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Fraser Institute

Canadians want major health-care reform now

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From the Fraser Institute

By Mackenzie Moir

Tragic stories of multiyear waits for patients are now a Canadian news staple. Is it any wonder, therefore, that a new Navigator poll found almost two-thirds of Canadians experienced (either themselves or a family member) unreasonably long for access to health care. The poll also found that 73 per cent of respondents agree the system needs major reform.

This situation shouldn’t surprise anyone. Last year Canadians could expect a 27.7-week delay for non-emergency treatment. Nearly half this time (13.1 weeks) was spent waiting for treatment after seeing a specialist—that’s more than one month longer than what physicians considered reasonable.

And it’s not as though these unreasonable waits are simple inconveniences for patients; they can have serious consequences including continued pain, psychological distress and disability. For many, there are also economic consequences for waiting due to lost productivity or wages (due to difficulty or inability to work) or for Canadians who pay for care in another country.

Canadians are also experiencing longer delays than their European and Australian universal health-care peers. In 2020, Canadians were the least likely (62 per cent) to report receiving non-emergency surgical treatment in under four weeks compared to Germans (99 per cent) and Australians (72 per cent).

What do they do differently? Put simply, they approach universal care in a different way than we do.

In particular, these countries all have a sizeable and well-integrated private sector that helps deliver universal care including surgical care. For example, in 2021, 45 per cent of hospitals in Germany (a plurality) were private for-profit. And 99 per cent of German hospital beds are accessible to those covered under the country’s mandatory insurance scheme. In Australia, governments regularly contract with private hospitals to provide surgical care, with private facilities handling 41 per cent of all hospital services in 2021/22.

These universal health-care countries also tend to fund their hospitals differently.

Governments in Canada primarily fund hospitals through “global budgets.” With a fixed budget set at the beginning of the year, this funding method is unconnected to the level of services provided. Consequently, patients are treated as costs to be minimized.

In contrast, hospitals in most European countries and Australia are funded on the basis of their activity. As a result, because they are paid for services they actually deliver, hospitals are incentivized to provide higher volumes of care.

The data are clear. Canadian patients are frustrated with their health-care system and have an appetite for change. We stand to learn from other countries who maintain their universal coverage while delivering health care faster than in Canada.

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Business

Fiscal update reveals extent of federal government mismanagement

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From the Fraser Institute

By Jake Fuss and Grady Munro

Following the sudden departure of Chrystia Freeland as finance minister, the Trudeau government released its 2024 fall fiscal update on Monday. Unsurprisingly, spending is up, the deficit has ballooned even higher, and the Trudeau government continues to utterly mismanage Canada’s finances.

Let’s get into the numbers.

For the current fiscal year (2024-25), the update estimates the federal government will spend $543.4 billion while taking in $495.2 billion in revenues. This means the government plans to run a $48.3 billion deficit—$8.5 billion higher than the $39.8 billion deficit that had originally been planned just eight months ago.

The Trudeau government’s incessant need to introduce new spending at every turn has driven this increase in borrowing. Indeed, discretionary spending on programs is now expected to be $6.1 billion higher than initially projected in this year’s budget tabled in April. Revenues have also taken a hit compared to projections from the spring, primarily from the federal government’s new GST holiday.

Not only will the government run a larger deficit this year, but future deficits are also expected to rise. Cumulative deficits from 2025-26 to 2028-29 are now expected to be $14.9 billion higher than projected in the spring budget.

There are costs associated with running deficits and accumulating debt, and Canadians ultimately bear these costs. Just like anyone who takes out a loan at a bank, government must pay interest on the money it borrows. In the case of the federal government, these interest costs will reach an estimated $53.7 billion in 2024-25 alone—more than all revenue collected via the federal GST. In other words, every dollar that Canadians are expected to pay in GST this year will go towards federal debt interest, as opposed to any services or programs. And as the federal government continues to borrow more, all else equal, these interest costs will continue to rise.

