Enough talk, we need to actually do something about Canadian health care

From the Macdonald Laurier Institute

By J. Edward Les for Inside Policy

Canada spends more on health care as a percentage of GDP than almost all other OECD countries, yet we rank behind most of them when it comes to outcomes that matter.

I drove a stretch of road near Calgary’s South Health Campus the other day, a section with a series of three intersections in a span of less than a few hundred metres. That is, I tried to drive it – but spent far more time idling than moving.

At each intersection, after an interminable wait, the light turned green just as the next one flipped to red, grinding traffic to a halt just after it got rolling. It was excruciating; I’m quite sure I spied a snail on crutches racing by – no doubt making a beeline (snail-line?) for the ER a stone’s throw away.

The street’s sluggishness is perhaps reflective of the hospital next to it, given that our once-cherished universal health care system has crumbled into a universal waiting system – a system seemingly crafted (like that road) to obstruct flow rather than enable it. In fact, the pace of medical care delivery in this country has become so glacial that even a parking lot by comparison feels like the Indianapolis Speedway.

The health care crisis grows more dire by the day. Reforms are long overdue. Canada spends more on health care as a percentage of GDP than almost all other OECD countries, yet we rank behind most of them when it comes to outcomes that matter.

And we’re paying with our lives: according to the Canadian Institute for Health Information, thousands of Canadians die each and every year because of the inefficiencies of our system.

Yet for all that we are paralyzed by the enormity and complexity of the mushrooming disaster. We talk about solutions – and then we talk and talk some more. But for all the talking, precious little action is taken.

I’m reminded of an Anne Lamotte vignette, related in her bestselling book Bird By Bird:

Thirty years ago my older brother, who was ten years old at the time, was trying to get a report written on birds that he’d had three months to write, which was due the next day. We were out at our family cabin in Bolinas, and he was at the kitchen table close to tears, surrounded by binder paper and pencils and unopened books about birds, immobilized by the hugeness of the task ahead. Then my father sat down beside him, put his arm around my brother’s shoulder, and said, “Bird by bird, buddy. Just take it bird by bird.”

So it is with Canadian health care: we’ve wasted years wringing our hands about the woeful state of affairs, while doing precious little about it.

Enough procrastinating. It’s time to tackle the crisis, bird by bird.

One thing we can do is to let doctors be doctors. A few weeks ago, in a piece titled “Should Doctors Mind Their Own Business?”, I questioned the customary habit of doctors hanging out their shingles in small independent community practices. Physicians spend long years of training to master their craft, years during which they receive no training in business methods whatsoever, and then we expect them to master those skills off to the side of their exam rooms. Some do it well, but many do not – and it detracts from their attention to patients.

We don’t install newly minted teachers in classrooms and at the same time task them with the keeping the lights on, managing the supply chain, overseeing staffing and payroll, and all the other mechanics of running schools. Why do we expect that of doctors?

Keeping doctors embedded within large, expensive, inefficient, bureaucracy-choked hospitals isn’t the solution, either.

There’s a better way, I argued in my essay: regional medical centres – centres built and administered in partnership with the private sector.

Such centres would allow practitioners currently practicing in the community to ply their trade unencumbered by the nuts and bolts of running a business; and they would allow us to decant a host of services from hospitals, which should be reserved for what only hospitals can do: emergency services, inpatient care, surgeries, and the like.

In short, we should let doctors be doctors, and hospitals be hospitals.

To garner feedback, I dumped my musings into a couple of online physician forums to which I belong, tagged with the query: “Food for thought, or fodder for the compost bin?”

The verdict? Hands down, the compost bin.

I was a bit taken aback, initially. Offended, even – because who among us isn’t in love with their own ideas?

But it quickly became evident from my peers’ comments that I’d been misunderstood. Not because my doctor friends are dim, but because I hadn’t been clear.

When I proposed in my essay that we “leave the administration and day-to-day tasks of running those centres to business folks who know what they’re doing,” my colleagues took that to mean that doctors would be serving at the beck and call of a tranche of ill-informed government-enabled administrators – and they reacted to the notion with anaphylactic derision. And understandably so: too many of us have long and painful experience with thick layers of health care bureaucracy seemingly organized according to the Peter Principle, with people promoted to – and permanently stuck at – the level of their incompetence.

But I didn’t mean to suggest – not for a minute – that doctors shouldn’t be engaged in running these centres. I also wrote: “None of which is to suggest that doctors shouldn’t be involved, by aptitude and inclination, in influencing the set-up and management of regional centres – of course, they should.”

Of course they should. There are plenty of physicians equipped with both the skills and interest needed to administer these centres; and they should absolutely be front and centre in leading them.

But more than that: everyone should have skin in the game. All workers have the right to share in the success of an enterprise; and when they do, everybody wins. When everyone is pulling in the same direction because everyone shares in the wins, waste and inefficiencies are rooted out like magic.

