‘No patient care should be affected by their ability to pay’: Canadian Medical Association president

The health care system has changed “tremendously” during more than three decades that Saint John-based oncologist Dr. Margot Burnell has practiced medicine.

For example, the number of available cancer treatments has multiplied, while doctors have transitioned from a one-size-fits-all model to a more personalized style of care.

On the other hand, the way that people receive their health care information has also changed, and not necessarily for the better. “There’s increased spread of misinformation, disinformation.”

As president of the Canadian Medical Association, Dr. Burnell is now warning about legislation from Alberta that will expand the role of private health care in that province.

Public health care advocates argue that those kinds of changes could undermine Medicare across the country.

It’s one change that Dr. Burnell doesn’t want to witness. “No patient care should be affected by their ability to pay,” she told the NB Media Co-op.

Premier Danielle Smith’s United Conservative Party government passed the amendments into law in December, making Alberta the first province to permit “dual practice” in which doctors can work in the public and private systems simultaneously.

In other words, a new category of “flexibly participating physicians” will be allowed to bill some patients privately, while continuing to bill the public medicare system for other patients.

Critics argue that the system violates the Canada Health Act, which establishes certain criteria that provincial health plans must respect — notably universality and accessibility — in order to receive full funding through the Canada Health Transfer.

In an open letter, public health care advocates including the NB Health Coalition have called on Ottawa to conduct a formal review of Bill 11.

They also urged the Carney government to “use the full range of federal tools available, including discretionary penalties permitted under the [Canada Health Act].”

The Alberta government has argued that dual practice is consistent with the Canada Health Act and that changes under Bill 11 will shorten wait times.

Dr. Burnell says the opposite is true.

“This plan would take resources away from the public system and create a private option that only some people could afford,” she said during a news conference in Ottawa recently, alongside representatives of groups including the Canadian Health Coalition and Canadian Doctors for Medicare.

“That would mean longer waits, fewer available doctors, and more strain on the public system.”

In an interview, she added that the public system would end up serving patients with more complex medical needs.

Demonstrations took place in a dozen cities across the country on Monday as part of a Day of Action for Public Health Care.

In New Brunswick, the NB Health Coalition announced that it would lobby lawmakers to oppose the Alberta legislation.

“We sent a letter to all Liberal and Conservative federal riding associations and also to each member of the Legislative Assembly,” Coalition co-chair Jean-Claude Basque said in a statement.

“We want them to convince the Carney government to take action to defend the Canada Health Act.”

The two-tier system could result in the “end of Canadian medicare as we know it” if other provinces introduce similar legislation, according to health policy researchers at the Canadian Centre for Policy Alternatives and the Parkland Institute.

They have warned that Bill 11 and other reforms introduced by the Alberta government are likely to attract American investors and insurance companies to the Canadian market.

That’s likely to further erode the public health-care system as American business interests “become entrenched and protected by trade and investment agreements.”

Asked about the potential for that kind of incursion from south of the border into the health care system, Dr. Burnell said: “I think this government and the CMA would advocate for our healthcare sovereignty wherever possible.”

Health Canada responds

A spokesperson for Health Canada said in an emailed statement that “the Government of Canada will always uphold the principles of the Canada Health Act. Medicare is a cornerstone of our national identity and contributes to a robust economy by safeguarding the productivity of our workforce. The federal government is continuing to engage with the Government of Alberta on its new legislation.”

It continued: “The Alberta government remains accountable to its citizens for the delivery of publicly-funded health care for essential, medically necessary care. We will continue to work with provincial and territorial partners to ensure Canadians can access care based on their medical needs, not their ability to pay. ”

The statement didn’t provide any indication that a formal compliance review is in the offing.

What about concerns about U.S. business interests gaining a foothold in the country through the Province of Alberta?

“Canada has put in place explicit exemptions (“reservations”) for health services that protect its publicly funded health care system from obligations under international trade agreements,” the statement said.

“The federal government is committed to maintaining Canada’s flexibility under international trade agreements with respect to health so that governments can continue to design and adapt the health care system in line with Canadian priorities without external constraint.”

This story was updated to include a statement from Health Canada at 11:30 a.m. on March 27, 2026. 

David Gordon Koch is a journalist with the NB Media Co-op based in Moncton. This reporting has been made possible in part by the Government of Canada, via the Local Journalism Initiative.

Editor’s note: NB Media Co-op coordinating editor Tracy Glynn is the national director of projects and operations of the Canadian Health Coalition.