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Fraser Institute

Bill Maher is right about Canadian health care

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4 minute read

From the Fraser Institute

By Mackenzie Moir

Recently, popular American comedian and talk show host, Bill Maher, took aim at some of Canada’s public policy failings in one of his monologues. In entertaining fashion, Maher highlighted our high housing costs, unemployment rates and “vaunted” health-care system.

Indeed, citing work published by the Fraser Institute, he explained that after adjusting for age, Canada spends 13.3 per cent of our economy on health care (2020), the highest level of spending by a developed country with universal coverage that year. And that Canada has some of the poorest access to timely appointments with family doctors when compared to our peers.

Unfortunately, while that’s where his segment on health care ended, the bad news for the Canadian system doesn’t stop there.

On top of Canada continuing to be one of the most expensive universal health-care systems in the world, we get little in return when it comes to both available medical resources and wait times. For example, among high-income countries with universal health care, Canada has some of the lowest numbers of physicians, hospital beds, MRI machines and CT scanners.

And in Canada, only 38 per cent of patients report seeing a specialist within four weeks (compared to 69 per cent in the Netherlands) and only 62 per cent report receiving non-emergency surgery within four months (compared to 99 per cent in Germany).

Unfortunately, wait times in Canada aren’t simply long compared to other countries, they’re the longest they’ve ever been. Last year the median wait for a Canadian patient seeking non-emergency care reached 27.7 weeks—nearly three times longer than the 9.3 week-wait Canadians experienced three decades ago.

This raises the obvious question. How do other countries outperform Canada’s health-care system while also often spending less as a share of their economies? In short, their approach to universal health care, and in particular their relationship with the private sector, departs drastically from the approach here at home.

Australia, for example, partners with private hospitals to deliver the majority (58.6 per cent) of all non-emergency surgeries within its universal health-care system. Australia also spends less of its total economy (i.e. GDP) on health care but outperforms Canada on every measure of timely care.

Even with restrictions on the private sector, Canada has some limited experience that should encourage policymakers to embrace greater private-sector involvement. Saskatchewan, for example, contracted with private surgical clinics starting in 2010 to deliver publicly-funded services as part of a four-year initiative to reduce wait times, which were among the longest in the country. Between 2010 and 2014, wait times in the province fell from 26.5 weeks to 14.2 weeks. After the initiative ended, the province’s wait times began to grow.

More recently, Quebec, which has some of the shortest wait times for medical services in the country, contracts out one out of every six day-surgeries to private clinics within the publicly-funded health-care system.

Maher’s monologue, which was viewed by millions online, highlighted the key failings of Canada’s health-care system. If policymakers in Ottawa and the provinces want to fix Canadian health care, they must learn from other countries that deliver universal health-care at the same or even lower cost, often with better access and results for patients.

Economy

Ottawa’s homebuilding plans might discourage much-needed business investment

Published on

From the Fraser Institute

By Steven Globerman

In the minds of most Canadians, there’s little connection between housing affordability and productivity growth, a somewhat wonky term used mainly by economists. But in fact, the connection is very real.

To improve affordability, the Trudeau government recently announced various financing programs to encourage more investment in residential housing including $6 billion for the Canada Housing Infrastructure Fund and $15 billion for an apartment construction loan program.

Meanwhile, Carolyn Rogers, senior deputy governor of the Bank of Canada, recently said weak business investment is contributing to Canada’s weak growth in productivity (essentially the value of economic output per hour of work). Therefore, business investment to promote productivity growth and income growth for workers is also an economic priority.

But here’s the problem. There’s only so much financial capital at reasonable interest rates to go around.

Because Canada is a small open economy, it might seem that Canadian investors have unlimited access to offshore financial capital, but this is not true. Foreign lenders and investors incur foreign exchange risk when investing in Canadian-dollar denominated assets, and the risk that Canadian asset values will decline in real value. Suppliers of financial capital expect to receive higher yields on their investments for taking on more risk. Hence, investment in residential housing (which the Trudeau government wants to promote) and investment in business assets (which the Bank of Canada warns is weak) compete against each other for scarce financial capital supplied by both domestic and foreign savers.

For perspective, investment in residential housing as a share of total investment increased from 22.4 per cent in 2000 to 41.3 per cent in 2021. Over the same period, investment in two asset categories critical to improving productivity—information and communications equipment and intellectual property products including computer software—decreased from 30.3 per cent of total domestic investment in 2000 to 22.7 per cent in 2021.
What are the potential solutions?

Of course, more financial capital might be available at existing interest rates for domestic investment in residential housing and productivity-enhancing business assets if investment growth declines in other asset categories such as transportation, roads and hospitals. But these assets also contribute to improved productivity and living standards.

