Fraser Institute
Policymakers in Ottawa and Edmonton maintain broken health-care system

From the Fraser Institute
What’s preventing these reforms? In a word, Ottawa.
To say Albertans, and indeed all Canadians, are getting poor value for their health-care dollars is a gross understatement. In reality, Canada remains among the highest spenders on health care in the developed world, in exchange for one of the least accessible universal health-care systems. And while Canadians are increasingly open to meaningful reform, policymakers largely cling to their stale approach of more money, platitudes and little actual change.
In 2021 (the latest year of available data), among high-income universal health-care countries, Canada spent the highest share of its economy on health care (after adjusting for age differences between countries). For that world-class level of spending, Canada ranked 28th in the availability of physicians, 23rd in hospital beds, 25th in MRI scanners and 26th in CT scanners. And we ranked dead last on wait times for specialist care and non-emergency surgeries.
This abysmal performance has been consistent since at least the early 2000s with Canada regularly posting top-ranked spending alongside bottom-ranked performance in access to health-care.
On a provincial basis, Albertans are no better off. Alberta’s health-care system ranks as one of the most expensive in Canada on a per-person basis (after adjusting for population age and sex) while wait times in Alberta were 21 per cent longer than the national average in 2023.
And what are governments doing about our failing health-care system? Not much it seems, other than yet another multi-billion-dollar federal spending commitment (from the Trudeau government) and some bureaucratic shuffling (by the Smith government) paired with grandiose statements of how this will finally solve the health-care crisis.
But people aren’t buying it anymore. Canadians increasingly understand that more money for an already expensive and failing system is not the answer, and are increasingly open to reforms based on higher-performing universal health-care countries where the public system relies more on private firms and entrepreneurs to deliver publicly-funded services. Indeed, according to one recent poll, more than six in 10 Canadians agree that Canada should emulate other countries that allow private management of public hospitals, and more than half of those polled would like increased access to care provided by entrepreneurs.
What’s preventing these reforms?
In a word, Ottawa. The large and expanding federal cash transfers so often applauded by premiers actually prevent provinces from innovating and experimenting with more successful health-care policies. Why? Because to receive federal transfers, provinces must abide by the terms and conditions of the Canada Health Act (CHA), which prescribes often vaguely defined federal preferences for health policy and explicitly disallows certain reforms such as cost-sharing (where patients pay fees for some services, with protections for low-income people).
That threat of financial penalty discourages the provinces from following the examples of countries that provide more timely universal access to quality care such as Germany, Switzerland, Australia and the Netherlands. These countries follow the same blueprint, which includes patient cost-sharing for physician and hospital services (again, with protections for vulnerable populations including low-income individuals), private competition in the delivery of universally accessible services with money following patients to hospitals and surgical clinics, and allowing private purchases of care. Yet if Alberta adopted this blueprint, which has served patients in these other countries so well, it would risk losing billions in health-care transfers from Ottawa.
Finally, provinces have seemingly forgot the lesson from Saskatchewan’s surgical initiative, which ran between 2010 and 2014. That initiative, which included contracting out publicly financed surgeries to private clinics, reduced wait lists in Saskatchewan from among the highest in the country to among the shortest. And when the initiative ended, wait times began to grow again.
The simple reality of health care in every province including Alberta is that the government system is failing despite a world-class price tag. The solutions to this problem are known and increasingly desired by Canadians. Ottawa just needs to get out of the way and allow the provinces to genuinely reform the way we finance and deliver universal health care.
Author:
Banks
Scrapping net-zero commitments step in right direction for Canadian Pension Plan

