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Other countries with universal health care don’t have Canada’s long wait times

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From the Fraser Institute

By Mackenzie Moir and Bacchus Barua

Unfortunately it’s now very common to see stories about how long provincial wait times for medical care are driving patients to seek care elsewhere, often at great personal cost. Take the recent case of the  Milburns in Manitoba who, after waiting years for a knee surgery, are now considering selling their home and moving to Alberta just to get on a potentially shorter public wait list.

Patients in Manitoba could expect to wait a median of 29 weeks to see an orthopedic specialist after a referral from a family physician, then they still faced a median 24.4 week wait to get treatment. In other words, the total typical wait for orthopedic surgery in the province is more than one year at 53.4 weeks. Remember, that’s a median measure, which means some patients wait much longer.

Unfortunately, the Milburns are unlikely to get more timely care on the public wait list in Alberta. At 64.1 weeks, the total median wait for orthopedic care in Alberta was actually longer than in Manitoba. And this doesn’t include the time it takes for provincial coverage to activate for a new provincial resident, or the time it will take to find a new family doctor and get the necessary tests, scans and referrals.

To get more timely care, the Milburns are left with unenviable options. Because they’re insured by Manitoba’s public health-care plan, paying for covered care out of pocket is restricted. They can, however, pay for and receive care privately in other provinces as uninsured visitors (i.e. not move there permanently). Specifically, certain provinces have “exemptions” that allow physicians to charge out-of-province patients directly to provide these procedures privately.

Alternatively, the Milburns could leave Canada and travel even further from home to receive timely care abroad.

But it doesn’t have to be this way.

Long wait times are not the necessary price Canadians must pay for universal coverage. In fact, Canada is one of 30 high-income countries with universal health care. Other countries such as Switzerland, the Netherlands, Germany and Australia have much shorter wait times. For example, only 62 per cent of Canadians reported access to non-emergency surgery in less than four months in 2020 compared to 99 per cent of Germans, 94 per cent of Swiss and 72 per cent of Australians.

The difference? These countries approach health care in a fundamentally different way than us. One notable difference is their attitude towards the private sector.

In Germany, patients can seek private care while still insured by the public system or can opt out and purchase regulated private coverage. These approaches (universal, privately paid or privately insured) are able to deliver rapid access to care. The Swiss simply mandate that patients purchase private insurance in a regulated-but-competitive marketplace as part of their universal scheme. Lower-income families receive a subsidy so they can participate on a more equal footing in the competitive marketplace to obtain the insurance that best fits their needs.

Perhaps the most direct comparator to Canada is Australia—not just geographically, but because it also primarily relies on a tax-funded universal health-care system. However, unlike Canada, individuals can purchase private insurance to cover (among other things) care received as a private patient in a public or private hospital, or simply pay for their private care directly if they choose. In 2021/22 more than two-thirds (70 per cent) of non-emergency admissions to a hospital involving surgery (both publicly and privately funded) took place in a private facility.

Of course, these faster-access countries share other differences in attitudes to universal health-care policy including requirements to share the cost of care for patients and funding hospitals on the basis of activity (instead of Canada’s outdated bureaucratically-determined budgets). A crucial difference, however, is that patients are not generally prevented from paying privately for health care in their home province (or canton or state) in any of these countries.

Without fundamental reform, and as provincial systems continue to struggle to provide basic non-emergency care, we’ll continue to see more stories like the Milburn’s. Without reform, many Canadians will continue to be forced to make similarly absurd decisions to get the care they need, rather than focusing on treatment and recovery.

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Virtue-signalling devotion to reconciliation will not end well

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From the Fraser Institute

By Bruce Pardy

In September, the British Columbia Supreme Court threw private property into turmoil. Aboriginal title in Richmond, a suburb of Vancouver, is “prior and senior” to fee simple interests, the court said. That means it trumps the property you have in your house, farm or factory. If the decision holds up on appeal, it would mean private property is not secure anywhere a claim for Aboriginal title is made out.

If you thought things couldn’t get worse, you thought wrong. On Dec. 5, the B.C. Court of Appeal delivered a different kind of upheaval. Gitxaala and Ehattesaht First Nations claimed that B.C.’s mining regime was unlawful because it allowed miners to register claims on Crown land without consulting with them. In a 2-to-1 split decision, the court agreed. The mining permitting regime is inconsistent with the United Nations Declaration on the Rights of Indigenous People (UNDRIP). And B.C. legislation, the court said, has made UNDRIP the law of B.C.

UNDRIP is a declaration of the United Nations General Assembly. It consists of pages and pages of Indigenous rights and entitlements. If UNDRIP is the law in B.C., then Indigenous peoples are entitled to everything—and to have other people pay for it. If you suspect that is an exaggeration, take a spin through UNDRIP for yourself.

Indigenous peoples, it says, “have the right to the lands, territories and resources which they have traditionally owned, occupied or otherwise used or acquired… to own, use, develop and control, as well as the right to “redress” for these lands, through either “restitution” or “just, fair and equitable compensation.” It says that states “shall consult and cooperate in good faith” in order to “obtain free and informed consent prior to the approval of any project affecting their lands or territories and other resources,” and that they have the right to “autonomy or self-government in matters relating to their internal and local affairs, as well as ways and means for financing their autonomous functions.”

The General Assembly adopted UNDRIP in 2007. At the time, Canada sensibly voted “no,” along with New Zealand, the United States and Australia. Eleven countries abstained. But in 2016, the newly elected Trudeau government reversed Canada’s objection.

