Policymakers in Ottawa and Edmonton maintain broken health-care system

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:

Nadeem Esmail

Senior Fellow, Fraser Institute

Related Topics:#BrokenHealthCareSystem #FraserInstitute #HealthCareAlberta #NadeemEsmail feature

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Latest shakedown attempt by Canada Post underscores need for privatization

Published on July 2, 2025

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From the Fraser Institute

By Alex Whalen and Jake Fuss

For the second time in just six months, the Canadian Union of Postal Workers (CUPW) is threatening strike action. As Canadians know all too well, postal strikes can be highly disruptive given the federal government provides Canada Post with a near-monopoly on letter mail across the country. CUPW is well aware of this and uses it to their advantage in negotiations. While CUPW has the right to ask for whatever they like, Canadians should finally be freed from this albatross.

In January, the Trudeau government loaned Canada Post a whopping $1.034 billion to help “maintain its solvency and continue operating.” Since 2018, Canada Post has lost more than $4.6 billion, and according to its latest financial update, lost more than $100 million in the first quarter of 2025 alone. Canadians are on the hook for these losses because the federal government owns Canada Post.

Salaries and other employee costs comprise more than 66 per cent of Canada Post’s expenses, and CUPW and Canada Post management both know they can simply pass any losses on to Canadians. Consequently, there’s less incentive for management to control the bottom line or make reasonable budget requests when negotiating with the government. But if the government privatizes Canada Post, it would impose a proper constraint on costs that doesn’t currently exist. This is only fair given there’s no compelling reason why Canadians should underwrite the inflation of salaries in a money-losing Crown corporation.

Of course, government ownership of Canada Post is archaic. When the organization was founded more than 250 years ago, the world was quite different. In today’s age of Amazon, a plethora of delivery services exist coast-to-coast that serve Canadian consumers. Other countries including the Netherlands, Austria and Germany long ago privatized their postal services. The result was increased competition, which in turn reduced prices and improved quality.

Alongside privatization, the federal government should also eliminate Canada Post’s near-monopoly status on letter mail. This policy is purportedly meant to ensure universal service. But in reality, it prohibits other potential service providers from entering the letter-delivery market (including in remote areas that may experience less Canada Post service post-privatization), deprives Canadians of choice, and crucially, reduces the incentive for Canada Post to improve its service.

Simply put, the federal government should focus on its core responsibilities, and delivering mail is clearly not one of them. Given Canada Post’s latest attempted shakedown of Canadians, it’s never been clearer that it’s time for Canada Post to go the way of Air Canada, de Havilland and CN Rail. Once upon a time, the federal government owned all three of these entities until it became clear there was no reason for the government to own an airline, build planes or deliver goods by train. Why is letter mail any different? Canadians deserve better.

Business

Municipal government per-person spending in Canada hit near record levels

Published on July 1, 2025

Todayville

From the Fraser Institute

By Austin Thompson

Municipal government spending in Canada hit near record levels in recent years, finds a new study by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

“In light of record-high spending in municipalities across Canada, residents should consider whether or not crime, homelessness, public transit and other services have actually improved,” said Austin Thompson, senior policy analyst at the Fraser Institute and author of The Expanding Finances of Local Governments in Canada.

From 2000 to 2023, per-person spending (inflation-adjusted) increased by 25.2 per cent, reaching a record-high $5,974 per person in 2021 before declining slightly to $5,851 in 2023, the latest year of available data.

During that same period, municipal government revenue—generated from property taxes and transfers from other levels of government—increased by 33.7 per cent per person (inflation-adjusted).

And yet, among all three levels of government including federal and provincial, municipal government spending (adjusted for inflation) has actually experienced the slowest rate of growth over the last 10 years, underscoring the large spikes in spending at all government levels across Canada.

“Despite claims from municipal policymakers about their dire financial positions, Canadians should understand the true state of finances at city hall so they can decide whether they’re getting good value for their money,” said Jake Fuss, director of fiscal studies at the Fraser Institute.

The Expanding Finances of Local Governments in Canada, 1990–2023

Canada’s local governments have experienced substantial fiscal growth in recent decades.
Revenue and expenditure by local governments—including municipal governments, school boards, and Indigenous governments—have increased faster than population growth and inflation combined. From 1990 to 2023, real per-capita revenue rose by 32.7%, and expenditure by 30.0%.
Local governments represent a significant component of Canada’s broader public sector. In 2023, net of inter-governmental transfers, municipal governments and school boards accounted for 18.6% of total government expenditure and 11.1% of revenue.
Despite this growth, local governments’ share of overall government revenue and expenditure has declined over time—especially since the COVID-19 pandemic—as federal and provincial budgets have expanded even more rapidly.
Nevertheless, between 2008 and 2023 the inflation-adjusted per-capita revenue of municipal governments in-creased by 10.1% and their expenditure by 12.4% , on average across the provinces.
Over the same period, municipal governments recorded above-inflation increases in their combined annual operating surpluses, which contributed to an 88.1% inflation-adjusted rise in their net worth—raising important questions about the allocation of accumulated resources.
In 2023, Ontario recorded the highest per-capita municipal revenue among the provinces ($4,156), while Alberta had the highest per-capita expenditure ($3,750). Prince Edward Island reported the lowest per-capita municipal revenue ($1,635) and expenditure ($1,186).
Wide variation in per-capita municipal revenue and expenditure across the provinces reflects differences in the responsibilities provinces assign to municipalities, as well as possible disparities in the efficiency of service delivery—issues that warrant further scrutiny.