by Nikolas Barry-Shaw & Saima Desai
On a 2021 podcast, the Alberta premier wondered aloud if privatizing health care would require breaking federal law. Despite learning the answer was ‘yes,’ she’s still going ahead with it.
Five years ago, Alberta Premier Danielle Smith was already gaming out how to dismantle public medicare, discussing how to get the federal government “out of the business of health care.”
In an episode of a podcast she hosted in 2021 for right-wing think tank the Fraser Institute, she mused about how she could build a parallel for-profit system—even if it involved breaking Canada’s foundational health care laws.
“You can tell me if our starting point needs to be throwing out the Canada Health Act,” she told her guest, the Fraser Institute’s senior fellow on health policy Nadeem Esmail.
The Canada Health Act ensures Canadians can access medically-necessary services for free, and provinces must abide by it to receive billions in federal transfer payments for health care.
At the time, Smith was working as a lobbyist on behalf of private health-care firms, hoping to convince policy-makers to embrace a “free enterprise approach” to delivering care.
Esmail explained to Smith that the Canada Health Act makes it illegal for provinces to let private insurers cover publicly-insured health care.
“Okay, that’s good to know,” Smith said.
But five years on, she is on track to do exactly that with Bill 11, pushing new legislation as Alberta premier to end Canadian medicare as we know it.
An independent legal opinion issued last week by a major law firm said Smith’s legislation “clearly violates” the Health Act.
Yet Mark Carney’s federal government has not intervened, despite pleas for months from health organizations, labour unions, and the NDP to use its powers, including financial penalties, to stop Alberta.
Smith: ‘Canada Health Act prevents us from moving in the direction’ of United States
In April, federal Health Minister Marjorie Michel said that Alberta’s health minister had assured her that the province would follow the Health Act while developing new regulations under Bill 11.
But that’s not what is happening.
A review by law firm Goldblatt Partners, which was commissioned by the Canada Health Coalition, concluded that Smith’s legislation breaks the Health Act because it lets people pay privately for faster care and allows doctors to give priority to higher-paying patients, making all other Albertans wait longer.
“Minister Michel needs to step up right away,” Steven Staples, director of policy and advocacy for the Canadian Health Coalition, told The Breach. “There is nothing that will be done in the regulations that will fix Bill 11. If she waits for the regulations to be implemented, it may be too late because they will be virtually impossible to reverse.”
It was precisely to prevent such privatization at the provincial level and guarantee national standards that the federal government passed the Canada Health Act in 1984.
Under the Health Act, any province that violates its principles should have its federal funding clawed back.
Alberta receives $6.6 billion per year in federal health transfers, over a quarter of the province’s health budget.
To Smith and the Fraser Institute’s Esmail back in 2021, the federal government’s high standards for public health care were an obstacle to establishing a profit-motivated system.
“The Canada Health Act prevents us from moving in the direction of some of the more successful universal systems,” Smith complained.
One of the “successful systems” she was talking about is the U.S.’s two-tier health-care model.
“There is some incredible care down there and some incredible knowledge,” Esmail told Smith, “and wouldn’t it be wonderful if we had the opportunity to access some of that in this country?”
But decades of research has found that in the U.S., health care is far more expensive—both for individuals and for the government—than anywhere else in the world, while delivering the worst overall health outcomes of any high-income country.
To move toward a U.S.-style system, Esmail had a proposal: “having the federal government get out of the business of health care.”
Smith chimed in that she “totally agrees.”
“Anyone who wants to create a two-tier, U.S.-style health-care system in Canada would be opposed to the Canada Health Act,” said Staples from the Canada Health Coalition, “because that’s exactly the kind of unfair, inefficient, and uncaring approach the Act is intended to prevent.”
Today, as Smith undermines Canada’s public health law, Ottawa has fallen silent.
When pressed in the House of Commons by the NDP’s health critic about enforcing the Canada Health Act back in February, federal Health Minister Marjorie Michel would only say that the ministry’s legal services were looking into Bill 11.
Three months later, she still hasn’t said whether Smith’s moves break the Health Act.
“Our government will always defend Canada’s universal health care system,” a spokesperson for the federal Health Minister told The Breach. He said the federal government would “closely assess the regulations associated with the bill.”
Since taking office, however, the Carney government has broken one promise after another on the health-care file.
Health Canada saw its funding chopped by $1.3 billion in the 2025 budget. The federal government has stopped negotiating any new pharmacare agreements with provinces.
While the federal government hangs back on enforcing the Health Act, Alberta’s privatization risks spreading across Canada.
It all means Smith is eyeing the success of a scheme, five years after she telegraphed it, to destroy the basic principles of universal health care in Canada.
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