Canadians are ready for health-care reform—Australia shows the way

Australia offers real-world examples of how public/private partnerships can be successfully integrated in a universal health-care framework. Not only does Australia prove it can be done without sacrificing universal coverage for all, Australia spends less money (as a share of its economy) than Canada and enjoys more timely medical care.

Canada’s health-care system is crumbling. Long wait times, hallway health care and burned-out staff are now the norm. Unsurprisingly, a new poll finds that the majority of Canadians (73 per cent) say the system needs major reform.

As noted in a recent editorial in the Globe and Mail, we can learn key lessons from Australia.

There are significant similarities between the two countries with respect to culture, the economy and even geographic characteristics. Both countries also share the goal of ensuring universal health coverage. However, Australia outperforms Canada on several key health-care performance metrics.

After controlling for differences in age (where appropriate) between the two countries, our recent study found that Australia’s health-care system outperformed Canada’s on 33 (of 36) performance measures. For example, Australia had more physicians, hospital beds, CT scanners and MRI machines per person compared to Canada. And among the 30 universal health-care countries studied, Canada ranked in the bottom quartile for the availability of these critical health-care resources.

Australia also outperforms Canada on key measures of wait times. In 2023 (the latest year of available data), 39.5 per cent of patients in Australia were able to make a same or next day appointment when they were sick compared to only 22.3 per cent in Canada. And 9.6 per cent of Canadians reported waiting more than one year to see a specialist compared to only 4.5 per cent of Australians. Similarly, almost one-in-five (19.9 per cent) Canadians reported waiting more than one year for non-emergency surgery compared to only 11.8 per cent of Australians.

So, what does Australia do differently to outperform Canada on these key measures?

Although the Globe and Mail editorial touches on the availability of private insurance in Australia, less attention is given to the private sector’s prominent role in the delivery of health care.

In 2016 (the latest year of available data) almost half of all hospitals in Australia (48.5 per cent) were private. And in 2021/22 (again, the latest year of available data), 41 per cent of all hospital care took place in a private facility. That percentage goes up to 70.3 per cent when only considering hospital admissions for non-emergency surgery.

But it’s not only higher-income patients who can afford private insurance (or those paying out of pocket) who get these surgeries. The Australian government encourages the uptake of private insurance and partially subsidizes private care (at a rate of 75 per cent of the public fee), and governments in Australia also regularly contract out publicly-funded care to private facilities.

In 2021/22, more than 300,000 episodes of publicly-funded care occurred in private facilities in Australia. Private hospitals also delivered 73.5 per cent of care funded by Australia’s Department of Veterans’ Affairs. And in 2019/20, government sources (including the federal government) paid for almost one-third (32.8 per cent) of private hospital expenditures.

Which takes us back to the new opinion poll (by Navigator), which found that 69 per cent of Canadians agree that health-care services should include private-sector involvement. While defenders of the status quo continue to criticize this approach, Australia offers real-world examples of how public/private partnerships can be successfully integrated in a universal health-care framework. Not only does Australia prove it can be done without sacrificing universal coverage for all, Australia spends less money (as a share of its economy) than Canada and enjoys more timely medical care.

While provincial governments remain stubbornly committed to a failed model, Canadians are clearly expressing their desire for health-care reforms that include a prominent role for private partners in the delivery of universal care.

Australia is just one example. Public/private partnerships are the norm in several more successful universal health-care systems (such as Germany and Switzerland). Instead of continuing to remain an outlier, Canada should follow the examples of Australia and other countries and engage with the private sector to fulfill the promise of universal health care.

Authors:

Bacchus Barua and Mackenzie Moir

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For the record—former finance minister did not keep Canada’s ‘fiscal powder dry’

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For the record—former finance minister did not keep Canada’s ‘fiscal powder dry’

Published on December 22, 2024

Todayville

From the Fraser Institute

By Ben Eisen

In case you haven’t heard, Chrystia Freeland resigned from cabinet on Monday. Reportedly, the straw that broke the camel’s back was Prime Minister Trudeau’s plan to send all Canadians earning up to $150,000 a onetime $250 tax “rebate.” In her resignation letter, Freeland seemingly took aim at this ill-advised waste of money by noting “costly political gimmicks.” She could not have been more right, as my colleagues and I have written here, here and elsewhere.

