Why health spending funds aviation over infrastructure

Sir Richard Branson famously said, “If you want to be a millionaire, start with a billion dollars and launch a new airline.” It is a notoriously brutal business model.

Just look at the headlines. Canadian carriers like Lynx Air and Canada Jetlines have completely collapsed, while American budget giants like Spirit Airlines are filing for bankruptcy.

Running an airline is an incredibly efficient way to burn through cash. Yet, looking at health-care spending, it appears to be standard operating procedure in Manitoba.

We did not set out to launch an airline, but we are certainly funding one.

Under the Non-Insured Health Benefits program — the federal system that funds health coverage for eligible First Nations and Inuit Canadians — Manitoba’s medical transportation spending surged from $168.7 million in 2019-20 to a staggering $261.4 million in 2023-24.

Air transportation alone accounted for $154.6 million of that bill. As a result, Manitoba now carries the highest regional medical transportation total in the entire country.

To put $154.6 million into perspective, you can launch a brand-new regional commercial airline from scratch for under $100 million.

But we aren’t even running a good airline.

We are funding a disjointed travel network that forces First Nations and Inuit patients to endure gruelling delays, cultural isolation and hundreds of kilometres of travel just to access basic assessments.

We are paying massive premiums for the mechanical work of moving people because the system has severely under-invested in the meaningful work of treating Indigenous patients in their own communities.

Imagine attempting to run both a health-care system and an aviation network and failing to be efficient at either.

Nationally, Canada is projected to spend $399 billion on health care in 2025. The fundamental crisis threatening our system is clearly not a lack of money. The issue is what we decide to buy.

Our reliance on aviation is not an accident; it is the predictable result of a fragmented system.

In health policy, this phenomenon is “institutional risk-shifting.” The federal office that pays for the aircraft does not influence the provincial budget for the local clinic, the community infrastructure or the road.

Because no single department feels the full weight of these disjointed costs, authorizing an emergency helicopter flight has become administratively simpler than building robust, permanent health capacity in northern and Indigenous communities.

This approach treats community health infrastructure as a sunk cost, when it must be viewed as a high-yield investment.

When we invest comprehensively in a community — by upgrading local nursing stations, expanding broadband for virtual specialist consultations and building permanent diagnostic hubs on-reserve — the return on investment is immediate. It manifests directly as plummeting transportation costs.

Instead of treating local capacity as temporary “pilots,” we need to recognize that every dollar spent building community infrastructure pays dividends by keeping patients off expensive, unnecessary flights.

Paying an air ambulance invoice is absolutely necessary in a true, life-threatening emergency.

But treating aviation as a default strategy for delivering everyday care is a massive failure of public policy that disproportionately burdens Indigenous patients.

If we are going to spend $150 million a year on planes, we should at least get a decent airline. But health care isn’t aviation.

The most economical, humane and efficient way to care for northern Manitobans is not to put them in the sky.

It is to build the community infrastructure required to keep them safely on the ground.

Dr. Rafiq Andani is a physician and health policy expert who has practised across rural, remote and urban Manitoba, including work in First Nations and Inuit communities. He has served as the Associate Chief Medical Officer for Shared Health Manitoba and as a medical consultant to the First Nations and Inuit Health Branch.