Exclusive: The end of Canada's public healthcare on the horizon
Alberta is set to either have a massive confrontation with the government, or to break open a dam that can't be fixed.
Canada might be facing the end of our public healthcare system. It probably won’t happen tomorrow, but the die has been cast: Alberta has created the first two-tier system in the country, one that allows for the wealthy to receive better health care. Ontario looks to follow suit, and Saskatchewan is already signalling their intention to follow.
In a report from the Canadian Center for Policy Alternatives, they explain that the UCP’s bill 11 will increase public wait times and create unequal access based on income. It allows for physicians to simultaneously be paid by state based insurance, while simultaneously running a practice. They are allowed to offer their patients these services during consultations, giving them an immense amount of pressure to force patients to pay in order for them to receive health care in a timely manner.
This is creating Canada’s first private insurance market for health care, which will drive up costs for both patients, and the public system, plus it will further fragment Canadian negotiating power, possibly driving up costs in other provinces.
“Administrative costs”
The result is physicians who will charge “administrative costs” and charge them to both public and private insurance– but this raised cost drives up the cost on public funds and eventually the public system has to remove access to certain services, narrowing their health care provisions.
The clincher in all of this is that the most likely group to provide services are private companies from the United States. The privatization of health care in Alberta is a major blow against sovereignty in Canada, particularly in Alberta.
Whether there is hope or not is unclear as of yet. The Bill explicitly violates multiple portions of Canada’s Health Act, and will lead to a major confrontation between Ottawa and Alberta, something that Danielle Smith is hoping for. As friendly as she’s become with Mark Carney and the 2025 Liberals, Smith has signalled several times that she wants to separate from Canada without fully separating.
“Alberta didn’t start this fight, but rest assured we will finish it,” she said during a press conference in 2025. During the Infoman 2025 end of year segment she said she wanted a “sovereign alberta” in a “united Canada”, but it’s the same words that the CAQ uses in their speeches– they want to have the perks of Canada, but none of the rules and cooperation that come with it.
Many Canadian provinces have been pushing for health care to be dismantled slowly introducing inflationary privatization into the system through backdoor means for decades. Many services are already outsourced to private companies, driving up costs enormously. Nurses are often employed by private groups, and those private groups have contracts with hospitals. Per capita spending in Canada is around 7,300 a year, with around $2,000 of that being private companies providing services.
The Law
The Canada Health Act (CHA) passed in 1984 guarantees the right to health care equally for all Canadians. It sets a federal standard and is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.” Bill 11 explicitly goes against that, by promoting different levels of access to health care based on financial barriers.
In other provinces, notably Quebec, there is a private health care sector on top of the provincial one. There is a massive difference between Quebec’s system and the one Alberta is introducing– notably, that no one is allowed to practice in both the public and private systems at the same time. Quebec chooses the number of people able to practice in the private system, and has been working to allow fewer people to leave the public system.
If other provinces create this system of dual access, enabling practitioners to work in both the private and public sector simultaneously, the feds will lose any leverage to fight these law breaking violations.
Bill 11 ignores some of the CHA. However, major legislation in Canada is often slowly dismantled by a failure to challenge clear violations. If the federal government doesn’t maintain and uphold the letter and principle of the CHA, it will be dismantled. Not overnight, but over the next decades. If the government doesn’t stand up to this, public health care in Canada could be a shell of itself in twenty years, depending solely on which provinces choose to vote in leaders who fight against this. There are fewer leaders every year who seem willing to push back against this trend.
Fallout
The fallout from this will be interesting to watch, and may further splinter our divided country. There are several factors to consider. If medical care in Alberta becomes solely accessible to the wealthy, there could be a large exodus of individuals from the province into neighbouring provinces like British Colombia. However, BC is already dealing with a growing extremist wing in their parliament with One BC having come and gone this past year, and a far right, Alberta-esque wing of the BC Conservatives beginning to take over the party. Meanwhile, Ford’s PC in Ontario have shown a strong interest in privatizing everything possible, and Saskatchewan is a long way removed from Tommy Douglas’ leadership.
The most overwhelming costs of private health care are false, inflated administration costs. In the United States, “Billing and Insurance-Related” (BIR) costs are costing $496 billion a year. The Center for American Progress says that $248 billion of that cost is “administrative excess.”
In Canada’s system, we have a similar problem that isn’t quite as acute– as previously mentioned, our Private Public Partnerships (PPP) within the system costs significantly more in administrative costs while simultaneously making sure that nurses and health care workers are not paid appropriately for their work. For profit medical providers are making huge profit off the backs of Canadian tax payers.
