Fraser Institute
Other countries with universal health care don’t have Canada’s long wait times
From the Fraser Institute
By Mackenzie Moir and Bacchus Barua
Unfortunately it’s now very common to see stories about how long provincial wait times for medical care are driving patients to seek care elsewhere, often at great personal cost. Take the recent case of the Milburns in Manitoba who, after waiting years for a knee surgery, are now considering selling their home and moving to Alberta just to get on a potentially shorter public wait list.
Patients in Manitoba could expect to wait a median of 29 weeks to see an orthopedic specialist after a referral from a family physician, then they still faced a median 24.4 week wait to get treatment. In other words, the total typical wait for orthopedic surgery in the province is more than one year at 53.4 weeks. Remember, that’s a median measure, which means some patients wait much longer.
Unfortunately, the Milburns are unlikely to get more timely care on the public wait list in Alberta. At 64.1 weeks, the total median wait for orthopedic care in Alberta was actually longer than in Manitoba. And this doesn’t include the time it takes for provincial coverage to activate for a new provincial resident, or the time it will take to find a new family doctor and get the necessary tests, scans and referrals.
To get more timely care, the Milburns are left with unenviable options. Because they’re insured by Manitoba’s public health-care plan, paying for covered care out of pocket is restricted. They can, however, pay for and receive care privately in other provinces as uninsured visitors (i.e. not move there permanently). Specifically, certain provinces have “exemptions” that allow physicians to charge out-of-province patients directly to provide these procedures privately.
Alternatively, the Milburns could leave Canada and travel even further from home to receive timely care abroad.
But it doesn’t have to be this way.
Long wait times are not the necessary price Canadians must pay for universal coverage. In fact, Canada is one of 30 high-income countries with universal health care. Other countries such as Switzerland, the Netherlands, Germany and Australia have much shorter wait times. For example, only 62 per cent of Canadians reported access to non-emergency surgery in less than four months in 2020 compared to 99 per cent of Germans, 94 per cent of Swiss and 72 per cent of Australians.
The difference? These countries approach health care in a fundamentally different way than us. One notable difference is their attitude towards the private sector.
In Germany, patients can seek private care while still insured by the public system or can opt out and purchase regulated private coverage. These approaches (universal, privately paid or privately insured) are able to deliver rapid access to care. The Swiss simply mandate that patients purchase private insurance in a regulated-but-competitive marketplace as part of their universal scheme. Lower-income families receive a subsidy so they can participate on a more equal footing in the competitive marketplace to obtain the insurance that best fits their needs.
Perhaps the most direct comparator to Canada is Australia—not just geographically, but because it also primarily relies on a tax-funded universal health-care system. However, unlike Canada, individuals can purchase private insurance to cover (among other things) care received as a private patient in a public or private hospital, or simply pay for their private care directly if they choose. In 2021/22 more than two-thirds (70 per cent) of non-emergency admissions to a hospital involving surgery (both publicly and privately funded) took place in a private facility.
Of course, these faster-access countries share other differences in attitudes to universal health-care policy including requirements to share the cost of care for patients and funding hospitals on the basis of activity (instead of Canada’s outdated bureaucratically-determined budgets). A crucial difference, however, is that patients are not generally prevented from paying privately for health care in their home province (or canton or state) in any of these countries.
Without fundamental reform, and as provincial systems continue to struggle to provide basic non-emergency care, we’ll continue to see more stories like the Milburn’s. Without reform, many Canadians will continue to be forced to make similarly absurd decisions to get the care they need, rather than focusing on treatment and recovery.
Authors:
Alberta
A Memorandum of Understanding that no Canadian can understand
From the Fraser Institute
The federal and Alberta governments recently released their much-anticipated Memorandum of Understanding (MOU) outlining what it will take to build a pipeline from Alberta, through British Columbia, to tidewater to get more of our oil to markets beyond the United States.
This was great news, according to most in the media: “Ottawa-Alberta deal clears hurdles for West Coast pipeline,” was the top headline on the Globe and Mail’s website, “Carney inks new energy deal with Alberta, paving way to new pipeline” according to the National Post.
And the reaction from the political class? Well, former federal environment minister Steven Guilbeault resigned from Prime Minister Carney’s cabinet, perhaps positively indicating that this agreement might actually produce a new pipeline. Jason Kenney, a former Alberta premier and Harper government cabinet minister, congratulated Prime Minister Carney and Premier Smith on an “historic agreement.” Even Alberta NDP Leader Naheed Nenshi called the MOU “a positive step for our energy future.”
Finally, as Prime Minister Carney promised, Canada might build critical infrastructure “at a speed and scale not seen in generations.”
