Alberta’s 2024 budget ramps up funding for a medical care system that already spent more per person than in B.C. and Ontario, while achieving poorer health outcomes. 

Big spending on medical care gets Alberta the best-paid doctors in the country. But not the most doctors. It also raises questions about the opportunity costs of dedicating more scarce resources to medical care rather than other needs.

Wellbeing, especially for younger residents, is collateral damage. This is because the budget spends relatively little where their health begins—like affordable homes, quality child care, poverty reduction, and a stable planet.  

The path to a healthier Alberta requires a course correction, one that invests more urgently in the building blocks for a healthy society than in medical care. Here’s why.

In the latest budget, annual spending on medical care will grow by $3.6 billion as of 2026.  

The increase for K-12 education is modest by comparison, up $0.7 billion. So are increases for postsecondary (up $0.8 billion) and child care ($0.3 billion), while spending on other social services is flat.

Since Canadians use more medical care after age 65 than earlier, Premier Smith’s 2024 budget will add new funding for retirees more than twice as fast as for residents under age 45. This leaves Alberta much less balanced in delivering investments for younger and older residents by comparison with B.C. and Ontario.  

This isn’t good news if you care about helping Albertans get and stay well. Whenever people can’t access safe homes, good incomes, quality child care, and a healthy environment, evidence shows our medical care system will never be enough to prevent people from becoming injured, sick, or dying early. 

We’re grateful that we can call on fire departments to put out the flames when we need them, but preventing fires is much less deadly, damaging, and costly. So it is with health care. Waiting to invest until people are ill is like showing up with hoses once the fire is already raging. We need to prevent the first sparks from getting out of hand. 

This means that clinics and hospitals should be the last stop, not the first stop, in our health system. The first stops for good health are found in our neighbourhoods, jobs, child care, and schools.

Alberta used to budget this way. In 1976, the province spent approximately 36 percent more on social and education programs by comparison with medicine. Now, it spends at least 10 percent less.

So it’s no coincidence that medical costs rise, while access doesn’t. Because we haven’t been preventing enough people from joining the queue waiting for medical care, especially as our population ages and care needs become more complex. 

This also helps to explain why medical professionals are burning out, even as the number of doctors per capita is up. Alberta had 128 physicians for every 100,000 people in 1976, including 70 family doctors. Today, Alberta has 244 doctors for every 100,000 residents, including 119 family physicians.  

Some Albertans may think that higher provincial spending on medical care is a point of pride, especially when many Canadians are concerned about gaps in our medical system. But the data show this spending isn’t worth bragging about, because it does not buy the province better outcomes.  

Not only does the Canadian Institute for Health Information show that Alberta spends more per resident on medical care than B.C. and Ontario, but it also reveals that Alberta ranks below those provinces and the national average for infant mortality, heart disease mortality, cervical cancer mortality, rectal cancer mortality, avoidable admissions for COPD (lung disease), avoidable admissions for diabetes, and even lower life expectancy.

While Alberta doesn’t often buy better health outcomes, it does buy the best-paid doctors in the country. Despite this, Alberta has not managed to recruit and retain physicians since the pandemic nearly as well as B.C., where physicians earn markedly less.

The size of the opportunity to spend more wisely may surprise readers. Even if Alberta’s medical budget was $2 billion less, it would still spend as much on medical care for every senior as does B.C. and Ontario. That’s a lot of inefficient spending on medical care when you consider that Ms. Smith’s government spends only $1.6 billion for $10/day child care (almost all of which is federal funding), and operating funds for affordable housing hover around $0.4 billion. 

The bottom line is that Albertans, like all Canadians, get well when we invest in safe and affordable homes, living wages, quality child care and schools, and a healthy environment—even more urgently than we invest in medical care. Alberta used to follow this prescription decades ago. The Smith government would be wise to return to it.

This week, Conservative candidate Jamil Jivani’s win in the Durham by-election portends a broader political trend that’s behind Pierre Poilievre’s broad-based appeal and the reason why he’s the favoured choice for Canada’s next prime minister. 

Laying out Poilevre’s own key message, Jivani spoke about how the working class is being betrayed by the Trudeau government and other major Canadian institutions, including universities and big business.

The themes of his speech—including the notion that working-class Canadians have been left behind, or worse, taken for chumps by big corporations and big government—align with a speech that Poilievre himself recently delivered to the C.D. Howe Institute in Toronto. The remarks were more than a routine address. They were a declaration of his priorities and a preview of his potential style of governance.

Poilievre began by saying bluntly that “after eight years of Trudeau, life is increasingly a living hell for the working-class people of this country.” He then drew on a devastating body of data and evidence to convey the challenges facing everyday Canadians. The facts tell a compelling story of struggle. 

