Fraser Institute
Virtual care will break the Canada Health Act—and that’s a good thing
From the Fraser Institute
The leadership of the Canadian Medical Association (CMA) is facing sharp criticism for its recent proposal to effectively ban private payment for virtual care. In a clear example of putting politics before patients, this would only erect additional barriers for those seeking care.
Moreover, it’s a desperate bid to cling to an outdated—and failed—model of health care while underestimating modern-day innovations.
Virtual care—online video doctor consultations—is a private-sector innovation. In response to our government system’s inability to provide timely care, private companies such as Maple have been offering these services to Canadians for almost a decade. In fact, the public system only pushed meaningfully into the virtual space during COVID when it established partnerships with these private companies alongside setting up new fee codes for virtual consultations.
In return for improving access to physician consultations for thousands of Canadians, these virtual care companies have been rewarded with increased government scrutiny and red tape. The weapon of choice? The Canada Health Act (CHA).
Specifically, sections 18 to 21 of the CHA prohibit user fees and extra billing for “medically necessary” services. Further, the insurance plan of a province must be publicly administered and provide “reasonable access” to 100 per cent of insured services. Provinces found in violation are punished by the federal government, which withholds a portion (or all) of federal health-care transfer payments.
Until recently, there had been no obvious conflict between the CHA and privately paid-for virtual care—primarily because the provinces are free to determine what’s medically necessary. Until recently, many provinces did not even have billing codes for virtual care. As virtual services are increasingly provided by the public sector, however, the ability to innovatively provide care for paying patients (either out-of-pocket or through private insurance) becomes restricted further.
Within this context, the CMA recently recommended formally including virtual care services within the public system, alongside measures to ensure “equitable access.” At the same time, it reiterated its recommendation that private insurance to access medically necessary services covered by the CHA be prohibited.
See where this is going?
The kicker is an additional recommendation banning dual practice (i.e. physicians working in both the public and private sector) except under certain conditions. This means doctors in the public system who could otherwise allocate their spare hours to private appointments online would now have to choose to operate exclusively in either the public or private system.
The combined effect of these policies would ensure that innovative private options for virtual care—whether paid for out-of-pocket or though private insurance—will either be overtaken by bureaucracies or disappear entirely.
But what the CMA report fails to recognize is that virtual care has expanded access to services the government fails to provide—there’s little reason to suspect a government takeover of the virtual-care sector will make things better for patients. And even if governments could somehow prevent Canadian doctors and companies providing these services privately, virtual care is not beholden to Canada’s physical borders. Patients with a little bit of technical knowhow will simply bypass the Canadian system entirely by having virtual consultations with doctors abroad. If Canadians can figure out how to access their favourite show in another country, you can be sure they’ll find a way to get a consultation with a doctor in Mumbai instead of Montreal.
Instead of forcing physicians and patients to operate within the crumbling confines of government-run health care, the CMA’s leadership should be grateful for the pressure valve that the private sector has produced. We should celebrate the private innovators who have provided Canadians better access to health care, not finding ways to shut them down in favour of more government control.
Author:
Business
Clean energy transition price tag over $150 billion and climbing, with very little to show for it
From the Fraser Institute
By Jake Fuss, Julio Mejía, Elmira Aliakbari, Karen Graham and Jock Finlayson
Ottawa and the four biggest provinces have spent (or foregone revenues) of at least $158 billion to create at most 68,000 “clean” jobs since 2014
Despite the hype of a “clean” economic transition, governments in Ottawa and in the four largest provinces have spent or foregone revenues of more than $150 billion (inflation-adjusted) on low-carbon initiatives since 2014/15, but have only created, at best, 68,000 clean jobs, according to two new studies published by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.
“Governments, activists and special interest groups have been making a lot of claims about the opportunities of a clean economic transition, but after a decade of policy interventions and more than $150 billion in taxpayers’ money, the results are
extremely underwhelming,” said Elmira Aliakbari, director of natural resource studies and co-author of The Fiscal Cost of Canada’s Low-Carbon Economy.
The study finds that since 2014/15, the federal government and provincial governments in the country’s four largest provinces (Ontario, Quebec, Alberta and British Columbia) combined have spent and foregone revenues of $158 billion (inflation adjusted to 2024 dollars) trying to create clean jobs, as defined by Statistics Canada’s Environmental and Clean Technology Products Economic Account.
Importantly, that cost estimate is conservative since it does not account for an exhaustive list of direct government spending and it does not measure the costs from Canada’s other six provinces, municipalities, regulatory costs and other economic
costs because of the low-carbon spending and tax credits.
A second study, Sizing Canada’s Clean Economy, finds that there was very little change over the 2014 to 2023 period in terms of the share of the total economy represented by the clean economy. For instance, in 2014, the clean economy represented 3.1 per cent of GDP compared to 3.6 per cent in 2023.
“The evidence is clear—the much-hyped clean economic transition has failed to fundamentally transform Canada’s $3.3 trillion economy,” said study co-author and Fraser Institute senior fellow Jock Finlayson.
State of the Green Economy
- The Fiscal Cost of Canada’s Low-Carbon Economy documents spending initiatives by the federal government and the governments of Ontario, British Columbia, Alberta, and Quebec since 2014 to promote the low-carbon economy, as well as how much revenue they have foregone through offering tax credits.
