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Fraser Institute

Endless spending increases will not fix Canada’s health-care system

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From the Fraser Institute

By Mackenzie Moir and Jake Fuss

Canada’s health-care system ranked as the most expensive (as a share of the economy) among 30 universal health-care countries. And despite these relatively high levels of spending, Canada continues to lag behind its peers on key indicators of performance.

In February 2023, the federal government announced the money they send to the provinces for health care would increase, yet again. Despite being billed as a fix for health care, these spending increases will not actually provide any relief for Canadian patients.

The Canada Health Transfer (CHT), the main federal financial tool for funding provincial health care, has increased from $34.0 billion in 2015/16 to $52.1 billion this year (2024/25), a 53.1 per cent increase in about a decade. Moreover, the federal government has committed to increases in the transfer at a guaranteed 5 per cent until 2027/28.

This latest increase in the CHT, however, is only one part of the $46.2 billion in new money being doled out over the next 10 years. More than half (roughly $25 billion) is currently being given to provinces who’ve signed up to work towards a number of “shared priorities” with Ottawa, such as mental health and substance abuse.

Clearly, the federal government has decided to substantially increase health-care spending in more than one way. But will it produce results?

These periodic “fixes” occasionally championed by Ottawa every few years are nothing new. And unfortunately, the data show that longstanding problems, including long waits for medical care and doctor shortages, will persist even though Canada is certainly no slouch when compared to its peers on health-care spending.

recent study found that, when adjusted for differences in age (because older populations tend to spend more on health care), Canada’s health-care system ranked as the most expensive (as a share of the economy) among 30 universal health-care countries. And despite these relatively high levels of spending, Canada continues to lag behind its peers on key indicators of performance.

For example, Canada had some of the fewest physicians (ranked 28th of 30 countries), hospital beds (ranked 23rd of 29) and diagnostic technology such as MRIs (ranking 25th of 29 countries) and CT scanners (ranking 26th out of 30 countries) compared to other high-income countries with universal health care.

It also ranked at or near the bottom on measures such as same-day medical appointments, how easy it is to find afterhours care, and the timeliness of specialist appointments and surgical care.

And wait times have been getting worse. Just last year Canada recorded the longest ever delay for non-emergency care at 27.7 weeks, a 198 per cent increase from the 9.3 week wait experienced in 1993 (the first year national estimates were published).

But it’s not just the health-care system that’s in shambles, despite our high spending. Our federal finances are, too. Years of substantial increases in federal spending have strained the country’s finances. The Trudeau government’s latest budget projects a deficit of $39.8 billion this year, with more spent on debt interest ($54.1 billion) than on what the federal government gives to the provinces for health care.

Again, these periodic injections of federal funds to the provinces to supposedly fix health care are nothing new. Ottawa has relied on this strategy in the past and wait times have grown longer over the last three decades. Endless increases in spending will not fix our health-care system.

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Fraser Institute

Here’s your annual bill for public health care

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From the Fraser Institute

By Bacchus Barua

Notably, the amount paid by the average family has increased by 239.7 per cent since 1997 (the first year of available data).

According to a recent survey by Statistics Canada, almost half of Canadians said that rising prices are affecting their ability to meet day-to-day expenses. At the same time, Canadians are increasingly aware of their significant tax burden, with 74 per cent feeling the average family is overtaxed. This is not surprising given the average Canadian family spends more on taxes than food, clothing and shelter combined.

However, one contributor to this growing tax burden remains hidden—the price we pay public health care. You read that right. Public health care is not free—but it’s very difficult to figure out exactly how much we pay for it on an individual or family basis.

This is primarily because our public health-care system is funded through general government revenues. In other words, there’s no dedicated tax that fully funds the system. Our income taxes, sales taxes, business taxes and other taxes get poured into a fiscal vat, from which governments take a generous portion for health care.

While it’s easy enough to gauge total health-care spending by governments ($225.1 billion) or how much was spent per Canadian ($5,614), it remains nearly impossible for Canadian families of different sizes and incomes to calculate how much they contribute towards that vast amount.

But a recent study helps us get a general idea. According to the study, an average family of four (two parents and two children) with an average income of $176,266 will pay an estimated $17,713 (in taxes) for public health care this year. Single Canadians, with an average income of $55,925, will pay $5,629. Of course, these amounts vary by income with the poorest 10 per cent of income earners paying $639 while the top 10 per cent pay $47,071.

