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Moreover, it’s a desperate bid to cling to an outdated—and failed—model of health care while underestimating modern-day innovations.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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Alberta Next Panel calls for less Ottawa—and it could pay off

Published on December 29, 2025

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From the Fraser Institute

By Tegan Hill

Last Friday, less than a week before Christmas, the Smith government quietly released the final report from its Alberta Next Panel, which assessed Alberta’s role in Canada. Among other things, the panel recommends that the federal government transfer some of its tax revenue to provincial governments so they can assume more control over the delivery of provincial services. Based on Canada’s experience in the 1990s, this plan could deliver real benefits for Albertans and all Canadians.

Federations such as Canada typically work best when governments stick to their constitutional lanes. Indeed, one of the benefits of being a federalist country is that different levels of government assume responsibility for programs they’re best suited to deliver. For example, it’s logical that the federal government handle national defence, while provincial governments are typically best positioned to understand and address the unique health-care and education needs of their citizens.

But there’s currently a mismatch between the share of taxes the provinces collect and the cost of delivering provincial responsibilities (e.g. health care, education, childcare, and social services). As such, Ottawa uses transfers—including the Canada Health Transfer (CHT)—to financially support the provinces in their areas of responsibility. But these funds come with conditions.

Consider health care. To receive CHT payments from Ottawa, provinces must abide by the Canada Health Act, which effectively prevents the provinces from experimenting with new ways of delivering and financing health care—including policies that are successful in other universal health-care countries. Given Canada’s health-care system is one of the developed world’s most expensive universal systems, yet Canadians face some of the longest wait times for physicians and worst access to medical technology (e.g. MRIs) and hospital beds, these restrictions limit badly needed innovation and hurt patients.

To give the provinces more flexibility, the Alberta Next Panel suggests the federal government shift tax points (and transfer GST) to the provinces to better align provincial revenues with provincial responsibilities while eliminating “strings” attached to such federal transfers. In other words, Ottawa would transfer a portion of its tax revenues from the federal income tax and federal sales tax to the provincial government so they have funds to experiment with what works best for their citizens, without conditions on how that money can be used.

According to the Alberta Next Panel poll, at least in Alberta, a majority of citizens support this type of provincial autonomy in delivering provincial programs—and again, it’s paid off before.

In the 1990s, amid a fiscal crisis (greater in scale, but not dissimilar to the one Ottawa faces today), the federal government reduced welfare and social assistance transfers to the provinces while simultaneously removing most of the “strings” attached to these dollars. These reforms allowed the provinces to introduce work incentives, for example, which would have previously triggered a reduction in federal transfers. The change to federal transfers sparked a wave of reforms as the provinces experimented with new ways to improve their welfare programs, and ultimately led to significant innovation that reduced welfare dependency from a high of 3.1 million in 1994 to a low of 1.6 million in 2008, while also reducing government spending on social assistance.

The Smith government’s Alberta Next Panel wants the federal government to transfer some of its tax revenues to the provinces and reduce restrictions on provincial program delivery. As Canada’s experience in the 1990s shows, this could spur real innovation that ultimately improves services for Albertans and all Canadians.

Tegan Hill

Director, Alberta Policy, Fraser Institute

Fraser Institute

Carney government sowing seeds for corruption in Ottawa

Published on December 28, 2025

Todayville

From the Fraser Institute

By Jason Clemens and Niels Veldhuis

A number of pundits and commentators have observed the self-confidence and near-unilateralist approach of our prime minister, Mark Carney. The seemingly boundless self-assurance of the prime minister in his own abilities to do the right thing has produced legislation that sets the foundation for corruption.

Consider the Carney government’s signature legislation, known as the Building Canada Act (Bill C-5), which among other things established the Major Projects Office (MPO). The stated purpose of the MPO and the act is to create a process whereby the government—in practical terms, the prime minister and his cabinet—identify projects in the “national interest” and fast-track their approval by overriding existing laws and regulations.

Put differently, a small group of politicians are now able to circumvent the laws and regulations that apply to every other entrepreneur, businessowner and investor to expedite projects they deem will benefit the country. According to several reports, senators openly referred to the bill as the “trust me” act because it lacked details and guardrails, which meant “trusting” that the prime minister and cabinet would use these new powers reasonably and responsibly.

Rather than fix the actual policies causing problems, which include a litany of laws and regulations from the Trudeau era such as Bill C-69 (which added vague criteria to the approval process for large infrastructure projects including pipelines) and Bill C-48 (which bans oil tankers from docking in British Columbia ports), the Carney government chose to create a new bureaucracy and political process to get around these rules.

And that’s the problem. By granting itself power to get around rules that everyone else has to play by, the government created the opportunity for corruption. Entrepreneurs, businessowners and investors interested in infrastructure projects, particularly energy projects, now need to consider how to convince a handful of politicians of the merits of their project. This lays the groundwork for potentially corrosive and damaging corruption now and into the future. While this prime minister may have an infinite amount of confidence in his abilities to do the right thing, what about the next prime minister, or the next one? These rules will outlive Prime Minister Carney and his government.

And it’s not just the Carney government’s signature Build Canada Act. The more recent Bill C-15, which implements certain aspects of the federal budget, contains provisions similar to the Build Canada Act that would also allow cabinet ministers to circumvent existing laws and regulations. A number of commentators have raised red flags about how the legislation would empower any minister to exempt any entity (i.e. person or firm) from any law or regulation—except the Criminal Code—under the minister’s responsibility for up to six years in order to foster innovation. The underlying rationale is that we have laws and regulations on the books that impede experimentation and innovation.

Again, rather than undertake the difficult work of updating and modernizing existing laws and regulations to empower entrepreneurs, businessowners, workers, and investors, and ensure they all play by the same rules, the Carney government instead wants to create a new mechanism for a select few to be able to sidestep existing laws and regulations.

A different way to think about both legislative initiatives is that the prime minister and his ministers are now able to provide specific companies with enormous advantages over their competitors through the political system. Those advantages have enormous value, and that value creates the opportunity for corruption now and in the future.

The Carney government recognizes that our regulatory system is badly broken, otherwise it wouldn’t create these work-around laws. It should do the hard work, which it was elected to do, and actually fix the laws and regulations that impede economic development and progress for all entrepreneurs, businessowners and investors. Otherwise, we risk a future littered with stories of advantage and corruption for political insiders.