Fraser Institute
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.
From the Fraser Institute
Recently, amid the backdrop of a teacher strike, an Alberta high school teacher began collecting signatures for a petition to end government funding of independent schools in the province. If she gets enough people to sign—10 per cent of the number of Albertans who voted in the last provincial election—Elections Alberta will consider launching a referendum about the issue.
In other words, the critical funding many Alberta families rely on for their children’s educational needs may be in jeopardy.
In Alberta, the provincial government partially funds independent schools and charter schools. The Alberta Teachers’ Association (ATA), whose members are currently on strike, opposes government funding of independent and charter schools.
But kids are not one-size-fits-all, and schools should reflect that reality, particularly in light of today’s increasing classroom complexity where different kids have different needs. Unlike government-run public schools, independent schools and charter schools have the flexibility to innovate and find creative ways to help students thrive.
And things aren’t going very well for all kids or teachers in government-run pubic school classrooms. According to the ATA, 93 per cent of teachers report encountering some form of aggression or violence at school, most often from students. Additionally, 85 per cent of unionized teachers face an increase in cognitive, social/emotional and behavioural issues in their classrooms. In 2020, one-quarter of students in Edmonton’s government-run public schools were just learning English, and immigration to Canada—and Alberta especially—has exploded since then. It’s not easy to teach a classroom of kids where a significant proportion do not speak English, many have learning disabilities or exceptional needs, and a few have severe behavioural problems.
Not surprisingly, demand for independent schools in Alberta is growing because many of these schools are designed for students with special needs, Autism, severe learning disabilities and ADHD. Some independent schools cater to students just learning English while others offer cultural focuses, expanded outdoor time, gifted learning and much more.
Which takes us back to the new petition—yet the latest attempt to defund independent schools in Alberta.
Wealthy families will always have school choice. But if the Alberta government wants low-income and middle-class kids to have the ability to access schools that fit them, too, it’s crucial to maintain—or better yet, increase—its support for independent and charter schools.
Consider a fictional Alberta family: the Millers. Their daughter, Lucy, is struggling at her local government-run public school. Her reading is below grade level and she’s being bullied. It’s affecting her self-esteem, her sleep and her overall wellbeing. The Millers pay their taxes. They don’t take vacations, they rent, and they haven’t upgraded their cars in many years. They can’t afford to pay full tuition for Lucy to attend an independent school that offers the approach to education she needs to succeed. However, because the Alberta government partially funds independent schools—which essentially means a portion of the Miller family’s tax dollars follow Lucy to the school of their choice—they’re able to afford the tuition.
The familiar refrain from opponents is that taxpayers shouldn’t pay for independent school tuition. But in fact, if you’re concerned about taxpayers, you should encourage school choice. If Lucy attends a government-run public school, taxpayers pay 100 per cent of her education costs. But if she attends an independent or charter school, taxpayers only pay a portion of the costs while her parents pay the rest. That’s why research shows that school choice saves tax dollars.
If you’re a parent with a child in a government-run public school in Alberta, you now must deal with another teacher strike. If you have a child in an independent or charter school, however, it’s business as usual. If Albertans are ever asked to vote on whether or not to end government funding for independent schools, they should remember that students are the most important stakeholder in education. And providing parents more choices in education is the solution, not the problem.
Paige MacPherson
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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