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Moreover, it’s a desperate bid to cling to an outdated—and failed—model of health care while underestimating modern-day innovations.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

Instead of competing, Ontario’s Ford plans to spend billions to stimulate growth

Published on January 28, 2025

Todayville

From the Fraser Institute

By Jake Fuss and Grady Munro

Premier Doug Ford, who will trigger an election this week, recently said he plans to “spend billions of dollars” to stimulate Ontario’s economy if President Donald Trump makes good on his threat to slap a 25 per cent tariff on Canadian exports into the United States.

But rather than piling on even more spending, the next Ontario government—whoever that may be—should enact policies that finally get provincial finances back in order and make Ontario an attractive place to work and invest.

Relief can’t come soon enough. The Ford government has woefully mismanaged provincial finances. When first elected in 2018, Premier Ford promised to balance the budget and reduce government debt—something Ford’s former finance minister Vic Fedeli described as a “moral” imperative. Yet since then, the government has run deficits in five of six years and its net debt burden has increased by an estimated $70.3 billion.

As a result, in 2023 Ontario had the second-highest debt burden of any province (only Newfoundland and Labrador had a larger burden) when measured on a per-person basis.

Based on the Ford government’s latest fiscal update, the reckless mismanagement has continued into this fiscal year (2024/25). Despite enjoying lower-than-expected debt interest costs and higher-than-expected revenues—which combined could have nearly eliminated the budget deficit—the Ford government instead chose to again increase spending and keep running deficits.

Why should Ontarians care?

Because the Ford government’s penchant for spending and borrowing is hurting Ontario’s economy. When the government runs a deficit and accumulates more debt, it competes with individuals, households and businesses for borrowing. This drives up interest rates (i.e. the cost of borrowing) for everyone, which can reduce the level of investment in the economy. Moreover, because rising debt and higher interest rates equal higher interest payments, the government faces pressure to raise taxes. And the brunt of the new tax burden will fall on younger generations of Ontarians.

Also this week, Premier Ford said President Trump “wants to attract businesses from Ontario to come down to the United States,” which will eliminate jobs in the province.

And Ford’s right. When policymakers create the conditions to attract people and investment, their economies grow and people prosper.

If the Ontario government wants to beat Trump at his own game, it should lower personal income taxes and make the province a more attractive destination for high-skilled workers such as engineers and entrepreneurs who contribute greatly to the economy and create jobs. Lower taxes also improve the incentive for individuals to engage in productive activities such as working, saving and investing. In 2023, Ontario had the third-highest top combined (provincial and federal) personal income tax rate in Canada and the U.S.

The government should also lower business taxes to make Ontario more competitive with the U.S. in attracting businesses and investment—the pillars of job-creation and prosperity.

Regardless of who wins the election, the next Ontario government should finally restore some semblance of fiscal responsibility and balance the budget. And it should lower taxes for workers and businesses to help create prosperity across the province. That’s a much more sensible and sustainable way to counter threats from Trump (or anyone else) than spending billions of dollars borrowed on the backs of Ontarians.

Jake Fuss

Director, Fiscal Studies, Fraser Institute

Grady Munro

Policy Analyst, Fraser Institute

Energy

Next prime minister should swiftly dismantle Ottawa’s anti-energy agenda

Published on January 23, 2025

Todayville

From the Fraser Institute

By Kenneth P. Green

Justin Trudeau’s imminent exit from office may mark the beginning of the end of a 10-year war on Canada’s energy sector, and by extension, Canada’s economy.

Canada is the world’s fourth-largest oil producer, currently supplying 6 per cent of global production. Canada is the fifth-largest producer of natural gas, supplying 5 per cent of global demand. The energy sector (oil, gas, electricity) constitutes more than 10 per cent of Canada’s total gross domestic product (GDP). In 2023, the latest year of available data, the energy sector provided, directly and indirectly, almost 700,000 jobs or 3.5 per cent of all jobs in Canada. And Canadian energy exports totalling $200 billion comprised 28 per cent of all Canadian exported goods.

But however vast and vital Canada’s energy sector is our wellbeing, Prime Minister Trudeau worked tirelessly to restrain, restrict, diminish and ultimately “phase out” Canada’s fossil fuel industries. Here are some of the highlights of his war on Canada’s energy sector.

In 2017, Trudeau introduced Bill C-48, which restricts oil tankers off Canada’s west coast and limits the ability of Canada’s oilsands sector to export product to new markets, keeping Canada’s energy resources trapped in a discount-price U.S. market. Also in 2017, much to the fury of many Albertans, Trudeau announced his intention to phase out oilsands production, the foundation of Alberta’s prosperity.

In 2018, Trudeau introduced Bill C-69, which tightened Canada’s environmental assessment process for major infrastructure projects and made the process of obtaining government permission for major energy projects more costly, time-consuming and arbitrary, thus increasing uncertainty across the energy sector. And he introduced the carbon tax despite strenuous opposition by Canada’s energy sector and energy-producing provinces.

In 2020, Trudeau launched his broadest and most intense regulatory crusade against Canada’s energy sector, introducing Bill C-12, which committed Canada to reach “net-zero” emissions of greenhouse gasses by 2050. Net-zero means Canada cannot emit more greenhouse gases via energy production and consumption than is taken out of the air by natural processes and the ecosystem. This would require vastly reduced production and consumption of fossil fuels in Canada, with consequences for the energy sector’s productivity and employment potential moving toward 2050.

In 2023, Trudeau attacked fossil fuel use in the transportation sector by mandating that all new cars sales be electric vehicles by 2035. And he released draft “clean electricity regulations” to phase out the use of fossil fuels in electricity generation by the year 2050.

During his time as prime minister, Trudeau attacked Canada’s energy sector, with eliminationist language and onerous regulations meant to essentially phaseout a major supplier of economic productivity and employment in Canada, to the great detriment of Canadians.

Hopefully, the next prime minister will reject Trudeau’s anti-energy agenda and have the will and ability to rescind the many damaging laws and regulations that that the Trudeau government has inflicted on a vital sector of the Canadian economy.