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Fraser Institute

Virtual care will break the Canada Health Act—and that’s a good thing

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From the Fraser Institute

By Bacchus Barua

The leadership of the Canadian Medical Association (CMA) is facing sharp criticism for its recent proposal to effectively ban private payment for virtual care. In a clear example of putting politics before patients, this would only erect additional barriers for those seeking care.

Moreover, it’s a desperate bid to cling to an outdated—and failed—model of health care while underestimating modern-day innovations.

Virtual care—online video doctor consultations—is a private-sector innovation. In response to our government system’s inability to provide timely care, private companies such as Maple have been offering these services to Canadians for almost a decade. In fact, the public system only pushed meaningfully into the virtual space during COVID when it established partnerships with these private companies alongside setting up new fee codes for virtual consultations.

In return for improving access to physician consultations for thousands of Canadians, these virtual care companies have been rewarded with increased government scrutiny and red tape. The weapon of choice? The Canada Health Act (CHA).

Specifically, sections 18 to 21 of the CHA prohibit user fees and extra billing for “medically necessary” services. Further, the insurance plan of a province must be publicly administered and provide “reasonable access” to 100 per cent of insured services. Provinces found in violation are punished by the federal government, which withholds a portion (or all) of federal health-care transfer payments.

Until recently, there had been no obvious conflict between the CHA and privately paid-for virtual care—primarily because the provinces are free to determine what’s medically necessary. Until recently, many provinces did not even have billing codes for virtual care. As virtual services are increasingly provided by the public sector, however, the ability to innovatively provide care for paying patients (either out-of-pocket or through private insurance) becomes restricted further.

Within this context, the CMA recently recommended formally including virtual care services within the public system, alongside measures to ensure “equitable access.” At the same time, it reiterated its recommendation that private insurance to access medically necessary services covered by the CHA be prohibited.

See where this is going?

The kicker is an additional recommendation banning dual practice (i.e. physicians working in both the public and private sector) except under certain conditions. This means doctors in the public system who could otherwise allocate their spare hours to private appointments online would now have to choose to operate exclusively in either the public or private system.

The combined effect of these policies would ensure that innovative private options for virtual care—whether paid for out-of-pocket or though private insurance—will either be overtaken by bureaucracies or disappear entirely.

But what the CMA report fails to recognize is that virtual care has expanded access to services the government fails to provide—there’s little reason to suspect a government takeover of the virtual-care sector will make things better for patients. And even if governments could somehow prevent Canadian doctors and companies providing these services privately, virtual care is not beholden to Canada’s physical borders. Patients with a little bit of technical knowhow will simply bypass the Canadian system entirely by having virtual consultations with doctors abroad. If Canadians can figure out how to access their favourite show in another country, you can be sure they’ll find a way to get a consultation with a doctor in Mumbai instead of Montreal.

Instead of forcing physicians and patients to operate within the crumbling confines of government-run health care, the CMA’s leadership should be grateful for the pressure valve that the private sector has produced. We should celebrate the private innovators who have provided Canadians better access to health care, not finding ways to shut them down in favour of more government control.

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Energy

Global fossil fuel use rising despite UN proclamations

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From the Fraser Institute

By Julio Mejía and Elmira Aliakbari

Major energy transitions are slow and take centuries, not decades… the first global energy transition—from traditional biomass fuels (including wood and charcoal) to fossil fuels—started more than two centuries ago and remains incomplete. Nearly three billion people in the developing world still depend on charcoal, straw and dried dung for cooking and heating, accounting for about 7 per cent of the world’s energy supply (as of 2020).

At the Conference of the Parties (COP29) in Azerbaijan, António Guterres, the United Nations Secretary-General, last week called for a global net-zero carbon footprint by 2050, which requires a “fossil fuel phase-out” and “deep decarbonization across the entire value chain.”

Yet despite the trillions of dollars already spent globally pursuing this target—and the additional trillions projected as necessary to “end the era of fossil fuels”—the world’s dependence on fossil fuels has remained largely unchanged.

So, how realistic is a “net-zero” emissions world—which means either eliminating fossil fuel generation or offsetting carbon emissions with activities such as planting trees—by 2050?

The journey began in 1995 when the UN hosted the first COP conference in Berlin, launching a global effort to drive energy transition and decarbonization. That year, global investment in renewable energy reached US$7 billion, according to some estimates. Since then, an extraordinary amount of money and resources have been allocated to the transition away from fossil fuels.

According to the International Energy Agency, between 2015 and 2023 alone, governments and industry worldwide spent US$12.3 trillion (inflation-adjusted) on clean energy. For context, that’s over six times the value of the entire Canadian economy in 2023.

Despite this spending, between 1995 and 2023, global fossil fuel consumption increased by 62 per cent, with oil consumption rising by 38 per cent, coal by 66 per cent and natural gas by 90 per cent.

And during that same 28-year period, despite the trillions spent on energy alternatives, the share of global energy provided by fossil fuels declined by only four percentage points, from 85.6 per cent to 81.5 per cent.

This should come as no surprise. Major energy transitions are slow and take centuries, not decades. According to a recent study by renowned scholar Vaclav Smil, the first global energy transition—from traditional biomass fuels (including wood and charcoal) to fossil fuels—started more than two centuries ago and remains incomplete. Nearly three billion people in the developing world still depend on charcoal, straw and dried dung for cooking and heating, accounting for about 7 per cent of the world’s energy supply (as of 2020).

Moreover, coal only surpassed wood as the main energy source worldwide around 1900. It took more than 150 years from oil’s first commercial extraction for oil to reach 25 per cent of all fossil fuels consumed worldwide. Natural gas didn’t reach this threshold until the end of the 20th century, after 130 years of industry development.

