Fraser Institute
Ottawa’s health-care deal cements failed status quo in Canada

From the Fraser Institute
By Mackenzie Moir and Jake Fuss
Canada will reach a projected $244.1 billion in 2023, which translates to $6,205 per person—nearly double the level of per-person spending (inflation-adjusted) three decades ago. And yet, last year Canadians endured the longest median wait time (27.7 weeks) ever recorded for non-emergency surgery.
Last week, as part of Ottawa’s promised $46 billion in additional health-care spending, the Trudeau government agreed to increase Quebec’s share of federal health-care dollars by $900 million annually. Quebec was the last province to reach an agreement with Ottawa before the March 31 deadline. With the closure of this agreement, Canadian taxpayers are on the hook for more health-care spending than ever before. For the same old broken health-care system.
Of course, it ultimately doesn’t matter whether the $46 billion originates from Ottawa or the provinces. In the end, Canadian taxpayers foot the bill. And what do we get in return for our health-care dollars?
In 2021, the latest year of comparable data, Canada’s total health-care spending (as a percentage of the economy) was the highest among 29 other comparable countries with universal health care (after adjusting for differences in population age). This isn’t a new development. Canada has a long history of having one of most expensive systems among high-income universal health-care countries.
Despite this, according to the latest comparable data, Canada ranks among the poorest performing universal health-care countries in key areas such as the number of physicians, hospital beds and diagnostic technology (e.g. MRI machines). Further, according to the Commonwealth Fund, in 2020 Canada ranked dead last on timely access to specialist consultations and non-emergency surgery.
Meanwhile, public health-care spending in Canada will reach a projected $244.1 billion in 2023, which translates to $6,205 per person—nearly double the level of per-person spending (inflation-adjusted) three decades ago. And yet, last year Canadians endured the longest median wait time (27.7 weeks) ever recorded for non-emergency surgery.
In short, Canada’s health-care system is in shambles, but the answer does not lie in simply throwing more money in its general direction. Federal politicians should instead look to the example of welfare reform during the Chrétien era in the 1990s. Those reforms, which reduced federal transfers to provinces and eliminated most of the “strings” attached to federal funding, resulted in increased provincial autonomy, greater policy experimentation, fewer Canadians needing welfare and savings for the federal government (i.e. taxpayers).
This is the opposite of today’s approach to health care, where the existing vehicle for federal funding (the Canada Health Transfer) is connected to the Canada Health Act (CHA), which prevents provincial governments from innovating and experimenting in health care by threatening financial penalties for non-compliance with often vaguely defined federal preferences. The result is a stalemate that satisfies no one and ensures that Canada’s policies remain at odds with the policies of our better-performing universal health-care peers.
While new federal dollars for health care are undoubtedly appealing to premiers, they will not improve the state of health care for Canadians. Until our federal politicians have the courage to reform the CHA and follow the example of 1990s welfare reform to improve outcomes, our health-care system’s unacceptable status quo will continue.
Authors:
Business
Canada’s finances deteriorated faster than any other G7 country

From the Fraser Institute
By Jake Fuss and Grady Munro
Some analysts compare Canada’s fiscal health with other countries in the Group of Seven (G7) to downplay concerns with how Canadian governments run their finances. And while it’s true that Canada’s finances aren’t as bad some other countries, the data show Canada’s finances are deteriorating fastest in the G7, and if we’re not careful we may lose any advantage we currently have.
The G7 (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States) represents seven of the world’s most advanced economies and some of Canada’s closest peer countries. As such, many commentators, organizations and governments use Canada’s standing within the group as a barometer of our fiscal health. Indeed, based on his oft-repeated goal to “build the strongest economy in the G7,” Prime Minister Carney himself clearly sees the G7 as a good comparator group for Canada.
Two key indicators of a country’s finances are government spending and debt, both of which are often measured as a share of gross domestic product (GDP) to allow for comparability across jurisdictions with various sized economies. Government spending as a share of GDP is a measure of the overall size of government in a country, while government debt-to-GDP is a measure of a country’s debt burden. Both the size of government in Canada and the country’s overall debt burden have grown over the last decade.
This is a problem because, in recent years, government spending and debt in Canada have reached or exceeded thresholds beyond which any additional spending or debt will most likely harm economic growth and living standards. Indeed, research suggests that when government spending exceeds 32 per cent of GDP, government begins to take over functions and resources better left to the private sector, and economic growth slows. However, the issues of high spending and debt are often downplayed by comparisons showing that Canada’s finances aren’t as bad as other peer countries—namely the rest of the G7.
It’s true that Canada ranks fairly well among the G7 when comparing the aforementioned measures of fiscal health. Based on the latest data from the International Monetary Fund (IMF), a new study shows that Canada’s general government (federal, provincial and local) total spending as a share of GDP was 44.7 per cent in 2024, while Canada’s general government gross debt was 110.8 per cent of GDP. Compared to the G7, Canada’s size of government ranked 4th highest while our overall debt burden ranked 5th highest.
But while Canada’s size of government and overall debt burden rank middle-of-the-pack among G7 countries, that same study reveals that Canada is not in the clear. Consider the following charts.

