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 Calgaryās 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, IĀ triedĀ to drive it ā 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; Iām quite sure I spied a snail on crutches racing by ā no doubt making a beeline (snail-line?) for the ER a stoneās throw away.
The streetās 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 ā 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.
TheĀ health care crisisĀ grows more dire by the day.Ā Reforms are long overdue. Canada spendsĀ more on health careĀ 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 weāre paying with our lives: according to theĀ 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 ā and then we talk and talk some more. But for all the talking, precious little action is taken.
Iām reminded of an Anne Lamotte vignette, related in her bestselling bookĀ 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 heād 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 brotherās shoulder, and said, āBird by bird, buddy. Just take it bird by bird.ā
So it is with Canadian health care: weāve wasted years wringing our hands about the woeful state of affairs, while doing precious little about it.
Enough procrastinating. Itās time to tackle the crisis, bird by bird.
One thing we can do is to let doctors be doctors.Ā A few weeks ago, in a piece titled āShould Doctors Mind Their Own Business?ā, 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 ā and it detracts from their attention to patients.
We donāt 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 isnāt the solution, either.
Thereās a better way, I argued in my essay: regional medical centres ā 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: āFood for thought, or fodder for the compost bin?ā
The verdict? Hands down, the compost bin.
I was a bit taken aback, initially. Offended, even ā because who among us isnāt in love with their own ideas?
But it quickly became evident from my peersā comments that Iād been misunderstood. Not because my doctor friends are dim, but because I hadnāt been clear.
When I proposed in my essay that we āleave the administration and day-to-day tasks of running those centres to business folks who know what theyāre doing,ā 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 ā 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 theĀ Peter Principle, with people promoted to ā and permanently stuck at ā the level of their incompetence.
But I didnāt mean to suggest ā not for a minute ā that doctors shouldnāt be engaged in running these centres. I also wrote: āNone of which is to suggest that doctors shouldnāt be involved, by aptitude and inclination, in influencing the set-up and management of regional centres ā of course, they should.ā
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: everyoneĀ should have skin in the game. All workers have the right to share in the success of an enterprise; and when they do,Ā everybody wins.Ā 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 donāt 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 governmentās 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 ā patient outcomes, patient satisfaction, and economic accountability ā always in focus.
No one should be mandated to work in non-hospital regional medical centres. Itās 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 āthe problems with the lack of supply, population growth, long wait times between admission and getting a bed, emergency room overuse,ā and so on.
āSomething has to give,ā he said. āProbably more resources but better managed. We really need major reform.ā
On that we can all agree. We canāt carry on this way.
So, letās stop idling; and letās green-light some fixes.
As Samwise Gamgee said inĀ The Lord of the Rings, āItās the job thatās never started as takes longest to finish.ā
Dr. J. Edward LesĀ is a pediatrician in Calgary who writes on politics, social issues, and other matters.
Automotive
Electric cars just another poor climate policy

From the Fraser Institute
The electric car is widely seen as a symbol of a simple, clean solution to climate change. In reality, itās inefficient, reliant on massive subsidies, and leaves behind a trail of pollution and death that is seldom acknowledged.
We are constantly reminded by climate activists and politicians that electric cars are cleaner, cheaper, and better. Canada and many other countries have promised to prohibit the sale of new gas and diesel cars within a decade. But if electric cars are really so good, why would we need to ban the alternatives?
And why has Canada needed to subsidize each electric car with a minimum $5,000 from the federal government and more from provincial governments to get them bought? Many people are not sold on the idea of an electric car because they worry about having to plan out where and when to recharge. They donāt want to wait for an uncomfortable amount of time while recharging; they donāt want to pay significantly more for the electric car and then see its used-car value decline much faster. For people not privileged to own their own house, recharging is a real challenge. Surveys show that only 15 per cent of Canadians and 11 per cent of AmericansĀ wantĀ to buy an electric car.
The main environmental selling point of an electric car is that it doesnāt pollute. It is true that its engine doesnāt produce any COā while driving, but it still emits carbon in other ways. Manufacturing the car generates emissionsāespecially producing the battery which requires a large amount of energy, mostly achieved with coal in China. So even when an electric car is being recharged with clean power in BC, over its lifetime it will emit aboutĀ one-thirdĀ of an equivalent gasoline car. When recharged in Alberta, it will emit almostĀ three-quarters.
In some parts of the world, like India, so much of the power comes from coal that electric cars end up emittingĀ moreĀ COā than gasoline cars. Across the world, on average, the International Energy Agency estimates that an electric car using the global average mix of power sources over its lifetime will emit nearlyĀ half as muchĀ COā as a gasoline-driven car, saving about 22 tonnes of COā.
But using an electric car to cut emissions is incredibly ineffective. On Americaās longest-established carbon trading system, you could buy 22 tonnes of carbon emission cuts for about $660 (US$460). Yet, Ottawa is subsidizing every electric car to the tune of $5,000 or nearly ten times as much, which increases even more if provincial subsidies are included. And since aboutĀ halfĀ of those electrical vehicles would have been bought anyway, it is likely that Canada has spent nearly twenty-times too much cutting COā with electric cars than it could have. To put it differently, Canada could have cut twenty-times more COā for the same amount of money.
Moreover, all these estimates assume that electric cars are driven as far as gasoline cars. They are not. In the US,Ā nine-in-tenĀ households with an electric car actually have one, two or more non-electric cars, with most including an SUV, truck or minivan. Moreover, the electric car is usually drivenĀ less than half as muchĀ as the other vehicles, which means the COā emission reduction is much smaller. Subsidized electric cars are typically a āsecondā car for rich people to show off their environmental credentials.
