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Fraser Institute

Other countries with universal health care don’t have Canada’s long wait times

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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.

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Crime

Numbers don’t lie—crime up significantly in Toronto and across Canada

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From the Fraser Institute

By Matthew Lau

It’s no secret that politicians often cherry-pick statistics instead of telling the full story when the full story doesn’t look great for them. For example, amid concerns of rising auto theft and crime, the federal Liberals recently highlighted that auto theft is down 17 per cent versus last year. But this statement deserves scrutiny.

It’s true, according to an insurance fraud prevention group, there was a 17 per cent year-over-year decline in auto thefts in the first half of 2024. But this doesn’t mean the number of stolen cars is low. The reason for the year-over-year decline is that auto thefts spiked significantly in 2023. While down in the first half of 2024, auto thefts remain at elevated levels relative to prior years.

For example, the Toronto Police Service reports 5,049 auto thefts in the first half of 2024—down 21 per cent year-over year, but still very high relative to the first half of 2022 (4,480 auto thefts) and the first half of 2021 (2,769 auto thefts). In light of an 82 per cent increase in auto thefts in Toronto compared to just three years ago, the Trudeau government shouldn’t celebrate too loudly its record at stopping auto theft.

In addition, cherry-picking auto theft stats ignores crime increases in other areas. In the first half of 2024 (again, according to Toronto Police Service data), assaults were up 8 per cent year-over-year, breaking and entering was up 6 per cent, homicides were up 36 per cent, robberies were up 21 per cent, and sexual violations were up 17 per cent.

And it’s not just Toronto.

Take York Region as another example. Faced with criticism that violent crime had risen dramatically in Ontario since the Liberals took office, a Liberal MP from York Region called such criticism “false and misleading” and declared “our community is safe,” citing the York Region Police’s published crime statistics. But what do York Region crime statistics actually show?

Like in Toronto, in the first half of 2024 auto thefts were down significantly versus the first half of 2023, and weapons violations and sexual violations were also down. However, assaults, breaking and entering, drug violations and robberies were all up. And again, the longer-term trend shows most types of crime on the rise. Despite the decline versus 2023, in the first half of 2024 auto thefts were 120 per cent higher than in 2021. And compared to 2021, the first half of 2024 in York Region saw 58 per cent more assaults, 99 per cent more breaking and entering incidents, 193 per cent more robberies, 69 per cent more firearm violations and 51 per cent more violations with other weapons.

Across Canada, That’s just a fact. Statistics Canada’s violent crime severity index in 2023 was 41 per cent higher than in 2014, and a recent report from the Ottawa-based Macdonald-Laurier Institute revealed a surge in violent crime in Canada’s largest urban centres.

However you crunch the numbers, the Trudeau government’s record on crime is nothing to boast about.

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Economy

Canada should not want to lead the world on climate change policy

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From the Fraser Institute

By Ross McKitrick

Some commentators in the media want the the federal Conservatives to take a leadership position on climate, and by extension make Canada a world leader on the journey to the low-carbon uplands of the future. This would be a mistake for three reasons.

First, unlike other areas such as trade, defence or central banking, where diplomats aim for realistic solutions to identifiable problems, in the global climate policy world one’s bona fides are not established by actions but by willingness to recite the words of an increasingly absurd creed. Take, for example, United Nations Secretary General António Guterres’ fanatical rhetoric about the “global boiling crisis” and his call for a “death knell” for fossil fuels “before they destroy our planet.” In that world no credit is given for actually reducing emissions unless you first declare that climate change is an existential crisis, that we are (again, to quote Guterres) at the “tip of a tipping point” of “climate breakdown” and that “humanity has become a weapon of mass extinction.” Any attempt to speak sensibly on the issue is condemned as denialism, whereas any amount of hypocrisy from jet-setting politicians, global bureaucrats and celebrities is readily forgiven as long as they parrot the deranged climate crisis lingo.