Regulatory and legal pressures on Canadian pension funds to invest more in Canada and less abroad would also free up domestic savings for increased investments in residential housing, machinery and equipment and intellectual property products. But this amounts to an implicit tax on Canadians with domestic pension fund holdings to subsidize other investors.

Alternatively, to increase domestic savings, governments in Canada could increase consumption taxes (e.g. sales taxes) while reducing or even eliminating capital gains taxes, which reduce the after-tax expected returns to investing in businesses, particularly riskier new and emerging domestic companies. (Although according to the recent federal budget, the Trudeau government plans to increase capital gains taxes.)

Or governments could reduce the regulatory burden on private-sector businesses, especially small and medium-sized enterprises, so financial capital and other inputs used to comply with often duplicative or excessive regulation can be used to invest in productivity-enhancing assets. And governments could eliminate restrictions on foreign investment in large parts of the Canadian economy including telecommunications, banking and transportation. By increasing competition, governments can improve productivity.

Eliminating such restrictions would also arguably increase the supply of foreign financial capital flowing into Canada to the extent that large foreign investors would prefer to manage their Canadian assets rather than take portfolio investment positions in Canadian-owned companies.

Canadians would undoubtedly benefit from increases in housing construction (and subsequently, increased affordability) and improved productivity from increased business investment. However, government subsidies to home builders, including the billions recently announced by the Trudeau government, simply move available domestic savings from one set of investments to another. The policy goal should be to increase the availability of risk-taking financial capital so the costs of capital decrease for Canadian investors.

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Economy

Today’s federal government—massive spending growth and epic betting

Published on

From the Fraser Institute

By Jock Finlayson

One can legitimately ask whether the federal government has simply grown too big, complex and unwieldy to be managed at all

The Trudeau government’s 2024 budget landed with a thud, evoking little enthusiasm and drawing spirited criticism from business leaders, investors, provincial premiers and (of course) the opposition parties. Several elements of the budget have garnered outsized attention, notably the pledge to run endless deficits, the imposition of higher capital gains taxes, and various new programs and policy initiatives intended to address Canada’s housing crisis.

But the budget includes a few eye-catching data points that have been downplayed in the subsequent political and media commentary.

One is the sheer size of the government. The just-completed fiscal year marked a milestone, as Ottawa’s total spending reached half a trillion dollars ($498 billion, to be exact, excluding “actuarial losses”). According to the budget, the government will spend $95 billion more in 2024-25 than it planned only three years ago, underscoring the torrid pace of spending growth under Prime Minister Trudeau.

One can legitimately ask whether the federal government has simply grown too big, complex and unwieldy to be managed at all, even if we assume the politicians in charge truly care about sound management. How many parliamentarians—or even cabinet ministers—have a sufficient understanding of the sprawling federal apparatus to provide meaningful oversight of the vast sums Ottawa is now spending?

The ArriveCAN scandal and chronic problems with defence procurement are well-known, but how good a job is the government doing with routine expenditure programs and the delivery of services to Canadians? The auditor general and the Parliamentary Budget Officer provide useful insights on these questions, but only in a selective way. Parliament itself tends to focus on things other than financial oversight, such as the daily theatre of Question Period and other topics conducive to quick hits on social media. Parliament isn’t particularly effective at holding the government to account for its overall expenditures, even though that ranks among its most important responsibilities.

A second data point from the budget concerns the fast-rising price tag for what the federal government classifies as “elderly benefits.” Consisting mainly of Old Age Security and the Guaranteed Income Supplement, these programs are set to absorb $81 billion of federal tax dollars this year and $90 billion by 2026-27, compared to $69 billion just two years ago. Ottawa now spends substantially more on income transfers to seniors than it collects in GST revenues. At some point, a future government may find it necessary to reform elderly benefit programs to slow the relentless cost escalation.

Finally, the budget provides additional details on the Trudeau government’s epic bet that massive taxpayer-financed subsidies will kickstart the establishment of a major, commercially successful battery and electric vehicle manufacturing “supply chain” in Canada. The government pledges to allocate “over $160 billion” to pay for its net-zero economic plan, including $93 billion in subsidies and incentives for battery, EV and other “clean” industries through 2034-35. This spending, the government insists, will “crowd in more private investment, securing Canada’s leadership” in the clean economy.

To say this is a high-risk industrial development strategy is an understatement. Canada is grappling with an economy-wide crisis of lagging business investment and stagnant productivity. Faced with this, the government has chosen to direct hitherto unimaginable sums to support industries that make up a relatively small slice of the economy. Even if the plan succeeds, it won’t do much to address the bigger problems of weak private-sector investment and slumping productivity growth.

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