Fraser Institute
Ottawa’s health-care deal cements failed status quo in Canada
From the Fraser Institute
By Mackenzie Moir and Jake Fuss
Canada will reach a projected $244.1 billion in 2023, which translates to $6,205 per person—nearly double the level of per-person spending (inflation-adjusted) three decades ago. And yet, last year Canadians endured the longest median wait time (27.7 weeks) ever recorded for non-emergency surgery.
Last week, as part of Ottawa’s promised $46 billion in additional health-care spending, the Trudeau government agreed to increase Quebec’s share of federal health-care dollars by $900 million annually. Quebec was the last province to reach an agreement with Ottawa before the March 31 deadline. With the closure of this agreement, Canadian taxpayers are on the hook for more health-care spending than ever before. For the same old broken health-care system.
Of course, it ultimately doesn’t matter whether the $46 billion originates from Ottawa or the provinces. In the end, Canadian taxpayers foot the bill. And what do we get in return for our health-care dollars?
In 2021, the latest year of comparable data, Canada’s total health-care spending (as a percentage of the economy) was the highest among 29 other comparable countries with universal health care (after adjusting for differences in population age). This isn’t a new development. Canada has a long history of having one of most expensive systems among high-income universal health-care countries.
Despite this, according to the latest comparable data, Canada ranks among the poorest performing universal health-care countries in key areas such as the number of physicians, hospital beds and diagnostic technology (e.g. MRI machines). Further, according to the Commonwealth Fund, in 2020 Canada ranked dead last on timely access to specialist consultations and non-emergency surgery.
Meanwhile, public health-care spending in Canada will reach a projected $244.1 billion in 2023, which translates to $6,205 per person—nearly double the level of per-person spending (inflation-adjusted) three decades ago. And yet, last year Canadians endured the longest median wait time (27.7 weeks) ever recorded for non-emergency surgery.
In short, Canada’s health-care system is in shambles, but the answer does not lie in simply throwing more money in its general direction. Federal politicians should instead look to the example of welfare reform during the Chrétien era in the 1990s. Those reforms, which reduced federal transfers to provinces and eliminated most of the “strings” attached to federal funding, resulted in increased provincial autonomy, greater policy experimentation, fewer Canadians needing welfare and savings for the federal government (i.e. taxpayers).
This is the opposite of today’s approach to health care, where the existing vehicle for federal funding (the Canada Health Transfer) is connected to the Canada Health Act (CHA), which prevents provincial governments from innovating and experimenting in health care by threatening financial penalties for non-compliance with often vaguely defined federal preferences. The result is a stalemate that satisfies no one and ensures that Canada’s policies remain at odds with the policies of our better-performing universal health-care peers.
While new federal dollars for health care are undoubtedly appealing to premiers, they will not improve the state of health care for Canadians. Until our federal politicians have the courage to reform the CHA and follow the example of 1990s welfare reform to improve outcomes, our health-care system’s unacceptable status quo will continue.
Authors:
Alberta
Alberta’s fiscal update projects budget surplus, but fiscal fortunes could quickly turn
From the Fraser Institute
By Tegan Hill
According to the recent mid-year update tabled Thursday, the Smith government projects a $4.6 billion surplus in 2024/25, up from the $2.9 billion surplus projected just a few months ago. Despite the good news, Premier Smith must reduce spending to avoid budget deficits.
The fiscal update projects resource revenue of $20.3 billion in 2024/25. Today’s relatively high—but very volatile—resource revenue (including oil and gas royalties) is helping finance today’s spending and maintain a balanced budget. But it will not last forever.
For perspective, in just the last decade the Alberta government’s annual resource revenue has been as low as $2.8 billion (2015/16) and as high as $25.2 billion (2022/23).
And while the resource revenue rollercoaster is currently in Alberta’s favor, Finance Minister Nate Horner acknowledges that “risks are on the rise” as oil prices have dropped considerably and forecasters are projecting downward pressure on prices—all of which impacts resource revenue.
In fact, the government’s own estimates show a $1 change in oil prices results in an estimated $630 million revenue swing. So while the Smith government plans to maintain a surplus in 2024/25, a small change in oil prices could quickly plunge Alberta back into deficit. Premier Smith has warned that her government may fall into a budget deficit this fiscal year.
This should come as no surprise. Alberta’s been on the resource revenue rollercoaster for decades. Successive governments have increased spending during the good times of high resource revenue, but failed to rein in spending when resource revenues fell.
Previous research has shown that, in Alberta, a $1 increase in resource revenue is associated with an estimated 56-cent increase in program spending the following fiscal year (on a per-person, inflation-adjusted basis). However, a decline in resource revenue is not similarly associated with a reduction in program spending. This pattern has led to historically high levels of government spending—and budget deficits—even in more recent years.
