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:
Alberta
CPP another example of Albertans’ outsized contribution to Canada

From the Fraser Institute
By Tegan Hill
Amid the economic uncertainty fuelled by Trump’s trade war, its perhaps more important than ever to understand Alberta’s crucial role in the federation and its outsized contribution to programs such as the Canada Pension Plan (CPP).
From 1981 to 2022, Albertan’s net contribution to the CPP—meaning the amount Albertans paid into the program over and above what retirees in Alberta received in CPP payments—was $53.6 billion. In 2022 (the latest year of available data), Albertans’ net contribution to the CPP was $3.0 billion.
During that same period (1981 to 2022), British Columbia was the only other province where residents paid more into the CPP than retirees received in benefits—and Alberta’s contribution was six times greater than B.C.’s contribution. Put differently, residents in seven out of the nine provinces that participate in the CPP (Quebec has its own plan) receive more back in benefits than they contribute to the program.
Albertans pay an outsized contribution to federal and national programs, including the CPP because of the province’s relatively high rates of employment, higher average incomes and younger population (i.e. more workers pay into the CPP and less retirees take from it).
Put simply, Albertan workers have been helping fund the retirement of Canadians from coast to coast for decades, and without Alberta, the CPP would look much different.
How different?
If Alberta withdrew from the CPP and established its own standalone provincial pension plan, Alberta workers would receive the same retirement benefits but at a lower cost (i.e. lower CPP contribution rate deducted from our paycheques) than other Canadians, while the contribution rate—essentially the CPP tax rate—to fund the program would likely need to increase for the rest of the country to maintain the same benefits.
And given current demographic projections, immigration patterns and Alberta’s long history of leading the provinces in economic growth, Albertan workers will likely continue to pay more into the CPP than Albertan retirees get back from it.
Therefore, considering Alberta’s crucial role in national programs, the next federal government—whoever that may be—should undo and prevent policies that negatively impact the province and Albertans ability to contribute to Canada. Think of Bill C-69 (which imposes complex, uncertain and onerous review requirements on major energy projects), Bill C-48 (which bans large oil tankers off B.C.’s northern coast and limits access to Asian markets), an arbitrary cap on oil and gas emissions, numerous other “net-zero” targets, and so on.
Canada faces serious economic challenges, including a trade war with the United States. In times like this, it’s important to remember Alberta’s crucial role in the federation and the outsized contributions of Alberta workers to the wellbeing of Canadians across the country.
2025 Federal Election
Homebuilding in Canada stalls despite population explosion

From the Fraser Institute
By Austin Thompson and Steven Globerman
Between 1972 and 2019, Canada’s population increased by 1.8 residents for every new housing unit started compared to 3.9 new residents in 2024. In other words, Canada must now house more than twice as many new residents per new housing unit as it did during the five decades prior to the pandemic
In many parts of Canada, the housing affordability crisis continues with no end in sight. And many Canadians, priced out of the housing market or struggling to afford rent increases, are left wondering how much longer this will continue.
Simply put, too few housing units are being built for the country’s rapidly growing population, which has exploded due to record-high levels of immigration and the federal government’s residency policies.
As noted in a new study published by the Fraser Institute, the country added an all-time high 1.2 million new residents in 2023—more than double the previous record in 2019—and another 951,000 new residents in 2024. Altogether, Canada’s population has grown by about 3 million people since 2022—roughly matching the total population increase during the 1990s.
Meanwhile, homebuilding isn’t keeping up. In 2024, construction started on roughly 245,000 new housing units nationwide—down from a recent peak of 272,000 in 2021. By contrast, in the 1970s construction started on more than 240,000 housing units (on average) per year—when Canada’s population grew by approximately 280,000 people annually.
In fact, between 1972 and 2019, Canada’s population increased by 1.8 residents for every new housing unit started compared to 3.9 new residents in 2024. In other words, Canada must now house more than twice as many new residents per new housing unit as it did during the five decades prior to the pandemic. And of course, housing follows the laws of supply and demand—when a lot more prospective buyers and renters chase a limited supply of new homes, prices increase.
This key insight should guide the policy responses from all levels of government.
For example, the next federal government—whoever that may be—should avoid policies that merely fuel housing demand such as home savings accounts. And provincial governments (including in Ontario and British Columbia) should scrap any policies that discourage new housing supply such as rent controls, which reduce incentives to build rental housing. At the municipal level, governments across the country should ensure that permit approval timelines and building fees do not discourage builders from breaking ground. Increasing housing supply is, however, only part of the solution. The next federal government should craft immigration and residency policies so population growth doesn’t overwhelm available housing supply, driving up costs for Canadians.
It’s hard to predict how long Canada’s housing affordability crisis will last. But without more homebuilding, slower population growth, or both, there’s little reason to expect affordability woes to subside anytime soon.
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