By Harinder Mahil

The province of Alberta has passed a new law that opens the door to a two-tier system which can destroy Canada’s public health care as we know it. The bill was granted royal assent on December 11, 2025.

At present, in every province other than Ontario, doctors must choose to enrol in the publicly funded plan or opt-out entirely and charge patients privately. They are not allowed to work in dual practice as they cannot bill some patients privately and then bill the public system for others.

The Alberta law allows doctors to work simultaneously in the public health care system and bill private patients for the same services delivered more speedily. According to experts, this law will not only mean unequal access based on income but will also increase wait times for those who receive services under the public system.

It is an Americanization of the Canadian health care system.

One major difference between Canada and the US is our health care system. We have a well-established public health care system under which services are provided to all Canadians irrespective of income levels. In the US, healthcare is privatized and controlled by insurance companies that make billions of dollars in profits from people’s misery. Approximately 30 million Americans do have health care coverage.

The dual-practice provisions in the Alberta law means that those who are willing to pay out of their pockets will get to the front of the line while others will be at the back of the line. The resources, which include doctors, nurses and hospitals, will remain the same. The new law will encourage doctors to focus on the more profitable part of the practice and give priority to those willing to pay extra for their services.

The change in law will affect healthcare in other provinces as well. Those doctors who bill individuals directly will make much more income than others. Doctors in other provinces will seek the same kind of system and are likely to succeed in provinces controlled by conservative governments.

Health care costs will increase as is the case in the US because of privatization of health services.

Dr. Malanie Becahrd, Chair of Canadian Doctors for Medicare recently wrote, “The new dual practice in Alberta will create a two-tiered multi-payer system. Dual practice does not address the real problems in health care because it does not involve adding more health care professionals to the system or enable more organized, efficient care.”

Health care costs will increase as is the case in the US because of privatization of health services.

The Canadian Centre for Policy Alternatives (CCPA) issued a report on February 3, 2026 expressing its concerns about the Alberta system. The report stated in part:

The cumulative effect of these reforms—allowing physicians to work in both the public system and private-pay market, encouraging investment in for-profit surgical facilities and hospitals, and building the insurance market for medically necessary health care—is very likely to attract U.S. investment interest…

Canada’s international trade and investment agreements provide limited protection to the entrance of U.S. investors and insurance corporations to the Canadian health care market. Once these corporations enter the Canadian market, they will become entrenched and protected by trade and investment agreements. We will not have U.S.-style health care, we will have U.S. health care.

The federal government can block these changes by enforcing the Canada Health Act. However, it isn’t expected to do so. The other option would be for some health care organizations to launch a court case to force the federal government to enforce the Canada Health Act.

Will prime minister Carney take any steps to enforce federal legislation?

Harinder Mahil is a human rights activist and is secretary of Dr. Hari Sharma Foundation.