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Enough talk, we need to actually do something about Canadian health care

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From the Macdonald Laurier Institute

By J. Edward Les for Inside Policy

Canada spends more on health care as a percentage of GDP than almost all other OECD countries, yet we rank behind most of them when it comes to outcomes that matter.

I drove a stretch of road near Calgary’s South Health Campus the other day, a section with a series of three intersections in a span of less than a few hundred metres. That is, I tried to drive it – but spent far more time idling than moving.

At each intersection, after an interminable wait, the light turned green just as the next one flipped to red, grinding traffic to a halt just after it got rolling. It was excruciating; I’m quite sure I spied a snail on crutches racing by – no doubt making a beeline (snail-line?) for the ER a stone’s throw away.

The street’s sluggishness is perhaps reflective of the hospital next to it, given that our once-cherished universal health care system has crumbled into a universal waiting system – a system seemingly crafted (like that road) to obstruct flow rather than enable it. In fact, the pace of medical care delivery in this country has become so glacial that even a parking lot by comparison feels like the Indianapolis Speedway.

The health care crisis grows more dire by the day. Reforms are long overdue. Canada spends more on health care as a percentage of GDP than almost all other OECD countries, yet we rank behind most of them when it comes to outcomes that matter.

And we’re paying with our lives: according to the Canadian Institute for Health Information, thousands of Canadians die each and every year because of the inefficiencies of our system.

Yet for all that we are paralyzed by the enormity and complexity of the mushrooming disaster. We talk about solutions – and then we talk and talk some more. But for all the talking, precious little action is taken.

I’m reminded of an Anne Lamotte vignette, related in her bestselling book Bird By Bird:

Thirty years ago my older brother, who was ten years old at the time, was trying to get a report written on birds that he’d had three months to write, which was due the next day. We were out at our family cabin in Bolinas, and he was at the kitchen table close to tears, surrounded by binder paper and pencils and unopened books about birds, immobilized by the hugeness of the task ahead. Then my father sat down beside him, put his arm around my brother’s shoulder, and said, “Bird by bird, buddy. Just take it bird by bird.”

So it is with Canadian health care: we’ve wasted years wringing our hands about the woeful state of affairs, while doing precious little about it.

Enough procrastinating. It’s time to tackle the crisis, bird by bird.

One thing we can do is to let doctors be doctors.  A few weeks ago, in a piece titled “Should Doctors Mind Their Own Business?”, I questioned the customary habit of doctors hanging out their shingles in small independent community practices. Physicians spend long years of training to master their craft, years during which they receive no training in business methods whatsoever, and then we expect them to master those skills off to the side of their exam rooms. Some do it well, but many do not – and it detracts from their attention to patients.

We don’t install newly minted teachers in classrooms and at the same time task them with the keeping the lights on, managing the supply chain, overseeing staffing and payroll, and all the other mechanics of running schools. Why do we expect that of doctors?

Keeping doctors embedded within large, expensive, inefficient, bureaucracy-choked hospitals isn’t the solution, either.

There’s a better way, I argued in my essay: regional medical centres – centres built and administered in partnership with the private sector.

Such centres would allow practitioners currently practicing in the community to ply their trade unencumbered by the nuts and bolts of running a business; and they would allow us to decant a host of services from hospitals, which should be reserved for what only hospitals can do: emergency services, inpatient care, surgeries, and the like.

In short, we should let doctors be doctors, and hospitals be hospitals.

To garner feedback, I dumped my musings into a couple of online physician forums to which I belong, tagged with the query: “Food for thought, or fodder for the compost bin?”

The verdict? Hands down, the compost bin.

I was a bit taken aback, initially. Offended, even – because who among us isn’t in love with their own ideas?

But it quickly became evident from my peers’ comments that I’d been misunderstood. Not because my doctor friends are dim, but because I hadn’t been clear.

When I proposed in my essay that we “leave the administration and day-to-day tasks of running those centres to business folks who know what they’re doing,” my colleagues took that to mean that doctors would be serving at the beck and call of a tranche of ill-informed government-enabled administrators – and they reacted to the notion with anaphylactic derision. And understandably so: too many of us have long and painful experience with thick layers of health care bureaucracy seemingly organized according to the Peter Principle, with people promoted to – and permanently stuck at – the level of their incompetence.

