Virtual care will break the Canada Health Act—and that’s a good thing

From the Fraser Institute

The leadership of the Canadian Medical Association (CMA) is facing sharp criticism for its recent proposal to effectively ban private payment for virtual care. In a clear example of putting politics before patients, this would only erect additional barriers for those seeking care.

Moreover, it’s a desperate bid to cling to an outdated—and failed—model of health care while underestimating modern-day innovations.

Virtual care—online video doctor consultations—is a private-sector innovation. In response to our government system’s inability to provide timely care, private companies such as Maple have been offering these services to Canadians for almost a decade. In fact, the public system only pushed meaningfully into the virtual space during COVID when it established partnerships with these private companies alongside setting up new fee codes for virtual consultations.

In return for improving access to physician consultations for thousands of Canadians, these virtual care companies have been rewarded with increased government scrutiny and red tape. The weapon of choice? The Canada Health Act (CHA).

Specifically, sections 18 to 21 of the CHA prohibit user fees and extra billing for “medically necessary” services. Further, the insurance plan of a province must be publicly administered and provide “reasonable access” to 100 per cent of insured services. Provinces found in violation are punished by the federal government, which withholds a portion (or all) of federal health-care transfer payments.

Until recently, there had been no obvious conflict between the CHA and privately paid-for virtual care—primarily because the provinces are free to determine what’s medically necessary. Until recently, many provinces did not even have billing codes for virtual care. As virtual services are increasingly provided by the public sector, however, the ability to innovatively provide care for paying patients (either out-of-pocket or through private insurance) becomes restricted further.

Within this context, the CMA recently recommended formally including virtual care services within the public system, alongside measures to ensure “equitable access.” At the same time, it reiterated its recommendation that private insurance to access medically necessary services covered by the CHA be prohibited.

See where this is going?

The kicker is an additional recommendation banning dual practice (i.e. physicians working in both the public and private sector) except under certain conditions. This means doctors in the public system who could otherwise allocate their spare hours to private appointments online would now have to choose to operate exclusively in either the public or private system.

The combined effect of these policies would ensure that innovative private options for virtual care—whether paid for out-of-pocket or though private insurance—will either be overtaken by bureaucracies or disappear entirely.

But what the CMA report fails to recognize is that virtual care has expanded access to services the government fails to provide—there’s little reason to suspect a government takeover of the virtual-care sector will make things better for patients. And even if governments could somehow prevent Canadian doctors and companies providing these services privately, virtual care is not beholden to Canada’s physical borders. Patients with a little bit of technical knowhow will simply bypass the Canadian system entirely by having virtual consultations with doctors abroad. If Canadians can figure out how to access their favourite show in another country, you can be sure they’ll find a way to get a consultation with a doctor in Mumbai instead of Montreal.

Instead of forcing physicians and patients to operate within the crumbling confines of government-run health care, the CMA’s leadership should be grateful for the pressure valve that the private sector has produced. We should celebrate the private innovators who have provided Canadians better access to health care, not finding ways to shut them down in favour of more government control.

Author:

Bacchus Barua

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US Supreme Court may end ‘emergency’ tariffs, but that won’t stop the President

Published on November 24, 2025

Todayville

From the Fraser Institute

By Scott Lincicome

The U.S. Supreme Court will soon decide the fate of the global tariffs President Donald J. Trump has imposed under the International Emergency Powers Act (IEEPA). A court decision invalidating the tariffs is widely expected—hovering around 75 per cent on various betting markets—and would be welcome news for American importers, the United States economy and the rule of law. Even without IEEPA, however, other U.S. laws all but ensure that much higher tariffs will remain the norm. Realizing that protection will just take a little longer and, perhaps, be a little more predictable.

As my Cato Institute colleague Clark Packard and I wrote last year, the Constitution grants Congress the power to impose tariffs, but the legislative branch during the 20th century delegated much of that authority to the president under the assumption that he would be the least likely to abuse it. Thus, U.S. trade law is today littered with provisions granting the president broad powers to impose tariffs for various reasons. No IEEPA needed.

This includes laws that Trump has already invoked. Today, for example, we have “Section 301” tariffs of up to 25 per cent on around half of all Chinese imports, due to alleged “unfair trade” practices by Beijing. We also have global “Section 232” tariffs of up to 50 per cent on imports of steel and aluminum, automotive goods, heavy-duty trucks, copper and wood products—each imposed on the grounds that these goods threaten U.S. national security. The Trump administration also has created a process whereby “derivative” products made from goods subject to Section 232 tariffs will be covered by those same tariffs. Several other Section 232 investigations—on semiconductors, pharmaceuticals, critical minerals, commercial aircraft, and more—were also initiated earlier this year, setting the stage for more U.S. tariffs in the weeks ahead.

Trump administration officials admit that they’ve been studying these and other laws as fallback options if the Supreme Court invalidates the IEEPA tariffs. Their toolkit reportedly includes completing the actions above, initiating new investigations under Section 301 (targeting specific countries) and Section 232 (targeting certain products), and imposing tariffs under other laws that have not yet been invoked. Most notably, there’s strong administration interest in Section 122 of the Trade Act of 1974, which empowers the president to address “large and serious” balance-of-payments deficits via global tariffs of up to 15 per cent for no more than 150 days (after which Congress must act to continue the tariffs). The administration might also consider Section 338 of the Tariff Act of 1930—a short and ambiguous law that authorizes the president to impose tariffs of up to 50 per cent on imports from countries that have “discriminated” against U.S. commerce—but this is riskier because the law may have been superseded by Section 301.