Indeed, Freeland was right to excoriate the government for a onetime rebate cheque that would do nothing to help Canada’s long-term economic growth prospects, but her reasoning was curious given her record in office. She wrote that such gimmicks were unwise because Canada must keep its “fiscal powder dry” given the possibility of trade disputes with the United States.

Again, to a large extent Freeland’s logic is sound. Emergencies come up from time to time, and governments should be particularly frugal with public dollars during non-emergency periods so money is available when hard times come.

For example, the federal government’s generally restrained approach to spending during the 1990s and 2000s was an important reason Canada went into the pandemic with its books in better shape than most other countries. This is an example of how keeping “fiscal powder dry” can help a government be ready when emergencies strike.

However, much of the sentiment in Freeland’s resignation letter does not match her record as finance minister.

Of course, during the pandemic and its immediate aftermath, it’s understandable that the federal government ran large deficits. However, several years have now past and the Trudeau government has run large continuous deficits. This year, the government forecasts a $48.3 billion deficit, which is larger than the $40 billion target the government had previously set.

A finance minister committed to keeping Canada’s fiscal powder dry would have pushed for balanced budgets so Ottawa could start shrinking the massive debt burden accumulated during COVID. Instead, deficits persisted and debt has continued to climb. As a result, federal debt may spike beyond levels reached during the pandemic if another emergency strikes.

Minister Freeland’s reported decision to oppose the planned $250 onetime tax rebates is commendable. But we should be cautious not to rewrite history. Despite Freeland’s stated desire to keep Canada’s “fiscal powder dry,” this was not the story of her tenure as finance minister. Instead, the story is one of continuous deficits and growing debt, which have hurt Canada’s capacity to withstand the next fiscal emergency whenever it does arrive.

Ben Eisen

Senior Fellow, Fraser Institute

Business

Comparing four federal finance ministers in moments of crisis

Published on December 21, 2024

Todayville

From the Fraser Institute

By Grady Munro, Milagros Palacios and Jason Clemens

The sudden resignation of federal finance minister (and deputy prime minister) Chrystia Freeland, hours before the government was scheduled to release its fall economic update has thrown an already badly underperforming government into crisis. In her letter of resignation, Freeland criticized the government, and indirectly the prime minister, for “costly political gimmicks” and irresponsible handling of the country’s finances and economy during a period of great uncertainty.

But while Freeland’s criticism of recent poorly-designed federal policies is valid, her resignation, in some ways, tries to reshape her history into that of a more responsible finance minister. That is, however, ultimately an empirical question. If we contrast the performance of the last four long-serving (more than three years) federal finance ministers—Paul Martin (Liberal), Jim Flaherty (Conservative), Bill Morneau (Liberal) and Freeland (Liberal)—it’s clear that neither Freeland nor her predecessor (Morneau) were successful finance ministers in terms of imposing fiscal discipline or overseeing a strong Canadian economy.

Let’s first consider the most basic measure of economic performance, growth in per-person gross domestic product (GDP), adjusted for inflation. This is a broad measure of living standards that gauges the value of all goods and services produced in the economy adjusted for the population and inflation. The chart below shows the average annual growth in inflation-adjusted per-person GDP over the course of each finance minister’s term. (Adjustments are made to reflect the effects of temporary recessions or unique aspects of each minister’s tenure to make it easier to compare the performances of each finance minister.)

Sources: Statistics Canada Table 17-10-0005-01, Table 36-10-0222-01; 2024 Fall Economic Statement

By far Paul Martin oversaw the strongest growth in per-person GDP, with an average annual increase of 2.4 per cent. Over his entire tenure spanning a decade, living standards rose more than 25 per cent.

The average annual increase in per-person GDP under Flaherty was 0.6 per cent, although that includes the financial recession of 2008-09. If we adjust the data for the recession, average annual growth in per-person GDP was 1.4 per cent, still below Martin but more than double the rate if the effects of the recession are included.