But I didn’t mean to suggest – not for a minute – that doctors shouldn’t be engaged in running these centres. I also wrote: “None of which is to suggest that doctors shouldn’t be involved, by aptitude and inclination, in influencing the set-up and management of regional centres – of course, they should.”

Of course they should. There are plenty of physicians equipped with both the skills and interest needed to administer these centres; and they should absolutely be front and centre in leading them.

But more than that: everyone should have skin in the game. All workers have the right to share in the success of an enterprise; and when they do, everybody wins.  When everyone is pulling in the same direction because everyone shares in the wins, waste and inefficiencies are rooted out like magic.

Contrast that to how hospitals are run, with scarcely anyone aware of the actual cost of the blood tests or CT scans they order or the packets of suture and gauze they rip open, and with the motivations of administrative staff, nurses, doctors, and other personnel running off in more directions than a flock of headless chickens. The capacity for waste and inefficiencies is almost limitless.

I don’t mean to suggest that the goal of regional medical centres should be to turn a profit; but fiscal prudence and economic accountability are to be celebrated, because money not wasted is money that can be allocated to enhancing patient care.

Nor do I mean to intimate that sensible resource management should be the only parameter tracked; patient outcomes and patient satisfaction are paramount.

What should government’s role be in all this? Initially, to incentivize the creation of these centres via public-private partnerships; and then, crucially, to encourage competition among them and to reward innovation and performance, with optimization of the three key metrics – patient outcomes, patient satisfaction, and economic accountability – always in focus.

No one should be mandated to work in non-hospital regional medical centres. It’s a free country (or it should be): doctors should be free to hang out their own community shingles if they wish. But if we build the model correctly, my contention is that most medical professionals will prefer to work collaboratively under one roof with a diverse group of colleagues, unencumbered by the mundanities of running a business, but also free of choking hospital bureaucracy.

I connected a couple weeks ago with the always insightful economist Jack Mintz (who is also a distinguished fellow at the Macdonald-Laurier Institute). Mintz sits on the board of a Toronto-area hospital and sees first-hand “the problems with the lack of supply, population growth, long wait times between admission and getting a bed, emergency room overuse,” and so on.

“Something has to give,” he said. “Probably more resources but better managed. We really need major reform.”

On that we can all agree. We can’t carry on this way.

So, let’s stop idling; and let’s green-light some fixes.

As Samwise Gamgee said in The Lord of the Rings, “It’s the job that’s never started as takes longest to finish.”


Dr. J. Edward Les is a pediatrician in Calgary who writes on politics, social issues, and other matters.

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Business

Here’s why your plane ticket is so expensive

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From the Fraser Institute

By Alex Whalen and Jake Fuss

While the strike by WestJet mechanics lasted only a few days, many Canadian air travellers faced long delays and cancelled flights. More broadly, according to the Canadian Transportation Agency, customer complaints have hit an all-time high.

Yet many dissatisfied travellers likely don’t realize that Ottawa heavily contributes to their frustrations. Let’s look at the various ways federal policies and laws make air travel worse in Canada.

First, federal laws insulate Canada’s airlines from competition. Foreign airlines are subject to highly restrictive  “cabotage” laws which, for example, dictate that foreign airlines cannot operate routes between Canadian cities. At the same time, foreign investors are forbidden from owning more than 49 per cent of Canadian airlines. By restricting international participation in the Canadian air travel market, these laws both deprive Canadian consumers of choice and insulate incumbent airlines from competition. When consumers have more choice, incumbents have a greater incentive to improve performance to keep pace with their competitors.

