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City hall’s finances aren’t so dire

I called up my friend Tracy Johnson recently and asked her a simple question, “how would you like it if your business saw a 6 per cent drop in revenues?”

She responded, “I’d love it if my problem was only that small.”

Tracy and her sister opened up a new brewery in Calgary about a month before COVID-19 took hold in Canada. Needless to say, their revenues have plummeted like countless other businesses. It’s easy to see why she would be happy with only having her budget off by such a small figure.

I asked the same question to a contact in Winnipeg who runs a small retail operation. She told me, “A 6 per cent decrease would hardly be a blip on the screen compared to what COVID-19 has caused.”

Since the pandemic emerged in Canada, countless businesses across the country have faced enormous budgetary shortfalls – many have simply shut down.

Yet at the same time, mayors of large cities in Canada have been pleading poverty over relatively small amounts. The shortfalls mayors have been communicating to the public are large, in dollar terms, but they’re not-so-large when you put them in the context of their entire city budgets.

The aforementioned “6 per cent” is what the shortfall identified by Calgary’s Mayor roughly works out to as a percentage of the city’s total budget. Winnipeg’s budget shortfall works out to around 6 per cent, Toronto’s is about 11 per cent, Edmonton’s is 9 per cent and Ottawa’s is around 1 per cent.

Premiers Jason Kenney, Brian Pallister, Doug Ford and Prime Minister Justin Trudeau and others are often approached by big these city mayors for funding assistance. Provincial and federal politicians would be wise to consider two things.

First, as demonstrated, city budgets aren’t so dire when compared to what everyone else is going through. Couldn’t cities cut back on compensation and delay spending on nice-to-have projects like the rest of society?

I previously experienced a 10 per cent pay reduction during a recession. It wasn’t pleasant, but I felt fortunate to still have a job. Perhaps cities could employ that same mindset?

Second, city budgets increase every single year. It’s not like cities are having to reduce spending after years of spending cuts or freezes. Quite the opposite.

If you peruse the activities of big cities, you’ll find they’re often not exactly lean machines.

In Winnipeg, citizens hired a private investigative firm last year to blow the whistle on city staff shopping at Costco, snow blowing their driveways and running personal errands during the workday to name a few examples; 20 staff were eventually disciplined, some fired. Make no mistake, there are many good people who work for the City of Winnipeg, but what kind of management structure allows for such waste?

Toronto had enough money to pay staff to harass senior citizens for gambling $1.25 during their unlicensed Euchre card games and Calgary was spending millions on staff bonuses each year and council didn’t even know.

If mayors can’t find savings in their budgets, then maybe they should ask the rest of society how to do it?

And if mayors aren’t willing to demonstrate true sacrifices then it’s hard to imagine why other levels of government should consider their requests in the first place.

 

Colin Craig is the President of SecondStreet.org, a new Canadian think tank

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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.