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.
Alberta
CPP another example of Albertansā outsized contribution to Canada

From the Fraser Institute
By Tegan Hill
Amid the economic uncertainty fuelled by Trumpās trade war, its perhaps more important than ever to understand Albertaās crucial role in the federation and its outsized contribution to programs such as the Canada Pension Plan (CPP).
From 1981 to 2022, Albertanās net contribution to the CPPāmeaning the amount Albertans paid into the program over and above what retirees in Alberta received in CPP paymentsāwasĀ $53.6 billion. In 2022 (the latest year of available data), Albertansā net contribution to the CPP was $3.0 billion.
During that same period (1981 to 2022), British Columbia was the only other province where residents paid more into the CPP than retirees received in benefitsāand Albertaās contribution was six times greater than B.C.ās contribution. Put differently, residents in seven out of the nine provinces that participate in the CPP (Quebec has its own plan) receive more back in benefits than they contribute to the program.
Albertans pay anĀ outsizedĀ contribution to federal and national programs, including the CPP because of the provinceās relatively high rates ofĀ employment, higherĀ average incomesĀ andĀ younger populationĀ (i.e. more workers pay into the CPP and less retirees take from it).
Put simply, Albertan workers have been helping fund the retirement of Canadians from coast to coast for decades, and without Alberta, the CPP would look much different.
How different?
If Alberta withdrew from the CPP and established its own standalone provincial pension plan, Alberta workers would receive the same retirement benefits but at a lower cost (i.e. lower CPP contribution rate deducted from our paycheques) than other Canadians, while the contribution rateāessentially the CPP tax rateāto fund the program would likely need to increase for the rest of the country to maintain the same benefits.
And given current demographic projections, immigration patterns and Albertaās long history of leading the provinces in economic growth, Albertan workers willĀ likelyĀ continue to pay more into the CPP than Albertan retirees get back from it.
Therefore, considering Albertaās crucial role in national programs, the next federal governmentāwhoever that may beāshould undo and prevent policies that negatively impact the province and Albertans ability to contribute to Canada. Think of Bill C-69 (which imposes complex, uncertain and onerous review requirements on major energy projects), Bill C-48 (which bans large oil tankers off B.C.ās northern coast and limits access to Asian markets), an arbitrary cap on oil and gas emissions, numerous other ānet-zeroā targets, and so on.
Canada faces serious economic challenges, including a trade war with the United States. In times like this, itās important to remember Albertaās crucial role in the federation and the outsized contributions of Alberta workers to the wellbeing of Canadians across the country.
2025 Federal Election
Homebuilding in Canada stalls despite population explosion

From the Fraser Institute
By Austin Thompson and Steven Globerman
Between 1972 and 2019, Canadaās population increased by 1.8 residents for every new housing unit started compared to 3.9 new residents in 2024. In other words, Canada must now house more than twice as many new residents per new housing unit as it did during the five decades prior to the pandemic
In many parts of Canada, the housing affordability crisis continues with no end in sight. And many Canadians, priced out of the housing market or struggling to afford rent increases, are left wondering how much longer this will continue.
Simply put, too few housing units are being built for the countryās rapidly growing population, which has exploded due to record-high levels of immigration and the federal governmentās residency policies.
As noted in a newĀ studyĀ published by the Fraser Institute, the country added an all-time high 1.2 million new residents in 2023āmore than double the previous record in 2019āand another 951,000 new residents in 2024. Altogether, Canadaās population has grown by about 3 million people since 2022āroughly matching the total population increase during the 1990s.
Meanwhile, homebuilding isnāt keeping up. In 2024, construction started on roughly 245,000 new housing units nationwideādown from a recent peak of 272,000 in 2021. By contrast, in the 1970s construction started on more than 240,000 housing units (on average) per yearāwhen Canadaās population grew by approximately 280,000 people annually.
In fact, between 1972 and 2019, Canadaās population increased by 1.8 residents for every new housing unit started compared to 3.9 new residents in 2024. In other words, Canada must now house more than twice as many new residents per new housing unit as it did during the five decades prior to the pandemic. And of course, housing follows the laws of supply and demandāwhen a lot more prospective buyers and renters chase a limited supply of new homes, prices increase.
This key insight should guide the policy responses from all levels of government.
For example, the next federal governmentāwhoever that may beāshould avoid policies that merely fuel housing demand such asĀ home savings accounts. And provincial governments (including in Ontario and British Columbia) should scrap any policies that discourage new housing supply such as rent controls, which reduce incentives to build rental housing. At the municipal level, governments across the country should ensure that permit approval timelines and building fees do not discourage builders from breaking ground. Increasing housing supply is, however, only part of the solution. The next federal government should craftĀ immigration and residency policiesĀ so population growth doesnāt overwhelm available housing supply, driving up costs for Canadians.
It’s hard to predict how long Canadaās housing affordability crisis will last. But without more homebuilding, slower population growth, or both, thereās little reason to expect affordability woes to subside anytime soon.
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