asian markets, exports to non-U.S. destinations increased by almost 60 per cent. This new global reach strengthens Canada’s leverage in trade negotiations with Washington, as it enables Canada to sell its energy to markets beyond the U.S.
Yet trade is just one piece of the broader economic impact. In its first year of operation, the TMX expansion generated $13.6 billion in additional revenue for the economy, including $2.0 billion in extra tax revenues for the federal government. By 2043, TMX operations will contribute a projected $9.2 billion to Canada’s economic output, $3.7 billion in wages, and support the equivalent of more than 36,000 fulltime jobs. And B.C. stands to gain the most, with $4.3 billion added to its economic output, nearly $1 billion in wages, and close to 9,000 new jobs. With all due respect to Premier Eby, this is good news for B.C. workers and the provincial economy.
In contrast, cancelling pipelines has come at a real cost to B.C. and Canada’s economy. When the Trudeau government scrapped the already-approved Northern Gateway project, Canada lost an opportunity to increase the volume of oil transported from Alberta to B.C. and diversify its trading partners. Meanwhile, according to the Canadian Energy Centre, B.C. lost out on nearly 8,000 jobs a year (or 224,344 jobs in 29 years) and more than $11 billion in provincial revenues from 2019 to 2048 (inflation-adjusted).
Now, with the TMX set to reach full capacity by 2027/28, and Premier Eby opposing Alberta’s pipeline proposal, Canada may miss its chance to export more to global markets amid rising oil demand. And Canadians recognize this opportunity—a recent poll shows that a majority of Canadians (including 56 per cent of British Columbians) support a new oil pipeline from Alberta to B.C.
But, as others have asked, if the economic case is so strong, why has no private company stepped up to build or finance a new pipeline?
Two words—bad policy.
At the federal level, Bill C-48 effectively bans large oil tankers from loading or unloading at ports along B.C.’s northern coast, undermining the case for any new private-sector pipeline. Meanwhile, Bill C-69 (a.k.a. the “no pipelines act”) has added massive uncertainty to the project approval process, requiring proponents to meet vague criteria that go far beyond any sensible environmental concerns—for example, assessing any project’s impact on the “intersection of sex and gender with other identity factors.” And the federal cap on greenhouse gas (GHG) emissions exclusively for the oil and gas sector will inevitably force a reduction in oil and gas production, again making energy projects including pipelines less attractive to investors.
Clearly, policymakers in Canada should help diversify trade, boost economic growth and promote widespread prosperity in B.C., Alberta and beyond. To achieve this goal, they should put politics aside, focus of the benefits to their constituents, and craft regulations that more thoughtfully balance environmental concerns with the need for investment and economic growth.
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