From the Fraser Institute
By Matthew Lau
And in January, all of Canada’s six largest banks quit the Net-Zero Banking Alliance, an alliance formerly led by Mark Carney (before he resigned to run for leadership of the Liberal Party) that aimed to align banking activities with net-zero emissions by 2050.
The Canada Pension Plan Investment Board (CPPIB) has cancelled its commitment, established just three years ago, to transition to net-zero emissions by 2050. According to the CPPIB, “Forcing alignment with rigid milestones could lead to investment decisions that are misaligned with our investment strategy.”
This latest development is good news. The CPPIB, which invest the funds Canadians contribute to the Canada Pension Plan (CPP), has a fiduciary duty to Canadians who are forced to pay into the CPP and who rely on it for retirement income. The CPPIB’s objective should not be climate activism or other environmental or social concerns, but risk-adjusted financial returns. And as noted in a broad literature review by Steven Globerman, senior fellow at the Fraser Institute, there’s a lack of consistent evidence that pursuing ESG (environmental, social and governance) objectives helps improve financial returns.
Indeed, as economist John Cochrane pointed out, it’s logically impossible for ESG investing to achieve social or environmental goals while also improving financial returns. That’s because investors push for these goals by supplying firms aligned with these goals with cheaper capital. But cheaper capital for the firm is equivalent to lower returns for the investor. Therefore, “if you don’t lose money on ESG investing, ESG investing doesn’t work,” Cochrane explained. “Take your pick.”
The CPPIB is not alone among financial institutions abandoning environmental objectives in recent months. In April, Canada’s largest company by market capitalization, RBC, announced it will cancel its sustainable finance targets and reduce its environmental disclosures due to new federal rules around how companies make claims about their environmental performance.
And in January, all of Canada’s six largest banks quit the Net-Zero Banking Alliance, an alliance formerly led by Mark Carney (before he resigned to run for leadership of the Liberal Party) that aimed to align banking activities with net-zero emissions by 2050. Shortly before Canada’s six largest banks quit the initiative, the six largest U.S. banks did the same.
There’s a second potential benefit to the CPPIB cancelling its net-zero commitment. Now, perhaps with the net-zero objective out of the way, the CPPIB can rein in some of the administrative and management expenses associated with pursuing net-zero.
As Andrew Coyne noted in a recent commentary, the CPPIB has become bloated in the past two decades. Before 2006, the CPP invested passively, which meant it invested Canadians’ money in a way that tracked market indexes. But since switching to active investing, which includes picking stocks and other strategies, the CPPIB ballooned from 150 employees and total costs of $118 million to more than 2,100 employees and total expenses (before taxes and financing) of more than $6 billion.
This administrative ballooning took place well before the rise of environmentally-themed investing or the CPPIB’s announcement of net-zero targets, but the net-zero targets didn’t help. And as Coyne noted, the CPPIB’s active investment strategy in general has not improved financial returns either.
On the contrary, since switching to active investing the CPPIB has underperformed the index to a cumulative tune of about $70 billion, or nearly one-tenth of its current fund size. “The fund’s managers,” Coyne concluded, “have spent nearly two decades and a total of $53-billion trying to beat the market, only to produce a fund that is nearly 10-per-cent smaller than it would be had they just heaved darts at the listings.”
Scrapping net-zero commitments won’t turn that awful track record around overnight. But it’s finally a step in the right direction.
Business
Federal fiscal anchor gives appearance of prudence, fails to back it up

From the Fraser Institute
By Jake Fuss and Grady Munro
The Parliamentary Budget Officer (PBO)—which acts as the federal fiscal watchdog—released a new report highlighting concerns with the Carney government’s fiscal plan. Key among these concerns is the fact that the government’s promise to balance its “operating budget” does not actually ensure the nation’s finances are sustainable. Instead, the plan to balance the operating budget by 2028/29 gives the appearance of fiscal prudence, but allows the government to continue running large deficits and borrow more money.
First, what’s the new government’s fiscal plan?
While the Carney government has chosen to delay releasing a budget until the fall—leaving Canadians and parliamentarians in the dark about the state of government finances and where we’re headed—the Liberal platform and throne speech lay out the plan in broad strokes.
The Carney government plans to introduce a new framework that splits federal spending into two separate budgets: The operating budget and the capital budget. The operating budget will include “day-to-day” spending (e.g. government salaries, cash transfers to provinces and individuals, etc.) while the capital budget will include spending on “anything that builds an asset.” Within this framework, the government has set itself an objective—also called a ‘fiscal anchor’—to balance the operating budget over the next three years.
Fiscal anchors help guide policy on government spending, taxes and borrowing, and are intended to prevent government finances from deteriorating while ensuring that debt is sustainable for future generations. The previous federal government made a habit of violating its own fiscal anchors—to the detriment of national finances—but the Carney government has promised a “very different approach” to fiscal policy.
The PBO’s new report highlights two critical concerns with this new approach to finances. First, the federal government has not yet defined what “operating” spending is and what “capital” spending is. Therefore, it’s difficult to know whether any new spending policies—such as the recently announced increase in defence spending—will hurt efforts to achieve the government’s goal of balancing the operating budget and how much overall debt will be accumulated. In other words, the government’s plan to split the budget in two simply muddies the waters and makes it harder to evaluate federal finances.
The PBO’s second, and more alarming, concern is that even if the government achieves its goal to balance the operating budget, federal finances may still continue to deteriorate and debt may rise at an unsustainable rate (growing faster than the economy).
While the Liberal election platform does outline a fiscal path that appears to balance the operating budget by 2028/29, this path also includes higher deficits and more borrowing than the previous government’s plan once you factor in capital spending. Specifically, the Carney government plans to run overall deficits over the next four years that are a combined $93.4 billion more than was previously planned in last year’s fall economic statement. This means that rather than the “very different approach” that Canadians have been promised, the Carney government may continue (or even worsen) the same costly habits of endless borrowing and rising debt.
The PBO is right to call out the major transparency issues with the Carney government’s new budget framework and fiscal anchor. While the devil will be in the details of the government’s fiscal plan, and we won’t know those details until it releases a budget, the government’s new fiscal anchor gives the appearance of prudence without the substance to back it up.
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