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Economy

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

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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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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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Economy

Toronto, Vancouver named “Impossibly Unaffordable”

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From the Frontier Centre for Public Policy

By Courtney Greenberg

Two Canadian cities — Toronto and Vancouver — have earned the title of “impossibly unaffordable” in a new report.

“There has been a considerable loss of housing affordability in Canada since the mid-2000s, especially in the Vancouver and Toronto markets,” according to the Demographia International Housing Affordability report, which is released annually.

“During the pandemic, the increase in remote work (working at home) fuelled a demand increase as many households were induced to move from more central areas to suburban, exurban and even more remote areas. The result was a demand shock that drove house prices up substantially, as households moved to obtain more space, within houses and in yards or gardens.”

Vancouver was the least affordable market in Canada, and the third least affordable out of all of the 94 markets observed in the report. The West Coast city’s affordability issue has “troublingly” spread to smaller areas like Chilliwack, the Fraser Valley, Kelowna, and markets on Vancouver Island, per the report.

Toronto was named as the second least affordable market in Canada. However, it fared slightly better than Vancouver when it came to the other markets, ranking 84 out of 94 in international affordability.

“As in Vancouver, severely unaffordable housing has spread to smaller, less unaffordable markets in Ontario, such as Kitchener-cambridge-waterloo, Brantford, London, and Guelph, as residents of metro Toronto seek lower costs of living outside the Toronto market,” the report says.

The findings of the report have “grave implications on the prospects for upward mobility,” said Joel Kotkin, the director at the Center for Demographics and Policy at Chapman University, a co-publisher of the report along with Canada’s Frontier Centre for Public Policy.

“As with any problem, the first step towards a resolution should be to understand the basic facts,” he said. “This is what the Demographia study offers.”

The report looked at housing affordability in 94 metropolitan areas in Australia, China, Ireland, New Zealand, Singapore, the United Kingdom, the United States and Canada. The data analyzed was taken from September 2023. The ratings are based on five categories (affordable, moderately unaffordable, seriously unaffordable, severely unaffordable, and impossibly unaffordable) with a points system to classify each area.

The report determined affordability by calculating the median price-to-income ratio (“median multiple”) in each market.

“There is a genuine need to substantially restore housing affordability in many markets throughout the covered nations,” said Frontier Centre for Public Policy president Peter Holle, in a statement. “In Canada, policymakers are scrambling to ‘magic wand’ more housing but continue to mostly ignore the main reason for our dysfunctional costly housing markets — suburban land use restrictions.”

Toronto and Vancouver both received the worst possible rating for affordability, making them stand out as the most expensive Canadian cities in which to buy a home. However, other Canadian markets — like Calgary, Montreal and Ottawa-gatineau — stood out as well. They were considered “severely unaffordable.”

“This is a long time coming,” senior economist with the Canadian Centre for Policy Alternatives David Macdonald told CTV News.

“We haven’t been building enough housing, we certainly haven’t had enough government investment in affordable housing for decades, and the chickens are coming home to roost.”

The most affordable Canadian city in the report was Edmonton, which was given a rating of “moderately unaffordable.” The city in Alberta was “at least twothirds more affordable” than Vancouver.

Overall, Canada ranked third in home ownership compared to the other regions observed in the report. The highest home ownership rate was in Singapore, at 89 per cent, followed by Ireland, at 70 per cent. In Canada, the rate was 67 per cent.

First published in the National Post here, June 17, 2024.

Courtney Greenberg is a Toronto-based freelance journalist writing for the National Post.

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