08/02/2026
This piece from Simon Fraser and University of Toronto Prof. Karen Palmer is a must read, imo. She systematically dismantles Danielle Smith's claim that the changes she is bringing to this province's health care system are "nothing new" and that the Alberta government is following a well-established and successful playbook that has been used in Europe and Japan for years.
Professor Palmer exposes that claim for what it is: just another in a long line of dishonest, bad faith justifications for privatizing Alberta's health care system.
It's worth noting that Danielle Smith's army of online trolls and bots are ALL OVER this issue on social media: any critique of what Smith is doing to health care is met with accusations of fear-mongering, along with a chorus of now-all-too-familiar retorts: "Europe has done this for years," "it's the Swedish model," "she's just trying to innovate to solve problems - why are you against that?", etc. None of those rejoinders is backed up with evidence or research, of course: they just repeat the lie often enough and trust that it'll start to sound like the truth.
But repeating and reposting bu****it just means more bu****it.
Here's Professor Palmer's piece, with thanks to her and to the Edmonton Journal:
Beginning July 31, Alberta will allow adults to self-refer and pay privately for MRI, CT scans, ultrasounds, and X-rays without a physician’s referral. Alberta’s government defends the policy by pointing to countries like Germany, Switzerland, Japan, and South Korea.
That comparison does not withstand scrutiny.
Alberta is introducing a fundamentally different approach from the systems it invokes. Among OECD countries with universal health care, Alberta is an outlier. The key difference is not whether private-pay imaging exists. It does in some countries. The difference is who decides whether imaging is appropriate and who pays.
In Germany, Switzerland, France, the Netherlands and the Nordic countries, most diagnostic imaging remains a medical service requiring physician authorization. Only a handful of countries with universal health care, including the United Kingdom, Australia, and New Zealand, allow limited forms of consumer-initiated private-pay imaging. Even there, clinical oversight remains the rule. Imaging requests are reviewed by clinicians, especially for CT scans which expose patients to radiation.
Yet, Canada already allows patients to pay for non-insured services, including full-body MRI scans and other “peace-of-mind” tests. If Alberta’s goal was simply to allow healthy people to purchase optional preventive testing that is not medically necessary, no new law or major policy change was required. Alberta has instead created a direct-to-consumer preventive testing system where anyone can purchase diagnostic imaging without first obtaining a medical referral.
That is not Japan’s model either.
Japan’s well-known voluntary ningen dock preventive health checkups, which began in 1954, are comprehensive one- or two-day medical assessments. They include physical exams, vision and hearing tests, lung function tests, blood and urine tests, electrocardiograms, and selected imaging. Advanced imaging, such as MRI or CT, may be offered as an optional component within an organized screening program — not as a stand-alone consumer purchase. Many exams are subsidized by employers, insurers, and municipalities and occur within a co-ordinated clinical framework.
The OECD notes that Japan lacks comprehensive national data demonstrating how frequently these private screening programs are used or their long-term outcomes.
Japan’s health-care capacity bears little resemblance to Alberta’s. Japan has approximately six times as many MRI scanners per capita as Alberta, about 60 machines per million people compared with Alberta’s roughly 10. South Korea has about four times Alberta’s MRI capacity. Those countries also have far greater numbers of imaging technologists and radiologists.
Simply copying one aspect of another country’s system while ignoring the infrastructure supporting it is not a meaningful comparison.
It may also be harmful.
Widespread diagnostic imaging of healthy people has repeatedly raised concerns about over-diagnosis.
South Korea and Japan provide a clear example of this. During the 2000s, thyroid ultrasound was widely incorporated into health-screening packages. Thyroid cancer diagnoses increased approximately 15-fold, while mortality remained essentially unchanged. Researchers concluded that the surge largely reflected over-diagnosis: detecting cancers that would never have caused illness or death.
This is not because the scans were inaccurate. They detected real abnormalities, but many findings never required treatment. Yet once discovered, they triggered additional imaging, biopsies, surgery, anxiety, and expense.
That same risk applies whenever advanced imaging is performed on healthy, low-risk individuals without a clear medical indication. More testing does not automatically produce better health.
The Alberta Medical Association found no evidence that private-pay diagnostic imaging meaningfully reduces wait times in the publicly funded system. Instead, international experience raises concerns about overuse, incidental findings, downstream costs, widening inequities, and competition for scarce health care personnel.
Alberta’s new private-pay-per-scan risks redirecting scarce machines, technologists, and radiologists toward more lucrative preventive exams, leaving patients with genuine medical need waiting longer in the public-pay system. If diagnostic imaging resources increasingly shift to low-value testing, people with suspected serious conditions may eventually feel compelled to pay privately for timely access.
That would transform private-pay scans from an optional service to a pathway for bypassing public-pay waits for medically necessary scans. This would spark mandatory dollar-for-dollar deductions from the federal transfer payments under the Diagnostic Services Policy.
Alberta should stop claiming this policy mirrors Germany, Switzerland, Japan, or South Korea. It does not. Alberta is not following an established international model. It is conducting a policy experiment with well-documented harms and unproven benefits.
Karen S. Palmer is an adjunct professor at Simon Fraser University and the University of Toronto.
