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Fraser Institute

One doctor’s battle to put patients ahead of politics

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From the Fraser Institute

By Yanick Labrie

For decades, Canadians have been told that our health-care system is the envy of the world, a symbol of national pride. But the reality, as exposed in the new book My Fight for Canadian Healthcare by Dr. Brian Day, is far less flattering—and far more troubling. Dr. Day’s account of his 30-year battle to put patients first reveals a system bogged down by ideology, political inertia and an aversion to necessary reform. His message is clear: it’s time for Canadians to take off the rose-coloured glasses and demand a system that actually works for patients.

The book is not an argument for dismantling universal health care—it’s a plea for modernization and responsiveness. Dr. Day, an orthopedic surgeon and founder of the Cambie Surgery Centre in Vancouver, offers a front-line perspective on how rationing, administrative inefficiency and outdated policies systematically deny timely care to patients. Through detailed stories and compelling data, he documents the tragic human cost of excessive waiting lists—patients suffering needless pain, enduring irreversible deterioration, and in some cases, dying of preventable deaths.

One of the most disturbing revelations in the book is the deliberate limitation of health-care capacity by provincial governments. Faced with budget constraints, administrators limit operating room time and restrict physician access, effectively forcing patients to suffer on long waiting lists. This isn’t the result of unavoidable resource shortages; it’s a consequence of deliberate policy choices aimed at controlling spending, even if that means denying patients the care they need when they need it.

What makes this all the more unacceptable is that many of the very politicians and bureaucrats who defend this system seek care in private clinics (including Dr. Day’s Cambie Surgery Centre) when their own health is on the line. This double standard—one system for the public, another for the elite—undermines the entire moral justification of Canada’s approach to health care. If the system were truly world-class, those in power would not seek alternatives.

Dr. Day’s legal battle began in 2009 when his clinic became the target of a government lawsuit for allegedly violating an existing prohibition on patients paying with their own money for medically necessary care. This same prohibition had already been found unconstitutional in Quebec by the Supreme Court’s Chaoulli ruling in 2005, on the grounds that it violated fundamental rights to life and security.

The case dragged on for more than a decade, exposing the dysfunction of both the health-care system and the legal process meant to evaluate its constitutionality. Evidence presented in court—including government data showing thousands of patients dying while waiting for care—was damning. Unfortunately for Canadians, the British Columbia Supreme Court ultimately upheld the government’s authority to ration care and forbid patients from seeking private alternatives.

This legal defeat underscores a core truth that Dr. Day has long emphasized—Canadian health care is driven more by ideology than by evidence. The obsession with preserving a government monopoly has become an end in itself, eclipsing the system’s primary purpose: ensuring timely quality care for all. In no other sphere of life would we tolerate this. Imagine being told you couldn’t pay for private tutoring if your child’s public school was failing him. Yet this is precisely what Canadian health-care policy imposes.

Crucially, Dr. Day’s critique is rooted not in theory but in practise. He has seen firsthand the harm caused by delays, the deterioration of patients left waiting months or years for treatment, and the exodus of talented young doctors who leave Canada because the system restricts their ability of practise to their full potential. He has also seen the benefits of mixed public-private models in countries such as Australia, Sweden and Germany—countries with universal care that still allow room for private-sector innovation and competition.

Predictably, critics paint Dr. Day as a champion of privatization at any cost, but this is a gross mischaracterization. His vision is not American-style health care but rather a modernized patient-centred system that retains universal coverage while embracing flexibility, innovation and patient choice. In short, he wants Canada to catch up with the rest of the developed world, where public and private systems work together to ensure patients receive timely care regardless of their financial means.

Perhaps the most sobering aspect of My Fight for Canadian Healthcare is the reminder that reform is not only necessary, but inevitable. Canada’s population is aging, demand for care is rising, and the costs of maintaining the current system are unsustainable. Clinging to outdated structures will only deepen the crisis. The choice is not between public and private care—it’s between a system that works and one that fails.

As Dr. Day argues, the ultimate victims of our broken system are the patients themselves—ordinary Canadians left to suffer while politicians cling to outdated dogma. His fight has been long and costly, but it offers a valuable lesson: health-care reform is not about ideology. It’s about compassion, common sense and the courage to admit when something isn’t working. The time for that honesty is now.

Yanick Labrie

Senior Fellow, Fraser Institute

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Alberta

Most Alberta municipalities spending more—but some far more than others

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From the Fraser Institute

By Tegan Hill and Austin Thompson

In Alberta, municipal government spending is on the rise—and not just because of higher prices or a growing population. Indeed, most of Alberta’s largest municipal governments have increased spending in recent years (even after adjusting for inflation and population growth). That means higher taxes for many Albertans. But depending on where you live, you might be paying much more than your neighbours.

From 2009 to 2023 (the latest year of available data), per-person spending across Alberta’s largest municipalities increased by 12.9 per cent (on average), climbing from $3,001 to $3,389 (inflation-adjusted).

Some governments have increased spending more sharply than others. For example, during that same 15-year period, local governments in Canmore, Grande Prairie County and Strathcona County all increased their per-person spending by more than 20 per cent to reach more than $4,000 per person. And Lethbridge, the province’s fourth-most populous city, increased per-person spending by 18.6 per cent to reach $4,423. (Again, all numbers adjusted for inflation.)

