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Fraser Institute

It’s budget season—but more money won’t solve Canada’s health-care woes

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From the Fraser Institute

By Mackenzie Moir

In light of regular reports of hallway health care, regular closures of emergency rooms, and the longest wait times for care on record, it’s understandable that Canadians want dramatic improvements to their health-care system. For governments, particularly during budget season, improvement often means an increase in spending.

However, Canada already ranks among the most expensive universal health-care systems in the world. In 2022 (the latest year of comparable data), and after adjusting for population age in each country, Canada ranked fourth-highest for health-care spending as a share of the economy (11.5 per cent). For per-person spending, Canada ranked ninth. In other words, whichever way you look at it, Canada ranked among the top-third of spenders among 31 universal health-care countries.

That’s a lot of money. But what do Canadians get in return?

Canada ranked near the bottom (28th of 30) on the availability of physicians. Canada also had some of the fewest hospital beds and diagnostic equipment (including CT scanners and MRI units) per person.

Moreover, among nine universal health-care countries surveyed by the Commonwealth Fund, a health-care research organization, 65.2 per cent of Canadian patients reported waiting more than one month for a specialist appointment (8th worst out of 9 countries) compared to 35.7 per cent in top-ranked the Netherlands.

We see the same thing for patients trying to access timely non-emergency surgical care. In Canada, 58.3 per cent of patients reported waiting more than two months (9th worst of 9 countries), far more than in the Netherlands (20.3 per cent), Germany (20.4 per cent) and Switzerland (21.1 per cent).

While Canada clearly struggles on measures of availability and timely access to medical resources, it reported mixed results in other areas. For example, Canada performed well on measures of heart attack survival (ranked 8th of 26). And while Canada had average performance for stroke survivability, it remained a bottom of the barrel performer on safety measures such as obstetric trauma during birth (23rd of 23).

With relatively fewer key medical resources and long waits for non-emergency surgery, patients in Canada face major challenges. And this budget season, while governments may be keen to simply spend more, in reality Canadians do not currently receive commensurate value for their health-care dollars. Without fundamental reform, based on the experiences of other more successful universal health-care systems, it’s unlikely we’ll see improvement.

Mackenzie Moir

Mackenzie Moir

Senior Policy Analyst, Fraser Institute

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Crime

Calgary has a 50% higher property crime rate than Phoenix

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From the Fraser Institute

By Livio Di Matteo

The rate of property crimes per person in Calgary is 50 per cent higher than in Phoenix, and Lethbridge has the highest rate of property crime of any large urban area in Canada, finds a new study published today by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

“Albertans are no doubt aware that the rate of property crimes in the province’s biggest cities is on the rise, but they might not know how bad it’s become relative to American cities to the south,” said Livio Di Matteo, senior fellow at the Fraser Institute and author of Comparing Recent Crime Trends in Canada and the US.

The study examines crime rates of large urban areas with 100,000 people or more, known as Census Metropolitan Areas in Canada and Metropolitan Statistical Areas in the U.S.

Using the maximum annual crime rate from 2019 to 2022 (the most recent years of comparable date), Lethbridge had the highest rate of property crimes (e.g., burglary, theft, motor vehicle theft) of all Canadian cities while Kelowna, BC ranked 2nd.

Both Lethbridge and Calgary ranked higher than Las Vegas for property crime, while Lethbridge also ranked higher than Denver, Salt Lake City, Utah, and Los Angeles, California.

Winnipeg, Manitoba is Canada’s most-violent city with the highest per person rate of violent crimes (murder, robbery, and assault with a weapon) of all Canadian urban areas. Crucially, Winnipeg ranked 18th out of all 334 urban areas in Canada and the U.S.

“Crime rates in Alberta’s largest cities, while still historically low, are on the rise and should be of greater concern for both citizens and policymakers,” Di Matteo said.

Comparing Recent Crime Trends in Canada and the United States

  • This study examines total property and total violent crimes, adjusted for population, across 36 Canadian Census Metropolitan Areas (CMAs) and over 300 U.S. Metropolitan Statistical Areas (MSAs). The data reported covers the 2019 to 2022 period.
  • In general, after decades of decline, recent years have seen increases in crime rates in both Canada and the United States, though by historic standards rates remain low.
  • For violent crimes, the top (worst) ranked city was Memphis, TN (1,311 per 100,000) while the top ranked Canadian city was Winnipeg, which ranked 18th overall at 675 per 100,000.
  • Twenty-five percent of Canadian CMAs are in the top half of Canada-U.S. violent crime rankings with the remaining 75 percent in the bottom half.
  • For property crime, the top (worst) ranked city was Lethbridge, AB at 5,521 per 100,000. Kelowna, BC ranked second highest (4,932 per 100,000). Pueblo, CO at 4,911 per 100,000 ranked third overall and was the highest (worst) ranked U.S. city.
  • While Canadian CMAs make up roughly 10 percent of the CMAs and MSAs used in this ranking, when it comes to property crime rates, they account for 24 percent of the top (worst) 10 percent of the property crime rankings whereas in the case of violent crimes they accounted for only 3 percent of the cities in the top 10 percent.
  • There is a distinct east-west divide in the data in that eastern Canadian cities, particularly in Quebec, tend to have lower rates (adjusted for population) of both violent and property crime compared to the west. A similar east-west trend holds in the United States.

