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Fraser Institute

Bill Maher is right about Canadian health care

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From the Fraser Institute

By Mackenzie Moir

Recently, popular American comedian and talk show host, Bill Maher, took aim at some of Canada’s public policy failings in one of his monologues. In entertaining fashion, Maher highlighted our high housing costs, unemployment rates and “vaunted” health-care system.

Indeed, citing work published by the Fraser Institute, he explained that after adjusting for age, Canada spends 13.3 per cent of our economy on health care (2020), the highest level of spending by a developed country with universal coverage that year. And that Canada has some of the poorest access to timely appointments with family doctors when compared to our peers.

Unfortunately, while that’s where his segment on health care ended, the bad news for the Canadian system doesn’t stop there.

On top of Canada continuing to be one of the most expensive universal health-care systems in the world, we get little in return when it comes to both available medical resources and wait times. For example, among high-income countries with universal health care, Canada has some of the lowest numbers of physicians, hospital beds, MRI machines and CT scanners.

And in Canada, only 38 per cent of patients report seeing a specialist within four weeks (compared to 69 per cent in the Netherlands) and only 62 per cent report receiving non-emergency surgery within four months (compared to 99 per cent in Germany).

Unfortunately, wait times in Canada aren’t simply long compared to other countries, they’re the longest they’ve ever been. Last year the median wait for a Canadian patient seeking non-emergency care reached 27.7 weeks—nearly three times longer than the 9.3 week-wait Canadians experienced three decades ago.

This raises the obvious question. How do other countries outperform Canada’s health-care system while also often spending less as a share of their economies? In short, their approach to universal health care, and in particular their relationship with the private sector, departs drastically from the approach here at home.

Australia, for example, partners with private hospitals to deliver the majority (58.6 per cent) of all non-emergency surgeries within its universal health-care system. Australia also spends less of its total economy (i.e. GDP) on health care but outperforms Canada on every measure of timely care.

Even with restrictions on the private sector, Canada has some limited experience that should encourage policymakers to embrace greater private-sector involvement. Saskatchewan, for example, contracted with private surgical clinics starting in 2010 to deliver publicly-funded services as part of a four-year initiative to reduce wait times, which were among the longest in the country. Between 2010 and 2014, wait times in the province fell from 26.5 weeks to 14.2 weeks. After the initiative ended, the province’s wait times began to grow.

More recently, Quebec, which has some of the shortest wait times for medical services in the country, contracts out one out of every six day-surgeries to private clinics within the publicly-funded health-care system.

Maher’s monologue, which was viewed by millions online, highlighted the key failings of Canada’s health-care system. If policymakers in Ottawa and the provinces want to fix Canadian health care, they must learn from other countries that deliver universal health-care at the same or even lower cost, often with better access and results for patients.

Alberta

Governments in Alberta should spur homebuilding amid population explosion

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From the Fraser Institute

By Tegan Hill and Austin Thompson

In 2024, construction started on 47,827 housing units—the most since 48,336 units in 2007 when population growth was less than half of what it was in 2024.

Alberta has long been viewed as an oasis in Canada’s overheated housing market—a refuge for Canadians priced out of high-cost centres such as Vancouver and Toronto. But the oasis is starting to dry up. House prices and rents in the province have spiked by about one-third since the start of the pandemic. According to a recent Maru poll, more than 70 per cent of Calgarians and Edmontonians doubt they will ever be able to afford a home in their city. Which raises the question: how much longer can this go on?

Alberta’s housing affordability problem reflects a simple reality—not enough homes have been built to accommodate the province’s growing population. The result? More Albertans competing for the same homes and rental units, pushing prices higher.

Population growth has always been volatile in Alberta, but the recent surge, fuelled by record levels of immigration, is unprecedented. Alberta has set new population growth records every year since 2022, culminating in the largest-ever increase of 186,704 new residents in 2024—nearly 70 per cent more than the largest pre-pandemic increase in 2013.

Homebuilding has increased, but not enough to keep pace with the rise in population. In 2024, construction started on 47,827 housing units—the most since 48,336 units in 2007 when population growth was less than half of what it was in 2024.

Moreover, from 1972 to 2019, Alberta added 2.1 new residents (on average) for every housing unit started compared to 3.9 new residents for every housing unit started in 2024. Put differently, today nearly twice as many new residents are potentially competing for each new home compared to historical norms.

While Alberta attracts more Canadians from other provinces than any other province, federal immigration and residency policies drive Alberta’s population growth. So while the provincial government has little control over its population growth, provincial and municipal governments can affect the pace of homebuilding.

For example, recent provincial amendments to the city charters in Calgary and Edmonton have helped standardize building codes, which should minimize cost and complexity for builders who operate across different jurisdictions. Municipal zoning reforms in CalgaryEdmonton and Red Deer have made it easier to build higher-density housing, and Lethbridge and Medicine Hat may soon follow suit. These changes should make it easier and faster to build homes, helping Alberta maintain some of the least restrictive building rules and quickest approval timelines in Canada.

There is, however, room for improvement. Policymakers at both the provincial and municipal level should streamline rules for building, reduce regulatory uncertainty and development costs, and shorten timelines for permit approvals. Calgary, for instance, imposes fees on developers to fund a wide array of public infrastructure—including roads, sewers, libraries, even buses—while Edmonton currently only imposes fees to fund the construction of new firehalls.

It’s difficult to say how long Alberta’s housing affordability woes will endure, but the situation is unlikely to improve unless homebuilding increases, spurred by government policies that facilitate more development.

Tegan Hill

Director, Alberta Policy, Fraser Institute

Austin Thompson

Senior Policy Analyst, Fraser Institute
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Alberta

CPP another example of Albertans’ outsized contribution to Canada

Published on

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.

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