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Fraser Institute

Ottawa’s health-care deal cements failed status quo in Canada

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From the Fraser Institute

By Mackenzie Moir and Jake Fuss

Canada will reach a projected $244.1 billion in 2023, which translates to $6,205 per person—nearly double the level of per-person spending (inflation-adjusted) three decades ago. And yet, last year Canadians endured the longest median wait time (27.7 weeks) ever recorded for non-emergency surgery.

Last week, as part of Ottawa’s promised $46 billion in additional health-care spending, the Trudeau government agreed to increase Quebec’s share of federal health-care dollars by $900 million annually. Quebec was the last province to reach an agreement with Ottawa before the March 31 deadline. With the closure of this agreement, Canadian taxpayers are on the hook for more health-care spending than ever before. For the same old broken health-care system.

Of course, it ultimately doesn’t matter whether the $46 billion originates from Ottawa or the provinces. In the end, Canadian taxpayers foot the bill. And what do we get in return for our health-care dollars?

In 2021, the latest year of comparable data, Canada’s total health-care spending (as a percentage of the economy) was the highest among 29 other comparable countries with universal health care (after adjusting for differences in population age). This isn’t a new development. Canada has a long history of having one of most expensive systems among high-income universal health-care countries.

Despite this, according to the latest comparable data, Canada ranks among the poorest performing universal health-care countries in key areas such as the number of physicians, hospital beds and diagnostic technology (e.g. MRI machines). Further, according to the Commonwealth Fund, in 2020 Canada ranked dead last on timely access to specialist consultations and non-emergency surgery.

Meanwhile, public health-care spending in Canada will reach a projected $244.1 billion in 2023, which translates to $6,205 per person—nearly double the level of per-person spending (inflation-adjusted) three decades ago. And yet, last year Canadians endured the longest median wait time (27.7 weeks) ever recorded for non-emergency surgery.

In short, Canada’s health-care system is in shambles, but the answer does not lie in simply throwing more money in its general direction. Federal politicians should instead look to the example of welfare reform during the Chrétien era in the 1990s. Those reforms, which reduced federal transfers to provinces and eliminated most of the “strings” attached to federal funding, resulted in increased provincial autonomy, greater policy experimentation, fewer Canadians needing welfare and savings for the federal government (i.e. taxpayers).

This is the opposite of today’s approach to health care, where the existing vehicle for federal funding (the Canada Health Transfer) is connected to the Canada Health Act (CHA), which prevents provincial governments from innovating and experimenting in health care by threatening financial penalties for non-compliance with often vaguely defined federal preferences. The result is a stalemate that satisfies no one and ensures that Canada’s policies remain at odds with the policies of our better-performing universal health-care peers.

While new federal dollars for health care are undoubtedly appealing to premiers, they will not improve the state of health care for Canadians. Until our federal politicians have the courage to reform the CHA and follow the example of 1990s welfare reform to improve outcomes, our health-care system’s unacceptable status quo will continue.

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Business

Broken ‘equalization’ program bad for all provinces

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From the Fraser Institute

By Alex Whalen  and Tegan Hill

Back in the summer at a meeting in Halifax, several provincial premiers discussed a lawsuit meant to force the federal government to make changes to Canada’s equalization program. The suit—filed by Newfoundland and Labrador and backed by British Columbia, Saskatchewan and Alberta—effectively argues that the current formula isn’t fair. But while the question of “fairness” can be subjective, its clear the equalization program is broken.

In theory, the program equalizes the ability of provinces to deliver reasonably comparable services at a reasonably comparable level of taxation. Any province’s ability to pay is based on its “fiscal capacity”—that is, its ability to raise revenue.

This year, equalization payments will total a projected $25.3 billion with all provinces except B.C., Alberta and Saskatchewan to receive some money. Whether due to higher incomes, higher employment or other factors, these three provinces have a greater ability to collect government revenue so they will not receive equalization.

However, contrary to the intent of the program, as recently as 2021, equalization program costs increased despite a decline in the fiscal capacity of oil-producing provinces such as Alberta, Saskatchewan, and Newfoundland and Labrador. In other words, the fiscal capacity gap among provinces was shrinking, yet recipient provinces still received a larger equalization payment.