Consider this: If this fiscal year the Smith government received an average level of resource revenue (based on levels over the last 10 years), it would receive approximately $13,000 per Albertan. Yet the government plans to spend nearly $15,000 per Albertan this fiscal year (after adjusting for inflation). That’s a huge gap of roughly $2,000—and it means the government is continuing to take big risks with the provincial budget.
Of course, if the government falls back into deficit there are implications for everyday Albertans.
When the government runs a deficit, it accumulates debt, which Albertans must pay to service. In 2024/25, the government’s debt interest payments will cost each Albertan nearly $650. That’s largely because, despite running surpluses over the last few years, Albertans are still paying for debt accumulated during the most recent string of deficits from 2008/09 to 2020/21 (excluding 2014/15), which only ended when the government enjoyed an unexpected windfall in resource revenue in 2021/22.
According to Thursday’s mid-year fiscal update, Alberta’s finances continue to be at risk. To avoid deficits, the Smith government should meaningfully reduce spending so that it’s aligned with more reliable, stable levels of revenue.
Author:
Business
Ottawa’s avalanche of spending hasn’t helped First Nations
From the Fraser Institute
By Tom Flanagan
When Justin Trudeau came to power in 2015, he memorably said that the welfare of Indigenous Canadians was his highest priority. He certainly has delivered on his promise, at least in terms of shovelling out money.
During his 10 years in office, budgeted Indigenous spending has approximately tripled, from about $11 billion to almost $33 billion. Prime Minister Trudeau’s instruction to the Department of Justice to negotiate rather than litigate class actions has resulted in paying tens of billions of dollars to Indigenous claimants over alleged wrongs in education and other social services. And his government has settled specific claims—alleged violations of treaty terms or of the Indian Act—at four times the previous rate, resulting in the award of at least an additional $10 billion to First Nations government.
But has this avalanche of money really helped First Nations people living on reserves, who are the poorest segment of Canadian society?
One indicator suggests the answer is yes. The gap between reserves and other communities—as measured by the Community Well-Being Index (CWB), a composite of income, employment, housing and education—fell from 19 to 16 points from 2016 to 2021. But closer analysis shows that the reduction in the gap, although real, cannot be due to the additional spending described above.
The gain in First Nations CWB is due mainly to an increase in the income component of the CWB. But almost all of the federal spending on First Nations, class-action settlements and specific claims do not provide taxable income to First Nations people. Rather, the increase in income documented by the CWB comes from the greatly increased payments legislated by the Liberals in the form of the Canada Child Benefit (CCB). First Nations people have a higher birth rate than other Canadians, so they have more children and receive more (on average) from the Canada Child Benefit. Also, they have lower income on average than other Canadians, so the value of the CCB is higher than comparable non-Indigenous families. The result? A gain in income relative to other Canadians, and thus a narrowing of the CWB gap between First Nations and other communities.
There’s an important lesson here. Tens of billions in additional budgetary spending and legal settlements did not move the needle. What did lead to a measurable improvement was legislation creating financial benefits for all eligible Canadian families with children regardless of race. Racially inspired policies are terrible for many reasons, especially because they rarely achieve their goals in practise. If we want to improve life for First Nations people, we should increase opportunities for Canadians of all racial backgrounds and not enact racially targeted policies.
Moreover, racial policies are also fraught with unintended consequences. In this case, the flood of federal money has made First Nations more dependent rather than less dependent on government. In fact, from 2018 to 2022, “Own Source Revenue” (business earnings plus property taxes and fees) among First Nations bands increased—but not as much as transfers from government. The result? Greater dependency on government transfers.
This finding is not just a statistical oddity. Previous research has shown that First Nations who are relatively less dependent on government transfers tend to achieve higher living standards (again, as measured by the CWB index). Thus, the increase in dependency presided over by the Trudeau government does not augur well for the future.
One qualification: this finding is not as robust as I would like because the number of band governments filing reports on their finances has drastically declined. Of 630 First Nation governments, only 260 filed audited statements for fiscal 2022. All First Nations are theoretically obliged by the First Nations Financial Transparency Act, 2013, to publish such statements, but the Trudeau government announced there would be no penalties for non-compliance, leading to a precipitous decline in reporting.
This is a shame, because First Nations, as they often insist, are governments, not private organizations. And like other governments, they should make their affairs visible to the public. Also, most of their income comes from Canadian taxpayers. Both band members and other Canadians have a right to know how much money they receive, how it’s being spent and whether it’s achieving its intended goals.
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