Alberta Premier Danielle Smith, left, and Matt Jones, then-minister of hospitals, make a health-care announcement in Calgary on Nov. 14, 2025.Jeff McIntosh/The Canadian Press
It’s not often that a prime minister is lauded for something that he doesn’t do, but Prime Minister Mark Carney is currently being celebrated by six policy organizations for his inaction on an important Canadian regulatory matter.
In an open letter published late last month, the CEO of the Canadian Health Policy Institute, the deputy director of domestic policy for the Macdonald-Laurier Institute and others applauded Mr. Carney for his government’s “openness to health care reforms being pursued in Alberta,” referring to the province’s plan to allow some doctors to perform some surgeries privately starting in the fall, as long as they complete a minimum number of hours in the public system. The dual-practice model will apply to certain specialties, including orthopedics and ophthalmology, but will not be applicable to cancer surgeries and other procedures for life-threatening conditions.
The letter’s signatories note that it is “encouraging” that Mr. Carney has “not yet signaled an intent to stifle Alberta’s decision.” In fact, he hasn’t signalled much of anything. Under the Canada Health Act (CHA), the federal government can claw back a portion of the Canada Health Transfer (CHT) if a province is charging patient fees for services that are insured under the public system. In March, 2025, for example, more than $23-million was deducted from B.C.’s CHT for fees levied to patients for insured surgical and diagnostic services. In 2021, former prime minister Justin Trudeau said the government would withhold a portion of New Brunswick’s CHT for its failure to fund abortion services outside of designated hospitals.
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Mr. Carney’s apparent passivity on Alberta’s plans is perhaps mostly striking because of its contrast to his predecessor, who was much more ideological about these sorts of things (“Canada’s universal public health system is a pillar of our national identity,” Mr. Trudeau said in 2024) and made a habit of wading into provincial affairs on all sorts of matters, not limited to health care. The real test for Mr. Carney will come after Alberta’s dual-practice model is up and running, and if and when CHT deductions are implemented. If that happens, the province will surely initiate some sort of challenge. Alberta’s position is that its plans are compliant with the CHA, which will necessitate a response from Mr. Carney’s government.
Mr. Carney’s relatively short tenure as Prime Minister has demonstrated that he’s not afraid to make decisions that we once considered radioactive – both to his party (cutting the carbon tax and signing pipeline deals) and to the wider political establishment (fixing up 24 Sussex). But while these actions, on the surface, might have been seen as bold and risky for a Liberal leader, polling was actually on Mr. Carney’s side.
The carbon tax was an obvious one: It was deeply unpopular by the time Mr. Carney became Prime Minister. But public support for pipeline production started building in response to tariff threats from U.S. President Donald Trump. An Angus Reid poll from February, 2025, for example, found that a majority of respondents would support reviving the Energy East and Northern Gateway pipelines. And on 24 Sussex, which a succession of prime ministers refused to address, a poll from 2023 actually found that nearly three-quarters of respondents supported either renovating or knocking down and replacing the official residence.
On health care, polling similarly shows that a majority of Canadians are open to some role for private delivery. A recent Nanos poll reported that about seven in 10 Canadians believe that the best way to improve health care in this country involves some aspect of private care.
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A 2023 survey from the Canadian Medical Association found that 63 per cent of respondents supported allowing dual practice, and at least one poll shows young people in Canada actually hold the strongest support for private delivery.
It’s not hard to see what’s happening: Canadians are witnessing the failures of the current model firsthand, and they realize that pouring more money into an inefficient system is not the answer (as a proportion of GDP, Canada spends more than many peer countries, but performs much worse on key metrics). Many recognize that we already have something of a two-tiered system in Canada (whereby those with connections can get faster access or pay for a procedure in another province), and that the alternative to Canada’s universal single-payer system is not the adoption of the U.S. health care system, but that of Australia, Switzerland, Japan, or the Netherlands. Sticking with the status quo because of romantic notions about Canadian identity should no longer be seen as the “safe” political choice. In fact, it should be the opposite.
So Mr. Carney, whose bold political choices largely fall on-side of public opinion, would be wise to continue to do nothing on this file: both because health care in Canada is desperately in need of reform, and because it might actually serve his political interests to do so.