    Livio Di Matteo

    Professor of Economics, Lakehead University
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Fraser Institute

Opposition says Premier Eby using tariff fight to give B.C. cabinet ‘unlimited power’

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From the Fraser Institute

By Bruce Pardy

It’s been 800 years since the Magna Carta. Governments everywhere now aspire to tear down the concept that it helped establish: the rule of law. Last week, British Columbia’s NDP government introduced the Economic Stabilization (Tariff Response) Act, also known as Bill 7, which would allow Premier David Eby and his cabinet the power to take the law into their own hands without going through the elected legislature.

In this case, the justification is President Donald Trump’s tariffs. But the bill would authorize any action taken for the vague purpose of supporting the economy of B.C. or Canada, or responding to the actions of any foreign government, even if the actions haven’t happened yet. But according to Eby, “These are not sweeping powers.”

The project of concentrating power in the executive branch (i.e. cabinet) and usurping the role of legislators has a long pedigree. In theory, no office or officers are above the law or are empowered to make it up as they go. In practise, that theory counts for less and less. Governments, including in Canada, don’t like the rule of law.

But what, exactly, does “the rule of law” mean? Legal theorists say it’s complicated. It need not be. To see it clearly, compare it to the alternative: the rule of persons. When King Solomon decreed that a baby claimed by two women should be split in half, he had absolute power to decide what to do. When Henry VIII ordered that Anne Boleyn should lose her head, that was absolute power, too. In each case, tyrants exercised their personal rule for good or bad.

The “rule of law” is the opposite idea. No single authority has free reign to decide how the state will use its force. The rule of law limits the powers of those who govern.

It does so in part by separating powers between three branches of the state. The Supreme Court of Canada has said that the “separation of powers” is a fundamental feature of the Canadian Constitution. Legislatures legislate. The executive executes. Judges adjudicate. In principle, no single office or officer can alone decide what should be done.

But not in practise. Exceptions are so common today as to be ubiquitous. The Human Rights Commission, not the legislature, declares what constitutes discrimination. The police decide whether to enforce court orders. Environment ministry officials determine when environmental impacts are permissible. Cabinet decides when pipelines will be built.

But in these cases, decision-makers at least must keep themselves within the boundaries of their authorizing statute, which was passed by elected legislatures. Under Bill 7, the Eby government will take delegation to the next level. Its cabinet will have the power not just to exercise broad discretion in accordance with legislation, but to override legislation itself. The bill will allow cabinet to make exceptions to the law, modify the law’s requirements, limit the law’s application, or establish powers or duties in place of the law. And not just a specific law, but any enactment on the books. The cabinet’s edicts will be valid for more than two years, until May 2027.

In 1539, the Statute of Proclamations conferred on King Henry VIII the power to rule by decree, directing that the King’s proclamations should be obeyed as though they were legislation. Such provisions, since known as “Henry VIII clauses,” are controversial because they eviscerate limits on executive power. Yet they may be constitutionally permissible in Canada. Parliament cannot abdicate its functions, the Supreme Court of Canada wrote in 1918, in a case considering the government’s conscription orders under the broad powers of the War Measures Act of 1914. But Parliament can pass legislation that delegates its powers to the executive as it sees fit. As long as the legislature retains the power to reverse the delegation, the theory goes, then separation of powers remains intact.

The rule of law is inconvenient. It gets in the way of governments and officials crafting solutions to problems they perceive as important. That’s not its downside but its purpose. Even when government efforts are well-intentioned, the power of officials to solve problems can pose a more serious threat to citizens than the problem itself. As the late Alan Borovoy, former general counsel of the Canadian Civil Liberties Association, once put it, “The source of the most insidious peril is not evil wrongdoers seeking to do harm, but parochial bureaucrats seeking to do good.” If the modern administrative state is incompatible with the rule of law, then the state should be required to adapt. For decades, the current has flowed strongly in the other direction.

Crises are an ideal time for the state to advance into territory from which it will not wish to retreat. COVID-19 was the previous excuse. Now the threat of American tariffs is the latest justification to declare an emergency and discard the limitations of the rule of law. Even impending calamity does not justify the tyranny of unfettered discretion. Boundless authority to respond to circumstances is an unbearable licence to dictate.

This commentary is based on previous commentaries.

Bruce Pardy

Professor of Law, Queen’s University
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