Enough talk, we need to actually do something about Canadian health care

From the Macdonald Laurier Institute

By J. Edward Les for Inside Policy

Canada spends more on health care as a percentage of GDP than almost all other OECD countries, yet we rank behind most of them when it comes to outcomes that matter.

I drove a stretch of road near Calgary’s South Health Campus the other day, a section with a series of three intersections in a span of less than a few hundred metres. That is, I tried to drive it – but spent far more time idling than moving.

At each intersection, after an interminable wait, the light turned green just as the next one flipped to red, grinding traffic to a halt just after it got rolling. It was excruciating; I’m quite sure I spied a snail on crutches racing by – no doubt making a beeline (snail-line?) for the ER a stone’s throw away.

The street’s sluggishness is perhaps reflective of the hospital next to it, given that our once-cherished universal health care system has crumbled into a universal waiting system – a system seemingly crafted (like that road) to obstruct flow rather than enable it. In fact, the pace of medical care delivery in this country has become so glacial that even a parking lot by comparison feels like the Indianapolis Speedway.

The health care crisis grows more dire by the day. Reforms are long overdue. Canada spends more on health care as a percentage of GDP than almost all other OECD countries, yet we rank behind most of them when it comes to outcomes that matter.

And we’re paying with our lives: according to the Canadian Institute for Health Information, thousands of Canadians die each and every year because of the inefficiencies of our system.

Yet for all that we are paralyzed by the enormity and complexity of the mushrooming disaster. We talk about solutions – and then we talk and talk some more. But for all the talking, precious little action is taken.

I’m reminded of an Anne Lamotte vignette, related in her bestselling book Bird By Bird:

Thirty years ago my older brother, who was ten years old at the time, was trying to get a report written on birds that he’d had three months to write, which was due the next day. We were out at our family cabin in Bolinas, and he was at the kitchen table close to tears, surrounded by binder paper and pencils and unopened books about birds, immobilized by the hugeness of the task ahead. Then my father sat down beside him, put his arm around my brother’s shoulder, and said, “Bird by bird, buddy. Just take it bird by bird.”

So it is with Canadian health care: we’ve wasted years wringing our hands about the woeful state of affairs, while doing precious little about it.

Enough procrastinating. It’s time to tackle the crisis, bird by bird.

One thing we can do is to let doctors be doctors. A few weeks ago, in a piece titled “Should Doctors Mind Their Own Business?”, I questioned the customary habit of doctors hanging out their shingles in small independent community practices. Physicians spend long years of training to master their craft, years during which they receive no training in business methods whatsoever, and then we expect them to master those skills off to the side of their exam rooms. Some do it well, but many do not – and it detracts from their attention to patients.

We don’t install newly minted teachers in classrooms and at the same time task them with the keeping the lights on, managing the supply chain, overseeing staffing and payroll, and all the other mechanics of running schools. Why do we expect that of doctors?

Keeping doctors embedded within large, expensive, inefficient, bureaucracy-choked hospitals isn’t the solution, either.

There’s a better way, I argued in my essay: regional medical centres – centres built and administered in partnership with the private sector.

Such centres would allow practitioners currently practicing in the community to ply their trade unencumbered by the nuts and bolts of running a business; and they would allow us to decant a host of services from hospitals, which should be reserved for what only hospitals can do: emergency services, inpatient care, surgeries, and the like.

In short, we should let doctors be doctors, and hospitals be hospitals.

To garner feedback, I dumped my musings into a couple of online physician forums to which I belong, tagged with the query: “Food for thought, or fodder for the compost bin?”

The verdict? Hands down, the compost bin.

I was a bit taken aback, initially. Offended, even – because who among us isn’t in love with their own ideas?

But it quickly became evident from my peers’ comments that I’d been misunderstood. Not because my doctor friends are dim, but because I hadn’t been clear.

When I proposed in my essay that we “leave the administration and day-to-day tasks of running those centres to business folks who know what they’re doing,” my colleagues took that to mean that doctors would be serving at the beck and call of a tranche of ill-informed government-enabled administrators – and they reacted to the notion with anaphylactic derision. And understandably so: too many of us have long and painful experience with thick layers of health care bureaucracy seemingly organized according to the Peter Principle, with people promoted to – and permanently stuck at – the level of their incompetence.

But I didn’t mean to suggest – not for a minute – that doctors shouldn’t be engaged in running these centres. I also wrote: “None of which is to suggest that doctors shouldn’t be involved, by aptitude and inclination, in influencing the set-up and management of regional centres – of course, they should.”

Of course they should. There are plenty of physicians equipped with both the skills and interest needed to administer these centres; and they should absolutely be front and centre in leading them.

But more than that: everyone should have skin in the game. All workers have the right to share in the success of an enterprise; and when they do, everybody wins. When everyone is pulling in the same direction because everyone shares in the wins, waste and inefficiencies are rooted out like magic.