Housing costs have doubled over the last decade, with rent growing from an average of about $900 to roughly $2,000 per month. The IMF says that Canada has the most dangerous mortgage debt in the entire OECD, warning that our country has the highest risk of mortgage defaults. Millions of Canadians are using food banks. These inconvertible facts are increasingly causing people to question whether the country’s economic and political systems are skewed against their interests. They are rightly angry. 

Poilievre has given them a voice. He is from and for Main Street and his appeal is clearly resonating. Don’t believe it? Take a peek at some of his visits to traditionally working-class communities like Windsor and St. John’s, where Liberals and New Democrats have dominated federal politics for decades. Ask a service worker the next time you’re buying coffee whether they feel like they are getting ahead. When Poilievre speaks, the polling shows working Canadians feel like he cares about them.

Some of the anger from Canadians toward the federal government is stemming from a sense of betrayal. Justin Trudeau’s 2015 campaign line about “being there for the middle class and those trying to join it,” was a highly effective mantra. Millions of Canadians responded positively to it. In fact, it’s a key reason why he won a majority government. 

Trudeau’s precipitous drop in public opinion polls lends weight to the betrayal hypothesis. While Poilievre’s communications and policy are key drivers of his own support, there’s the accumulating picture of an effete, out-of-touch prime minister who hasn’t lived up to his promise as a champion of the middle class. 

Poilievre’s early warnings about inflation, famously predating Bay Street and the Bank of Canada, has given him a huge advantage—namely, real credibility—on these issues with ordinary voters. He was speaking about inflation and the now-present housing crisis before business, the media, and, of course, the Trudeau government started to.

Just as important is the communications revolution powered by social media, which is enfranchising all kinds of new voters. The rise of platforms like YouTube and the end of traditional media are drawing in people who previously wouldn’t have paid attention to politics. Imagine how much larger the Diefenbaker and Mulroney majorities might have been with YouTube channels instead of only the Toronto Star, the Winnipeg Free Press, and CBC dominating the media landscape. These developments have given Poilievre the ability to reach Canadians who may not have voted Conservative in the past, or who perhaps didn’t vote at all. 

But his success thus far isn’t merely about communications. He’s signaled that he plans to challenge corporate interests and bureaucratic inefficiencies head-on. His stance on increasing competition, especially in protected sectors, suggests a readiness to disrupt the status quo for greater service and affordability, and could potentially include leveraging the tax code to encourage foreign investment and competition.

It’s well known in Ottawa that the Business Council of Canada, whose members are the CEOs of Canada’s largest companies, can’t even get a meeting with Poilievre. Rather than the council’s CEOs, Poilievre has said he’ll gladly meet with the employees and workers of the companies themselves. If that’s not a wake-up call for those who run these companies, I don’t know what is.

And it’s not just corporate interests who are in the crosshairs of voters who want to see change in Ottawa. Federal agencies like Service Canada, Passport Canada, and the CRA are regularly subject to complaints by Canadians who are having trouble receiving basic government services. Voters will expect improvement in how these agencies operate and serve Canadians.

Poilievre’s style, though unorthodox for some and polarizing for the elites that his leadership threatens, underscores his connection to the electorate he works for. The people have had enough. They believe the system doesn’t work for them, they are falling further behind, and they are looking to send a wrecking ball to Ottawa to break down the obstacles to change. Poilievre may not be everyone’s cup of tea, but he’s the choix du jour of millions of Canadians who are dying to send a message to Ottawa and those special interests Ottawa protects.

How would Poilievre harness this desire for change? Let’s take the example of competition reform. Maybe it’s time for increased foreign competition in protected sectors, an approach that could and should provide fodder for the next round of USMCA discussions which are slated for July 2026. 

Airlines, airports, telecoms, and banks will have to go beyond proposing the removal of gatekeepers and taxes to improve service and lower costs. The ultimate lever that any prime minister can use to force business action is through competition. Poilievre’s views on the importance of market forces driving behaviour are illustrative of how he might tackle problems that regular Canadians are facing relating to travel, cell phone bills, or their mortgage.

The carrot of increased access to the Canadian market for U.S. firms could be an opportunity for Canada to resolve some very big, long-standing issues with our American neighbours. Imagine inking a long-term deal with the White House and Congress on softwood lumber access for Canadian firms on the back of introducing U.S.-based competition in our domestic telecom sector. Governing is about trade-offs, and that hypothetical example is a trade-off that exhibits the kind of bold thinking Poilievre ought to embrace in the service of working-class Canadians. 

Whether the Conservatives can win an election is still up to the will of voters. Recent party leaders have missed scoring into an open net, so anything is possible. But should Poilievre win, he’s been very clear about who he’ll be governing for: those Main Street Canadians who have too often been forgotten and left behind.