Canada's Transit Crisis: A Hidden Barrier to Healthcare Innovation

TORONTO, ON – December 04, 2025

As Canada embarks on one of the most significant infrastructure expansions in its history, a stark warning has emerged from the heart of the transit construction industry. The Transit Rail Association for Canadian Construction Standards (TRACCS) recently issued an urgent call for a national framework to govern passenger rail, revealing a system plagued by staggering costs and debilitating delays. While headlines focus on the eye-watering price tags—up to $1.2 billion per kilometer—the true disruption extends far beyond the tracks. This crisis in public works is not merely about transportation; it's a systemic failure that directly impacts the resilience, accessibility, and financial stability of our most critical public service: healthcare.

A System Off the Rails: The Staggering Cost of Inefficiency

The numbers are nothing short of alarming. According to data from the NYU Marron Institute, Canadian rail projects can cost up to four times more than similar builds in European nations, which average around $250 million per kilometer. The problem, as TRACCS Chairperson Mark Salsberg points out, isn't a lack of funding, but a profound lack of efficiency. "Canada spends up to 50 per cent of every rail dollar on planning, management, and advisory costs, while the global benchmark is closer to 20 per cent," Salsberg stated. "It's not sustainable. There's no reason our taxpayers should pay four times more than other countries."

This inefficiency is not an abstract concept; it is written in the concrete and steel of projects across the country. Toronto's Eglinton Crosstown LRT, once slated for a 2020 opening, is now years behind schedule with its budget swelling from $8.2 billion to over $12.8 billion. In Montreal, the Réseau express métropolitain (REM) has seen its costs balloon by billions, with its full commissioning pushed back by years. Similarly, Ottawa's LRT has been hobbled by operational failures, while the projected cost of Toronto's new Ontario Line has skyrocketed, making it one of the most expensive transit projects in North America on a per-kilometer basis.

The common thread is a delivery model that TRACCS describes as "overly bureaucratic." Fragmented oversight across federal, provincial, and municipal levels, coupled with inconsistent standards and redundant approval processes, creates a quagmire of indecision. Decisions that should take weeks stretch into months or years, all while the meter runs for taxpayers.

The Unseen Toll: How Infrastructure Failure Undermines Public Health

For those of us focused on the future of healthcare, this infrastructure crisis should set off alarm bells. The connection is direct and deeply concerning. Reliable public transit is a cornerstone of healthcare access. When transit projects are delayed or cancelled, it is patients who cannot get to their appointments and essential healthcare workers who face grueling, unreliable commutes. This creates tangible barriers to care, exacerbating health inequities for vulnerable populations who depend on public transport.

Beyond direct access, the colossal waste of public funds represents a massive opportunity cost for the healthcare sector. The nearly $5 billion cost overrun on the Eglinton Crosstown alone could have funded the construction of multiple state-of-the-art hospitals. The billions more lost to inefficiency on other projects could have been invested in digital health platforms, advanced medical research, or programs to address critical staffing shortages. Every dollar misspent on redundant administrative layers for a subway line is a dollar that cannot be used to purchase an MRI machine, fund a public health initiative, or improve long-term care.

Furthermore, a robust and efficient transit network is a critical component of a resilient healthcare system. During a public health emergency, the ability to move personnel, patients, and supplies swiftly and reliably is paramount. A fragile, incomplete, and overburdened transit system compromises a city's ability to respond effectively, leaving its entire population more vulnerable.

A Tale of Two Systems: Lessons from the Fast Track

The Canadian experience stands in stark contrast to international models of success. TRACCS highlights countries like Spain, France, and Japan, which operate under clear national frameworks that foster efficiency and predictability. Spain, for instance, has built Europe’s largest high-speed rail network at a fraction of the cost seen elsewhere. Its success is built on a national consensus, standardized designs that prevent the costly reinvention of the wheel for each project, and a focus on the entire infrastructure lifecycle.

These countries cultivate in-house expertise within their public agencies, ensuring knowledge is retained and applied consistently. Canada, conversely, has increasingly relied on a fragmented model of public-private partnerships (P3s) and external consultants. While intended to transfer risk, this approach has often led to a delegation of core expertise, creating adversarial relationships and complex legal disputes that drive up both costs and timelines, as seen in the ongoing conflicts surrounding the Eglinton Crosstown project.

A National Prescription: TRACCS's Four Pillars for a Cure

To break this cycle of waste and delay, TRACCS has proposed a National Framework for Passenger Rail Delivery built on four key pillars: Standards, Training, Procurement Reform, and Competency Development. This is not just a plan for building railways; it is a prescription for curing a systemic ailment in how Canada manages large-scale public works.

Establishing clear, consistent national Standards would eliminate the bespoke, and often over-engineered, designs that plague Canadian projects. Modernizing Procurement would attack the bloated overhead and simplify the contracting systems that invite inefficiency. Investing in Training and Competency Development, exemplified by the Toronto Transit Commission's award-winning Hands On Training Centre (HOTC), ensures the workforce has the verified skills to build and maintain these complex systems safely and effectively.

These pillars represent a shift in philosophy—from simply spending more money to investing in the systems, standards, and people that enable us to build smarter. The principles are directly transferable to other complex sectors, including healthcare, where standardized electronic health records, streamlined procurement for medical supplies, and continuous workforce training are essential for building a more efficient and patient-centered system. If we want a future where innovation thrives and essential services are both accessible and sustainable, we must first get the fundamentals of our public infrastructure right.