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Economy

Canadians face serious economic costs due to health-care wait times

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4 minute read

From the Fraser Institute

By Mackenzie Moir

Not only does Canada pay the most for health care (as a share of its economy) among high-income countries with universal health care (after adjusting for differences in the age structure of the population), it also has some of the fewest medical resources and the worst access to timely medical care.

We hear a lot about how much money we must spend to simply maintain the status quo in health care, with billions of new dollars from Ottawa just to keep the same system afloat.

The irony, of course, is that maintaining the status quo imposes some of the harshest costs on Canadians. Last year, Canadians could expect to wait an average of 13.1 weeks to receive treatment after receiving a specialist consultation. Not only was this wait more than two times longer than in 1993, it resulted in an estimated 1.2 million procedures being waited for across the country.

And at one month longer than the wait doctors consider reasonable, these delays are not benign. In fact, they can produce devastating physical and psychological consequences.

While it may be tempting to blame our current predicament on the aftereffects of the pandemic, in reality, long waits were the norm long before COVID. In fact, in 2019 the wait between a specialist consultation and receiving care was nearly two and a half weeks less than today, and the number of procedures being waited for (1.1 million) was slightly less than the number today (1.2 million).

In addition to the physical and psychological costs of waiting, there are also serious economic costs. According to a new study, wait times for non-emergency treatment in 2023 cost Canadians $3.5 billion in lost wages and productivity, or $2,871 per person waiting for a procedure. For perspective, this is more than double the cost in 2004 (inflation-adjusted). After we account for patient leisure time outside of work, the estimate for 2023 increases to $10.6 billion or $8,730 per person waiting.

Some advocates of the status quo suggest these costs are necessary to maintain our universal health-care system but international evidence indicates the opposite. In fact, not only does Canada pay the most for health care (as a share of its economy) among high-income countries with universal health care (after adjusting for differences in the age structure of the population), it also has some of the fewest medical resources and the worst access to timely medical care.

What do other higher-performing universal health-care systems do differently?

To varying degrees, they embrace the private sector as a partner. For example, Australia now delivers the majority of non-emergency surgeries and care through private hospitals, while frequently outperforming Canada and spending less than we do (as a share of the economy).

Here at home, we’ve seen what real reform, which embraces the private sector, can do. In Saskatchewan between 2010 and 2014, the government contracted out publicly-financed procedures to private clinics, which helped lower the province’s wait times from some of the longest in the country (26.5 weeks in 2010) to some of the shortest (14.2 weeks in 2014). Quebec, which has consistently “low” wait times, in recent years has contracted out one in six day-surgeries to private clinics.

Despite objections from defenders of today’s unworkable status quo, there’s in fact a way to improve Canada’s health-care system while preserving its universality. However, until we’re willing to pursue that path, wait times and their associated costs will continue to burden Canadian patients and their loved ones.

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Economy

Can Hawaii afford climate change lawsuit settlement?

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From The Center Square

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Hawaii recently entered into a settlement in a first-of-its-kind lawsuit that requires the state to implement climate change initiatives by court order, setting forth a potential template for lawsuits in other states.

Thirteen young people, at least one as young as nine, filed the lawsuit against the Hawaii Department of Transportation in June 2022. They said the state DOT needed to do more to protect the state and their future from climate change.

The state spent $3 million settling the lawsuit, money the attorney general’s office said was “well-spent” to avoid a trial that would have started June 24.

The settlement provides a road map of tasks the DOT must do per the court order. These include creating a greenhouse gas reduction plan for the Hawaii Department of Transportation that could cost the state more. Only one price tag is included in the plan—$40 million for public electric charging stations and charging infrastructure for all state and county vehicles by 2030.

The agreement includes a dispute-resolution component that could keep differences out of court. But, the First Circuit of Hawaii will oversee the settlement until 2045 if Hawaii has not met its zero-emission goals.

The Hawaii Department of Transportation must receive “sufficient appropriations” from the Hawaii Legislature, but the settlement does not include a specific amount for the other requirements.

Gov. Josh Green admitted it would not be inexpensive or easy. He said the court order would help him when he had to go to the Legislature and say, “Look, we have to do this.”

“We have these policies in mind but we don’t have the resources that come from the Legislature,” Green said. “We don’t often have the absolute insistence of the courts to do certain things so having a settlement like this creates some guarantees.”

For two years, the governor has pushed for a $25 tourist fee that has not passed the Legislature.

“We have 10 million individuals that come to Hawaii every year,” Green said. “Can you imagine only for a moment if we successfully were humbly asking people to pay $25 when they came to the state? That would be $250 million every single year to pay for the bikeways, extra to bring very advanced analytics to what our carbon impact is from any of the technologies we use, money to get bond to navigate major protections against erosion of the coastline.”

Thomas Yamachika, president of the Tax Foundation of Hawaii, told The Center Square, “There’s going to be some pain,” when finding money to implement the settlement’s initiatives. The Legislature passed tax breaks this year to increase the standard income tax deduction in odd years and lower tax rates for all brackets in even years. It’s possible those tax cuts could be “walked back,” Yamachika said.

Truth in Accounting, which does an annual financial analysis of the 50 states, told The Center Square that Hawaii is already $11 billion in debt.

“The state doesn’t have money sitting around that can be used for settlements like this,” said Sheila A. Weinberg, founder and CEO of Truth in Accounting. “To pay for this settlement, taxes will have to be raised or services and benefits will have to be cut. The other option is to even underfund the pension and retiree health care benefits even more.”

