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Fraser Institute

Bill Maher is right about Canadian health care

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From the Fraser Institute

By Mackenzie Moir

Recently, popular American comedian and talk show host, Bill Maher, took aim at some of Canada’s public policy failings in one of his monologues. In entertaining fashion, Maher highlighted our high housing costs, unemployment rates and “vaunted” health-care system.

Indeed, citing work published by the Fraser Institute, he explained that after adjusting for age, Canada spends 13.3 per cent of our economy on health care (2020), the highest level of spending by a developed country with universal coverage that year. And that Canada has some of the poorest access to timely appointments with family doctors when compared to our peers.

Unfortunately, while that’s where his segment on health care ended, the bad news for the Canadian system doesn’t stop there.

On top of Canada continuing to be one of the most expensive universal health-care systems in the world, we get little in return when it comes to both available medical resources and wait times. For example, among high-income countries with universal health care, Canada has some of the lowest numbers of physicians, hospital beds, MRI machines and CT scanners.

And in Canada, only 38 per cent of patients report seeing a specialist within four weeks (compared to 69 per cent in the Netherlands) and only 62 per cent report receiving non-emergency surgery within four months (compared to 99 per cent in Germany).

Unfortunately, wait times in Canada aren’t simply long compared to other countries, they’re the longest they’ve ever been. Last year the median wait for a Canadian patient seeking non-emergency care reached 27.7 weeks—nearly three times longer than the 9.3 week-wait Canadians experienced three decades ago.

This raises the obvious question. How do other countries outperform Canada’s health-care system while also often spending less as a share of their economies? In short, their approach to universal health care, and in particular their relationship with the private sector, departs drastically from the approach here at home.

Australia, for example, partners with private hospitals to deliver the majority (58.6 per cent) of all non-emergency surgeries within its universal health-care system. Australia also spends less of its total economy (i.e. GDP) on health care but outperforms Canada on every measure of timely care.

Even with restrictions on the private sector, Canada has some limited experience that should encourage policymakers to embrace greater private-sector involvement. Saskatchewan, for example, contracted with private surgical clinics starting in 2010 to deliver publicly-funded services as part of a four-year initiative to reduce wait times, which were among the longest in the country. Between 2010 and 2014, wait times in the province fell from 26.5 weeks to 14.2 weeks. After the initiative ended, the province’s wait times began to grow.

More recently, Quebec, which has some of the shortest wait times for medical services in the country, contracts out one out of every six day-surgeries to private clinics within the publicly-funded health-care system.

Maher’s monologue, which was viewed by millions online, highlighted the key failings of Canada’s health-care system. If policymakers in Ottawa and the provinces want to fix Canadian health care, they must learn from other countries that deliver universal health-care at the same or even lower cost, often with better access and results for patients.

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Economy

With no will for political union, Canada should consider economic union with the U.S.

Published on

From the Fraser Institute

By Cornelis “Kees” van Kooten

According to an announcement on Friday by White House press secretary Karoline Leavitt, President Dondald Trump will implement a 25 per cent tariff on Canada and Mexico (and a 10 per cent tariff on China) beginning Saturday, Feb. 1.

Over the last few weeks, Canadian policymakers have been rather naïve in responding to Trump’s tariffs threats. They seem not to have figured out what Trump really wants (although perhaps no one knows what he really wants). But the Canadian side has focused on retaliatory measures, lobbying to ensure certain industries are exempt, and an advertising campaign to get consumers to prefer Canadian products—a “Made in Canada” preference.

It’s also been proposed that by lowering trade barriers between provinces, the Canadian economy can offset a trade war with the United States. But this raises the question—why hasn’t this already been done if it leads to such great benefit?

It’s clear that Canadians don’t want to be part of the U.S. However, given Canada’s dependency on the U.S. economy, Canada’s lagging productivity, the inefficiency of separate currencies, and the effect of changes in the Canadian-U.S. exchange rate on prices in Canada, it’s surprising that some kind of economic union with the U.S. is not being considered or even discussed. Or at least it does not appear to be something that politicians north of the border consider.

The post-war European enterprise can serve as a model for how Canada might approach the U.S. In Europe, the Germans remain German, the French remain French and the Dutch remain Dutch. This, despite the fact that the European enterprise has gone well beyond that of economic union. The Maastricht Treaty (1992) created the European Union (EU) by combining the three European Communities—the European Atomic Energy Community, the European Coal and Steel Community and the European Economic Community—into a single entity. While it set the stage for a single currency (the Euro), the Treaty was seen as a first step toward an eventual political union. While the EU has taken large steps toward political union, the enterprise is not going as well as envisioned. The United Kingdom left the EU principally because it did not want to take orders from Brussels. The U.K. was interested in an economic union, but not political union.