Notably, the amount paid by the average family has increased by 239.7 per cent since 1997 (the first year of available data). This increase is 3.1 times greater than the rate of inflation, 2.2 times greater than food cost increases, and 1.6 times greater than housing costs increases. And crucially, the cost of public health care for the average family has increased 1.7 times faster than their average incomes grew during the same period.

These figures are not only important for families who are interested in how their tax dollars are spent, they are one very important side of the equation when trying to understand whether we receive good value for our health-care dollars. Moreover, as politicians continue to promise ever increasing health-care spending to fix our crumbling system, it’s crucial for Canadians to understand exactly how that spending impacts their wallets.

One thing is clear. With nearly an $18,000 price tag for the average family of four, Canada’s public health-care system is anything but free.

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Economy

Energy transition will be much longer and more arduous than they’re telling you

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From the Fraser Institute

By Jock Finlayson

While many Canadian politicians and activists continue to trumpet the “energy transition” and conjure visions of a low-carbon future that supposedly lurks just around the corner, along comes Natural Resources Canada with its latest Energy Fact Book. A careful review of the publication pours cold water on any notion of a rapid shift to a fundamentally different energy system, one that features a much smaller role for the fossil fuels that now supply the vast majority of the energy used by Canadians.

The book contains a wealth of information on Canada’s large and notably diverse energy sector, covering production, consumption trends, investment, and the environmental impact of energy production and use.  Separately, Natural Resources Canada also publishes “energy profiles” for the individual provinces and territories that provide further insight into energy production and consumption patterns across the country.

Starting with energy production (and considering all sources of energy, including uranium), crude oil accounts for about 45 per cent of Canadian energy output, measured in petajoules. Natural gas and natural gas liquids comprise another 32 per cent, with uranium chipping in 11 per cent of primary energy production. Smaller shares come from coal (5 per cent), hydroelectricity (5 per cent) and “other” renewables (3 per cent).

The statistics on energy output confirm that fossil fuels dominate the mix of energy sources produced in Canada. There’s little reason to believe this will change in a significant way in the near term.

Turning to energy consumption, a review of the most recent information leads to a broadly similar conclusion.

Based on Statistics Canada’s latest data, industry, collectively, is responsible for about 35 per cent of final end-use energy demand; this category includes manufacturing, natural resource extraction and processing, and construction. Transportation is the second-largest consumer of energy (29 per cent of final demand), followed by the residential (16 per cent) and commercial sectors (14 per cent).

What about the various sources of energy Canadians depend on for their comfort and well-being and to enable industrial and other business activity? Refined petroleum products rank first, providing about two-fifths of all energy consumed. Natural gas is second (35-36 per cent). Electricity comprises just 16-17 per cent of the energy used in Canada. Overall, fossil fuels still meet more than three quarters of Canadians’ requirements for primary energy.

Some may be surprised that electricity constitutes less than one-fifth of the energy used in Canada. A principal strategy of governments aspiring to slash greenhouse gas emissions is to redirect energy demand to electricity and away from oil, natural gas and other carbon-based energy sources. That makes sense, particularly since Canada’s existing electricity grid is about 80 per cent carbon-free. But a “big switch” to electricity won’t be easy. Consider that, over the first two decades of the millennium, Canadian natural gas consumption jumped by 34 per cent while electricity demand rose by 12 per cent. This underscores the resiliency of household and business demand for reliable affordable energy—of which natural gas is the best example.

Raising electricity’s share of total energy consumption will necessitate an enormous expansion across all segments of the Canadian electricity sector, encompassing not only the development of far more generation capacity but also the construction of additional transmission networks to deliver electric energy to end-users. Industry experts talk of boosting the amount of electricity produced in Canada by up to three times within two decades—a herculean task, assuming it’s even possible.

And, in line with the “net zero” goals espoused by many governments, virtually all of new electricity presumably must come from carbon-free sources (e.g., hydropower, other renewables, biomass, nuclear). There’s also the challenge of replacing the remaining carbon-based electricity still produced in Canada with carbon-free alternatives, as mandated by the Clean Electricity Regulations (CER) recently adopted by the Trudeau government.

Suffice to say the transition away from fossil fuels as the predominant source of energy consumed in Canada will be a lengthy and arduous journey and is sure to encounter more and bigger obstacles than most of Canada’s political class understands or cares to acknowledge.

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