UN General Assembly resolutions are not binding in international law. Nor are they enforceable in Canadian courts. But in 2019, NDP Premier John Horgan and his Attorney General David Eby, now the Premier, introduced Bill 41, the Declaration on the Rights of Indigenous Peoples Act (DRIPA). DRIPA proposed to require the B.C. government to “take all measures necessary to ensure the laws of British Columbia are consistent with the Declaration.” The B.C. Legislature unanimously passed the bill. (The Canadian Parliament passed a similar bill in 2021.)

Two years later, the legislature passed an amendment to the B.C. Interpretation Act. Eby, still B.C.’s Attorney General, sponsored the bill. The amendment read, “Every Act and regulation must be construed as being consistent with the Declaration.”

Eby has expressed dismay about the Court of Appeal decision. It “invites further and endless litigation,” he said. “It looked at the clear statements of intent in the legislature and the law, and yet reached dramatically different conclusions about what legislators did when we voted unanimously across party lines” to pass DRIPA. He has promised to amend the legislation.

These are crocodile tears. The majority judgment from the Court of Appeal is not a rogue decision from activist judges making things up and ignoring the law. Not this time, anyway. The court said that B.C. law must be construed as being consistent with UNDRIP—which is what Eby’s 2021 amendment to the Interpretation Act says.

In fact, Eby’s government has been doing everything in its power to champion Aboriginal interests. DRIPA is its mandate. It’s been making covert agreements with specific Aboriginal groups over specific territories. These agreements promise Aboriginal title and/or grant Aboriginal management rights over land use. In April 2024, an agreement with the Haida Council recognized Haida title and jurisdiction over Haida Gwaii, an archipelago off the B.C. coast formerly known as the Queen Charlotte Islands. Eby has said that the agreement is a template for what’s possible “in other places in British Columbia, and also in Canada.” He is putting title and control of B.C. into Aboriginal hands.

But it’s not just David Eby. The Richmond decision from the B.C. Supreme Court had nothing to do with B.C. legislation. It was a predictable result of years of Supreme Court of Canada (SCC) jurisprudence under Section 35 of the Constitution. That section guarantees “existing” Aboriginal and treaty rights as of 1982. But the SCC has since championed, evolved and enlarged those rights. Legislatures can fix their own statutes, but they cannot amend Section 35 or override judicial interpretation, even using the “notwithstanding clause.”

Meanwhile, on yet another track, Aboriginal rights are expanding under the Charter of Rights and Freedoms. On the same day as the B.C. Court of Appeal decision on UNDRIP, the Federal Court released two judgments. The federal government has an actionable duty to Aboriginal groups to provide housing and drinking water, the court declared. Taxpayer funded, of course.

One week later, at the other end of the country, the New Brunswick Court of Appeal weighed in. In a claim made by Wolastoqey First Nation for the western half of the province, the court said that Aboriginal title should not displace fee simple title of private owners. Yet it confirmed that a successful claim would require compensation in lieu of land. Private property owners or taxpayers, take your pick.

Like the proverb says, make yourself into a doormat and someone will walk all over you. Obsequious devotion to reconciliation has become a pathology of Canadian character. It won’t end well.

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The great policy challenge for governments in Canada in 2026

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From the Fraser Institute

By Ben Eisen and Jake Fuss

According to a recent study, living standards in Canada have declined over the past five years. And the country’s economic growth has been “ugly.” Crucially, all 10 provinces are experiencing this economic stagnation—there are no exceptions to Canada’s “ugly” growth record. In 2026, reversing this trend should be the top priority for the Carney government and provincial governments across the country.

Indeed, demographic and economic data across the country tell a remarkably similar story over the past five years. While there has been some overall economic growth in almost every province, in many cases provincial populations, fuelled by record-high levels of immigration, have grown almost as quickly. Although the total amount of economic production and income has increased from coast to coast, there are more people to divide that income between. Therefore, after we account for inflation and population growth, the data show Canadians are not better off than they were before.

Let’s dive into the numbers (adjusted for inflation) for each province. In British Columbia, the economy has grown by 13.7 per cent over the past five years but the population has grown by 11.0 per cent, which means the vast majority of the increase in the size of the economy is likely due to population growth—not improvements in productivity or living standards. In fact, per-person GDP, a key indicator of living standards, averaged only 0.5 per cent per year over the last five years, which is a miserable result by historic standards.

A similar story holds in other provinces. Prince Edward Island, Nova Scotia, Quebec and Saskatchewan all experienced some economic growth over the past five years but their populations grew at almost exactly the same rate. As a result, living standards have barely budged. In the remaining provinces (Newfoundland and Labrador, New Brunswick, Ontario, Manitoba and Alberta), population growth has outstripped economic growth, which means that even though the economy grew, living standards actually declined.

This coast-to-coast stagnation of living standards is unique in Canadian history. Historically, there’s usually variation in economic performance across the country—when one region struggles, better performance elsewhere helps drive national economic growth. For example, in the early 2010s while the Ontario and Quebec economies recovered slowly from the 2008/09 recession, Alberta and other resource-rich provinces experienced much stronger growth. Over the past five years, however, there has not been a “good news” story anywhere in the country when it comes to per-person economic growth and living standards.

In reality, Canada’s recent record-high levels of immigration and population growth have helped mask the country’s economic weakness. With more people to buy and sell goods and services, the overall economy is growing but living standards have barely budged. To craft policies to help raise living standards for Canadian families, policymakers in Ottawa and every provincial capital should remove regulatory barriers, reduce taxes and responsibly manage government finances. This is the great policy challenge for governments across the country in 2026 and beyond.

Ben Eisen

Senior Fellow, Fraser Institute

Jake Fuss

Director, Fiscal Studies, Fraser Institute
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