The lesson for Canada is clear—we do not want political union, but should be open to economic union with the U.S. This would essentially mean two things. First, eliminating the border with respect to trade in goods and services, and free movement of investment capital. Whether this would include labour would need to be addressed, although economists would argue that, from an efficiency point of view, it should. As a blueprint, one might begin with what’s referred to in Europe as the Schengen Area, which is a group of EU countries that have eliminated all internal border controls and established common entry and exist requirements. This would require that the effective border protects both Canada and the U.S. simultaneously—the northern U.S. border moves to the Pacific, Arctic and Atlantic oceans. If a person qualifies to come to Canada, they automatically qualify to come into the U.S. and vice versa.

Second, monetary union under those circumstances makes a lot of sense. It would be simple to implement. For example, we might say that one Canadian dollar is on par with one U.S. dollar, or that it’s equal to US0.85 or 0.90. The exact value is less important as wages and other costs will adjust with increases in Canadian productivity that will then lead to increases in wages.

Finally, Trump insists that Canada commit 2 per cent of its GDP to defence. I would argue that, given a willingness to negotiate an economic union, and a commitment to increase defence spending to meet the 2 per cent target by 2030, would be sufficient to remove the Trumpian tariffs.

By agreeing to negotiate an economic union, Canada may convince the Trump administration to remove the tariffs. If an economic union were a threat to Canada’s viability, to our Dominion, then we do not deserve to be Canadian. I would venture that our national identity vis-à-vis the U.S. is strong enough to survive an economic union.

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Cornelis “Kees” van Kooten

Professor of Economics, University of Victoria
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Alberta

Alberta government should rely on dividends—not ‘political will’—to grow Heritage Fund

Published on

From the Fraser Institute

By Tegan Hill

The Smith government on Wednesday released its plan to grow Alberta’s Heritage Fund to at least $250 billion over the next 25 years, mainly by reinvesting all investment returns back into the fund. But even Smith recognizes her plan will “take political will over a long period of time.” Of course, political will is subjective and can change from government to government. If Smith wants to establish a sustainable plan to grow the Heritage Fund, it should pay dividends to Albertans.

First, some quick history. When the Alberta government created the Heritage Fund in 1976, it established a rule that the government must deposit 30 per cent of resource revenue (including oil and gas royalties) into the fund annually. That quickly fell to 15 per cent by 1982/83, and after an oil price collapse the government eliminated the requirement in 1986/87. Since then, governments have routinely failed to make deposits into the fund, the fund’s value (after accounting for inflation) has eroded over time, and governments have spent nearly all of the fund’s earnings. Consequently, this fiscal year the fund will be worth less than $26 billion.

In other words, political will hasn’t been a successful strategy in growing the Heritage Fund.

Which brings us back to dividends. Here’s where Alberta can learn from Alaska. Alaska’s resource revenue savings fund (the Permanent Fund) was also created in 1976, but is now worth about US$80 billion (roughly CA$115 billion). What does the Alaska government do differently?

While various rules contribute to the fund’s success, the dividend rule is arguably the most critical. The Alaskan government pays a share of the fund’s earnings to Alaskan citizens via a dividend each year. Crucially, this gives citizens an ownership share in the fund. And therein lies the political will for governments to responsibly grow and maintain the fund. Any government that tried to use the fund for irresponsible purposes (e.g. raid the fund to spend money elsewhere) would likely face the wrath of Alaskan voters, given their understandable attachment to the dividend cheques.

Indeed, while the Alaskan government can reduce or eliminate the annual dividend, it has consistently allocated funds to the dividend for more than 40 years, even though this reduces the amount of money available for government spending. Overall, the fund has paid out more than US$30 billion to Alaskan citizens via dividends. Last year, each Alaskan received US$1,702.

According to its plan released on Wednesday, the Smith government will rely on “political will” to grow the Heritage Fund. But that’s not a recipe for success. Instead, the Smith government should learn from Alaska’s success and start paying dividends to Albertans who will provide the political pressure necessary to grow the fund over the long term.

Tegan Hill

Director, Alberta Policy, Fraser Institute
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