Eighty-six per cent still see universal care based on need, not ability to pay, as a core Canadian value
Nine in 10 Canadians are concerned about the future of public health care.
But Canadians aren’t clamouring for U.S.-style health care privatization. In fact, it’s the opposite. Canadians remain deeply committed to equal access to health care based on need and not wealth.
A new public opinion survey of 1,500 Albertans and 1,500 respondents in the rest of Canada shows that there is strong opposition to the introduction of U.S.-style, two-tier health care by the Alberta government.
That government claims that the public is frustrated with long health care wait times and that greater private-pay options will address these challenges. The survey challenges these claims, yet Alberta is moving forward with large-scale health care privatization.
On Sept. 1, the Alberta government will establish a U.S.-style, two-tier health care system under Bill 11, where physicians and surgeons can work in both the public system and the private-pay market at the same time, charging patients for medically necessary health care, including surgeries and medical imaging.
Alberta’s U.S.-style reforms create a private health insurance market for health care already covered under the public plan, which directly contravenes the Canada Health Act. The Alberta government likens its reforms to “European” health care, but careful analysis shows this is not the case.
The public opinion survey’s most important finding is that Albertans and Canadians are not asking for the system the Alberta government is creating.
- Albertans (86 per cent) overwhelmingly believe that universal health care based on need, not ability to pay, is a core Canadian value.
- 78 per cent of Albertans also strongly believe that public health care can meet the needs of Canadians if governments invest more in it.
- 77 per cent of Albertans and patients disagree that corporations and doctors should have unrestricted ability to charge patients for health care.
Across every area polled, Canadians are concerned about the consequences of Alberta’s Bill 11.
These concerns include higher health care costs (85 per cent), unequal access to health care based on income (83 per cent), the additional cost of private health care insurance (83 per cent), longer wait times in the public health care system (81 per cent), and for-profit companies making money from health care (81 per cent).
This isn’t opposition to privatization just on principle. Across every area polled, Canadians are worried about its practical consequences.
In fact, the survey shows broad opposition to U.S.-style health care across the country, including in Alberta, where the provincial government is pushing these unpopular reforms.
Albertans, like the rest of the country, realize that Alberta’s two-tier reforms will actually make health care a new household expense, driving the cost of living crisis that faces residents across the country.
Instead, the survey shows that people across the country want provincial and federal governments to implement public solutions rooted in the research evidence that has been shown to reduce wait times for everyone.
Some of these solutions include health care workforce expansion (65 per cent for all of Canada and 68 per cent of Albertans), investing more in public health care, even if it requires additional funding (53 per cent across Canada and among 57 per cent of Alberta residents), making better use of public operating rooms and better coordination of specialist referrals.
Canadians are worried about public health care, and they don’t see privatization as the solution. They want public investments and reforms that improve the system for everyone. But by rapidly moving to introduce U.S.-style health care into Canada, through Bill 11, the Alberta provincial government is doing the opposite of what Canadians want.
Alberta’s two-tier legislation should be thrown into the dustbin of history.
Andrew Longhurst is a senior researcher and political economist, with a focus on health policy, at the Canadian Centre for Policy Alternatives
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Letter to the Editor:
**Editor’s note:** Quebec offers an important real-world test of the arguments being made about Alberta’s move toward two-tier health care. Its experience suggests the issue is more complicated than a choice between Canadian medicare and a U.S.-style system.
Quebec already operates a form of two-tier health care, with a substantial private-pay medical sector alongside universal public health insurance. Physicians can practise within the Régie de l’assurance maladie du Québec (RAMQ) system or outside it. Non-participating physicians set their own fees, charge patients directly and are not reimbursed by RAMQ.
That matters because Quebec shows that private-pay medicine can exist alongside universal public insurance. A private tier does not, by itself, turn a provincial health system into the American model or end publicly insured access to medically necessary care.
Quebec also complicates the argument that allowing a private market for health care necessarily contravenes the Canada Health Act. The act does not prohibit private health care simply because a provider operates privately. It requires provinces to cover medically necessary insured services and prohibits extra-billing and user charges for insured services. Ottawa has deducted money from Quebec’s federal health transfers over prohibited patient charges, not simply because Quebec has a private medical sector.
But Quebec’s experience also provides a warning for Alberta.
Private care has not made Quebec’s public waiting lists disappear. More importantly, private practice has grown enough that Quebec has become concerned about doctors leaving the public system. In 2025, the province tightened the rules, requiring doctors to get permission before leaving the public plan and generally requiring newly licensed physicians to spend their first five years in the public system.
That gives weight to one of the strongest concerns raised in this column: public and private systems ultimately draw from the same pool of doctors.
It also shows why the consequences of two-tier care should be demonstrated rather than assumed. Simply calling Bill 11 “two-tier” or “U.S.-style” does not tell us what it will do to Alberta health care.
Alberta does not need to prove that private medicine can exist alongside universal public insurance. Quebec already shows that it can. Alberta needs to show that its particular model can give patients another option without pulling so many doctors and so much capacity toward private care that the public system gets worse.
Critics of Bill 11 face a test as well. It is not enough to point to a private tier as evidence that universal medicare is being dismantled. They need to show that Alberta’s model will produce the consequences they predict: fewer doctors available to public patients, longer public wait times, higher costs or access increasingly determined by ability to pay.
Quebec cannot tell us what will happen in Alberta. But it does tell us what to watch.
If Alberta can expand patient choice without weakening care for people who cannot afford to pay, Bill 11 will have answered one of its strongest criticisms. If doctors and capacity move toward private patients while everyone else waits longer, its critics will have been proved right.
That is a more useful test than whether we call the system public, private or two-tier.
Dana Wilson