Now, consider the current push by governments to force an energy transition via regulation and spending. In Canada, the Trudeau government has set a target to fully decarbonize electricity generation by 2035 so all electricity is derived from renewable power sources such as wind and solar. But merely replacing Canada’s existing fossil fuel-based electricity with clean energy sources within the next decade would require building the equivalent of 23 major hydro projects (like British Columbia’s Site C) or 2.3 large-scale nuclear power plants (like Ontario’s Bruce Power). The planning and construction of significant electricity generation infrastructure in Canada is a complex and time-consuming process, often plagued by delays, regulatory hurdles and substantial cost overruns.

The Site C project took around 43 years from initial feasibility studies in 1971 to securing environmental certification in 2014. Construction began on the Peace River in northern B.C. in 2015, with completion expected in 2025 at a cost of at least $16 billion. Similarly, Ontario’s Bruce Power plant took nearly two decades to complete, with billions in cost overruns. Given these immense practical, financial and regulatory challenges, achieving the government’s 2035 target is highly improbable.

As politicians gather at high-profile conferences and set ambitious targets for a swift energy transition, global reliance on fossil fuels has continued to increase. As things stand, achieving net-zero by 2050 appears neither realistic nor feasible.

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Energy

Ottawa’s proposed emission cap lacks any solid scientific or economic rationale

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From the Fraser Institute

By Jock Finlayson and Elmira Aliakbari

Forcing down Canadian oil and gas emissions within a short time span (five to seven years) is sure to exact a heavy economic price, especially when Canada is projected to experience a long period of weak growth in inflation-adjusted incomes and GDP per person.

After two years of deliberations, the Trudeau government (specifically, the Environment and Climate Change Canada department) has unveiled the final version of Ottawa’s plan to slash greenhouse gas emissions (GHGs) from the oil and gas sector.

The draft regulations, which still must pass the House and Senate to become law, stipulate that oil and gas producers must reduce emissions by 35 per cent from 2019 levels by between 2030 and 2032. They also would establish a “cap and trade” regulatory regime for the sector. Under this system, each oil and gas facility is allocated a set number of allowances, with each allowance permitting a specific amount of annual carbon emissions. These allowances will decrease over time in line with the government’s emission targets.

If oil and gas producers exceed their allowances, they can purchase additional ones from other companies with allowances to spare. Alternatively, they could contribute to a “decarbonization” fund or, in certain cases, use “offset credits” to cover a small portion of their emissions. While cutting production is not required, lower oil and gas production volumes will be an indirect outcome if the cost of purchasing allowances or other compliance options becomes too high, making it more economical for companies to reduce production to stay within their emissions limits.

The oil and gas industry accounts for almost 31 per cent of Canada’s GHG emissions, while transportation and buildings contribute 22 and 13 per cent, respectively. However, the proposed cap applies exclusively to the oil and gas sector, exempting the remaining 69 per cent of the country’s GHG emissions. Targeting a single industry in this way is at odds with the policy approach recommended by economists including those who favour strong action to address climate change.

The oil and gas cap also undermines the Trudeau government’s repeated claims that carbon-pricing is the main lever policymakers are using to reduce GHG emissions. In its 2023 budget (page 71), the government said “Canada has taken a market-driven approach to emissions reduction. Our world-leading carbon pollution pricing system… is highly effective because it provides a clear economic signal to businesses and allows them the flexibility to find the most cost-effective way to lower their emissions.”

This assertion is vitiated by the expanding array of other measures Ottawa has adopted to reduce emissions—hefty incentives and subsidies, product standards, new regulations and mandates, toughened energy efficiency requirements, and (in the case of oil and gas) limits on emissions. Most of these non-market measures come with a significantly higher “marginal abatement cost”—that is, the additional cost to the economy of reducing emissions by one tonne—compared to the carbon price legislated by the Trudeau government.

And there are other serious problems with the proposed oil and gas emissions gap. For one, emissions have the same impact on the climate regardless of the source; there’s no compelling reason to target a single sector. As a group of Canadian economists wrote back in 2023, climate policies targeting specific industries (or regions) are likely to reduce emissions at a much higher overall cost per tonne of avoided emissions.

Second, forcing down Canadian oil and gas emissions within a short time span (five to seven years) is sure to exact a heavy economic price, especially when Canada is projected to experience a long period of weak growth in inflation-adjusted incomes and GDP per person, according to the OECD and other forecasting agencies. The cap stacks an extra regulatory cost on top of the existing carbon price charged to oil and gas producers. The cap also promises to foster complicated interactions with provincial regulatory and carbon-pricing regimes that apply to the oil and gas sector, notably Alberta’s industrial carbon-pricing system.

The Conference Board of Canada think-tank, the consulting firm Deloitte, and a study published by our organization (the Fraser Institute) have estimated the aggregate cost of the federal government’s emissions cap. All these projections reasonably assume that Canadian oil and gas producers will scale back production to meet the cap. Such production cuts will translate into many tens of billions of lost economic output, fewer high-paying jobs across the energy supply chain and in the broader Canadian economy, and a significant drop in government revenues.

Finally, it’s striking that the Trudeau government’s oil and gas emissions cap takes direct aim at what ranks as Canada’s number one export industry, which provides up to one-quarter of the country’s total exports. We can’t think of another advanced economy that has taken such a punitive stance toward its leading export sector.

In short, the Trudeau government’s proposed cap on GHG emissions from the oil and gas industry lacks any solid scientific, economic or policy rationale. And it will add yet more costs and complexity to Canada’s already shambolic, high-cost and ever-growing suite of climate policies. The cap should be scrapped, forthwith.

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