- Overall, the combined cost of spending and tax credits supporting a low-carbon economy by the federal government and the four provincial governments is estimated at $143.6 billion from 2014–15 to 2024–25, in nominal terms. When adjusted for inflation, the total reaches $158 billion in 2024 dollars.
- These estimates are based on very conservative assumptions, and they do not cover every program area or government-controlled expenditure related to the low-carbon economy and/or reducing greenhouse gas emissions.
- Sizing Canada’s Green Economy assesses the composition, growth, share of Gross Domestic Product (GDP) output, and employment of Canada’s “clean economy” from 2014 to 2023.
- Canada’s various environmental and clean technology industries collectively have accounted for between 3.07% and 3.62% of all-industry GDP over the 10-year period from 2014 to 2023. While it has grown, the sector as a whole has not been expanding at a pace that meaningfully exceeds the growth of the overall Canadian economy, despite significant policy attention and mounting public subsidies.
- The clean economy represents a respectable and relatively stable share of Canada’s $3.3 trillion economy. However, it remains a small part of Canada’s broader industrial mix, it is not a major source of export earnings, and it is not about to supplant the many other industries that underpin the country’s prosperity and dominate its international exports.
Alberta
B.C. would benefit from new pipeline but bad policy stands in the way
From the Fraser Institute
By Julio Mejía and Elmira Aliakbari
Bill C-69 (a.k.a. the “no pipelines act”) has added massive uncertainty to the project approval process, requiring proponents to meet vague criteria that go far beyond any sensible environmental concerns—for example, assessing any project’s impact on the “intersection of sex and gender with other identity factors.”
In case you haven’t heard, the Alberta government plans to submit a proposal to the federal government to build an oil pipeline from Alberta to British Columbia’s north coast.
But B.C. Premier Eby dismissed the idea, calling it a project imported from U.S. politics and pursued “at the expense of British Columbia and Canada’s economy.” He’s simply wrong. A new pipeline wouldn’t come at the expense of B.C. or Canada’s economy—it would strengthen both. In fact, particularly during the age of Trump, provinces should seek greater cooperation and avoid erecting policy barriers that discourage private investment and restrict trade and market access.
The United States remains the main destination for Canada’s leading exports, oil and natural gas. In 2024, nearly 96 per cent of oil exports and virtually all natural gas exports went to our southern neighbour. In light of President Trump’s tariffs on Canadian energy and other goods, it’s long past time to diversify our trade and find new export markets.
Given that most of Canada’s oil and gas is landlocked in the Prairies, pipelines to coastal terminals are the only realistic way to reach overseas markets. After the completion of the Trans Mountain Pipeline Expansion (TMX) project in May 2024, which transports crude oil from Alberta to B.C. and opened access to Asian markets, exports to non-U.S. destinations increased by almost 60 per cent. This new global reach strengthens Canada’s leverage in trade negotiations with Washington, as it enables Canada to sell its energy to markets beyond the U.S.
Yet trade is just one piece of the broader economic impact. In its first year of operation, the TMX expansion generated $13.6 billion in additional revenue for the economy, including $2.0 billion in extra tax revenues for the federal government. By 2043, TMX operations will contribute a projected $9.2 billion to Canada’s economic output, $3.7 billion in wages, and support the equivalent of more than 36,000 fulltime jobs. And B.C. stands to gain the most, with $4.3 billion added to its economic output, nearly $1 billion in wages, and close to 9,000 new jobs. With all due respect to Premier Eby, this is good news for B.C. workers and the provincial economy.
In contrast, cancelling pipelines has come at a real cost to B.C. and Canada’s economy. When the Trudeau government scrapped the already-approved Northern Gateway project, Canada lost an opportunity to increase the volume of oil transported from Alberta to B.C. and diversify its trading partners. Meanwhile, according to the Canadian Energy Centre, B.C. lost out on nearly 8,000 jobs a year (or 224,344 jobs in 29 years) and more than $11 billion in provincial revenues from 2019 to 2048 (inflation-adjusted).
Now, with the TMX set to reach full capacity by 2027/28, and Premier Eby opposing Alberta’s pipeline proposal, Canada may miss its chance to export more to global markets amid rising oil demand. And Canadians recognize this opportunity—a recent poll shows that a majority of Canadians (including 56 per cent of British Columbians) support a new oil pipeline from Alberta to B.C.
But, as others have asked, if the economic case is so strong, why has no private company stepped up to build or finance a new pipeline?
Two words—bad policy.
At the federal level, Bill C-48 effectively bans large oil tankers from loading or unloading at ports along B.C.’s northern coast, undermining the case for any new private-sector pipeline. Meanwhile, Bill C-69 (a.k.a. the “no pipelines act”) has added massive uncertainty to the project approval process, requiring proponents to meet vague criteria that go far beyond any sensible environmental concerns—for example, assessing any project’s impact on the “intersection of sex and gender with other identity factors.” And the federal cap on greenhouse gas (GHG) emissions exclusively for the oil and gas sector will inevitably force a reduction in oil and gas production, again making energy projects including pipelines less attractive to investors.
Clearly, policymakers in Canada should help diversify trade, boost economic growth and promote widespread prosperity in B.C., Alberta and beyond. To achieve this goal, they should put politics aside, focus of the benefits to their constituents, and craft regulations that more thoughtfully balance environmental concerns with the need for investment and economic growth.
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