Contrast that to how hospitals are run, with scarcely anyone aware of the actual cost of the blood tests or CT scans they order or the packets of suture and gauze they rip open, and with the motivations of administrative staff, nurses, doctors, and other personnel running off in more directions than a flock of headless chickens. The capacity for waste and inefficiencies is almost limitless.

I don’t mean to suggest that the goal of regional medical centres should be to turn a profit; but fiscal prudence and economic accountability are to be celebrated, because money not wasted is money that can be allocated to enhancing patient care.

Nor do I mean to intimate that sensible resource management should be the only parameter tracked; patient outcomes and patient satisfaction are paramount.

What should government’s role be in all this? Initially, to incentivize the creation of these centres via public-private partnerships; and then, crucially, to encourage competition among them and to reward innovation and performance, with optimization of the three key metrics – patient outcomes, patient satisfaction, and economic accountability – always in focus.

No one should be mandated to work in non-hospital regional medical centres. It’s a free country (or it should be): doctors should be free to hang out their own community shingles if they wish. But if we build the model correctly, my contention is that most medical professionals will prefer to work collaboratively under one roof with a diverse group of colleagues, unencumbered by the mundanities of running a business, but also free of choking hospital bureaucracy.

I connected a couple weeks ago with the always insightful economist Jack Mintz (who is also a distinguished fellow at the Macdonald-Laurier Institute). Mintz sits on the board of a Toronto-area hospital and sees first-hand “the problems with the lack of supply, population growth, long wait times between admission and getting a bed, emergency room overuse,” and so on.

“Something has to give,” he said. “Probably more resources but better managed. We really need major reform.”

On that we can all agree. We can’t carry on this way.

So, let’s stop idling; and let’s green-light some fixes.

As Samwise Gamgee said in The Lord of the Rings, “It’s the job that’s never started as takes longest to finish.”

Dr. J. Edward Les is a pediatrician in Calgary who writes on politics, social issues, and other matters.

Up Next

The Fight Against Ottawa’s Crazy and Unconstitutional Single-Use Plastics Ban

Don't Miss

ESG rankings have no significant effect on investment performance of Canadian public companies

Todayville

Todayville is a digital media and technology company. We profile unique stories and events in our community. Register and promote your community event for free.

Follow Author

Canada’s future prosperity runs through the northwest coast

Daily Caller / 40 mins ago

Tech Mogul Gives $6 Billion To 25 Million Kids To Boost Trump Investment Accounts

Business / 2 hours ago

Ottawa’s gun ‘buyback’ program will cost billions—and for no good reason

Business

Ottawa’s gun ‘buyback’ program will cost billions—and for no good reason

Published on December 2, 2025

Todayville

From the Fraser Institute

By Gary Mauser

The government told Cape Bretoners they had two weeks to surrender their firearms to qualify for reimbursement or “buyback.” The pilot project netted a grand total of 22 firearms.

Five years after then-prime minister Justin Trudeau banned more than 100,000 types of so-called “assault-style firearms,” the federal government recently made the first attempt to force Canadians to surrender these firearms.

It didn’t go well.

The police chief in Cape Breton, Nova Scotia, volunteered to run a pilot “buyback” project, which began last month. The government told Cape Bretoners they had two weeks to surrender their firearms to qualify for reimbursement or “buyback.” The pilot project netted a grand total of 22 firearms.

This failure should surprise no one. Back in 2018, a survey of “stakeholders” warned the government that firearms owners wouldn’t support such a gun ban. According to Prime Minister Carney’s own Privy Council Office the “program faces a risk of non-compliance.” And federal Public Safety Minister Gary Anandasangaree was recently recorded admitting that the “buyback” is a partisan maneuver, and if it were up to him, he’d scrap it. What’s surprising is Ottawa’s persistence, particularly given the change in the government and the opportunity to discard ineffective policies.

So what’s really going on here?

One thing is for certain—this program is not, and never has been, about public safety. According to a report from the federal Department of Justice, almost all guns used in crimes in Canada, including in big cities such as Toronto, are possessed illegally by criminals, with many smuggled in from the United States. And according to Ontario’s solicitor general, more than 90 per cent of guns used in crimes in the province are illegally imported from the U.S. Obviously, the “buyback” program will have no effect on these guns possessed illegally by criminals.

Moreover, Canadian firearms owners are exceptionally law-abiding and less likely to commit murder than other Canadians. That also should not be surprising. To own a firearm in Canada, you must obtain a Possession and Acquisition Licence (PAL) from the RCMP after initial vetting and daily monitoring for possible criminal activity. Between 2000 and 2020, an average of 12 PAL-holders per year were accused of homicide, out of approximately two million PAL-holders. During that same 10-year period, the PAL-holder firearms homicide rate was 0.63 (per 100,000 PAL-holders) compared to 0.72 (per 100,000 adult Canadians)—that’s 14 per cent higher than the rate for PAL-holders.

In other words, neither the so-called “assault-style firearms” nor their owners pose a threat to the public.