The first chart shows the overall change in general government total spending as a share of GDP in G7 countries from 2014 to 2024. Canada observed the largest increase in the size of government of any G7 country, as total spending compared to GDP increased 6.34 percentage points over the decade. This increase was nearly three times larger than the increase in the U.S., and both France and Italy were actually reduced their size of government during this time.
The second chart shows the overall change in general government gross debt as a share of GDP over the same decade, and again Canada experienced the largest increase of any G7 country at 25.23 percentage points. That’s considerably higher than the next closest increases in France (16.97 percentage points), the U.S. (16.36 percentage points) and the U.K. (14.13 percentage points).
Simply put, the study shows that Canada’s finances have deteriorated faster than any country in the G7 over the last decade. And if we expand this comparison to a larger group of 40 advanced economies worldwide, the results are very similar—Canada experienced the 2nd highest increase in its size of government and 3rd highest increase in its overall debt burden, from 2014 to 2024. Some analysts downplay mismanagement of government finances in Canada by pointing to other countries that have worse finances. However, if Canada continues as it has for the last decade, we’ll be joining those other countries before too long.
Alberta
Carney government should end damaging energy policies amid separatist sentiment in Alberta

From the Fraser Institute
By Tegan Hill
Following last month’s Liberal election victory, and after a decade of damaging federal policies by the Trudeau government, some Albertans are calling for a referendum on separation. While Premier Danielle Smith said she does not support separation she “will honour” the referendum process. And according to a recent poll, more than one-third of Albertans are open to leaving Canada. But whether or not the referendum actually happens, one thing is clear—Albertans have reason to be frustrated with confederation.
In our current system, Ottawa collects taxes from people and businesses across the country then transfers that money to Canadians for federal and national programs including the Canada Pension Plan (CPP) and employment insurance. Albertans contribute disproportionately to this system thanks to the province’s relatively high rates of employment, higher average incomes and younger population.
For example, from 1981 to 2022 (the latest year of available data), Albertans’ net contribution to the CPP—meaning the amount Albertans paid into the program over and above what retirees in Alberta received in CPP benefit payments—was $53.6 billion. British Columbia was the only other province where workers paid more into the CPP than retirees received in benefits—and Alberta’s contribution was six times greater than B.C.’s contribution.
On equalization—Canada’s transfer program aimed at ensuring each province can provide comparable levels of public services—Alberta has not received payments since 1964/65. In 2022 (the latest year of available data), the federal government spent $21.9 billion on equalization while 13.5 per cent of total federal revenue came from Alberta, which means Alberta taxpayers contributed an estimated $3.0 billion to the equalization program that year—while receiving no payments.
More broadly, Alberta’s total net contribution to federal finances and national programs (that is, total federal taxes and payments paid by Albertans minus federal money spent or transferred to Albertans) was $244.6 billion from 2007 to 2022—more than five times more than the net contribution from British Columbians or Ontarians (the only other two net contributors) despite Alberta’s smaller population.
So that’s the reality—Alberta massively overcontributes to federal and national programs. But that’s not necessarily a problem, in and of itself. The problem is that despite Alberta’s outsized importance within Canada, Albertans have faced a barrage of federal policies that disproportionately and negatively impact the province including Bill C-69 (which imposes complex, uncertain and onerous review requirements on major energy projects), Bill C-48 (which bans large oil tankers off B.C.’s northern coast and limits access to Asian markets), an arbitrary cap on oil and gas emissions, numerous “net-zero” targets, and so on.
On the campaign trail, Prime Minister Mark Carney promised to keep the emissions cap and Bill C-69 (which opponents call the “no more pipelines act”). Yet in a recent interview with CTV, Carney said he will “change things at the federal level that need to be changed in order for projects to move forward” adding that he may eventually remove both the emissions cap and Bill C-69.
That would be welcomed news in Alberta, which continues to punch above its economic weight despite federal policies that prevent the province from reaching its full economic potential. And any policies that restrict Alberta ultimately limit prosperity in Canada.
Albertans may soon face a referendum on separation. The rest of Canada should understand why so many Albertans are frustrated with the status quo. Federal policies specifically target their province’s energy industry despite their disproportionate contribution to the federation. It’s time to undo these federal policies, for the benefit of all Canadians.
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