Electric cars are alsoĀ 320–440Ā kilograms heavier than equivalent gasoline cars because of their enormous batteries. This means they will wear down roads faster, and cost societies more. They will also cause more air pollution by shredding more particulates from tire and road wear along with their brakes. Now, gasoline cars also pollute through combustion, but electric cars in total pollute more, both from tire and road wear and from forcing more power stations online, often the most polluting ones. TheĀ latest meta-studyĀ shows that overall electric cars are worse on particulate air pollution.Ā Another studyĀ found that in two-thirds of US states, electric cars cause more of the most dangerous particulate air pollution than gasoline-powered cars.
These heavy electric cars are also more dangerous when involved in accidents, because heavy cars more often kill the other party. A study inĀ NatureĀ shows that in total, heavier electric cars will cause so many more deaths that the toll could outweigh the total climate benefits from reduced COā emissions.
Many pundits suggest electric car sales will dominate gasoline cars within a few decades, but the reality is starkly different. AĀ 2023-estimate from the Biden Administration shows that even in 2050, more than two-thirds of all cars globally will still be powered by gas or diesel.
Source:Ā US Energy Information Administration, reference scenario, October 2023
Fossil fuel cars, vast majority is gasoline, also some diesel, all light duty vehicles, the remaining % is mostly LPG.
Electric vehicles will only take over when innovation has made them better and cheaper for real. For now, electric cars run not mostly on electricity but on bad policy and subsidies, costing hundreds of billions of dollars, blocking consumers from choosing the cars they want, and achieving virtually nothing for climate change.
2025 Federal Election
Fixing Canadaās immigration system should be next governmentās top priority

From the Fraser Institute
Whichever party forms government after the April 28 election must put Canadaās broken immigration system at the top of the to-do list.
This country has one of the worldās lowest fertility rates. Were it not for immigration, our population would soon start to decline, just as itās declining inĀ dozensĀ of other low-fertility countries around the world.
To avoid the social and economic tensions of an aging and declining population, the federal government should re-establish an immigration system that combines a high intake with strictly enforced regulations. Once Canadians see that program in place and working, public support for immigration should return.
Canadaās total fertility rate (the number of children, on average, a woman will have in her lifetime) has been declining, with the odd blip here and there,Ā since the 1960s. In 1972, it fell below the replacement rate of 2.1.
According toĀ Statistics Canada, the countryās fertility rate fell to a record low of 1.26 in 2023. That puts us in the company of otherĀ lowest-low fertilityĀ countries such as Italy (1.21), Japan (1.26) and South Korea (0.82).
Those three countries are all losing population. But Canadaās population continues to grow, with immigrants replacing the babies who arenāt born. The problem is that, in the years that followed the COVID-19 lockdowns, the population grew too much.
The Liberal government was unhappy that the pandemic had forced Canada to restrict immigration and concerned about post-pandemic labour shortages. To compensate, Ottawa set aĀ targetĀ of 500,000 new permanent residents for 2025, double the already-high intake of about 250,000 a year that had served as a benchmark for the Conservative government of Stephen Harper and the Liberal governments of Paul Martin and Jean ChrĆ©tien.
Ottawa also loosened restrictions on temporary foreign worker permits and the admission of foreign students to colleges and universities. Both populations quickly exploded.
Employers preferred hiring workers from overseas rather than paying higher wages for native-born workers. Community colleges swelled their ranks with international students who were also issued work permits. Private collegesāImmigration Minister Marc MillerĀ calledĀ them āpuppy millsāāsprang up that offered no real education at all.
At the same time, the number of asylum claimants in Canada skyrocketed due to troubles overseas and relaxed entry procedures,Ā reachingĀ a total of 457,285 in 2024.
On January 1 of this year, Statistics CanadaĀ estimatedĀ that there were more than three million temporary residents in the country, pushing Canadaās population up above 41.5 million.
Their presence worsened housing shortages, suppressed wages and increased unemployment among younger workers. The public became alarmed at the huge influx of foreign residents.
For the first time in a quarter century, according to anĀ Environics poll, a majority of Canadians believed there were too many immigrants coming into Canada.
Some may argue that the solution to Canadaās demographic challenges lie in adopting family-friendly policies that encourage couples to have children. But while governments improve parental supports and filter policies through a family-friendly lensāfor example, houses with backyards are more family-friendly than high-rise towersāno government has been able to reverse declining fertility back up to the replacement rate of 2.1.
The steps to repairing Canadaās immigration mess lie in returning to first principles.
According toĀ Statistics Canada, there were about 300,000 international students at postsecondary institutions when the Liberals came to power in 2015. Letās return to those levels.
The temporary foreign worker program should be toughened up. The government recentlyĀ implementedĀ stricter Labour Market Impact Assessments, but even stricter rules may be needed to ensure that foreign workers are only brought in when local labour markets cannot meet employer needs, while paying workers a living wage.
New legislation should ensure that only asylum claimants who can demonstrate they are at risk of persecution or other harm in their home country are given refuge in Canada, and that the process for assessing claims is fair, swift and final. If necessary, the government should consider employing the Constitutionās notwithstanding clause to protect such legislation from court challenges.
Finally, the government should admit fewer permanent residents under the family reunification stream and more from the economic stream. And the total admitted should be kept to around 1 per cent of the total population. That would still permit an extremely robust intake of about 450,000 new Canadians each year.
Restoring public confidence in Canadaās immigration system will take much longer than it took to undermine that confidence. But there can be no higher priority for the federal government. The countryās demographic future is at stake.
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