Contrast that to how hospitals are run, with scarcely anyone aware of the actual cost of the blood tests or CT scans they order or the packets of suture and gauze they rip open, and with the motivations of administrative staff, nurses, doctors, and other personnel running off in more directions than a flock of headless chickens. The capacity for waste and inefficiencies is almost limitless.

I don’t mean to suggest that the goal of regional medical centres should be to turn a profit; but fiscal prudence and economic accountability are to be celebrated, because money not wasted is money that can be allocated to enhancing patient care.

Nor do I mean to intimate that sensible resource management should be the only parameter tracked; patient outcomes and patient satisfaction are paramount.

What should government’s role be in all this? Initially, to incentivize the creation of these centres via public-private partnerships; and then, crucially, to encourage competition among them and to reward innovation and performance, with optimization of the three key metrics – patient outcomes, patient satisfaction, and economic accountability – always in focus.

No one should be mandated to work in non-hospital regional medical centres. It’s a free country (or it should be): doctors should be free to hang out their own community shingles if they wish. But if we build the model correctly, my contention is that most medical professionals will prefer to work collaboratively under one roof with a diverse group of colleagues, unencumbered by the mundanities of running a business, but also free of choking hospital bureaucracy.

I connected a couple weeks ago with the always insightful economist Jack Mintz (who is also a distinguished fellow at the Macdonald-Laurier Institute). Mintz sits on the board of a Toronto-area hospital and sees first-hand “the problems with the lack of supply, population growth, long wait times between admission and getting a bed, emergency room overuse,” and so on.

“Something has to give,” he said. “Probably more resources but better managed. We really need major reform.”

On that we can all agree. We can’t carry on this way.

So, let’s stop idling; and let’s green-light some fixes.

As Samwise Gamgee said in The Lord of the Rings, “It’s the job that’s never started as takes longest to finish.”

Dr. J. Edward Les is a pediatrician in Calgary who writes on politics, social issues, and other matters.

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Virtue-signalling devotion to reconciliation will not end well

Published on January 4, 2026

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From the Fraser Institute

By Bruce Pardy

In September, the British Columbia Supreme Court threw private property into turmoil. Aboriginal title in Richmond, a suburb of Vancouver, is “prior and senior” to fee simple interests, the court said. That means it trumps the property you have in your house, farm or factory. If the decision holds up on appeal, it would mean private property is not secure anywhere a claim for Aboriginal title is made out.

If you thought things couldn’t get worse, you thought wrong. On Dec. 5, the B.C. Court of Appeal delivered a different kind of upheaval. Gitxaala and Ehattesaht First Nations claimed that B.C.’s mining regime was unlawful because it allowed miners to register claims on Crown land without consulting with them. In a 2-to-1 split decision, the court agreed. The mining permitting regime is inconsistent with the United Nations Declaration on the Rights of Indigenous People (UNDRIP). And B.C. legislation, the court said, has made UNDRIP the law of B.C.

UNDRIP is a declaration of the United Nations General Assembly. It consists of pages and pages of Indigenous rights and entitlements. If UNDRIP is the law in B.C., then Indigenous peoples are entitled to everything—and to have other people pay for it. If you suspect that is an exaggeration, take a spin through UNDRIP for yourself.

Indigenous peoples, it says, “have the right to the lands, territories and resources which they have traditionally owned, occupied or otherwise used or acquired… to own, use, develop and control, as well as the right to “redress” for these lands, through either “restitution” or “just, fair and equitable compensation.” It says that states “shall consult and cooperate in good faith” in order to “obtain free and informed consent prior to the approval of any project affecting their lands or territories and other resources,” and that they have the right to “autonomy or self-government in matters relating to their internal and local affairs, as well as ways and means for financing their autonomous functions.”

The General Assembly adopted UNDRIP in 2007. At the time, Canada sensibly voted “no,” along with New Zealand, the United States and Australia. Eleven countries abstained. But in 2016, the newly elected Trudeau government reversed Canada’s objection.

UN General Assembly resolutions are not binding in international law. Nor are they enforceable in Canadian courts. But in 2019, NDP Premier John Horgan and his Attorney General David Eby, now the Premier, introduced Bill 41, the Declaration on the Rights of Indigenous Peoples Act (DRIPA). DRIPA proposed to require the B.C. government to “take all measures necessary to ensure the laws of British Columbia are consistent with the Declaration.” The B.C. Legislature unanimously passed the bill. (The Canadian Parliament passed a similar bill in 2021.)

Two years later, the legislature passed an amendment to the B.C. Interpretation Act. Eby, still B.C.’s Attorney General, sponsored the bill. The amendment read, “Every Act and regulation must be construed as being consistent with the Declaration.”