And the government’s own actions belie its claims. If these firearms are such a threat to Canadians, why slow-roll the “buyback” program? If inaction increased the likelihood of criminality by law-abiding firearms owners, why wait five years before launching a pilot program in a small community such as Cape Breton? And why continue to extend the amnesty period for another year, which the government did last month at the same time its pilot project netted a mere 22 firearms?

To ask those questions is to answer them.

Another question—how much will the “buyback” program cost taxpayers?

The government continues to block any attempt to disclose the full financial costs (although the Canadian Taxpayers Federation has launched a lawsuit to try to force the government to honour its Access to Information Act request). But back in 2020 the Trudeau government said it would cost $200 million to compensate firearms owners (although the Parliamentary Budget Officer said compensation costs could reach $756 million). By 2024, the program had spent $67.2 million—remember, that’s before it collected a single gun. The government recently said the program’s administrative costs (safe storage, destruction of hundreds of thousands of firearms, etc.) would reach an estimated $1.8 billion. And according to Carney’s first budget released in November, his government will spend $364 million on the program this fiscal year—at a time of massive federal deficits and debt.

This is reminiscent of the Chretien government’s gun registry fiasco, which wound up costing more than $2 billion even after then-justice minister Allan Rock promised the registry program would “almost break even” after an $85 million initial cost. The Harper government finally scrapped the registry in 2012.

As the Carney government clings to the policies of its predecessor, Canadians should understand the true nature of Ottawa’s gun “buyback” program and its costs.

Gary Mauser

Professor Emeritus, Simon Fraser University

Business

Recent price declines don’t solve Toronto’s housing affordability crisis

Published on December 2, 2025

Todayville

From the Fraser Institute

By Jake Fuss and Austin Thompson

House prices in Toronto are declining. But the city’s affordability crisis is far from over—and government policies will likely make it worse.

While most Torontonians know there’s a crisis, the numbers make it clear. According to our new study, in 2023 (the latest year of available data), a family earning the city’s median after-tax income ($60,510) had to save $216,240 (the equivalent of 42.9 months of its after-tax income) for a 20 per cent downpayment on a typical home of any type (single-detached, semi-detached, condominium). But even if that family could somehow clear this monumental hurdle, it then had to dedicate 110.2 per cent of its after-tax income for monthly mortgage payments ($5,557)—a financial impossibility, unless the family can share housing costs (e.g. live-in tenants) or rely on financial support from elsewhere.

At this point, some long-time Toronto residents might recall their own difficult home purchase and think, “Hasn’t it always been this bad?” But just a decade ago, the hurdles weren’t nearly as high.

For example, in 2014 in Toronto, a 20 per cent downpayment cost 26.4 months of median after-tax family income—not 42.9 months. And the monthly mortgage payment on a typical home purchase required 56.0 per cent of median after-tax family income—not 110.2 per cent. So yes, typical homes have been broadly unaffordable for median-income-earning Toronto families for years, but it’s way worse now.

For Torontonians priced out of homeownership, renting has not offered much relief. In 2023, Toronto had the least affordable rents in Canada. The monthly cost of the median rental unit was $1,750, equal to 34.7 per cent of the median after-tax family income. That’s up from $1,110 (or 27.7 per cent of after-tax income) in 2014.

Fast-forward to today, and Torontonians should view reports of “crashing” home prices in the proper context. Typical home prices peaked at $1.27 million in the first quarter of 2022. By the second quarter of 2025, they had fallen to $1.00 million. That’s a marked decline, but prices remain well above pre-pandemic levels and far beyond the reach of most typical families.

And while the fall in house prices hasn’t been enough to restore affordability, it has caused a steep contraction in homebuilding as builders take a more cautious approach to development at a time when the city still needs more new homes to improve affordability.

This unhealthy dynamic, where price declines weigh heavily on housing construction, is made worse by government policy. Despite hundreds of millions of taxpayer dollars spent on housing initiatives by the federal government, the Ford government and Toronto City Hall, key provincial and municipal policies continue to impose needless costs and restrictions on new housing.

For example, Toronto homebuilders must endure costly wait times of more than two years for municipal approvals—more than three times longer than in Vancouver and seven times longer than in Edmonton. New high-rise developments in Toronto face municipal charges of $134,900 per unit compared to $38,100 in Ottawa and $6,900 in Edmonton. Meanwhile, the Ford government has backed away from several critical recommendations from its own Housing Task Force, which would make it easier to build more and denser housing, such as allowing fourplexes provincewide without special approval.

Of course, federal immigration policy, particularly over the last five years, has increased demand for new homes in Toronto and across the country. But even so, if not for lengthy approval processes, sky-high fees and restrictive land-use policies, many more new homes would be built in Toronto today despite declining prices. Homes only get built when buyers can cover the cost of construction plus a reasonable return on investment for developers. But when governments drive up costs, increase uncertainty and claim a significant share of the final sale price through fees and charges, projects that might otherwise proceed can become financially unviable. The result is less new housing, fewer options for buyers and a slower path to improved affordability.

To help improve housing affordability, Toronto needs a steady flow of new homebuilding. Torontonians should demand faster approvals, lower fees and more sensible rules on what types of homes can be built.