Studies show that public medicare saves billions a year. The United States has the highest cost for medical procedures in the world, and systems like Canada are fundamentally flawed because of how inefficient they are. If everything was in house (which it used to be), it would decrease costs and raise efficiency.
Public insurance systems typically operate with overhead administrative costs of 1.5 per cent to 3 per cent, and private insurance operates with upwards of 12 per cent.
Inflation for public insurance is exponentially more than public insurers as well. In New York, private insurance spending per beneficiary increased by 38 per cent, while medicare rose by 16 per cent, and Medicaid by 8 per cent.
Nothing to brag about
Nonetheless, no one should be writing home about our health care system. The constant fragmentation and capitulation to private drug insurers, and PPPs in our system leads to much higher costs for Canada. The semi-subsidized drug insurance in most provinces has led to Canada having the third highest drug prices in the OECD. Meanwhile, we have higher administrative costs because of the PPPs that we rely so heavily on.
Private systems are also significantly less efficient with costs.
However, calling a system like Quebec’s private health care “private” is a lie. In Quebec the private system is semi subsidized, with the CAQ spending $6 billion on the private system according to a CSN calculation. If the government had relied on the public service, it would have saved them $700 million.
Guillaume Hébert, a researcher at the Institut de recherche et d’informations socioéconomiques explained that significant investment in public healthcare—and a move away from “hospital centricity,” where funding is disproportionately allocated to hospitals—would create a more resilient and responsive health system in the event of a national emergency. “A public system is best able to respond to people’s needs. But it needs to be decentralized… that is the way the system can best respond to [an area’s] needs with the available resources.” Most provinces, particularly Quebec, have increasingly centralized the system over the past decades, leading to a less efficient system than it could otherwise be.
This privatization has taken place under our noses, and with Alberta breaking the dam open it will likely become a flood before it’s too late. Ontario is seeing a workforce crisis. Per capita spending on private companies staffing their public hospitals doubled between 2013 and 2023. The cost of hiring private staff can be more than three times the cost of hiring staff in house. There is no excuse to do so, except for a slow privatization of the health care system with the eventual intention to completely privatize it.
Who’s gonna fix it?
Unless there is a massive shift in Canada, a government ready to reinforce the Canada health act looking to outlaw private corporations operating in our public system, this trend will likely continue. We are barrelling towards the end of our publicly funded system at an incredible speed (incredible speed being within a couple decades.) On the horizon of almost every province there is no indication of a strong political will to fix this.
Charles Milliard is the only candidate who seems to have solutions in Quebec, and it is well needed. He wants to implement a telemedicine system in Quebec, which would significantly help. In the previous election, Paul St-Pierre Plamondon wanted to ban private health care. His party, the PQ, is on track to win the election this year, but his rapid movement to the extreme right is well documented, and his party refuses to speak about anything except their dislike of immigrants.This means that the Liberals are the only ones talking about improving health care in the province, but it’s their fault in the first place that the private system even exists in Quebec.
Ontario and BC also have telemedicine, and they’re still struggling. Ontario and Saskatchewan have highly conservative governments that more openly want to privatize. The federal Liberals in their current makeup have announced an insignificant, almost negligible amount for expanding health care in Canada, as well as much lower increases to health transfers compared to the Trudeau era.
Most provinces, and especially the feds, are betting on AI to increase efficiency around health care. Of course, this poses other problems that are not within the scope of this article to discuss. AI has proven to be a more effective diagnostician than many doctors in certain cases, but there are many legal grey zones around the use of the technology because of privacy concerns. AI being in our health care systems might improve efficiency long term, but that is not guaranteed. The technology has been an overall failure since its inception, costing many jobs with minimal benefits. It also opens the door to another private company slithering its fingers into our public systems.
In the end, the data tells the whole story: Inefficient spending, and a purposeful, slow privatization of our health care system is slowly choking the system until one day it will be completely gone. The political reality is that there are few, if no governments with an interest in truly fixing the systemic problems. This article has endeavoured to highlight the simple, but effective solutions that would repair our health care across the country.
Alberta might be the first place to explicitly defy the CHA, but when a dam breaks, it’s hard to rebuild. If Ontario follows, and the federal government doesn’t stop the onslaught, it might be too late.
Canada is the only developed country with Universal Healthcare that does not have a two tier system. Our health care system has more similarities to North Korea and Cuba’s than it does to Switzerland and Japan’s.