Time to finally change the Canada Health Act for the sake of patients

Back in 1984, the Canada Health Act (CHA) received royal assent and has since reached near iconic status. At the same time, under its purview, the Canadian health-care system has become one of the least accessible—and most expensive—universal health-care systems in the developed world.

Clearly, policymakers should reform the CHA to reflect a more contemporary understanding of how to structure a truly world-class universal health-care system.

Consider for a moment the remarkably poor state of access to health care in Canada today. According to international comparisons of universal health-care systems, we endure some of the lowest access to physicians, medical technologies and hospital beds in the developed world. Wait times for health care in Canada also routinely rank among the longest in the developed world.

None of this is new. Canada’s poor ranking in the availability of services reaches back at least two decades. And wait times for health care have nearly tripled since the early 1990s. Back then, in 1993, Canadians could expect to wait 9.3 weeks for medical treatment after GP referral compared to 30 weeks in 2024.

This is all happening despite Canadians paying for one of the world’s most expensive universal-access health-care systems. And this brings us back to the CHA, which contains the federal government’s requirements for provincial policymaking. To receive their full federal cash transfers for health care from Ottawa, provinces must abide by CHA rules and regulations. And therein lies the rub.

We can find the solutions to our health-care woes in other countries such as Germany, Switzerland, the Netherlands and Australia, which all provide more timely access to quality care. Every one of these countries requires patient cost-sharing for physician and hospital services, and private competition in the delivery of universally accessible services with money following patients to hospitals and surgical clinics. And all these countries allow private purchases of health care, as this reduces the burden on the publicly-funded system and creates a valuable pressure valve for it.

Unfortunately for Canadians, the CHA expressly disallows requiring patients to share the cost of treatment while the CHA’s often vaguely defined terms and conditions have been used by federal governments to discourage a larger role for the private sector in the delivery of health-care services. At the same time, every new federal commitment to fix health care means increased provincial reliance on Ottawa. In 2024-25, federal cash transfers for health care are expected to total $52 billion, which means there’s $52 billion on the line for perceived non-compliance with the CHA. In short, this is why the provinces beholden to a policy approach that’s clearly failing Canadians.

So, what to do?

For starters, Ottawa should learn from its own welfare reforms in the 1990s, which reduced federal transfers and allowed provinces more flexibility with policymaking. The resulting period of provincial policy innovation reduced welfare dependency and government spending on social assistance (i.e. savings for taxpayers). When Ottawa stepped back and allowed the provinces to vary policy to their unique circumstances, Canadians got improved outcomes for fewer dollars.

We need that same approach for health care today, and it begins with the federal government reforming the CHA to expressly allow provinces the ability to explore alternate policy approaches, while maintaining the foundational principles of universality.

Next, the federal government should either hold cash transfers for health care constant (in nominal terms), reduce them or eliminate them entirely with a concordant reduction in federal taxes. By reducing (or eliminating) the pool of cash tied to the strings of the CHA, provinces would have greater freedom to pursue reform policies they consider to be in the best interests of their residents without federal intervention.

After 40 years, it’s high time to remove ambiguity and minimize uncertainty—and the potential for politically motivated interpretations—of the CHA. If federal policymakers want Canadians to finally have access to world-class health care, they should allow the provinces to choose their own set of universal health-care policies. The first step is to fix the 40-year-old legislation that has held the provinces back.

Nadeem Esmail

Senior Fellow, Fraser Institute

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Carney’s ‘major projects’ list no cause for celebration

Published on September 16, 2025

Todayville

From the Fraser Institute

By Alex Whalen

Early in his term, Prime Minister Mark Carney placed great emphasis on the need to think big and move quickly, to make Canada the “world’s leading energy superpower.” Recently, the government announced the first group of projects to be championed by its new Major Projects Office (MPO), which was also recently created to circumvent existing rules and regulations to speed up approvals. Unfortunately, the list of projects is decidedly underwhelming, which highlights the need for a true course correction when it comes to fixing Canada’s investment crisis.

According to the government, the purpose of the Major Projects Office is to fast-track “nation building” projects, with a focus on regulatory approvals and financing. Yet, of the first five projects referred to the MPO, regulatory approvals have largely already been secured and the projects were likely to proceed without any intervention or assistance from Ottawa.

For example, many of the regulatory approvals required for the Darlington Small Nuclear Reactor are already in place, and construction has already begun. The McIlvenna Bay copper mine in Saskatchewan is already half-built.

Other projects, such as LNG Phase 2 and the Red Chris Copper Mine, both in British Columbia, are expansions of existing facilities and are backed by industry-leading firms such as Shell and Rio Tinto, respectively. In general, these projects do not need government assistance or financing since they’re already largely approved.

A further six projects being referred to the MPO are at an earlier stage of development, and for the most part do not yet require regulatory approvals. Carney has referred this list—which includes projects ranging from carbon capture to high speed rail to offshore wind—to the MPO to be matched with government “business development teams” to “advance these concepts.”

These initiatives parallel the approach by the Trudeau government to rely on government-directed projects to foster economic growth, which failed miserably. The Trudeau government’s economic policies featured a much larger role for government in the economy, including a general increase in the size and scope of the federal government, as measured by increased spending and regulation. The result? Under Trudeau, annual growth of per-person GDP (an indicator of living standards) was just 0.3 per cent, the worst track record of any recent prime minister. Net business investment (foreign direct investment in Canada minus Canadian direct investment abroad) declined by $388 billion between 2015 and 2023 (the latest year of available data).

