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Fraser Institute

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

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From the Fraser Institute

By Bacchus Barua and Mackenzie Moir

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.

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Automotive

New federal government should pull the plug on Canada’s EV revolution

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During his victory speech Monday night, Prime Minister Mark Carney repeated one of his favourite campaign slogans and vowed to make Canada a “clean energy superpower.” So, Canadians can expect Ottawa to “invest” more taxpayer money in “clean energy” projects including electric vehicles (EVs), the revolutionary transportation technology that’s been ready to replace internal combustion since 1901 yet still requires government subsidies.

It’s a good time for a little historical review. In 2012 south of the border, the Obama administration poured massive subsidies into companies peddling green tech, only to see a vast swath go belly up including Solyndra, would-be maker of advanced solar panels, which failed so spectacularly CNN called the company the “poster child for well-meaning government policy gone bad.”

One might think that such a spectacular failure might have served as a cautionary tale for today’s politicians. But one would be wrong. Even as the EV transition slammed into stiff headwinds, the Trudeau government and Ontario’s Ford government poured $5 billion in subsidies into Honda to build an EV battery plant and manufacture EVs in Ontario. That “investment” came on top of a long list of other “investments” including $15 billion for Stellantis and LG Energy Solution; $13 billion for Volkswagen (or $16.3 billion, per the Parliamentary Budget Officer), a combined $4.24 billion (federal/Quebec split) to Northvolt, a Swedish battery maker, and a combined $644 million (federal/Quebec split) to Ford Motor Company to build a cathode manufacturing plant in Quebec.

How’s all that working out? Not great.

“Projects announced for Canada’s EV supply chain are in various states of operation, and many remain years away from production,” notes automotive/natural resource reporter Gabriel Friedman, writing in the Financial Post. “Of the four multibillion-dollar battery cell manufacturing plants announced for Canada, only one—a joint venture known as NextStar Energy Inc. between South Korea’s LG Energy Solution Ltd. and European automaker Stellantis NV—progressed into even the construction phase.”

In 2023, Volkswagen said it would invest $7 billion by 2030 to build a battery cell manufacturing complex in St. Thomas, Ontario. However, Friedman notes “construction of the VW plant is not scheduled to begin until this spring [2025] and initial cell production will not begin for years.” Or ever, if Donald Trump’s pledge to end U.S. government support for a broad EV transition comes to pass.

In the meantime, other elements of Canada’s “clean tech” future are also in doubt. In December 2024, Saint-Jérome, Que.-based Lion Electric Co., which had received $100 million in provincial and government support to assemble batteries in Canada for electric school buses and trucks, said it would file for bankruptcy in the United States and creditor protection in Canada. And Ford Motor Company last summer scrapped its planned EV assembly plant in Oakville, Ontario—after $640 million in federal and provincial support.

And of course, there’s Canada’s own poster-child-of-clean-tech-subsidy failure, Northvolt. According to the CBC, the Swedish battery manufacturer, with plans to build a $7 billion factory in Quebec, has declared bankruptcy in Sweden, though Northvolt claims that its North American operations are “solvent.” That’s cold comfort to some Quebec policymakers: “We’re going to be losing hundreds of millions of dollars in a bet that our government in Quebec made on a poorly negotiated investment,” said Parti Québécois MNA Pascal Paradis.

Elections often bring about change. If the Carney government wants to change course and avoid more clean-tech calamities, it should pull the plug on the EV revolution and avoid any more electro-boondoggles.

Kenneth P. Green

Senior Fellow, Fraser Institute
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Bjorn Lomborg

How Canada Can Respond to Climate Change Smartly

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From the Fraser Institute

By Bjørn Lomborg

At a time when public finances are strained, and Canada and the world are facing many problems and threats, we need to consider policy choices carefully. On climate, we should spend smartly to solve it effectively, making sure there is enough money left over for all the other challenges.

A sensible response to climate change starts with telling it as it is. We are bombarded with doom-mongering that is too often just plain wrong. Climate change is a problem but it’s not the end of the world.

Yet the overheated rhetoric has convinced governments to spend taxpayer funds heavily on subsidizing current, inefficient solutions. In 2024, the world spent a record-setting CAD$3 trillion on the green energy transition. Taxpayers are directly and indirectly subsidizing millions of wind turbines and solar panels that do little for climate change but line the coffers of green energy companies.

