To the Point for the Week of June 29, 2025
To the Point for the Week of June 29, 2025
Before diving into this week’s To the Point topics, we want to extend our sincere thanks for making this newsletter such a success. We hope you enjoy reading it as much as we enjoy putting it together.
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Now, let’s get into this week’s edition:
The Ontario government follows through on its commitment to expand publicly funded, privately delivered care, but at what cost and is it enough? Did the federal government overplay its hand during trade negotiations?
ONTARIO
Scanning the Government’s Expansion of Publicly Funded Private Care
Ontario's MRI/CT/GI Licensing Initiative: Balancing Access and Accountability
Make no bones about it, the Ford government is dug in on publicly funded, privately delivered healthcare in Ontario. On Wednesday, Ontario's Health Minister, Sylvia Jones, issued a call for applications for clinics to perform orthopedic surgeries outside of hospitals that is part three of the government's pledge to expand publicly funded but privately delivered medical procedures outlined under the Integrated Community Health Services Act, 2023 (ICHSA).
The Minister announced the province is spending $125M over two years to add up to 20,000 orthopaedic surgeries in Integrated Community Health Service Centres (formerly known as an Independent Health Facility, because why not make the name longer?). The objective is to reduce the wait times for hip and knee replacements to meet the “clinically-recommended” timeframe for 90% of Ontarians.
The first and second part of the government's expansion of services under ICHSA was a call for applications announced in June 2024 for MRI/CT scans and a subsequent call for applications for gastrointestinal endoscopy in August 2024. The process culminated in the awarding of licenses to a total of 57 clinics. Thirty-five licenses for MRI/CT and 22 for endoscopy scans, to the tune of $155M over two years. The objective is to connect an additional 1.2M Ontarians to more diagnostic scans.
The 35 new MRI/CT centres are expected to add roughly 400,000 additional scans annually, which would be a 41% increase in capacity. However, this must be measured against Ontario's ambitious target of reducing wait times to 28 days for all regions. Currently, patients wait an average of 16.2 weeks for MRI scans and 8.1 weeks for CT scans, requiring a 75% reduction in MRI wait times to meet the government's targets.
The shift toward private delivery has predictably generated considerable debate among stakeholders. Healthcare unions representing 295,000 workers argue that private clinics create system inefficiencies by drawing staff away from public hospitals while focusing on less complex procedures.
The results of privatization's impact remain mixed, with success appearing to depend more on design and oversight than privatization itself. The track record on similar initiatives provides important context—data shows mixed results from Ontario's expansion of private cataract surgery clinics, with only 66% of surgeries performed on time in 2024, down from 72% in 2020. At the same time, Ontario maintains the shortest total wait times in Canada for medical procedures at 23.6 weeks, compared to the national average of 30 weeks.
Some stakeholders are pointing out that the intent was directionally correct and that we should better align with a mix of privately and public service delivery, but that they were deeply disappointed with the number of licenses awarded. The government has not released a list of license recipients, making it hard to ascertain what criteria may have been weighted heavily ahead of the newest call to orthopedic applications.
Looking ahead, success will ultimately be measured by the province’s ability to deliver on three key promises: reducing wait times to 28 days across all regions, maintaining quality standards, and ensuring equitable access without illegal billing practices.
There remains a third rail in healthcare that Ontario, and Canadians broadly, seem unwilling to touch, and Ontario voters will ultimately judge whether this approach delivers better access when they need it most.
FEDERAL
A Deal Undone by Digital Ambitions
Weeks ago, it appeared the Prime Minister would deliver on his signature campaign pledge: secure a bilateral trade and security agreement with the United States. Reports indicated that terms of a deal had been exchanged, with Carney and Trump holding regular direct talks. The July 21st deadline to lock in a deal seemed promising. Then, on June 27th, President Trump took to Truth Social: “We are hereby terminating ALL discussions on Trade with Canada, effective immediately,” the President announced. The reason? The Digital Service Tax (DST) passed by the Trudeau government in June 2024, set to begin retroactive collection this past Monday, June 30th. In response, both the Prime Minister and Finance Minister issued statements announcing they rescinded the tax.
The DST is a three percent tax on revenue earned from certain digital services provided to Canadian users, primarily targeting large tech companies, both foreign and domestic, with global revenues of at least $1.1B CAD (~$803M USD) and more than $20M CAD in Canadian digital revenue. Unlike the GST/HST, the DST is not a sales tax, but a levy on revenue earned by tech firms from Canadians. The tax directly targeted US tech giants like Uber, Google, Airbnb, Apple, and Meta.
Partisan reaction to the tax’s rescinding was predictably polarized. The political left hailed the decision as “4D chess”—a calculated move by a government thinking several steps ahead. The right, meanwhile, lambasted the move, likening it to getting lost in Bisaro Anima or the Rat’s Nest—two of Canada’s most famous, and confusing, caves.
This was less a political blunder than a tactical miscalculation with real political consequences. The government was fully aware that both the Biden and Trump administrations were strongly opposed to the DST, citing it as a discriminatory trade violation that could undermine multilateral tax cooperation and provoke US retaliation. It appears Ottawa held on to the DST as a bargaining chip for too long, and ultimately failed to play it in their favour.
It’s conceivable the government hoped threatening to implement the DST would extract concessions from the US, but timing was critical. President Trump has a track record of following through on tariff threats. Knowing this, the Prime Minister should have offered to scrap the DST at the outset, in exchange for concrete commitments from Trump not to impose new tariffs on steel, aluminum, or autos.
Committing to drop the DST early could have yielded two benefits: avoiding concessions on supply management and reopening global tax cooperation discussions at the OECD, likely an approach the US would have found acceptable. Instead, rescinding the DST abruptly, and under visible pressure, has given Washington leverage. President Trump may now believe he can extract more from Canada while offering less in return. The economic impact for Canadian tech firms, who had already begun preparing for DST compliance, remains unclear, though Shopify’s president posted on X they were pleased it was scrapped, saying “That tax didn’t just hit foreign companies, it placed a ceiling on the success of our own entrepreneurs.”
The abrupt withdrawal of the Digital Service Tax, under pressure from Washington, leaves Canada in a weakened negotiating position and exposes the risks of using contentious policies as bargaining chips without a clear endgame. While the government may have hoped to leverage the DST for trade concessions, the timing and manner of its removal have instead emboldened America to demand more, while offering little clarity on what Canada stands to gain. As the July 21st deadline approaches, the true cost of this tactical gamble, both economically and diplomatically, remains uncertain. What is clear, however, is that Canada’s ability to shape the terms of its most important bilateral relationship may have been diminished, with consequences that could extend well beyond this round of negotiations.
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To the Point – ONpoint Strategy Group's weekly roundup – cuts through the noise to deliver insight and analysis of key federal, provincial, and municipal stories shaping Canada's policy and political landscape. Designed for decision-makers and thought leaders, this newsletter is your go-to resource for staying ahead. Share these trusted insights with your network to spark meaningful conversations. Simply hit forward or follow ONpoint Strategy Group on X and LinkedIn to spread these valuable perspectives."
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ONpoint Strategy Group is all about helping clients make an impact where it counts. Specializing in government relations and strategic execution, our team—Nico Fidani-Diker, Mariana Di Rezze, Krystle Caputo, David Morgado, Christopher Mourtos, Ellen Gouchman, and Brandon Falcone—works closely with clients to navigate complex political landscapes and bring their goals to life. With a practical, results-driven approach, we build strong relationships, craft winning strategies, and make sure every step brings clients closer to meaningful outcomes. We’re passionate about making sure our clients are heard, supported, and positioned for success.