To set Canada on a course to reverse the investment crisis, Carney must abandon the notion of government-directed economic growth. Approving projects already largely approved, while sending other less-certain projects to government business development bureaucrats, will not fix Canada’s problem. Simply put, the government should craft policy to create the right conditions for investment and entrepreneurship for all firms in all sectors of the economy, not simply its chosen winners.

To attract the kinds of major projects that will meaningfully improve Canada’s investment crisis, the Carney government should eliminate a host of regulations and reform those that survive. As other analysts have noted, the list of regulatory hurdles in Canada is long. Canada’s total regulatory load has increased substantially over time and across a wide range of industries including energy, autos, child care, supermarkets and more.

Nowhere is this more evident than the energy industry, which is one of the largest drivers of investment in Canada. Federal Bills C-69 and C-48 (which govern the project approval process and ban oil tankers on the west cost, respectively), alongside the federal greenhouse gas emissions cap, net-zero policies, and a host of other regulation such as new fuel standard have significantly constrained this industry, which is vital to Canada’s economic success.

Canada’s regulatory explosion has effectively decimated the country’s investment climate. While Bill C-5 allows cabinet to circumvent these regulations, it places the cabinet, and more specifically the prime minister, in the position of picking winners and losers. Broad-based tax and regulatory reduction and reform would be a much more effective approach.

Canada continues to struggle amid an investment crisis that’s holding back economic growth and living standards. Our country needs bold changes to the policy environment conducive to attracting more investment. The government’s response to date, through Bill C-5 and the MPO, involves making the government more, not less, involved in the economy. The government should reverse course.

Business

Carney government’s housing GST rebate doesn’t go far enough

Published on September 15, 2025

Todayville

From the Fraser Institute

By Austin Thompson

While there are many reasons for Canada’s housing affordability crisis, taxes on new homes—including the federal Goods and Services Tax (GST)—remain a major culprit. The Carney government is currently advancing legislation that would rebate GST on some new home purchases, but only for a narrow slice of the market, falling short of what’s needed to improve affordability. A broader GST rebate, extending to more homebuyers and more new homes, would cost Ottawa more, but it would likely deliver better results than the billions the Carney government plans to spend on other housing-related programs.

Today, Ottawa already offers some GST relief for new housing: partial rebates for homes under $450,000, full rebates for small-scale rental units (e.g. condos, townhomes, duplexes) valued under $450,000, and a full rebate for large-scale rental buildings (with no price cap). Rebates can lower costs for homebuyers and encourage more homebuilding. However, at today’s high prices, these rebate programs mean most new homes, and many small-scale rental projects, remain burdened by federal GST.

The Carney government’s new proposal would offer a full GST rebate for new homes—but only for first-time homebuyers purchasing a primary residence at under $1 million (a partial rebate would be available for homes up to $1.5 million). Any tax cut on new housing is welcome, but these criteria are arbitrary and will limit the policy’s impact.

Firstly, by restricting the new GST rebate to first-time buyers, the government ignores how housing markets work. If a retired couple downsizes into a new condo, or a growing family upgrades to a bigger house, they typically free up their previous home for someone else to buy or rent. It doesn’t matter whether the new home is purchased by a first-time buyer—all buyers can benefit when a new home appears on the market.

Secondly, by limiting the GST rebate to primary residences, the government won’t reduce the existing tax burden on rental properties—recall, many small-scale projects still face the full GST burden. Extending the rebate to include rental properties would reduce costs, unlock more construction and expand options for renters.

Thirdly, because the proposed GST rebate only applies in-full to homes under $1 million, it will have little effect in Canada’s most expensive cities. For example, in the first half of 2025, 31.8 per cent of new homes sold in Toronto and 27.4 per cent in Vancouver exceeded $1 million. Taxing these homes discourages homebuilding where it’s most needed.

Altogether, these restrictions mean the Carney proposal would help very few Canadians. According to the Parliamentary Budget Officer, of the 237,324 housing units projected to be completed in 2026—the first full year of the proposed GST rebate program—only 12,903 (5.4 per cent) would qualify for the new rebate. With such limited coverage, the policy is unlikely to spur much new housing or improve affordability.

The proposed GST rebate will cost a projected $390 million per year. However, if the Carney government went further and expanded the rebate to cover all new homes under $1.3 million, it would cost about $2 billion. That’s a big price tag, especially given Ottawa’s strained finances, but it would do much more to improve housing affordability.

Instead, the Carney government plans to spend $3 billion annually on “Build Canada Homes”—a misguided federal entity set to compete with private builders for scarce construction resources. The government has earmarked another $1.5 billion per year to subsidize municipal fees on new housing projects—an approach that merely shift costs from city halls to Ottawa. A broader GST rebate would likely be a more effective, lower-risk alternative to these programs.

Finally, it’s important to note that exempting new homes from GST is not a slam dunk. GST is one of the more efficient ways for the federal government to raise revenue, since it doesn’t discourage work or investment as much as other taxes. GST rebates mean the government may increase more economically harmful taxes to recoup the lost revenue. Still, tax relief is a better way to increase housing affordability than the Carney government’s expensive spending programs. In fact, the government should also reform other federal taxes on housing-related capital gains and rental income to help encourage more homebuilding.

The Carney government’s proposed GST rebate is a step in the right direction, but it’s too narrow to meaningfully boost supply or ease affordability. If Ottawa is prepared to spend billions on questionable programs such as “Build Canada Homes,” it should first consider a more expansive GST rebate on new home purchases, which would likely do more to help Canadian homebuyers.