Canadians are ready for health-care reform—Australia shows the way

Australia offers real-world examples of how public/private partnerships can be successfully integrated in a universal health-care framework. Not only does Australia prove it can be done without sacrificing universal coverage for all, Australia spends less money (as a share of its economy) than Canada and enjoys more timely medical care.

Canada’s health-care system is crumbling. Long wait times, hallway health care and burned-out staff are now the norm. Unsurprisingly, a new poll finds that the majority of Canadians (73 per cent) say the system needs major reform.

As noted in a recent editorial in the Globe and Mail, we can learn key lessons from Australia.

There are significant similarities between the two countries with respect to culture, the economy and even geographic characteristics. Both countries also share the goal of ensuring universal health coverage. However, Australia outperforms Canada on several key health-care performance metrics.

After controlling for differences in age (where appropriate) between the two countries, our recent study found that Australia’s health-care system outperformed Canada’s on 33 (of 36) performance measures. For example, Australia had more physicians, hospital beds, CT scanners and MRI machines per person compared to Canada. And among the 30 universal health-care countries studied, Canada ranked in the bottom quartile for the availability of these critical health-care resources.

Australia also outperforms Canada on key measures of wait times. In 2023 (the latest year of available data), 39.5 per cent of patients in Australia were able to make a same or next day appointment when they were sick compared to only 22.3 per cent in Canada. And 9.6 per cent of Canadians reported waiting more than one year to see a specialist compared to only 4.5 per cent of Australians. Similarly, almost one-in-five (19.9 per cent) Canadians reported waiting more than one year for non-emergency surgery compared to only 11.8 per cent of Australians.

So, what does Australia do differently to outperform Canada on these key measures?

Although the Globe and Mail editorial touches on the availability of private insurance in Australia, less attention is given to the private sector’s prominent role in the delivery of health care.

In 2016 (the latest year of available data) almost half of all hospitals in Australia (48.5 per cent) were private. And in 2021/22 (again, the latest year of available data), 41 per cent of all hospital care took place in a private facility. That percentage goes up to 70.3 per cent when only considering hospital admissions for non-emergency surgery.

But it’s not only higher-income patients who can afford private insurance (or those paying out of pocket) who get these surgeries. The Australian government encourages the uptake of private insurance and partially subsidizes private care (at a rate of 75 per cent of the public fee), and governments in Australia also regularly contract out publicly-funded care to private facilities.

In 2021/22, more than 300,000 episodes of publicly-funded care occurred in private facilities in Australia. Private hospitals also delivered 73.5 per cent of care funded by Australia’s Department of Veterans’ Affairs. And in 2019/20, government sources (including the federal government) paid for almost one-third (32.8 per cent) of private hospital expenditures.

Which takes us back to the new opinion poll (by Navigator), which found that 69 per cent of Canadians agree that health-care services should include private-sector involvement. While defenders of the status quo continue to criticize this approach, Australia offers real-world examples of how public/private partnerships can be successfully integrated in a universal health-care framework. Not only does Australia prove it can be done without sacrificing universal coverage for all, Australia spends less money (as a share of its economy) than Canada and enjoys more timely medical care.

While provincial governments remain stubbornly committed to a failed model, Canadians are clearly expressing their desire for health-care reforms that include a prominent role for private partners in the delivery of universal care.

Australia is just one example. Public/private partnerships are the norm in several more successful universal health-care systems (such as Germany and Switzerland). Instead of continuing to remain an outlier, Canada should follow the examples of Australia and other countries and engage with the private sector to fulfill the promise of universal health care.

Authors:

Bacchus Barua and Mackenzie Moir

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Published on January 19, 2025

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From the Fraser Institute

By Elmira Aliakbari and Jason Clemens

As Donald Trump, who will be sworn in as president on Monday, threatens to impose tariffs on Canadian exports including oil and natural gas, the calls from some Canadian politicians and analysts for greater energy trade diversification grow louder. However, these calls highlight a hard truth—Canada has repeatedly foregone opportunities to reduce our dependence on the United States by cancelling already approved pipelines and failing to approve new pipeline and LNG projects that could have increased our access to global markets.

The U.S. is not just Canada’s largest energy customer—it’s nearly our only customer. In 2023, 97 per cent of crude oil exports and virtually all natural gas exports were sent south of the border. This dependence on the U.S. for exports leaves Canadian producers and the Canadian economy exposed to policy shifts in Washington and even state capitals.

Consider Energy East, a pipeline proposed by TransCanada (now TC Energy) to transport oil from Alberta and Saskatchewan to refineries and export terminals in Atlantic Canada. The pipeline would have reduced Atlantic Canada’s reliance on imported oil and opened export markets for Canadian oil to Europe.

However, in 2017 the Trudeau government introduced new criteria for evaluating and approving major pipeline projects, and for the first time assessments included not only the greenhouse gas (GHG) emissions from constructing the pipeline but also emissions from producing and using the oil it would transport. Later that year, TransCanada suspended its application for the project, effectively cancelling it. The CEO of TransCanada blamed “changed circumstances” but many observers recognized it was a combination of the new regulations and opposition from Quebec, particularly the City of Montreal. Consequently, the refineries in Atlantic Canada continue to rely on imported oil.

