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Fraser Institute

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.

Business

B.C. premier wants a private pipeline—here’s how you make that happen

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From the Fraser Institute

By Julio Mejía and Elmira Aliakbari

At the federal level, the Carney government should scrap several Trudeau-era policies including Bill C-69 (which introduced vague criteria into energy project assessments including the effects on the “intersection of sex and gender with other identity factors”)

The Eby government has left the door (slightly) open to Alberta’s proposed pipeline to the British Columbia’s northern coast. Premier David Eby said he isn’t opposed to a new pipeline that would expand access to Asian markets—but he does not want government to pay for it. That’s a fair condition. But to attract private investment for pipelines and other projects, both the Eby government and the Carney government must reform the regulatory environment.

First, some background.

Trump’s tariffs against Canadian products underscore the risks of heavily relying on the United States as the primary destination for our oil and gas—Canada’s main exports. In 2024, nearly 96 per cent of oil exports and virtually all natural gas exports went to our southern neighbour. Clearly, Canada must diversify our energy export markets. Expanded pipelines to transport oil and gas, mostly produced in the Prairies, to coastal terminals would allow Canada’s energy sector to find new customers in Asia and Europe and become less reliant on the U.S. In fact, following the completion of the Trans Mountain Pipeline expansion between Alberta and B.C. in May 2024, exports to non-U.S. destinations increased by almost 60 per cent.

However, Canada’s uncompetitive regulatory environment continues to create uncertainty and deter investment in the energy sector. According to a 2023 survey of oil and gas investors, 68 per cent of respondents said uncertainty over environmental regulations deters investment in Canada compared to only 41 per cent of respondents for the U.S. And 59 per cent said the cost of regulatory compliance deters investment compared to 42 per cent in the U.S.

When looking at B.C. specifically, investor perceptions are even worse. Nearly 93 per cent of respondents for the province said uncertainty over environmental regulations deters investment while 92 per cent of respondents said uncertainty over protected lands deters investment. Among all Canadian jurisdictions included in the survey, investors said B.C. has the greatest barriers to investment.

How can policymakers help make B.C. more attractive to investment?

At the federal level, the Carney government should scrap several Trudeau-era policies including Bill C-69 (which introduced vague criteria into energy project assessments including the effects on the “intersection of sex and gender with other identity factors”), Bill C-48 (which effectively banned large oil tankers off B.C.’s northern coast, limiting access to Asian markets), and the proposed cap on greenhouse gas (GHG) emissions in the oil and gas sector (which will likely lead to a reduction in oil and gas production, decreasing the need for new infrastructure and, in turn, deterring investment in the energy sector).

At the provincial level, the Eby government should abandon its latest GHG reduction targets, which discourage investment in the energy sector. Indeed, in 2023 provincial regulators rejected a proposal from FortisBC, the province’s main natural gas provider, because it did not align with the Eby government’s emission-reduction targets.

Premier Eby is right—private investment should develop energy infrastructure. But to attract that investment, the province must have clear, predictable and competitive regulations, which balance environmental protection with the need for investment, jobs and widespread prosperity. To make B.C. and Canada a more appealing destination for investment, both federal and provincial governments must remove the regulatory barriers that keep capital away.

Julio Mejía

Policy Analyst

Elmira Aliakbari

Director, Natural Resource Studies, Fraser Institute
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Business

Carney government should recognize that private sector drives Canada’s economy

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From the Fraser Institute

By Jock Finlayson

An important lesson of the Justin Trudeau era is that economic prosperity cannot be built on the back of an expanding government sector, higher deficits and ever-greater political tinkering with the economy. It’s time for something different.

At the half-way point of what’s shaping up to be a turbulent 2025, how is Canada’s economy faring?

By any measure, the past six months have been a bumpy ride. The Canadian economy lost momentum over much of last year, with economic growth cooling, job creation slowing, and the unemployment rate creeping higher. Then as 2025 began came the shock of Donald Trump’s tariffs and—more recently—the outbreak of increased military conflict in the Middle East.

Amid these developments, indices of global policy and business uncertainty have risen sharply. This creates a difficult backdrop for Canadian businesses and for the re-elected Liberal government led by Prime Minister Carney.

Economic growth in the first quarter of 2025 received a temporary boost from surging cross-border trade as companies in both Canada and the United States sought to “front-run” the risk of tariffs by increasing purchases of manufactured and semi-finished goods and building up inventories. But trade flows are now diminishing as higher U.S. and Canadian tariffs come into effect in some sectors and are threatened in others. Meanwhile, consumer confidence has plunged, household spending has softened, housing markets across most of Canada are in a funk, and companies are pausing investments until there’s greater clarity on the future of the Canada-U.S. trade relationship.

Some forecasters believe a recession will unfold over the second and third quarters of 2025, as the Canadian economy absorbs a mix of internal and external blows, before rebounding modestly in 2026. For this year, average economic growth (after inflation) is unlikely to exceed 1 per cent, down from 1.6 per cent in 2024. The unemployment rate is expected to tick higher over the next 12-18 months. Housing starts are on track to drop, notwithstanding a rhetorical political commitment to boost housing supply in Ottawa and several provincial capitals. And business investment is poised to decline further or—at best—remain flat, continuing the pattern seen throughout the Trudeau era. Even this underwhelming forecast is premised on the assumption that ongoing trade tensions with the U.S. don’t spiral out of control.

How should Canadian policymakers respond to this unsettled economic picture? We do not face a hit to the economy remotely equivalent to that generated by the COVID pandemic in 2020-21, so there’s no argument for additional deficit-financed spending by governments—particularly when public debt already has been on a tear.

For the Carney government, the top priority must be to lessen uncertainty around Canada-U.S. trade and mitigate the threat of sweeping tariffs as quickly as possible. Until this is accomplished, the economic outlook will remain dire.

A second priority is to improve the “hosting conditions” for business growth in Canada after almost a decade of stagnant living standards and chronically weak private-sector investment. This will require significant reforms to current taxation, regulatory and project assessment policies aimed at making Canada a more attractive location for companies, investors and entrepreneurs.

An important lesson of the Justin Trudeau era is that economic prosperity cannot be built on the back of an expanding government sector, higher deficits and ever-greater political tinkering with the economy. It’s time for something different.

Policymakers must recognize that Canada is a largely market-based economy where the private sector rather than government is responsible for the bulk of production, employment, investment, innovation and exports. This insight should inform the design and delivery of economic policymaking going forward.

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