Second, a wide array of taxes and fees heavily influence the cost of airline tickets in Canada. Airport improvement fees, for example, average $32.20 per departing passenger at airports in Canada’s 10 largest markets. In contrast, airport improvement fees in the United States cannot exceed $4.50. And last year the Trudeau government increased the “air travellers security charge” by 32.85 per cent—this fee, which now ranges from $9.94 to $34.82 per flight, is higher in Canada than the U.S. across all flight categories. On the tax front, in addition to fuel taxes including the federal carbon tax, the federal excise tax on unleaded aviation gasoline in Canada is 10 cents per litre compared to 6.9 cents per litre in the U.S. And the U.S., unlike Canada, does not apply sales taxes to aviation fuel.

Third, air travel is a heavily regulated sector. Federal legislation generates thousands of provisions airlines must follow to operate legally in Canada. Of course, some regulation is necessary to ensure passenger safety, but each regulation adds administrative and compliance costs, which ultimately affect ticket prices. To lower the cost of air travel, the federal government should reduce the regulatory burden while maintaining safety standards.

Lastly, the ownership model of Canada’s airports results in a yearly transfer of rent to the federal government. The federal government used to own Canada’s national system of airports until they were transferred to private not-for-profit corporations in the early 1990s. However, these airports must still pay rent to the federal government—nearly half a billion dollars annually, according to the Canada Airports Council. As with the other examples listed above, these costs are ultimately passed on to consumers in the form of higher ticket prices.

While a precise estimate is difficult to obtain, various government policies, taxes and fees comprise a large share of the cost of each airline ticket sold in Canada. With complaints from travellers at all-time highs, the federal government should reduce the regulatory burden, increase competition, and lower fees and taxes. Policy reform for air travel in Canada is long overdue.

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Fraser Institute

Ignore climate-obsessed propagandists and enjoy your summer

Published on

From the Fraser Institute

By Kenneth P. Green

Ah summer, a season we used to meet with joy. Outdoor parties, leisurely road trips, weekends at the beach, blazing barbecues by day, blazing bonfires by night. We used to sing paeans to the season—“Summertime, and the living is easy, fish are jumping and the cotton is high.”

But a strange thing has happened—the climate-obsessed folks have seized upon summer as a primary propaganda source and use it to demonize activities that might produce greenhouse gases. They don’t want your living to be easy. They want your coal or gas barbecues gone, your road trips gone, your air conditioning coolant weakened or gone, and so on. And every heatwave, every forest fire, every hint of drought, every reported case of heatstroke, and even observations of jumping catfish will be proof of a climate crisis where extreme weather will eventually kill us all.

But in a recent study, I found that the evidence of increases in extreme weather events in Canada and around the world is spotty and of limited quality, and often contradictory of the narrative.

First, what about wildfires? The United Nations Intergovernmental Panel on Climate Change (IPCC), in its latest climate report, only assigns “medium confidence” to the idea that climate change has actually caused increased “fire weather” in some regions on Earth.

Here at home, as average atmospheric temperatures have risen from 1970 to 2017, Canadian forest fires have actually declined sharply in number and show little obvious trend in areas burnt. As economist/professor Ross McKitrick observes: “Canadian forest fire data are available from the Wildland Fire Information System. Wildfires have been getting less frequent in Canada over the past 30 years. The annual number of fires grew from 1959 to 1990, peaking in 1989 at just over 12,000 that year, and has been trending down since. From 2017 to 2021 (the most recent interval available), there were about 5,500 fires per year, half the average from 1987 to 1991. The annual area burned also peaked 30 years ago. It grew from 1959 to 1990, peaking in 1989 at 7.6 million hectares before declining to the current average of 2.4 million hectares per year over 2017-21. And 2020 marked the lowest point on record with only 760,000 hectares burned.”

Well, but what about drought? According to an international research team, “In the vast majority of the world, trends in meteorological drought duration and magnitude are not statistically significant, with the exception of some small regions of Africa and South America, which is also where data uncertainty is greater.” The International Energy Agency (IEA) in a 2021 report suggests that drought severity in Canada from 2000 to 2020 was only slightly above the global average.

Well, but what about floods? The IPCC says floods have likely increased globally since 1950, but in Canada, at least, “there is a lack of detectable trends in observed annual maximum daily (or shorter duration) precipitation.”

So, summertime and the living is easy. Ignore the shrieks of the climate-obsessed about extreme weather coming for us all, and have some fun in the sun.

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