A year earlier in 2016, the Trudeau government cancelled the already-approved Northern Gateway pipeline, which would have connected Alberta oil production with the west coast and created significant export opportunities to Asian markets.

Canada is even more dependent on the U.S. for natural gas exports than oil exports. In 2023, Canada exported approximately 84 billion cubic metres of natural gas—all to the U.S.—via 39 pipelines, again leaving producers in Canada vulnerable to U.S. policy changes.

Meanwhile, Canada currently has no operational infrastructure for exporting liquified natural gas (LNG). While LNG Canada, the country’s first LNG export terminal, is expected to become operational this year in British Columbia, it’s long overdue.

Indeed, several energy companies have cancelled or delayed high-profile LNG projects in Canada due largely to onerous regulations that make approvals uncertain or even unlikely, including the $36 billion Pacific NorthWest LNG project in 2017, the $9 billion Énergie Saguenay LNG project in 2020, Kitimat LNG in 2021 and East Coast Canada LNG in 2023.

This all adds up to a missed opportunity, as global demand for LNG increases. If governments in Canada allowed or even facilitated more development of LNG facilities, Canadian companies could supply high-demand regions such as Asia and Europe. Indeed, during Europe’s 2022 energy crisis, Germany and several other countries turned to Canada for reliable LNG supply, but the Trudeau government rejected the requests.

The contrast with the U.S. is stark. Since 2011, 18 LNG export facilities have been proposed in Canada but only one—LNG Canada Phase 1—is nearing completion, more than 12 years after it was announced. Meanwhile, as of January 2025, the U.S. has built eight LNG export terminals and approved 20 more, securing its position as a global LNG leader.

Years of inaction and regulatory roadblocks have left Canadian energy producers overly dependent on a single trading partner and vulnerable to shifting U.S. policies. The looming threat of tariffs should be a wake-up call. To secure its energy future, Canada must address the regulatory barriers that have long hindered progress and prioritize the development of infrastructure to connect our energy resources to global markets.

Elmira Aliakbari

Director, Natural Resource Studies, Fraser Institute

Jason Clemens

Executive Vice President, Fraser Institute

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Trudeau leaves office with worst economic growth record in recent Canadian history

Published on January 18, 2025

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From the Fraser Institute

By Ben Eisen

In the days following Prime Minister Justin Trudeau’s resignation as leader of the Liberal Party, there has been much ink spilt about his legacy. One effusively positive review of Trudeau’s tenure claimed that his successors “will be hard-pressed to improve on his economic track record.”

But this claim is difficult to square with the historical record, which shows the economic story of the Trudeau years has been one of dismal growth. Indeed, when the growth performance of Canada’s economy is properly measured, Trudeau has the worst record of any prime minister in recent history.

There’s no single perfect measure of economic success. However, growth in inflation-adjusted per-person GDP—an indicator of living standards and incomes—remains an important and broad measure. In short, it measures how quickly the economy is growing while adjusting for inflation and population growth.

Back when he was first running for prime minister in 2015, Trudeau recognized the importance of long-term economic growth, often pointing to slow growth under his predecessor Stephen Harper. On the campaign trail, Trudeau blasted Harper for having the “worst record on economic growth since R.B. Bennett in the depths of the Great Depression.”

And growth during the Harper years was indeed slow. The Harper government endured the 2008/09 global financial crisis and subsequent weak recovery, particularly in Ontario. During Harper’s tenure as prime minister, per-person GDP growth was 0.5 per cent annually—which is lower than his predecessors Brian Mulroney (0.8 per cent) and Jean Chrétien (2.4 per cent).

So, growth was weak under Harper, but Trudeau misdiagnosed the causes. Shortly after taking office, Trudeau said looser fiscal policy—with more spending, borrowing and bigger deficits—would help spur growth in Canada (and indeed around the world).

Trudeau’s government acted on this premise, boosting spending and running deficits—but Trudeau’s approach did not move the needle on growth. In fact, things went from bad to worse. Annual per-person GDP growth under Trudeau (0.3 per cent) was even worse than under Harper.

The reasons for weak economic growth (under Harper and Trudeau) are complicated. But when it comes to performance, there’s no disputing that Trudeau’s record is worse than any long-serving prime minister in recent history. According to our recent study published by the Fraser Institute, which compared the growth performance of the five most recent long-serving prime ministers, annual per-person GDP growth was highest under Chrétien followed by Martin, Mulroney, Harper and Justin Trudeau.

Of course, some defenders will blame COVID for Trudeau’s poor economic growth record, but you can’t reasonably blame the steep but relatively short pandemic-related recession for nearly a decade of stagnation.

There’s no single perfect measure of economic performance, but per-person inflation-adjusted economic growth is an important and widely-used measure of economic success and prosperity. Despite any claims to the contrary, Justin Trudeau’s legacy on economic growth is—in historical terms—dismal. All Canadians should hope that his successor has more success and oversees faster growth in the years ahead.