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

From the Fraser Institute

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Moreover, it’s a desperate bid to cling to an outdated—and failed—model of health care while underestimating modern-day innovations.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

Author:

Bacchus Barua

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2025 Federal Election

Housing starts unchanged since 1970s, while Canadian population growth has more than tripled

Published on April 15, 2025

Todayville

From the Fraser Institute

By: Austin Thompson and Steven Globerman

The annual number of new homes being built in Canada in recent years is virtually the same as it was in the 1970s, despite annual population growth
now being three times higher, finds a new study published today by the Fraser Institute, an independent, non-partisan Canadian public policy think tank.

“Despite unprecedented levels of immigration-driven population growth following the COVID-19 pandemic, Canada has failed to ramp up homebuilding sufficiently to meet housing demand,” said Steven Globerman, Fraser Institute senior fellow and co-author of The Crisis in Housing Affordability: Population Growth and Housing Starts 1972–2024.

Between 2021 and 2024, Canada’s population grew by an average of 859,473 people per year, while only 254,670 new housing units were started annually. From 1972 to 1979, a similar number of new housing units were built—239,458—despite the population only growing by 279,975 people a year.

As a result, more new residents are competing for each new home than in the past, which is driving up housing costs.

“The evidence is clear—population growth has been outpacing housing construction for decades, with predictable results,” Globerman said.

“Unless there is a substantial acceleration in homebuilding, a slowdown in population growth, or both, Canada’s housing affordability crisis is unlikely to improve.”

The Crisis in Housing Affordability: Population Growth and Housing Starts 1972–2024

Canada experienced unprecedented population growth following the COVID-19 pandemic without a commensurately large increase in new homebuilding.
The imbalance between population growth and new housing construction is reflected in a significant gap between housing demand and supply, which is driving up housing costs.
Canada’s population grew by a record 1.23 million new residents in 2023 almost entirely due to immigration. That growth was more than double the pre-pandemic record set in 2019.
Population growth slowed to 951,517 in 2024, still well above any year before 2023.
Nationally, construction began on about 245,367 new housing units in 2024, down from a recent high of 271,198 starts in 2021—Canada’s annual number of housing starts peaked at 273,203 in 1976.
Canada’s annual number of housing starts regularly exceeded 200,000 in past decades, when absolute population growth was much lower.
In 2023, Canada added 5.1 new residents for every housing unit started, which was the highest ratio over the study’s timeframe and well above the average rate of 1.9 residents for every unit started observed over the study period (1972–2024).
This ratio improved modestly in 2024, with 3.9 new residents added per housing start. However, the ratio remains far higher than at any point prior to the COVID-19 pandemic.
These national trends are broadly mirrored across all 10 provinces, where annual population growth relative to housing starts is, to varying degrees, elevated when compared to long-run averages.
Without an acceleration in homebuilding, a slowdown in population growth, or both, Canada’s housing affordability crisis will likely persist.

Austin Thompson

Senior Policy Analyst, Fraser Institute

Steven Globerman

Senior Fellow and Addington Chair in Measurement, Fraser Institute

Education

Schools should focus on falling math and reading grades—not environmental activism

Published on April 15, 2025

Todayville

From the Fraser Institute

By Michael Zwaagstra

In 2019 Toronto District School Board (TDSB) trustees passed a “climate emergency” resolution and promised to develop a climate action plan. Not only does the TDSB now have an entire department in their central office focused on this goal, but it also publishes an annual climate action report.

Imagine you were to ask a random group of Canadian parents to describe the primary mission of schools. Most parents would say something along the lines of ensuring that all students learn basic academic skills such as reading, writing and mathematics.

Fewer parents are likely to say that schools should focus on reducing their environmental footprints, push students to engage in environmental activism, or lobby for Canada to meet the 2016 Paris Agreement’s emission-reduction targets.

And yet, plenty of school boards across Canada are doing exactly that. For example, the Seven Oaks School Division in Winnipeg is currently conducting a comprehensive audit of its environmental footprint and intends to develop a climate action plan to reduce its footprint. Not only does Seven Oaks have a senior administrator assigned to this responsibility, but each of its 28 schools has a designated climate action leader.

Other school boards have gone even further. In 2019 Toronto District School Board (TDSB) trustees passed a “climate emergency” resolution and promised to develop a climate action plan. Not only does the TDSB now have an entire department in their central office focused on this goal, but it also publishes an annual climate action report. The most recent report is 58 pages long and covers everything from promoting electric school buses to encouraging schools to gain EcoSchools certification.

Not to be outdone, the Vancouver School District (VSD) recently published its Environmental Sustainability Plan, which highlights the many green initiatives in its schools. This plan states that the VSD should be the “greenest, most sustainable school district in North America.”

Some trustees want to go even further. Earlier this year, the British Columbia School Trustees Association released its Climate Action Working Group report that calls on all B.C. school districts to “prioritize climate change mitigation and adopt sustainable, impactful strategies.” It also says that taking climate action must be a “core part” of school board governance in every one of these districts.

Apparently, many trustees and school board administrators think that engaging in climate action is more important than providing students with a solid academic education. This is an unfortunate example of misplaced priorities.

There’s an old saying that when everything is a priority, nothing is a priority. Organizations have finite resources and can only do a limited number of things. When schools focus on carbon footprint audits, climate action plans and EcoSchools certification, they invariably spend less time on the nuts and bolts of academic instruction.

This might be less of a concern if the academic basics were already understood by students. But they aren’t. According to the most recent data from the Programme for International Student Assessment (PISA), the math skills of Ontario students declined by the equivalent of nearly two grade levels over the last 20 years while reading skills went down by about half a grade level. The downward trajectory was even sharper in B.C., with a more than two grade level decline in math skills and a full grade level decline in reading skills.

If any school board wants to declare an emergency, it should declare an academic emergency and then take concrete steps to rectify it. The core mandate of school boards must be the education of their students.

For starters, school boards should promote instructional methods that improve student academic achievement. This includes using phonics to teach reading, requiring all students to memorize basic math facts such as the times table, and encouraging teachers to immerse students in a knowledge-rich learning environment.

School boards should also crack down on student violence and enforce strict behaviour codes. Instead of kicking police officers out of schools for ideological reasons, school boards should establish productive partnerships with the police. No significant learning will take place in a school where students and teachers are unsafe.

Obviously, there’s nothing wrong with school boards ensuring that their buildings are energy efficient or teachers encouraging students to take care of the environment. The problem arises when trustees, administrators and teachers lose sight of their primary mission. In the end, schools should focus on academics, not environmental activism.