Time to finally change the Canada Health Act for the sake of patients

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.

Nadeem Esmail

Senior Fellow, Fraser Institute

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Federal government should swiftly axe foolish EV mandate

Published on July 9, 2025

Todayville

From the Fraser Institute

By Kenneth P. Green

Two recent events exemplify the fundamental irrationality that is Canada’s electric vehicle (EV) policy.

First, the Carney government re-committed to Justin Trudeau’s EV transition mandate that by 2035 all (that’s 100 per cent) of new car sales in Canada consist of “zero emission vehicles” including battery EVs, plug-in hybrid EVs and fuel-cell powered vehicles (which are virtually non-existent in today’s market). This policy has been a foolish idea since inception. The mass of car-buyers in Canada showed little desire to buy them in 2022, when the government announced the plan, and they still don’t want them.

Second, President Trump’s “Big Beautiful” budget bill has slashed taxpayer subsidies for buying new and used EVs, ended federal support for EV charging stations, and limited the ability of states to use fuel standards to force EVs onto the sales lot. Of course, Canada should not craft policy to simply match U.S. policy, but in light of policy changes south of the border Canadian policymakers would be wise to give their own EV policies a rethink.

And in this case, a rethink—that is, scrapping Ottawa’s mandate—would only benefit most Canadians. Indeed, most Canadians disapprove of the mandate; most do not want to buy EVs; most can’t afford to buy EVs (which are more expensive than traditional internal combustion vehicles and more expensive to insure and repair); and if they do manage to swing the cost of an EV, most will likely find it difficult to find public charging stations.

Also, consider this. Globally, the mining sector likely lacks the ability to keep up with the supply of metals needed to produce EVs and satisfy government mandates like we have in Canada, potentially further driving up production costs and ultimately sticker prices.

Finally, if you’re worried about losing the climate and environmental benefits of an EV transition, you should, well, not worry that much. The benefits of vehicle electrification for climate/environmental risk reduction have been oversold. In some circumstances EVs can help reduce GHG emissions—in others, they can make them worse. It depends on the fuel used to generate electricity used to charge them. And EVs have environmental negatives of their own—their fancy tires cause a lot of fine particulate pollution, one of the more harmful types of air pollution that can affect our health. And when they burst into flames (which they do with disturbing regularity) they spew toxic metals and plastics into the air with abandon.

So, to sum up in point form. Prime Minister Carney’s government has re-upped its commitment to the Trudeau-era 2035 EV mandate even while Canadians have shown for years that most don’t want to buy them. EVs don’t provide meaningful environmental benefits. They represent the worst of public policy (picking winning or losing technologies in mass markets). They are unjust (tax-robbing people who can’t afford them to subsidize those who can). And taxpayer-funded “investments” in EVs and EV-battery technology will likely be wasted in light of the diminishing U.S. market for Canadian EV tech.

If ever there was a policy so justifiably axed on its failed merits, it’s Ottawa’s EV mandate. Hopefully, the pragmatists we’ve heard much about since Carney’s election victory will acknowledge EV reality.

Kenneth P. Green

Senior Fellow, Fraser Institute

Fraser Institute

Before Trudeau average annual immigration was 617,800. Under Trudeau number skyrocketted to 1.4 million from 2016 to 2024

Published on July 8, 2025

Todayville

From the Fraser Institute

By Jock Finlayson and Steven Globerman

From 2000 to 2015, annual immigration averaged 617,800 immigrants, compared to a more than doubling to 1.4 million annually from 2016 to
2024 (excluding 2020), according to a new study published by the Fraser Institute, an independent non-partisan Canadian think-tank.

“Over the past decade, Canada’s immigration numbers have skyrocketed, most starkly since 2021,” said Jock Finlayson, senior fellow at the Fraser Institute and co-author of Canada’s Changing Immigration Patterns, 2000–2024.

The study finds from 2000 to 2015, immigration (including temporary foreign workers and international students) grew on average by 3.5 per cent per year. However, from 2016 to 2024 (excluding 2020) immigration grew annually at 21.3 per cent—more than six times the 2000-2015 pace.

The sharp rise in recent years reflects both planned increases in permanent immigrant inflows as well as unprecedented and largely unplanned growth in the numbers of temporary foreign workers, international students, and asylum seekers. For example, in 2024 alone, 485,600 permanent immigrants entered Canada, along with 518,200 international students and nearly one million (912,900) temporary foreign workers.

However, due to concerns about the impact of unprecedented in-migration on housing affordability, employment opportunities (or lack thereof), access to health care and other issues, late last year the federal government unveiled plans to substantially reduce immigration levels over the 2025-27 period, affecting permanent immigrants, international students, and other temporary visa holders.

The composition of immigration also changed dramatically during this period. From 2000 to 2015, the average share of total immigrants in the permanent category was 42.1 per cent while the non-permanent share (mainly international students and temporary workers) was 57.9 per cent. From 2016 to 2024 (excluding Covid 2020), permanent immigrants averaged 27.7 per cent of total in-migration versus 72.3 per cent for non-permanent.

“We’re in the midst of a housing crisis in Canada, and the unfortunate truth is we lack the necessary infrastructure to accommodate immigration at the 2022-24 rate,” said Steven Globerman, senior fellow at the Fraser Institute and study co-author.

“While the reductions announced late last year have been confirmed by the new government, the levels of immigration over the next two year will still be well above historic benchmarks.”

This study is the first in a series of papers from the authors on immigration.

Canada’s Changing Immigration Patterns, 2000—2024

Immigration, after 2000 and especially after 2015, is characterized by substantial increases in the absolute number of immigrants admitted, as well the share admitted as temporary foreign workers and international students.
For example, from 2000 to 2015, the total number of immigrants increased at a simple average annual rate of 4% compared to 15% from 2016 to 2024. As well, permanent admissions as a share of total admissions declined by .83 percentage points per year from 2000 to 2015 and by 1.1 percentage points per year from 2016 to 2024.
These recent developments reflect changes in government policy. In particular, the International Mobility Program (IMP) of 2014 enabled Canadian employers to bring in greater numbers of temporary workers from abroad to fill lower-paying jobs.
The Advisory Council on Economic Growth appointed by the Trudeau government in early 2016 recommended substantial increases in permanent immigration, as well as in the number of international students who would become eligible for permanent status after acquiring Canadian educational credentials. The Trudeau government enthusiastically embraced the recommendation.
Recent immigrants to Canada seem better equipped to participate in the labour market than earlier cohorts. For example, over the period from 2011 to 2021, the percentage of established immigrants with a bachelor’s degree or higher increased, and the vast majority of admitted immigrants speak at least one of the official languages. Moreover, recent immigrants enjoy higher employment rates than did earlier cohorts.
Nevertheless, public concern about the impact of increased immigration—primarily on the affordability of housing—has led the federal government to reduce planned levels of future immigration substantially.