FINANCIAL POST COLUMN: Post-Pandemic Policy By The eBook

Quebecers have just regained the right to go for a walk at night without being accompanied by a dog. Albertans will soon be able to sit on restaurant patios with their friends and family. Ontario is even letting people — gasp! — golf again.

Canada appears to be finally emerging from the pandemic. While we’re all planning on celebrations in the months ahead, our elected officials shouldn’t set aside too much time for festivities. Canada faces some very serious issues in our new post-pandemic world.

Five organizations involved in public policy in Canada recently came together to create a free ebook — Life After COVID — to highlight some of those major issues. Most importantly, our ebook doesn’t just outline problems; it proposes more than 30 potential policy solutions.

For starters, Canadians should know that our nation’s federal debt has passed a staggering $1 trillion and will continue to rise in the years ahead. Divide that among 38 million of us and your share works out to nearly $29,000. But Ottawa isn’t the only government loading up its credit card. Provincial governments have also been busy incurring debt. In fact, Newfoundland and Labrador is on the brink of insolvency.

To understand how government debt affects you, think of the tried-and-true advice “if it sounds too good to be true, it probably is.” Rising government debt ultimately means higher tax rates, inflation and bigger interest charges for governments, which means fewer dollars for services citizens care about.

Fortunately, there are many ways governments could curtail their expenditures without taxpayers noticing a decrease in the services they consider most important. Reducing pay for federal employees, scaling back their generous pensions and curbing discretionary expenditures are just a few measures the Canadian Taxpayers Federation proposes.

Health care is another major problem area for governments. Before the pandemic, Canada faced an enormous cash crunch due to our nation’s aging population. Retired people tend to earn less, pay less in taxes and require more costly health care procedures. That’s not a slight on older Canadians, it’s just a fact of life.

The problem is that governments have not saved enough to pay for the wave of baby boomers as they age. The oldest of the boomers turn 75 this year and people in the 75-79 age bracket cost the health care system three times more, on average, than those 50-54 years old. The pandemic has only made things worse. After COVID emerged, governments postponed upwards of 400,000 surgeries and procedures nation-wide. Canada’s already long waiting lists have gotten even longer.

The Montreal Economic Institute proposes several common-sense policy solutions to improve health care for patients — for example, allowing pharmacists and nurses to provide a wider array of health services. This could save the system large sums of money as it becomes less dependent on higher-cost doctors to handle the tasks in question.

Similarly, allowing Canadians something the rest of the developed world enjoys — a choice between public and non-government providers — could take pressure off the public system as some patients decide to pay out-of-pocket for private care.

Canada’s high unemployment rate is another problem that deserves attention. The federal government has promised to borrow $101 billion and spend the money to “create jobs” and get the economy going. But instead of governments giving businesses billions of our tax dollars, it could create thousands of jobs by simply getting out of the way. Cutting red tape, tearing down interprovincial trade barriers and making it easier for natural resource projects to proceed could create more jobs than the government’s stimulus plan. As SecondStreet.org research has shown, between 2014 and 2020, the value of major mining and oil and gas projects delayed or obstructed by government policies was in excess of $200 billion.

These are just a few potential solutions to the challenges facing Canada. As much as our politicians want to celebrate finally getting COVID under control, for the sake of everyday Canadians, the celebration shouldn’t last too long. There’s lots of work to be done.

Colin Craig is president of SecondStreet.org and contributed a chapter to Life After COVID. The Montreal Economic Institute, Canadian Constitution Foundation, Canadian Taxpayers Federation and Justice Centre for Constitutional Freedoms were other partners in the policy ebook project.

This column was published in The Financial Post on June 1st, 2021. To see article click here.

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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.