While the updated deficits for 2024-25 and beyond are still estimates, the 2024 FES presents what’s likely the final deficit number for the 2023-24 fiscal year. In a remarkable display of fiscal mismanagement, the Trudeau government ran a $61.9 billion deficit last year—$21.9 billion higher than the $40.0 billion deficit projected in the budget.

This means the federal government has broken one of its fiscal rules (a.k.a. guardrails) that help guide policy on spending, taxes and borrowing. One year ago, the Trudeau government established three fiscal rules—including to keep the 2023-24 deficit at or below $40.1 billion. These rules were reaffirmed in the spring budget, and have been a key feature of the Trudeau government’s so-called “responsible economic plan.”

However, there’s nothing responsible about establishing a rule only to break it a year later. Unfortunately, the Trudeau government has made a habit breaking its self-imposed rules. In 2015, the government established its first fiscal rule—balancing the budget by fiscal year 2019-20. But it quickly abandoned this rule in subsequent months and proposed an alternative rule—to reduce federal debt relative to the size of the economy (GDP). But again, this rule became an afterthought, as federal debt increased relative to GDP in 2019-20 and continued to sharply increase during the pandemic and has yet to return to anywhere near pre-COVID levels.

As has happened consistently in the past decade, this year’s fall update reveals that spending and deficits are up compared to the budget plan the government presented just months ago. The Trudeau government is utterly mismanaging the Canada’s finances, which has caused turmoil inside the government while Canadians bear the consequences.

Jake Fuss

Director, Fiscal Studies, Fraser Institute

Grady Munro

Policy Analyst, Fraser Institute
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Business

Massive growth in federal workforce contributes to Ottawa’s red ink

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From the Fraser Institute

By Ben Eisen

At the same time the Trudeau government opened Canada’s borders to historic numbers of immigrants leading to an explosion in population, the federal workforce was growing even faster.. much faster.

Here’s a fact that all Canadians should understand. Prime Minister Justin Trudeau has overseen the seven highest years of federal government spending in Canadian history (on a per-person basis, after adjusting for inflation).

The federal government’s high spending levels have produced a long string of budget deficits and growing mountain of debt. Federal net debt has approximately doubled in nominal terms since 2014/15 (one year before Trudeau took office), rising from $17,800 per person to $34,000 this year.

What’s driving all of this?

There are many factors, including the growth in the number of federal government employees. Our new study published by the Fraser Institute (based on data from the Parliamentary Budget Officer) found that after years of shrinking, the size of the federal government workforce began to grow in the mid-2010s. In fact, it began to grow significantly faster than the Canadian population.

To measure the growth, we used the federal government’s Full Time Equivalents (FTEs), which captures the expected work hours of a fulltime employee and allows for comparisons over time. In 2014/15, there were 340,669 FTE workers working directly for the federal government. By 2022/23 (the latest fiscal year of comparable data), this number had grown to 431,537 or by 26.1 per cent. By comparison, the Canadian population grew 9.1 per cent during this period—still a substantial growth rate, but far slower than the rate of growth of the federal workforce.

Government sector employees

So how much has the rapid growth in federal government jobs cost taxpayers?

In our study, we consider what would have happened had the Trudeau government simply held the rate of growth in federal employment to the rate of population growth. Under this scenario, the federal government’s workforce today would be 57,170 fewer FTE workers than is in fact the case. Given that the average per-FTE cost of federal employment in 2022/23 was $130,583 (which includes salaries and other costs), the savings would have been substantial. Specifically, taxpayers would have saved $7.5 billion in 2022/23 alone. And if this money had not been spent, the federal deficit would have been 21.2 per cent smaller that year.

At all times, but particularly during a period of large deficits, the federal government should scrutinize all areas of spending including government employment. Personnel costs represent approximately half of the federal government’s operating costs, so it’s no surprise that growing employment costs have heavily contributed to Ottawa’s recent string of deficits.

According to the Trudeau government’s latest budget, Ottawa will run deficits for the foreseeable future and in 2029 net federal debt will reach $1.5 trillion. Unless the government reverses its spending trends, the cost of increased government employment will continue to strain federal finances in the years ahead, with taxpayers paying the bill.’

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