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Moreover, it’s a desperate bid to cling to an outdated—and failed—model of health care while underestimating modern-day innovations.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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Freedom of speech under threat on university campuses in Canada

Published on September 13, 2025

Todayville

From the Fraser Institute

By Michael Zwaagstra and Matthew D. Mitchell

Obviously, when students feel that their grades are at risk, they will be far less likely to express their genuine opinions or even ask questions during class discussions. Not only does this make classes less interesting, it also undermines the entire purpose of a university education.

Universities should be places where all ideas are welcomed and explored. In many Canadian university classrooms, however, only the “correct” viewpoint is heard.

According to a new survey (conducted by Leger and published by the Fraser Institute) of 1,200 Canadian university students and recent graduates, politically left-of-centre students were far more likely than their right-of-centre classmates to report that their views were welcomed and encouraged in class.

For example, 83 per cent of right-leaning students believe that professors advocate a left-of-centre view—and 45 per cent of left-leaning students agree with them.

Forty-two per cent of right-leaning students say they experienced a university classroom environment that limited discussion and questions on controversial topics to only one side of the argument. In contrast, only 29 per cent of left-leaning students felt the same way.

To make matters worse, 50 per cent of right-leaning students said they sometimes felt uncomfortable expressing their opinions due to the views of the professors leading the class. Only 36 per cent of left-leaning students reported the same experience.

Interestingly, when asked whether there was a “safe” point of view on controversial topics in university classes, a majority from both groups answered “yes” with little difference between right-leaning students (58 per cent) and left-leaning students (51 per cent).

A significant number of right-leaning students (37 per cent) also said they feared formal consequences for expressing honest thoughts, opinions or even asking questions in their classes. Among right-leaning students who expressed this concern, 74 per cent feared their professors would lower their grades for expressing the “wrong” opinion in class.

Obviously, when students feel that their grades are at risk, they will be far less likely to express their genuine opinions or even ask questions during class discussions. Not only does this make classes less interesting, it also undermines the entire purpose of a university education.

Other studies also reveal the politically one-sided nature of university campuses. For example, a 2022 survey published by the Macdonald-Laurier Institute found that 88 per cent of Canadian university professors vote for parties of the left and only 9 per cent support parties on the right. No wonder students feel their class discussions are consistently one-sided.

Similarly, a 2024 survey published by Heterodox Academy and College Plus found that more than half of students were reluctant to discuss certain issues such as the current Israel/Hamas conflict and transgender identity, and nearly half were reluctant to even broach the subject of politics. More alarmingly, a majority of students favoured limiting free expression on campus.

While many university professors are quick to describe themselves as strong supporters of diversity, this does not seem to include diversity of thought. A truly diverse campus would welcome a variety of intellectual perspectives in the spirit of open and scholarly debate. A campus where everyone looks different but thinks the same is not meaningfully diverse. As economist and philosopher John Stuart Mill argued many years ago, we are all impoverished when we silence one perspective.

It’s concerning that most students feel there’s a “safe” political view on controversial topics, particularly when students who hold a minority viewpoint feel the least safe expressing their views.

Of course, things won’t change overnight. But the first step to dealing with a problem is to admit that you have one. In that light, university administrators, professors and politicians should acknowledge that the current lack of viewpoint diversity on campus is a serious problem for all Canadians. Democracies function best when people freely express, and vigorously debate, competing ideas. As institutions of higher learning, universities should exemplify what free and open discussion looks like.

While there’s nothing wrong with professors holding political views and sharing those views with their students, they should not restrict free and open debate in their classrooms. This means ensuring that all students, including those whose opinions are in the minority, are guaranteed the right to share their views without fear of reprisal.

Michael Zwaagstra

Senior Fellow, Fraser Institute

Matthew D. Mitchell

Senior Fellow in the Centre for Human Freedom, Fraser Institute

Business

Carney engaging in Orwellian doublethink with federal budget rhetoric

Published on September 13, 2025

Todayville

From the Fraser Institute

By Jake Fuss

In George Orwell’s classic 1984, he describes a dystopian world dominated by “doublethink”—instances whereby people hold two contradictory beliefs simultaneously while accepting them both. In recent comments about the upcoming October federal budget, Prime Minister Carney unfortunately offered a prime example of doublethink in action.

During a press conference, Carney was critical of his predecessor’s mismanagement of federal finances, specifically unsustainable increases in spending year after year, and stated his 2025 budget will instead focus on “both austerity and investments.” This should strike Canadians as an obvious contradiction. Austerity involves lowering government spending while investing refers to the exact opposite.

Such doublethink may make for good political rhetoric, but it only muddies the waters on the actual direction of fiscal policy in Ottawa. The government can either cut overall spending to try to get a handle on federal finances and reduce the role of Ottawa in the economy, or it can increase spending (but call it “investment”) to continue the spending policies of the Trudeau government. It can’t do both. It must pick a lane when it comes to mutually exclusive policies.

Despite the smoke and mirrors on display during his press junket, the prime minister appears poised to be a bigger spender and borrower than Trudeau. Late last year, the Trudeau government indicated it planned to grow program spending from $504.1 billion in 2025/26 to $547.8 billion by 2028/29.

After becoming the Liberal Party leader earlier this year, Carney delivered a party platform that pledged to increase spending to roughly $533.3 billion this year, well above what the Trudeau government planned last fall, and then to $566.4 billion by 2028/29. Following the election, he then announced plans to significantly increase military spending.

While the prime minister has touted a plan to find “ambitious savings” in the operating budget through a so-called “comprehensive expenditure review,” his government is excluding more than half of all federal spending including transfers to individuals such as Old Age Security and transfers to the provinces for health care and other social programs. Even with the savings anticipated following the review, the Carney government will likely not reduce overall spending but rather simply slow the pace of annual spending increases.

Moreover, the Liberal Party platform shows the government expects to borrow $224.8 billion—$93.4 billion more than Trudeau planned to borrow. And that’s before the new military spending. That’s not austerity—even if Prime Minister Carney truly believes it to be.

Actual austerity would require a decrease in year-over-year expenses, smaller deficits than what the Trudeau government planned, and a path back to a true balanced budget in a reasonable timeframe. Instead, Carney will almost certainly hike overall spending each year, raise the deficits compared to his predecessor, and could even fall short of his tepid goal of balancing the operating budget within three years (which would still involve tens of billions more borrowed in a separate capital budget).

While budgets normally provide clarity on a government’s spending, taxing, and borrowing expect more doublethink from the October budget that will tout the government’s austerity measures while increasing spending and borrowing via “investments.”