But not all municipalities share this approach to spending. Alberta’s two largest cities, Calgary (2.1 per cent) and Edmonton (4.8 per cent) saw relatively modest spending increases from 2009 to 2023. As a result, their 2023 per-person spending levels ($3,144 and $3,241, respectively) were around the middle of the pack.

Airdrie, Chestermere and Cochrane—all fast-growing communities near Calgary—each spent under $2,200 per person in 2023. And all three reduced their per-person spending. (after adjusting for inflation).

Of course, no two municipalities are exactly alike. They all make different policy choices about which services to fund and how to fund them. But the sheer size of these differences across Alberta—and the overall upward trend in spending—should grab the attention of Albertans.

Local governments have an enormous impact on the day-to-day lives of Albertans. They build local water infrastructure, maintain local roads, manage local parks and set municipal property tax rates. And yet, their budgets often receive far less public scrutiny than their provincial or federal counterparts.

Moreover, when municipal spending grows faster than population and inflation, year after year, it raises important questions about value, sustainability, and accountability. Albertans in high-spending municipalities are right to ask: has additional spending translated into better services? Or are costs rising without clear public benefit?

Municipalities need resources to function well—but they also should use those resources wisely. Albertans should pay attention to what their local government representatives spend—and how spending levels compare across the province—to help assess whether they’re getting good value for their tax dollars.

Tegan Hill

Director, Alberta Policy, Fraser Institute
Austin Thompson

Austin Thompson

Senior Policy Analyst, Fraser Institute
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Agriculture

Canada should eliminate its supply management system—with or without Trump

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From the Fraser Institute

By Alex Whalen and Jake Fuss

Post-deregulation Australia’s dairy industry increased exports by $3 billion. Exports now account for more than 30 per cent of Australia’s total dairy production (and 20 per cent in New Zealand, which also ended its supply management system) compared to less than one per cent in Canada.

In one of the latest salvos in his trade war, President Trump recently took aim at supply management in Canada—a set of regulations that restricts  supply and controls imports to allow Canadian dairy producers of milk, eggs and poultry to maintain higher prices for their products than would otherwise exist in a competitive market.

In his attacks on Canada, Trump gets a lot wrong. But in fact, if Ottawa and the provinces dismantled our supply management system in a fair and productive way, it would be a rare win-win in trade negotiations with the Trump administration. And a win-win for both Canadian consumers and Canadian farmers.

For lessons in reform, Canada can look to other countries. For example, Australia’s dairy industry was heavily regulated for most of the 20th century, but by the 1990s, the weight of higher prices for supply-managed goods created public pressure for reform. The country also faced pressure from its trading partners to stop shielding its domestic dairy industry on grounds of fairness, much like the U.S. pressure Canada faces today.

So, around the turn of the century, the Australian government gradually dismantled its supply management system. Immediately following deregulation, milk prices fell by 12 cents per litre in Australia. Since then, prices have remained relatively flat, with price increases below the rate of inflation.

In other words, when the Australian dairy industry transitioned from a tightly-regulated protected industry to a more open industry with competition from both domestic and international firms, consumers reaped the rewards.

Of course, opponents of reform in Canada (including the dairy lobby) claim that supply management is necessary to help Canadian farmers survive and thrive. But in fact, after the Australian government eliminated supply management, the farming industry was arguably stronger. Some farmers exited the industry (and were compensated for doing so), and those that remained were more productive and more competitive in export markets.

In fact, post-deregulation Australia’s dairy industry increased exports by $3 billion. Exports now account for more than 30 per cent of Australia’s total dairy production (and 20 per cent in New Zealand, which also ended its supply management system) compared to less than one per cent in Canada. Despite Canada’s larger economy and population, both Australia and New Zealand export more dairy products than Canada.

At the same time, the Australian government introduced programs to financially support farmers to either help them adjust their operations or exit the industry. Farmers who remained in the industry experienced a 56 per cent increase in revenues and a substantial increase in the value of exports.

Moreover, according to a study from 2011, government subsidies for farmers equalled six per cent of total farm receipts in Australia and one per cent in New Zealand compared to 18 per cent in Canada. Which means that, due largely to Canada’s supply management system, the burden on taxpayers in Canada is far heavier than in those two countries.

Here in Canada, reform requires cooperation between the federal and provincial governments. Currently, Ottawa controls the trade component of supply management through restrictive import tariffs, while the provinces work alongside the federal government to regulate milk marketing boards, which set minimum prices for consumers.

In the face of President Trump’s aggressive trade actions, the premiers should agree to work with the Carney government to finally eliminate Canada’s arcane supply management system. It won’t be easy—politicians are slow to challenge entrenched interests and constituencies. But as the experience of our other allies clearly shows, governments can reform the dairy industry to the benefit of both consumers and farmers. There could be a silver lining to Trump’s attack on supply management in Canada.

Alex Whalen

Director, Atlantic Canada Prosperity, Fraser Institute

Jake Fuss

Director, Fiscal Studies, Fraser Institute
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