Health
Public coverage of cross-border health care would help reduce waiting times

News release from the Montreal Economic Institute and Second Street
450,000 European patients had surgery outside their country of residence in 2022
Allowing Canadian patients to get reimbursed from the government for care received outside the country – just like Europeans do – would help reduce waiting times, according to an economic note published jointly by the Montreal Economic Institute and SecondStreet.org this morning.
“Long waiting times for surgery in Canada have damaging effects on patients‘ health and quality of life,” says Frederik Cyrus Roeder, health economist and author of the study. “Allowing Canadian patients to seek treatment elsewhere would help them regain their health, while breaking the cycle of constant catching up in Canadian healthcare systems.”
Since 2011, European patients have been permitted to seek treatment in any EU member country and receive reimbursement of their medical expenses equivalent to what their national health insurance plan would have covered at home.
This mechanism is known as the “cross-border directive,” or the “patients’ rights directive.”
Thanks to this arrangement, 450,000 European patients were able to access elective surgery outside their country of residence in 2022. Nearly 80% of the requests submitted that year were approved.
The economist explains that a large part of the voluntary program’s success is due to the fact that it acts as a safety valve when healthcare systems are no longer delivering.
“Such a system is no more expensive for the public insurer, because the reimbursements provided cannot exceed the costs of delivering the same treatment in the local healthcare system,” explains Mr. Roeder. “Where this directive really comes into its own is when a healthcare system can no longer manage to treat patients within an acceptable timeframe.”
“Patients are then free to turn to other alternatives without having to pay a stiff price. It’s important to note that even patients who don’t want to travel for treatment still benefit from this as it helps shorten waiting lists.”
In 2023, more than four out of ten Canadian patients had to wait longer than the recommended time to obtain a knee replacement in Canada. For hip replacements, the figure was one in three.
The joint study by the MEI and SecondStreet.org is available here.
* * *
The MEI is an independent public policy think tank with offices in Montreal and Calgary. Through its publications, media appearances, and advisory services to policymakers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.
SecondStreet.org launched in 2019 to focus on researching how government policies affect everyday Canadians. In addition to policy research, we tell short stories featuring Canadians from coast-to-coast explaining how they’re affected by government policies.
Mental Health
Headline that reads ‘Ontario must pay for surgery to give trans resident both penis and vagina: appeal court’ a sign of the times in Canada

From LifeSiteNews
Gender ideology so entrenched, surgical mutilation is no longer considered fringe
If you’d like a glimpse of what 10 years of progressive rule has done to Canada in a single sentence, I submit to you this April 24 headline: “Ontario must pay for surgery to give trans resident both penis and vagina: appeal court.”
Imagine reading a headline like that in, say, 2010. You’d wonder what country you were living in — that is, if you weren’t trying to figure out what you just read. But in Canada in 2025, this stuff isn’t fringe. It’s establishment.
The Ontario Court of Appeal, the province’s top court, issued a ruling this week stating that the province must pay for a “penile-sparing vaginoplasty” for a resident who identifies as transgender but does not identify “exclusively” as either male or female and thus would like to possess both a penis and a vagina.
According to the Post, “a three-judge panel of the Ontario Court of Appeal confirmed a lower court’s ruling that the novel phallus-preserving surgery qualifies as an insured service under the Ontario Health Insurance Plan.” In case you’re tempted to write this off as an aberration at the hands of a handful of activist judges, this ruling is the third unanimous decision in favor of the “patient,” identified in court records as “K.S.”
“K.S. is pleased with the Court of Appeal’s decision, which is now the third unanimous ruling confirming that her gender affirming surgery is covered under Ontario’s Health Insurance Act and its regulation,” K.S.’s lawyer, John McIntyre, told the Post. K.S., as it turns out, identifies as neither male nor female … but uses female pronouns:
The legal battle between K.S., whose sex at birth was male, dates to 2022, when the Ontario Health Insurance Plan (OHIP) refused her request to pay for the cost of surgery at a Texas clinic to construct a vagina while sparing the penis, a procedure this is not available in Ontario, or anywhere else in Canada. K.S. uses female pronouns but does not identify as either fully female or fully male.
Previously, saner generations would have no idea how to interpret the preceding paragraph, but gender ideology has made fools of us all. OHIP attempted to argue that “because the vaginoplasty would not be accompanied by a penectomy, the procedure isn’t one specifically listed in OHIP’s Schedule of Benefits and therefore shouldn’t be publicly funded” and also that the surgery is “experimental” in Ontario and thus can’t be covered.
But K.S., who has a male member but would also like a neo-vagina, appealed to the Health Services Appeal and Review Board, which overturned OHIP’s decision. OHIP appealed to the Divisional Court but lost; the latest appeal, heard November 26, was also rejected because a “penectomy,” the removal of the penis, was “neither recommended by K.S.’s health professionals nor desired by K.S.,” according to the court’s decision.
I wonder if the judges thought that they’d be ruling on whether a man who identifies as neither a man or a woman was entitled to obtain a vagina while retaining his penis when they were going to law school.
The court stated that K.S., who is in his early 30s, “has experienced significant gender dysphoria since her teenage years, as well as physical, mental and economic hardships to transition her gender expression to align with her gender identity.” Of course, K.S. isn’t “transgender,” per se — because he doesn’t identify as the opposite sex, even though he uses the pronouns of the opposite sex. He wants to be … both, somehow. And he wants the taxpayer to pay for it.
As the Post reported:
K.S.’s doctor submitted a request to OHIP for prior funding approval for the surgical creation of a vaginal cavity and external vulva. The request made it clear that K.S. wasn’t seeking a penectomy. In a letter accompanying the request, her doctor said that because K.S. is “not completely on the ‘feminine’ end of the spectrum” it was important for her to have a vagina while maintaining her penis, adding that the Crane Center for Transgender Surgery in Austin, Tx.,” has an excellent reputation” for gender-affirming surgery, “and especially with these more complicated procedures.”
The surgeries, depending on which are performed, range in cost “from US $10,000 to $70,000.” The court also ordered Ontario to pay K.S. $23,250 after dismissing OHIP’s appeal; the province has until June 23 to seek leave to the Supreme Court of Canada.
Mental Health
Suspect who killed 11 in Vancouver festival attack ID’d