The opposite is also true. Unwillingness to state absurdities means actual accomplishments count for nothing. Compare President Donald Trump, who pulled out of the Paris treaty and disparaged climate change as unimportant, to Prime Minister Justin Trudeau who embraced climate emergency rhetoric and dispatched ever-larger Canadian delegations to the annual greenhouse gabfests. In the climate policy world, that made Canada a hero and the United States a villain. Meanwhile, thanks in part to expansion of natural gas supplies under the Trump administration, from 2015 to 2019 U.S. energy-based CO2 emissions fell by 3 per cent even as primary energy consumption grew by 3 per cent. In Canada over the same period, CO2 emissions fell only 1 per cent despite energy consumption not increasing at all. But for the purpose of naming heroes and villains, no one cared about the outcome, only the verbiage. Likewise, climate zealots will not credit Conservatives for anything they achieve on the climate file unless they are first willing to repeat untrue alarmist nonsense, and probably not even then.

On climate change, Conservatives should resolve to speak sensibly and use mainstream science and economic analysis, but that means rejecting climate crisis rhetoric and costly “net zero” aspirations. Which leads to the second problem—climate advocates love to talk about “solutions” but their track record is 40 years of costly failure and massive waste. Here again leadership status is tied to one’s willingness to dump ever-larger amounts of taxpayer money into impractical schemes loaded with all the fashionable buzzwords. The story is always the same. We need to hurry and embrace this exciting economic opportunity, which for some reason the private sector won’t touch.

There are genuine benefits to pursuing practical sensible improvements in the way we make and use fossil fuels. But the current and foreseeable state of energy technology means CO2 mitigation steps will be smaller and much slower than was the case for other energy side-effects such as acid rain and particulates. It has nothing to do with lack of “political will;” it’s an unavoidable consequence of the underlying science, engineering and economics. In this context, leadership means being willing sometimes to do nothing when all the available options yield negative net benefits.

That leads to the third problem—opportunity cost. Aspiring to “climate leadership” means not fixing any of the pressing economic problems we currently face. Climate policy over the past four decades has proven to be very expensive, economically damaging and environmentally futile. The migration of energy-intensive industry to China and India is a very real phenomenon and more than offsets the tiny emission-reduction measures Canada and other western countries pursued under the Kyoto Protocol.

The next government should start by creating a new super-ministry of Energy, Resources and Climate where long-term thinking and planning can occur in a collaborative setting, not the current one where climate policy is positioned at odds with—and antagonistic towards—everything else. The environment ministry can then return its focus to air and water pollution management, species and habitat conservation, meteorological services and other traditional environmental functions. The climate team should prepare another national assessment but this time provide much more historical data to help Canadians understand long-term observed patterns of temperature and precipitation rather than focusing so much on model simulations of the distant future under implausible emission scenarios.

The government should also move to extinguish “climate liability,” a legal hook on which dozens of costly nuisance lawsuits are proliferating here and elsewhere. Canada should also use its influence in the UN Intergovernmental Panel on Climate Change to reverse the mission creep, clean out the policy advocacy crowd and get the focus back on core scientific assessments. And we should lead a push to move the annual “COPs”—Conferences of the Parties to the Rio treaty—to an online format, an initiative that would ground enough jumbo jets each year to delay the melting of the ice caps at least a century.

Finally, the new Ministry of Energy, Resources and Climate should work with the provinces to find one region or municipality willing to be a demonstration project on the feasibility of relying only on renewables for electricity. We keep hearing from enthusiasts that wind and solar are the cheapest and best options, while critics point to their intermittency and hidden costs. Surely there must be one town in Canada where the councillors, fresh from declaring a climate crisis and buying electric buses, would welcome the chance to, as it were, show leadership. We could fit them out with all the windmills and solar panels they want, then disconnect them from the grid and see how it goes. And if upon further reflection no one is willing to try it, that would also be useful information.

In the meantime, the federal Conservatives should aim merely to do some sensible things that yield tangible improvements on greenhouse gas emissions without wrecking the economy. Maybe one day that will be seen as real leadership.

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