Eby has expressed dismay about the Court of Appeal decision. It “invites further and endless litigation,” he said. “It looked at the clear statements of intent in the legislature and the law, and yet reached dramatically different conclusions about what legislators did when we voted unanimously across party lines” to pass DRIPA. He has promised to amend the legislation.

These are crocodile tears. The majority judgment from the Court of Appeal is not a rogue decision from activist judges making things up and ignoring the law. Not this time, anyway. The court said that B.C. law must be construed as being consistent with UNDRIP—which is what Eby’s 2021 amendment to the Interpretation Act says.

In fact, Eby’s government has been doing everything in its power to champion Aboriginal interests. DRIPA is its mandate. It’s been making covert agreements with specific Aboriginal groups over specific territories. These agreements promise Aboriginal title and/or grant Aboriginal management rights over land use. In April 2024, an agreement with the Haida Council recognized Haida title and jurisdiction over Haida Gwaii, an archipelago off the B.C. coast formerly known as the Queen Charlotte Islands. Eby has said that the agreement is a template for what’s possible “in other places in British Columbia, and also in Canada.” He is putting title and control of B.C. into Aboriginal hands.

But it’s not just David Eby. The Richmond decision from the B.C. Supreme Court had nothing to do with B.C. legislation. It was a predictable result of years of Supreme Court of Canada (SCC) jurisprudence under Section 35 of the Constitution. That section guarantees “existing” Aboriginal and treaty rights as of 1982. But the SCC has since championed, evolved and enlarged those rights. Legislatures can fix their own statutes, but they cannot amend Section 35 or override judicial interpretation, even using the “notwithstanding clause.”

Meanwhile, on yet another track, Aboriginal rights are expanding under the Charter of Rights and Freedoms. On the same day as the B.C. Court of Appeal decision on UNDRIP, the Federal Court released two judgments. The federal government has an actionable duty to Aboriginal groups to provide housing and drinking water, the court declared. Taxpayer funded, of course.

One week later, at the other end of the country, the New Brunswick Court of Appeal weighed in. In a claim made by Wolastoqey First Nation for the western half of the province, the court said that Aboriginal title should not displace fee simple title of private owners. Yet it confirmed that a successful claim would require compensation in lieu of land. Private property owners or taxpayers, take your pick.

Like the proverb says, make yourself into a doormat and someone will walk all over you. Obsequious devotion to reconciliation has become a pathology of Canadian character. It won’t end well.

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The great policy challenge for governments in Canada in 2026

Published on January 1, 2026

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From the Fraser Institute

By Ben Eisen and Jake Fuss

According to a recent study, living standards in Canada have declined over the past five years. And the country’s economic growth has been “ugly.” Crucially, all 10 provinces are experiencing this economic stagnation—there are no exceptions to Canada’s “ugly” growth record. In 2026, reversing this trend should be the top priority for the Carney government and provincial governments across the country.

Indeed, demographic and economic data across the country tell a remarkably similar story over the past five years. While there has been some overall economic growth in almost every province, in many cases provincial populations, fuelled by record-high levels of immigration, have grown almost as quickly. Although the total amount of economic production and income has increased from coast to coast, there are more people to divide that income between. Therefore, after we account for inflation and population growth, the data show Canadians are not better off than they were before.

Let’s dive into the numbers (adjusted for inflation) for each province. In British Columbia, the economy has grown by 13.7 per cent over the past five years but the population has grown by 11.0 per cent, which means the vast majority of the increase in the size of the economy is likely due to population growth—not improvements in productivity or living standards. In fact, per-person GDP, a key indicator of living standards, averaged only 0.5 per cent per year over the last five years, which is a miserable result by historic standards.

A similar story holds in other provinces. Prince Edward Island, Nova Scotia, Quebec and Saskatchewan all experienced some economic growth over the past five years but their populations grew at almost exactly the same rate. As a result, living standards have barely budged. In the remaining provinces (Newfoundland and Labrador, New Brunswick, Ontario, Manitoba and Alberta), population growth has outstripped economic growth, which means that even though the economy grew, living standards actually declined.

This coast-to-coast stagnation of living standards is unique in Canadian history. Historically, there’s usually variation in economic performance across the country—when one region struggles, better performance elsewhere helps drive national economic growth. For example, in the early 2010s while the Ontario and Quebec economies recovered slowly from the 2008/09 recession, Alberta and other resource-rich provinces experienced much stronger growth. Over the past five years, however, there has not been a “good news” story anywhere in the country when it comes to per-person economic growth and living standards.

In reality, Canada’s recent record-high levels of immigration and population growth have helped mask the country’s economic weakness. With more people to buy and sell goods and services, the overall economy is growing but living standards have barely budged. To craft policies to help raise living standards for Canadian families, policymakers in Ottawa and every provincial capital should remove regulatory barriers, reduce taxes and responsibly manage government finances. This is the great policy challenge for governments across the country in 2026 and beyond.