Quick Hit:
Authorities have identified the driver responsible for the devastating attack at Vancouver’s Lapu Lapu Day festival that killed at least 11 and injured dozens more. The suspect, Kai-Ji Adam Lo, 30, had a well-documented history of mental illness, and his family sought help just hours before the tragic event.
Key Details:
- Kai-Ji Adam Lo, 30, was identified as the driver who plowed into a crowd, killing 11 and injuring dozens more.
- Lo’s family sought psychiatric help for him hours before the attack; he was already known to law enforcement.
- Police believe the attack was not terror-related, citing Lo’s extensive mental health struggles.
At least 9 dead in mass casualty event after driver crashes into crowd at Vancouver street festival.
The 30 year old driver was taken into custody by festival goers then arrested.
According to law enforcement “the suspect was known to police for certain circumstances”. pic.twitter.com/slG7LsZNFG
— Kevin Dalton (@TheKevinDalton) April 27, 2025
Diving Deeper:
The city of Vancouver is grappling with unspeakable tragedy following the deadly assault that unfolded during the Lapu Lapu Day festival, a vibrant celebration honoring the Filipino community. Authorities have identified the man behind the wheel as 30-year-old Kai-Ji Adam Lo, who was apprehended at the scene Saturday night.
Lo, whose troubled history with mental illness was well known to local authorities and mental health professionals, faces eight counts of second-degree murder, with additional charges expected as the investigation continues. According to reports, Lo’s family had reached out to a hospital psychiatric ward just hours before the incident, desperately seeking help for him amid his escalating paranoia and delusions. It remains unclear whether any intervention was made in response to the family’s call.
Vancouver Police Chief Steve Rai confirmed that Lo had no interactions with law enforcement immediately prior to the event, but acknowledged that the city is reeling from its “darkest day.” Investigators emphasized that, because of Lo’s mental state, they do not believe the attack was terror-related.
Adding to the complex portrait of the suspect, Lo was mourning profound personal loss. His brother, Alexander Lo, was murdered in January 2024. Following the death, Lo had penned heartbreaking posts online, sharing how his brother’s death and his mother’s subsequent suicide attempt shattered their family.
Tragically, among the 11 killed during Saturday’s carnage was a 5-year-old child. Dozens more were wounded when Lo drove his SUV into the densely packed crowd gathered for the festivities. Lo has since appeared in court and will remain in custody as prosecutors prepare to bring additional charges.
The horror that unfolded in Vancouver serves as a stark reminder of the broader systemic failures surrounding mental health interventions. While Canadian authorities attempt to grapple with the aftermath, this tragedy sadly echoes similar stories in other nations where warnings about individuals in crisis have gone unheeded—with catastrophic results.
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