We should expect the administration to move quickly to use these measures to reverse engineer Trump’s global tariff regime under IEEPA. The main difference would be in how he does so. IEEPA was essentially a tariff switch in the Oval Office that could be flipped on and off instantly, creating massive uncertainty for businesses, foreign governments and the U.S. economy. The alternative authorities, by contrast, all have substantive and procedural guardrails that limit their size and scope, or, at the very least, give American and foreign companies time to prepare for forthcoming tariffs (or lobby against them).

Section 301, for example, requires an investigation of a foreign country’s trade and economic policies—cases that typically take nine months and involve public hearings and formal findings. Section 232 requires an investigation into and a report on whether imports threaten national security—actions that also typically take months. Section 122 has fewer procedures, but its limited duration and 15 per cent cap make it far less dangerous than IEEPA, under which Trump has repeatedly threatened tariffs of 100 per cent or more.

Of course, “procedural guardrails” is a relative term for an administration that has already stretched Section 232’s “national security” rationale to cover bathroom vanities. The courts also have largely rubber-stamped the administration’s previous moves under Section 232 and Section 301—a big reason why we should expect the Trump administration’s tariff “Plan B” to feature them.

Thus, a court ruling against the IEEPA tariffs would be an important victory for constitutional governance and would eliminate the most destabilizing element of Trump’s tariff regime. But until the U.S. Congress reclaims some of its constitutional authority over U.S. trade policy, high and costly tariffs will remain.

Carbon Tax

Carney fails to undo Trudeau’s devastating energy policies

Published on November 23, 2025

Todayville

From the Fraser Institute

By Tegan Hill and Elmira Aliakbari

On the campaign trail and after he became prime minister, Mark Carney has repeatedly promised to make Canada an “energy superpower.” But, as evidenced by its first budget, the Carney government has simply reaffirmed the failed plans of the past decade and embraced the damaging energy policies of the Trudeau government.

First, consider the Trudeau government’s policy legacy. There’s Bill C-69 (the “no pipelines act”), the new electricity regulations (which aim to phase out natural gas as a power source starting this year), Bill C-48 (which bans large oil tankers off British Columbia’s northern coast and limit Canadian exports to international markets), the cap on emissions only from the oil and gas sector (even though greenhouse gas emissions have the same effect on the environment regardless of the source), stricter regulations for methane emissions (again, impacting the oil and gas sector), and numerous “net-zero” policies.

According to a recent analysis, fully implementing these measures under Trudeau government’s emissions reduction plan would result in 164,000 job losses and shrink Canada’s economic output by 6.2 per cent by the end of the decade compared to a scenario where we don’t have these policies in effect. For Canadian workers, this will mean losing $6,700 (annually, on average) by 2030.

Unfortunately, the Carney government’s budget offers no retreat from these damaging policies. While Carney scrapped the consumer carbon tax, he plans to “strengthen” the carbon tax on industrial emitters and the cost will be passed along to everyday Canadians—so the carbon tax will still cost you, it just won’t be visible.

There’s also been a lot of buzz over the possible removal of the oil and gas emissions cap. But to be clear, the budget reads: “Effective carbon markets, enhanced oil and gas methane regulations, and the deployment at scale of technologies such as carbon capture and storage would create the circumstances whereby the oil and gas emissions cap would no longer be required as it would have marginal value in reducing emissions.” Put simply, the cap remains in place, and based on the budget, the government has no real plans to remove it.

Again, the cap singles out one source (the oil and gas sector) of carbon emissions, even when reducing emissions in other sectors may come at a lower cost. For example, suppose it costs $100 to reduce a tonne of emissions from the oil and gas sector, but in another sector, it costs only $25 a tonne. Why force emissions reductions in a single sector that may come at a higher cost? An emission is an emission regardless of were it comes from. Moreover, like all these policies, the cap will likely shrink the Canadian economy. According to a 2024 Deloitte study, from 2030 to 2040, the cap will shrink the Canadian economy (measured by inflation-adjusted GDP) by $280 billion, and result in lower wages, job losses and a decline in tax revenue.

At the same time, the Carney government plans to continue to throw money at a range of “green” spending and tax initiatives. But since 2014, the combined spending and forgone revenue (due to tax credits, etc.) by Ottawa and provincial governments in Ontario, Quebec, British Columbia and Alberta totals at least $158 billion to promote the so-called “green economy.” Yet despite this massive spending, the green sector’s contribution to Canada’s economy has barely changed, from 3.1 per cent of Canada’s economic output in 2014 to 3.6 per cent in 2023.

In his first budget, Prime Minister Carney largely stuck to the Trudeau government playbook on energy and climate policy. Ottawa will continue to funnel taxpayer dollars to the “green economy” while restricting the oil and gas sector and hamstringing Canada’s economic potential. So much for becoming an energy superpower.