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Moreover, it’s a desperate bid to cling to an outdated—and failed—model of health care while underestimating modern-day innovations.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:

Bacchus Barua

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Fraser Institute

Métis will now get piece of ever-expanding payout pie

Published on October 20, 2025

Todayville

From the Fraser Institute

By Tom Flanagan

The history of Ile-à-la-Crosse (IALC) in northern Saskatchewan goes back to 1776, when Thomas Frobisher established a fur trading post. Catholic Oblate missionaries arrived in 1846 and founded a small day school the next year, which was turned into a boarding school in 1860. Louis Riel’s sister Sara taught there until she died of TB in 1883. Under various names and at various locations, the school survived until the early 1970s.

The students were mainly Métis from northern Saskatchewan, with a sprinkling of Indian and white children. It was never an Indian Residential School (IRS) in the legal sense, though the federal government did at times make financial contributions proportional to the small number of status Indian children who attended. The school was mainly supported by the Oblate order and the Grey Nuns, with contributions from the province of Saskatchewan in later years.

Because the school was not an IRS, those who had attended were excluded from the IRS Settlement Agreement negotiated by Paul Martin’s government in 2005 and implemented by Stephen Harper’s government afterwards. Most students had been Métis, and the Settlement Agreement generally excluded Métis who had attended mission boarding schools that were not IRS. Wanting to share in the $5 billion financial compensation provided by the Agreement, the IALC students started legal action, using Tony Merchant’s law firm. Merchant, however, moved too slowly for the complainants, so the Sotos firm started another class action in 2022.

Following the “resistance is futile” policy enunciated by Jodi Wilson-Raybould when she was minister of justice, the federal government had already decided not to litigate, having signed in 2019 a memorandum of understanding to negotiate the claims. In March 2025, the federal government reached an agreement-in-principle with IALC students, which will go before a federal court judge for approval in January 2026. Saskatchewan announced its own agreement-in-principle in September, which will also go before the federal court.

Canada is putting up $27 million and Saskatchewan $40 million for individual compensation. With an estimated 600-700 “survivors,” this equates to individual payouts of about $100,000 apiece. This is admittedly guesswork, because neither agreement-in-principle has been published. News reports indicate that “families” will be involved in the compensation, so a larger number of claimants may materialize.

The federal news release says that compensation is being paid for “cultural loss abuse,” which includes loss of proficiency in the Cree and Michif languages spoken by the Métis in that area. Sexual and physical abuse are not mentioned, even though “survivors” claim to have been abused. Payments will be made to all who attended, as with the federal day school settlement and the “common experience” payment in the IRS settlement.

In the world of government, the joint payout of $67 million is a penny-ante affair, but the long-term implications are much greater. There are tens of thousands of Métis adults who attended mission boarding schools, both Protestant and Catholic, that were not considered IRS and were not admitted to the IRS Settlement Agreement. For them, the IALC settlement is like a dam breaking, setting a precedent for compensation. Class action law firms will commence new actions. Individual cases will be small, but there will be so many of them that the federal government will probably consolidate them into one multi-billion-dollar settlement, and the provinces will fall into line.

When Prime Minister Harper decided to implement the IRS settlement Agreement, he thought it would bring peace on the Indigenous front, allowing the government to move forward. It was an understandable hope, but in fact that decision unleashed a series of class actions that have cost taxpayers more than $50 billion and rising. When Harper was in power, he kept the lid on; but payments exploded after Justin Trudeau became prime minister in 2015 and made Wilson-Raybould minister of justice. Her instruction to Department of Justice lawyers to negotiate rather than litigate, which is still in force, caused resistance to Indigenous class actions to collapse and facilitated enormous payouts culminating in the $40 billion-plus child-care settlement. Now the Métis will get their piece of this ever-expanding payout pie.

Tom Flanagan

Professor Emeritus of Political Science and Distinguished Fellow, School of Public Policy, University of Calgary

Business

US government buys stakes in two Canadian mining companies

Published on October 20, 2025

Todayville

From the Fraser Institute

By Steven Globerman

Prime Minister Mark Carney recently visited the White House for meetings with President Donald Trump. In front of the cameras, the mood was congenial, with both men complimenting each other and promising future cooperation in several areas despite the looming threat of Trump tariffs.

But in the last two weeks, in an effort to secure U.S. access to key critical minerals, the Trump administration has purchased sizable stakes in in two Canadian mining companies—Trilogy Metals and Lithium Americas Corp (LAC). And these aggressive moves by Washington have created a dilemma for Ottawa.

Since news broke of the investments, the Carney government has been quiet, stating only it “welcomes foreign direct investment that benefits Canada’s economy. As part of this process, reviews of foreign investments in critical minerals will be conducted in the best interests of Canadians.”

In the case of LAC, lithium is included in Ottawa’s list of critical minerals that are “essential to Canada’s economic or national security.” And the Investment Canada Act (ICA) requires the government to scrutinize all foreign investments by state-owned investors on national security grounds. Indeed, the ICA specifically notes the potential impact of an investment on critical minerals and critical mineral supply chains.

But since the lithium will be mined and processed in Nevada and presumably utilized in the United States, the Trump administration’s investment will likely have little impact on Canada’s critical mineral supply chain. But here’s the problem. If the Carney government initiates a review, it may enrage Trump at a critical moment in the bilateral relationship, particularly as both governments prepare to renegotiate the Canada-U.S.-Mexico Agreement (CUSMA).

A second dilemma is whether the Carney government should apply the ICA’s “net benefits” test, which measures the investment’s impact on employment, innovation, productivity and economic activity in Canada. The investment must also comport with Canada’s industrial, economic and cultural policies.

Here, the Trump administration’s investment in LAC will likely fail the ICA test, since the main benefit to Canada is that Canadian investors in LAC have been substantially enriched by the U.S. government’s initiative (a week before the Trump administration announced the investment, LAC’s shares were trading at around US$3; two days after the announcement, the shares were trading at US$8.50). And despite any arguments to the contrary, the ICA has never viewed capital gains by Canadian investors as a benefit to Canada.

Similarly, the shares of Trilogy Minerals surged some 200 per cent after the Trump administration announced its investment to support Trilogy’s mineral exploration in Alaska. Again, Canadian shareholders benefited, yet according to the ICA’s current net benefits test, that’s irrelevant.

But in reality, inflows of foreign capital augment domestic savings, which, in turn, provide financing for domestic business investment in Canada. And the prospect of realizing capital gains from acquisitions made by foreign investors encourages startup Canadian companies.

So, what should the Carney government do?

In short, it should revise the ICA so that national security grounds are the sole basis for approving or rejecting investments by foreign governments in Canadian companies. This may still not sit well in Washington, but the prospect of retaliation by the Trump administration should not prevent Canada from applying its sovereign laws. However, the Carney government should eliminate the net benefits test, or at least recognize that foreign investments that enrich Canadian shareholders convey benefits to Canada.

These recent investments by the Trump administration may not be unique. There are hundreds of Canadian-owned mining companies operating in the U.S. and in other jurisdictions, and future investments in some of those companies by the U.S. or other foreign governments are quite possible. Going forward, Canada’s review process should be robust while recognizing all the benefits of foreign investment.