From national budget visions to provincial fault lines, Canada’s healthcare systems are at a tipping point. This week, bold policy ideas collided with harsh realities, laying bare the urgency for systemic reform as governments, experts, and healthcare workers grapple with surging demand, stalled innovation, and a growing crisis in care.
Budget Ideas Collide
The Alternative Federal Budget 2026, released by the Canadian Centre for Policy Alternatives, laid out a sweeping vision for a stronger, more equitable healthcare system. It called for expanding pharmacare and dental coverage, capping agency nurse use, boosting mental health spending to 12% of total health funding, and transforming long-term and childcare systems through public, non-profit models.
The report underscored the collaboration of health professionals, unions, and universities, including the Canadian Mental Health Association and Canadian Health Coalition, to advance equitable, accessible, and sustainable public healthcare. It proposed $75 million over three years to establish an Office of Health Equity, strengthen data-driven policy, and introduce a federal Quality of Life Act to improve national health reporting and reduce disparities. To enhance seniors’ care, the plan commits $18.1 billion over three years for 115 million additional direct care hours, $2.55 billion for housing and facility upgrades, and $9 million annually to support the seniors’ care workforce.
It also advocated for prison reform through $100 million in annual funding for addiction treatment, mental health services, and community rehabilitation, aiming to reduce the prison population by 30% by 2035. Finally, it urged $349.2 billion in investments over seven years to close the First Nations infrastructure gap, ensure access to clean water, housing, and healthcare, and uphold reconciliation through self-governed funding frameworks rather than the One Canadian Economy Act.
But while Canada debates systemic reform, pharmaceutical giants and U.S. regulators are moving fast in a different direction. As U.S. drug pricing negotiations and tariffs intensify under President Trump, experts argued that while revising the U.S. regulatory framework could help, further policies are needed, such as state laws allowing pharmacist substitutions and policies to address payer strategies that limit competition. Additionally, educating clinicians and expanding Medicare’s price negotiations could also improve biosimilar market dynamics and drug affordability.
Following policy changes from the Trump administration, pharmaceutical companies like Johnson & Johnson and Novartis have navigated tariff threats and manufacturing investments to align with U.S. priorities. J&J CEO Joaquin Duato confirmed the company’s investment in U.S. manufacturing to avoid tariffs, while Novartis’ Vas Narasimhan argued for addressing underlying issues beyond the “Most Favoured Nation” framework in drug pricing negotiations.
In an interview, Luca Maini from Harvard Medical School discussed the implications of U.S. policies, like drug pricing and tariffs, on patients and health systems, emphasizing transparency and informed policy-making. Proposed changes in U.S. negotiations resemble European practices but lack explicit regulatory frameworks, leaving many questions about impact and cost savings unanswered.
The gap between progressive health policy proposals and global pharmaceutical pressures remains stark, raising critical questions about what’s politically feasible in Budget 2025 and beyond.
Universal Pharmacare Meets a System in Crisis
According to a Toronto Star report, Dr. Eric Hoskins, who chaired the 2019 Federal Advisory Council on Pharmacare, called on Prime Minister Mark Carney to treat universal pharmacare as a “nation-building” project, arguing that it would unlock labour mobility, end employer-based benefit “job lock,” and align with Carney’s focus on inclusive growth.
Six years ago, Hoskins issued a landmark report urging the country to adopt a universal, publicly funded drug coverage system. This concept gained renewed attention as Carney has elevated the term “nation-building” to a key political focus.
But while national leaders weigh long-term reforms, provincial healthcare systems are already showing signs of collapse. In Alberta, emergency departments are operating beyond capacity, with frontline staff warning of “pure chaos” as hospitals exceed 100% occupancy. Health experts blame the government’s structural overhaul of Alberta Health Services, splitting it into four regional pillars, and declining immunization rates for worsening the strain heading into winter.
In British Columbia, legislators used the fall session to flag deepening pressures on healthcare delivery, citing overworked providers and pending reforms. Legislators argue on the critical shortage and crisis in ob-gyn services in Kamloops, demanding for policy reforms beneficial to physicians.
Quebec’s Performance Pay Law Triggers Doctor Exodus
In a dramatic week for Quebec healthcare,
The Quebec government passed a law under gag order imposing a new performance-based pay system for doctors, banning collective pressure tactics, and introducing a monitoring system with financial penalties ranging from $200 for individuals to $500,000 for groups.
The law allows Health Minister Christian Dubé to extend or amend agreements with medical federations until 2028, delays full patient coverage targets to January 1, 2027, links part of physician pay to collective performance targets, freezes overall salary envelopes until 2028, allocates $150 million annually to support doctors, establishes government-appointed monitors, and includes protections for doctors aged 63 and over.
The law has triggered intense backlash. Many doctors are considering leaving the province, retiring early, or relocating to regions like Ottawa due to performance-linked pay and penalties for concerted actions, raising concerns about shortages and orphaned patients, particularly in smaller communities and Western Quebec.
Liberal leader Pablo Rodriguez urged doctors to stay, warning that the CAQ’s special law risks worsening doctor shortages, promising to repeal it if his party takes power in 2026, and proposing decentralization of the health system with reopening of equipped CLSCs.
Québec solidaire condemned the CAQ for forcing adoption of the physician remuneration bill under a gag order, calling it undemocratic, ineffective for patients, and subject to cabinet-determined regulations.
The Fédération des médecins omnipraticiens du Québec (FMOQ) denounced Bill 2 as authoritarian, warning it threatens the motivation, stability, and appeal of family medicine and pledging to challenge it in court, while Quebec medical students claimed the law wasted their internship training and may drive future doctors to study or work outside the province.
The Provincial Association of User Committees (RPCU) welcomed the adoption of the law, noting that while positive effects for patients will take time to materialize, the measure is essential for ensuring rapid care for vulnerable clients, particularly during evenings and weekends.
Quebec doctors expressed deep dismay, with some reportedly in tears, and former Health Minister Gaétan Barrette described the law as extreme, pre-planned, and unprecedented in Canada.
The Canadian Medical Association warned that Bill 2 could harm physician motivation, worsen access to care, and prompt early retirements or departures, calling for dialogue and independent arbitration to stabilize the health system.
Within days, Ontario Premier Doug Ford invited Quebec doctors unhappy with the new performance-based pay law, Bill 2, to “call” him and move to Ontario, saying the province would “roll out the red carpet.” New Brunswick Premier Susan Holt joined in courting Quebec physicians, prompting more than 100 to apply for licences in Ontario and New Brunswick.
Quebec Premier François Legault condemned Ford’s recruitment remarks as “totally unacceptable” and a lack of judgment, while Health Minister Christian Dubé urged doctors to stay, learn more about the legislation, and await negotiations. Opposition leaders Pablo Rodriguez and Pascal Paradis also encouraged doctors not to leave, and both of Quebec’s medical federations are preparing legal challenges against the law.
Dubé published an open letter defending Bill 2 as a modernization of doctor pay that links part of remuneration to performance goals and teamwork, aiming for fair compensation, better work–life balance, and improved healthcare access rather than cuts.
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