Why? Because a “fixed-growth rule,” introduced by the Harper government in 2009, ensures that payments grow roughly in line with the economy—even if the gap between richer and poorer provinces shrinks. The result? Total equalization payments (before adjusting for inflation) increased by 19 per cent between 2015/16 and 2020/21 despite the gap in fiscal capacities between provinces shrinking during this time.

Moreover, the structure of the equalization program is also causing problems, even for recipient provinces, because it generates strong disincentives to natural resource development and the resulting economic growth because the program “claws back” equalization dollars when provinces raise revenue from natural resource development. Despite some changes to reduce this problem, one study estimated that a recipient province wishing to increase its natural resource revenues by a modest 10 per cent could face up to a 97 per cent claw back in equalization payments.

Put simply, provinces that generally do not receive equalization such as Alberta, B.C. and Saskatchewan have been punished for developing their resources, whereas recipient provinces such as Quebec and in the Maritimes have been rewarded for not developing theirs.

Finally, the current program design also encourages recipient provinces to maintain high personal and business income tax rates. While higher tax rates can reduce the incentive to work, invest and be productive, they also raise the national standard average tax rate, which is used in the equalization allocation formula. Therefore, provinces are incentivized to maintain high and economically damaging tax rates to maximize equalization payments.

Unless premiers push for reforms that will improve economic incentives and contain program costs, all provinces—recipient and non-recipient—will suffer the consequences.

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Alberta

Alberta’s fiscal update projects budget surplus, but fiscal fortunes could quickly turn

Published on

From the Fraser Institute

By Tegan Hill

According to the recent mid-year update tabled Thursday, the Smith government projects a $4.6 billion surplus in 2024/25, up from the $2.9 billion surplus projected just a few months ago. Despite the good news, Premier Smith must reduce spending to avoid budget deficits.

The fiscal update projects resource revenue of $20.3 billion in 2024/25. Today’s relatively high—but very volatile—resource revenue (including oil and gas royalties) is helping finance today’s spending and maintain a balanced budget. But it will not last forever.

For perspective, in just the last decade the Alberta government’s annual resource revenue has been as low as $2.8 billion (2015/16) and as high as $25.2 billion (2022/23).

And while the resource revenue rollercoaster is currently in Alberta’s favor, Finance Minister Nate Horner acknowledges that “risks are on the rise” as oil prices have dropped considerably and forecasters are projecting downward pressure on prices—all of which impacts resource revenue.

In fact, the government’s own estimates show a $1 change in oil prices results in an estimated $630 million revenue swing. So while the Smith government plans to maintain a surplus in 2024/25, a small change in oil prices could quickly plunge Alberta back into deficit. Premier Smith has warned that her government may fall into a budget deficit this fiscal year.

This should come as no surprise. Alberta’s been on the resource revenue rollercoaster for decades. Successive governments have increased spending during the good times of high resource revenue, but failed to rein in spending when resource revenues fell.

Previous research has shown that, in Alberta, a $1 increase in resource revenue is associated with an estimated 56-cent increase in program spending the following fiscal year (on a per-person, inflation-adjusted basis). However, a decline in resource revenue is not similarly associated with a reduction in program spending. This pattern has led to historically high levels of government spending—and budget deficits—even in more recent years.

Consider this: If this fiscal year the Smith government received an average level of resource revenue (based on levels over the last 10 years), it would receive approximately $13,000 per Albertan. Yet the government plans to spend nearly $15,000 per Albertan this fiscal year (after adjusting for inflation). That’s a huge gap of roughly $2,000—and it means the government is continuing to take big risks with the provincial budget.

Of course, if the government falls back into deficit there are implications for everyday Albertans.

When the government runs a deficit, it accumulates debt, which Albertans must pay to service. In 2024/25, the government’s debt interest payments will cost each Albertan nearly $650. That’s largely because, despite running surpluses over the last few years, Albertans are still paying for debt accumulated during the most recent string of deficits from 2008/09 to 2020/21 (excluding 2014/15), which only ended when the government enjoyed an unexpected windfall in resource revenue in 2021/22.

According to Thursday’s mid-year fiscal update, Alberta’s finances continue to be at risk. To avoid deficits, the Smith government should meaningfully reduce spending so that it’s aligned with more reliable, stable levels of revenue.

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