During Bill Morneau’s term, average annual growth in per-person GDP was -0.5 per cent, although this includes the effects of the COVID recession. If we adjust to exclude 2020, Morneau averaged a 0.7 per cent annual increase—half the adjusted average annual growth rate under Flaherty.

Finally, Chrystia Freeland averaged annual growth in per-person GDP of -0.3 per cent during her tenure. And while the first 18 or so months of her time as finance minister, from the summer of 2020 through 2021, were affected by the COVID recession and the subsequent rebound, the average annual rate of per-person GDP growth was -0.2 per cent during her final three years. Consequently, at the time of her resignation from cabinet in 2024, Canadian living standards are projected to be 1.8 per cent lower than they were in 2019.

Let’s now consider some basic fiscal measures.

Martin is by far the strongest performing finance minister across almost every metric. Faced with a looming fiscal crisis brought about by decades of deficits and debt accumulation, he reduced spending both in nominal terms and as a share of the economy. For example, after adjusting for inflation, per-person spending on federal programs dropped by 5.9 per cent during his tenure as finance minister (see chart below). As a result, the federal government balanced the budget and lowered the national debt, ultimately freeing up resources via lower interest costs for personal and business tax relief that made the country more competitive and improved incentives for entrepreneurs, businessowners, investors and workers.

*Note: Freeland’s term began in 2020, but given the influence of COVID, 2019 is utilized as the baseline for the overall change in spending. Sources: Statistics Canada Table 17-10-0005-01, Table 36-10-0130-01; Fiscal Reference Tables 2024; 2024 Fall Economic Statement

Flaherty’s record as finance minister is mixed, in part due to the recession of 2008-09. Per-person program spending (inflation adjusted) increased by 11.6 per cent, and there was a slight (0.6 percentage point) increase in spending as a share of the economy. Debt also increased as a share of the economy, although again, much of the borrowing during Flaherty’s tenure was linked with the 2008-09 recession. Flaherty did implement tax relief, including extending the business income tax cuts started under Martin, which made Canada more competitive in attracting investment and fostering entrepreneurship.

Both Morneau and Freeland recorded much worse financial performances than Flaherty and Martin. Morneau increased per-person spending on programs (inflation adjusted) by 37.1 per cent after removing 2020 COVID-related expenditures. Even if a more generous assessment is used, specifically comparing spending in 2019 (prior to the effects of the pandemic and recession) per-person spending still increased by 18.1 per cent compared to the beginning of his tenure.

In his five years, Morneau oversaw an increase in total federal debt of more than $575 billion, some of which was linked with COVID spending in 2020. However, as multiple analyses have concluded, the Trudeau government spent more and accumulated more debt during COVID than most comparable industrialized countries, with little or nothing to show for it in terms of economic growth or better health performance. Simply put, had Morneau exercised more restraint, Canada would have accumulated less debt and likely performed better economically.

Freeland’s tenure as finance minister is the shortest of the four ministers examined. It’s nonetheless equally as unimpressive as that of her Trudeau government predecessor (Morneau). If we use baseline spending from 2019 to adjust for the spike in spending in 2020 when she was appointed finance minister, per-person spending on programs by the federal government (inflation adjusted) during Freeland’s term increased by 4.1 per cent. Total federal debt is expected to increase from $1.68 trillion when Freeland took over to an estimated $2.2 trillion this year, despite the absence of a recession or any other event that would impair federal finances since the end of COVID in 2021. For some perspective, the $470.8 billion in debt accumulated under Freeland is more than double the $220.3 billion accumulated under Morneau prior to COVID. And there’s an immediate cost to that debt in the form of $53.7 billion in expected federal debt interest costs this year. These are taxpayer resources unavailable for actual services such as health care.

Freeland’s resignation from cabinet sent shock waves throughout the country, perhaps relieving her of responsibility for the Trudeau government’s latest poorly-designed fiscal policies. However, cabinet ministers bear responsibility for the performance of their ministries—meaning Freeland must be held accountable for her previous budgets and the fiscal and economic performance of the government during her tenure. Compared to previous long-serving finances ministers, it’s clear that Chrystia Freeland, and her Trudeau predecessor Bill Morneau, failed to shepherd a strong economy or maintain responsible and prudent finances.