Given this seemingly great news, I eagerly read the six-page Memorandum of Understanding. Then I read it again and again. Each time, my enthusiasm and understanding diminished rapidly. By the fourth reading, the only objective conclusion I could reach was not that a pipeline would finally be built, but rather that only governments could write an MOU that no Canadian could understand.
The MOU is utterly incoherent. Go ahead, read it for yourself online. It’s only six pages. Here are a few examples.
The agreement states that, “Canada and Alberta agree that the approval, commencement and continued construction of the bitumen pipeline is a prerequisite to the Pathways project.” Then on the next line, “Canada and Alberta agree that the Pathways Project is also a prerequisite to the approval, commencement and continued construction of the bitumen pipeline.”
Two things, of course, cannot logically be prerequisites for each other.
But worry not, under the MOU, Alberta and Ottawa will appoint an “Implementation Committee” to deliver “outcomes” (this is from a federal government that just created the “Major Project Office” to get major projects approved and constructed) including “Determining the means by which Alberta can submit its pipeline application to the Major Projects Office on or before July 1, 2026.”
What does “Determining the means” even mean?
What’s worse is that under the MOU, the application for this pipeline project must be “ready to submit to the Major Projects Office on or before July 1, 2026.” Then it could be another two years (or until 2028) before Ottawa approves the pipeline project. But the MOU states the Pathways Project is to be built in stages, starting in 2027. And that takes us back to the circular reasoning of the prerequisites noted above.
Other conditions needed to move forward include:
The private sector must construct and finance the pipeline. Serious question: which private-sector firm would take this risk? And does the Alberta government plan to indemnify the company against these risks?
Indigenous Peoples must co-own the pipeline project.
Alberta must collaborate with B.C. to ensure British Columbians get a cut or “share substantial economic and financial benefits of the proposed pipeline” in MOU speak.
None of this, of course, addresses the major issue in our country—that is, investors lack clarity on timelines and certainty about project approvals. The Carney government established the Major Project Office to fast-track project approvals and provide greater certainty. Of the 11 project “winners” the federal government has already picked, most either already had approvals or are already at an advanced stage in the process. And one of the most important nation-building projects—a pipeline to get our oil to tidewater—hasn’t even been referred to the Major Project Office.
What message does all this send to the investment community? Have we made it easier to get projects approved? No. Have we made things clearer? No. Business investment in Canada has fallen off a cliff and is down 25 per cent per worker since 2014. We’ve seen a massive outflow of capital from the country, more than $388 billion since 2014.
To change this, Canada needs clear rules and certain timelines for project approvals. Not an opaque Memorandum of Understanding.
Business
Carney government should privatize airports—then open airline industry to competition
From the Fraser Institute
By Alex Whalen and Jake Fuss
This holiday season, many Canadians will fly to spend time to with family and friends. But air travellers in Canada consistently report frustration with service, cost and choice. In its recent budget, the Carney government announced it will consider “options for the privatization of airports.” What does this mean for Canadians?
Up until the 1990s, the federal government served as both the owner and operator of Canada’s major airports. The Chrétien government partially privatized and transferred the operation of major airports to not-for-profit airport authorities, while the federal government remained the owner of the land. Since then, the federal government has effectively been the landlord for Canada’s airports, collecting rent each year from the not-for-profit operating authorities.
What would full privatization of airports look like?
If the government allows private for-profit businesses to own Canada’s major airports, their incentives would be to operate as efficiently as possible, serve customers and generate profits. Currently, there’s little incentive to compete as the operating authorities are largely unaccountable because they only report to government officials in a limited form, rather than reporting directly to shareholders as they would under privatization. Private for-profit airports exist in many other countries, and research has shown they are often less costly for passengers and more innovative.
Yet, privatization of airports should be only the first step in a broader package of reforms to improve air travel in Canada. The federal government should also open up competition by creating the conditions for new airports, new airlines and new investment. Currently, Canada restricts foreign ownership of Canadian airlines, while also restricting foreign airlines from flying within Canada. Consequently, Canadians are left with little choice when booking air travel. Opening up the industry by reversing these policies would force incumbent airlines to compete with a greater number of airlines, generating greater choice and likely lower costs for consumers.
Moreover, the federal government should reduce the taxes and fees on air travel that contribute to the cost of airline tickets. Indeed, according to our recent research, among peer countries, Canada has among the most expensive air travel taxes and fees. These costs get passed on to consumers, so it’s no surprise that Canada consistently ranks as a very expensive country for air travel.
If the Carney government actually privatizes Canada’s airports, this would be a good first step to introducing greater competition in an industry where it’s badly needed. But to truly deliver for Canadians, the government must go much further and overhaul the numerous policies, taxes and fees that limit competition and drive up costs.
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