We need to do better and invest more in the only realistic solution to climate change: low-carbon energy research and development. Studies indicate that every dollar invested in green R&D can prevent $11 in long-term climate damages, making it the most effective long-term global climate policy.

Throughout history, humanity has tackled major challenges not by imposing restrictions but by innovating and developing transformative technologies. We didn’t address 1950s air pollution in Los Angeles by banning cars but by creating the catalytic converter. We didn’t combat hunger by urging people to eat less, but through the 1960s Green Revolution that innovated high-yielding varieties to grow much more food.

In 1980, after the oil price shocks, the rich world spent more than 8 cents of every $100 of GDP on green R&D to find energy alternatives. As fossil fuels became cheap again, investment dropped. When climate concern grew, we forgot innovation and instead the focus shifted to subsidizing existing, ineffective solar and wind.

In 2015, governments promised to double green R&D spending by 2020, but did no such thing. By 2023, the rich world still wasn’t back to spending even 4 cents out of every $100 of GDP.

Globally, the rich world spends just CAD$35 billion on green R&D — one-hundredth of overall “green” spending. We should increase this four-fold to about $140 billion a year. Canada’s share would be less than $5 billion a year, less than a tenth of its 2024 CAD$50 billion energy transition spending.

This would allow us to accelerate green innovation and bring forward the day green becomes cheaper than fossil fuels. Breakthroughs are needed in many areas. Take nuclear power. Right now, it is way too expensive, largely because extensive regulations force the production of every new power plant into what essentially becomes a unique, eye-wateringly expensive, extravagant artwork.

The next generation of nuclear power would work on small, modular reactors that get type approval in the production stage and then get produced by the thousand at low cost. The merits of this approach are obvious: we don’t have a bureaucracy that, at a huge cost, certifies every consumer’s cellphone when it is bought. We don’t see every airport making ridiculously burdensome requirements for every newly built airplane. Instead, they both get type-approved and then mass-produced.

We should support the innovation of so-called fourth-generation nuclear power, because if Canadian innovation can make nuclear energy cheaper than fossil fuels, everyone in the world will be able to make the switch—not just rich, well-meaning Canadians, but China, India, and countries across Africa.

Of course, we don’t know if fourth-generation nuclear will work out. That is the nature of innovation. But with smarter spending on R&D, we can afford to focus on many potential technologies. We should consider investing in innovation to grow hydrogen production along with water purification, next-generation battery technology, growing algae on the ocean surface producing CO₂-free oil (a proposal from the decoder of the human genome, Craig Venter), CO₂ extraction, fusion, second-generation biofuels, and thousands of other potential areas.

We must stop believing that spending ever-more money subsidizing still-inefficient technology is going to be a major part of the climate solution. Telling voters across the world for many decades to be poorer, colder, less comfortable, with less meat, fewer cars and no plane travel will never work, and will certainly not be copied by China, India and Africa. What will work is innovating a future where green is cheaper.

Innovation needs to be the cornerstone of our climate policy. Secondly, we need to invest in adaptation. Adaptive infrastructure like green areas and water features help cool cities during heatwaves. Farmers already adapt their practices to suit changing climates. As temperatures rise, farmers plant earlier, with better-adapted varieties or change what they grow, allowing the world to be ever-better fed.

Adaptation has often been overlooked in climate change policy, or derided as a distraction from reducing emissions. The truth is it’s a crucial part of avoiding large parts of the climate problem.

Along with innovation and adaptation, the third climate policy is to drive human development. Lifting communities out of poverty and making them flourish is not just good in and of itself — it is also a defense against rising temperatures. Eliminating poverty reduces vulnerability to climate events like heat waves or hurricanes. Prosperous societies afford more healthcare, social protection, and investment in climate adaptation. Wealthy countries spend more on environmental preservation, reducing deforestation, and promoting conservation efforts.

Focusing funds on these three policy areas will mean Canada can help spark the breakthroughs that are needed to lower energy costs while reducing emissions and making future generations around the world more resilient to climate and all the other big challenges. The path to solving climate change lies in innovation, adaptation, and building prosperous economies.

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