Hawaii is the first to settle a climate change lawsuit, but it may not be the last. The case may set a precedent in other states where young people have filed lawsuits over climate concerns, according to an op-ed written by Cara Horowitz, executive director of the Emmett Institute on Climate Change and the institute’s communications director, Evan George.

“Many defendants facing climate lawsuits — notably including Hawaii officials in the earlier stages of this case — often protest that climate change policy should be made by legislatures, not judges,” Horowitz and George said in the op-ed  published in the Los Angeles Times. “This landmark settlement demonstrates that the courts can hold decision-makers accountable if they fail to live up to their promises.”

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Automotive

Ottawa’s EV mandate may destroy Canadian auto industry

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From the Fraser Institute

By Ross McKitrick

No one had to force the public to abandon land lines for cellphones, or vinyl records for CDs and then online streaming. When superior products appear, people will switch voluntarily. An EV mandate may be affordable by 2035—but only if the product quality and user costs have progressed to the point that people want to switch anyway, in which case the mandate is not needed.

According to energy transition and “net zero” enthusiasts, the future looks bright for electric vehicles (EVs). So bright that the federal government and some provincial governments have had to offer some $15 billion in subsidies to prompt carmakers to develop Canadian production facilities while also offering lavish subsidies to get people to buy EVs. And since even that isn’t enough, according to a Trudeau government mandate, all new light-duty vehicles sold in Canada must be electric or plug-in hybrid by 2035. In other words, the government wants to ban traditional internal combustion engine vehicles (ICEVs).

The fundamental problem is that EVs cost more to make and operate than most consumers are willing to pay. In a 2016 submission to the Quebec government, which was then considering an EV mandate of its own, the Canadian Vehicle Manufacturing Association warned that its members were then losing between $12,000 and $20,000 per EV sold. Since then, the situation has gotten worse, with Ford reporting first quarter 2024 losses of US$132,000 per EV.

What will be the economic consequences of a national EV mandate in Canada? In a new paper forthcoming in the peer-reviewed Canadian Journal of Economics, I develop and run a detailed inter-provincial model of the Canadian economy including the auto sector. I argue that during the phase-in period the auto sector will raise the price of ICEVs and earn above-market rents on them, but that won’t cover the losses on the EV side and the industry will go into overall losses by the late-2020s. The losses will be permanent unless and until EV production costs fall enough that a mandate is unnecessary. In short, the 2035 mandate is affordable only if it’s not needed. If it takes a mandate to force consumers to choose EVs over ICEVs, the mandate will destroy the Canadian auto industry.

The mandate sets up a race between regulation and technology. Some aspects of EV production are falling, such as batteries. Others, such as specialty metals used in motors, are sole-sourced from China and are not getting cheaper. Other user costs are rising including electricity, for which we can thank two decades of green energy madness. Taking all aspects together, suppose EV technology improves so quickly that by 2035 consumers are absolutely indifferent between an EV and an ICEV, so the mandate is costless thereafter. Getting to that point would still impose Canadian auto industry losses that total $140 billion compared to the no-policy base case. As of 2031 the losses in real GDP and industrial output compared to the base case would average more than $1,000 per worker across Canada. Greenhouse gas emissions would fall by just under 3 per cent relative to the base case as of 2035, but the abatement costs reach about $2,800 per tonne as of 2030.

That’s the best-case scenario. What if full EV cost parity takes until 2050? According to the model, the auto sector will lose $1.3 trillion relative to the base case between 2025 and 2050. Of course, in reality the sector would simply shut down, but in the model a sector must keep operating even at a loss. In absolute terms the national economy would continue to grow but much more slowly. Economic losses relative to the base case as of 2035 include a 4.8 per cent reduction in real GDP nationally (8.9 per cent in Ontario), a 2.6 per cent cut in real earnings per worker, 137,000 jobs lost, a 10.5 per cent drop in auto demand nationally and a 16.8 per cent drop in capital earnings relative to average. Greenhouse gas emissions would fall by just under 6 per cent against the base case as of 2035 but at a cost of more than $3,400 per tonne, 20 times the nominal carbon tax rate.

These are unprecedented costs, but then again we have never before proposed to ban the production and purchase of one of the most popular consumer products of all time. A large part of our economy is organized around making and using gasoline-powered cars, so if the government plans to outlaw them we should not be surprised that doing so will have harsh and far-reaching economic consequences. While production of EVs will partially offset the losses, it’s a classic error in economic reasoning to suppose the policy package as a whole could yield a net gain or offer a genuine economic opportunity. If it could, think of all the economic growth we could contrive simply by banning things. We could ban computers and make people read books instead—think of the boom in publishing. We could ban all forms of transportation and make people walk. Think of how much money they’d save, and the opportunities this would open up for shoemakers.

I better stop there before I put ideas in politicians’ heads. To be clear, people are willing to pay for computers, cars and lots of other things because they perceive that they get greater consumption value than the cost of buying the item. So far that has not proven to be true of EVs, so an EV mandate by definition must make people worse off. No one had to force the public to abandon land lines for cellphones, or vinyl records for CDs and then online streaming. When superior products appear, people will switch voluntarily. An EV mandate may be affordable by 2035—but only if the product quality and user costs have progressed to the point that people want to switch anyway, in which case the mandate is not needed.

Will an EV mandate destroy the Canadian auto industry and impose serious harm on the Canadian economy? There’s a simple way to tell: if the government perceives, based on trends in vehicle sales data, that a mandate is necessary to force consumers to switch, the answer is yes.

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