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:
Carbon Tax
Carney fails to undo Trudeau’s devastating energy policies
From the Fraser Institute
By Tegan Hill and Elmira Aliakbari
On the campaign trail and after he became prime minister, Mark Carney has repeatedly promised to make Canada an “energy superpower.” But, as evidenced by its first budget, the Carney government has simply reaffirmed the failed plans of the past decade and embraced the damaging energy policies of the Trudeau government.
First, consider the Trudeau government’s policy legacy. There’s Bill C-69 (the “no pipelines act”), the new electricity regulations (which aim to phase out natural gas as a power source starting this year), Bill C-48 (which bans large oil tankers off British Columbia’s northern coast and limit Canadian exports to international markets), the cap on emissions only from the oil and gas sector (even though greenhouse gas emissions have the same effect on the environment regardless of the source), stricter regulations for methane emissions (again, impacting the oil and gas sector), and numerous “net-zero” policies.
According to a recent analysis, fully implementing these measures under Trudeau government’s emissions reduction plan would result in 164,000 job losses and shrink Canada’s economic output by 6.2 per cent by the end of the decade compared to a scenario where we don’t have these policies in effect. For Canadian workers, this will mean losing $6,700 (annually, on average) by 2030.
Unfortunately, the Carney government’s budget offers no retreat from these damaging policies. While Carney scrapped the consumer carbon tax, he plans to “strengthen” the carbon tax on industrial emitters and the cost will be passed along to everyday Canadians—so the carbon tax will still cost you, it just won’t be visible.
There’s also been a lot of buzz over the possible removal of the oil and gas emissions cap. But to be clear, the budget reads: “Effective carbon markets, enhanced oil and gas methane regulations, and the deployment at scale of technologies such as carbon capture and storage would create the circumstances whereby the oil and gas emissions cap would no longer be required as it would have marginal value in reducing emissions.” Put simply, the cap remains in place, and based on the budget, the government has no real plans to remove it.
Again, the cap singles out one source (the oil and gas sector) of carbon emissions, even when reducing emissions in other sectors may come at a lower cost. For example, suppose it costs $100 to reduce a tonne of emissions from the oil and gas sector, but in another sector, it costs only $25 a tonne. Why force emissions reductions in a single sector that may come at a higher cost? An emission is an emission regardless of were it comes from. Moreover, like all these policies, the cap will likely shrink the Canadian economy. According to a 2024 Deloitte study, from 2030 to 2040, the cap will shrink the Canadian economy (measured by inflation-adjusted GDP) by $280 billion, and result in lower wages, job losses and a decline in tax revenue.
At the same time, the Carney government plans to continue to throw money at a range of “green” spending and tax initiatives. But since 2014, the combined spending and forgone revenue (due to tax credits, etc.) by Ottawa and provincial governments in Ontario, Quebec, British Columbia and Alberta totals at least $158 billion to promote the so-called “green economy.” Yet despite this massive spending, the green sector’s contribution to Canada’s economy has barely changed, from 3.1 per cent of Canada’s economic output in 2014 to 3.6 per cent in 2023.
In his first budget, Prime Minister Carney largely stuck to the Trudeau government playbook on energy and climate policy. Ottawa will continue to funnel taxpayer dollars to the “green economy” while restricting the oil and gas sector and hamstringing Canada’s economic potential. So much for becoming an energy superpower.
Alberta
Calgary mayor should retain ‘blanket rezoning’ for sake of Calgarian families
From the Fraser Institute
By Tegan Hill and Austin Thompson
Calgary’s new mayor, Jeromy Farkas, has promised to scrap “blanket rezoning”—a policy enacted by the city in 2024 that allows homebuilders to construct duplexes, townhomes and fourplexes in most neighbourhoods without first seeking the blessing of city hall. In other words, amid an affordability crunch, Mayor Farkas plans to eliminate a policy that made homebuilding easier and cheaper—which risks reducing housing choices and increasing housing costs for Calgarian families.
Blanket rezoning was always contentious. Debate over the policy back in spring 2024 sparked the longest public hearing in Calgary’s history, with many Calgarians airing concerns about potential impacts on local infrastructure, parking availability and park space—all important issues.
Farkas argues that blanket rezoning amounts to “ignoring the community” and that Calgarians should not be forced to choose between a “City Hall that either stops building, or stops listening.” But in reality, it’s virtually impossible to promise more community input on housing decisions and build more homes faster.
If Farkas is serious about giving residents a “real say” in shaping their neighbourhood’s future, that means empowering them to alter—or even block—housing proposals that would otherwise be allowed under blanket rezoning. Greater public consultation tends to give an outsized voice to development opponents including individuals and groups that oppose higher density and social housing projects.
Alternatively, if the mayor and council reform the process to invite more public feedback, but still ultimately approve most higher-density projects (as was the case before blanket rezoning), the consultation process would be largely symbolic.
Either way, homebuilders would face longer costlier approval processes—and pass those costs on to Calgarian renters and homebuyers.
It’s not only the number of homes that matters, but also where they’re allowed to be built. Under blanket rezoning, builders can respond directly to the preferences of Calgarians. When buyers want duplexes in established neighbourhoods or renters want townhomes closer to work, homebuilders can respond without having to ask city hall for permission.
According to Mayor Farkas, higher-density housing should instead be concentrated near transit, schools and job centres, with the aim of “reducing pressure on established neighbourhoods.” At first glance, that may sound like a sensible compromise. But it rests on the flawed assumption that politicians and planners should decide where Calgarians are allowed to live, rather than letting Calgarians make those choices for themselves. With blanket rezoning, new homes are being built in areas in response to buyer and renter demand, rather than the dictates of city hall. The mayor also seems to suggest that city hall should thwart some redevelopment in established neighbourhoods, limiting housing options in places many Calgarians want to live.
The stakes are high. Calgary is not immune to Canada’s housing crisis, though it has so far weathered it better than most other major cities. That success partly reflects municipal policies—including blanket rezoning—that make homebuilding relatively quick and inexpensive.
A motion to repeal blanket rezoning is expected to be presented to Calgary’s municipal executive committee on Nov. 17. If it passes, which is likely, the policy will be put to a vote during a council meeting on Dec. 15. As the new mayor and council weigh changes to zoning rules, they should recognize the trade-offs. Empowering “the community” may sound appealing, but it may limit the housing choices available to families in those communities. Any reforms should preserve the best elements of blanket rezoning—its consistency, predictability and responsiveness to the housing preferences of Calgarians—and avoid erecting zoning barriers that have exacerbated the housing crisis in other cities.
Austin Thompson
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