Facts and Four Points

The slogans “Axe the Tax” and “Build the Homes” resonate with major economic concerns of Canadians. The devil is in the details when we study the best way to implement effective taxation that accomplishes our need to address climate change and finance the building of the housing needed to address emergency homelessness in our country.

How to Action The Slogans 

Aaron Wherry of CBC News reports that beneath the back-and-forth over the Liberal government's carbon tax and the Conservative leader's agenda, Justin Trudeau and Pierre Poilievre are also duelling over very different theories of change.

Much of what's wrong with the way things are can be traced, Poilievre suggests, to higher levels of federal spending under Trudeau. For Poilievre, that spending marked a particularly dramatic break with the past and with a historic consensus.

"Balancing the budget to keep inflation and interest rates low was the unanimous policy of all the major political parties at all levels of government for 30 years, right up to the radical departure [in 2015]," he said. 

Wherry points out that if the way things were in 2015 is to be a point of reference, it's equally fair to note how much higher greenhouse gas emissions were projected to be back then, how many more Indigenous communities lacked access to clean drinking water, how many more children were living in poverty and how much higher child care fees were. (Wherry, 2024)

Things are changing — the planet's climate certainly is. And Trudeau can argue that significant parts of his government's agenda have been about meeting the need for change and preparing Canadians for the future.

But it's on his ability to "tackle" the problems of today that he is being challenged — and earlier action on housing would have put him in a better place now, even if provincial and municipal governments deserve significant amounts of blame for the current situation.

Opposite Trudeau, Poilievre is laying the rhetorical groundwork to do things very differently — even if he frames it in terms of simply changing things back to way they were. The more he can convince people that the country is in terrible shape — and that everything currently wrong with it can be blamed on Trudeau — the easier it becomes for him to justify doing something close to the opposite. (Wherry, 2024)

Paul Kershaw, in a special article in the Globe and Mail, comments that if you make a mess, you should help clean it up. That’s a responsibility his Mom taught him.

As the House of Commons returned to session, Pierre Poilievre, the Conservative Leader, betrayed this family value by courting voters with his promise to eliminate responsibility to pay for our pollution.

Whether to pay for pollution isn’t about consumer preferences. It’s a duty we owe to our kids. We need our politicians to recognize as much if they are to identify real solutions to the affordability crisis, and to reduce risks from extreme weather.

A new Abacus poll signals Mr. Poilievre has convinced many Canadians that the price on pollution is a primary source of financial pain. Alas, research from the University of Calgary shows he is pulling the wool over our eyes. (Kershaw & Urback, 2024)

Professors Trevor Tombe and Jennifer Winter in a report for the School of Public Policy, University of Calgary, calculated the direct and indirect costs of the carbon tax to examine the entire financial impact of the tax relative to its absence. They use data from British Columbia, where the carbon price is the same as that levied by the federal plan. They found that carbon pricing adds 0.5 per cent to the cost of food and beverages; 0.29 per cent to rent; 0.2 per cent for clothing and footwear; and less than 0.13 per cent for insurance and financial services.

While some politicians and policymakers are blaming emissions pricing for high costs of living, the figure shows that the actual effect is quite modest for most items.

Emissions pricing is just one of many indirect taxes that households face. Other examples are sales taxes and alcohol levies. We estimate that the combined effect on Canadian consumer prices from all indirect tax increases between January 2015 and October 2023 was 0.6%.

Knowing that much of the present affordability crisis is due to factors other than emissions pricing, the elimination of the carbon tax is unlikely to solve the problem. As Canada slowly recovers from high inflation in 2021 and 2022, policy makers will need to consider alternative solutions. (Tombe & Winter, n.d.)

Geordie Dent, in an article for The Breach, concludes that cheap money and privatization made housing unaffordable, but organizing can reverse the tide

Canada used to build a decent amount of social housing. By ensuring that low-income renters had affordable options, the government kept the market honest and stopped housing speculation from spiraling into feedback loops.

Until around 1993, Canada funded the construction of 10,000 or more social housing units in a typical year. 

So what happened in 1993? That’s the year the federal Liberals were elected on a platform of progressive promises. But once in power, they pivoted to a policy of fiscal austerity. Finance Minister Paul Martin slashed housing spending to almost nothing. 

The construction of housing had been completely privatized. (Dent, 2023)

The recent climate disasters in Canada require a taxation strategy to incentivize transition to a carbon reduced economy. Research shows the additional tax burden adds less than 1% to most of the purchases of Canadians. Because we cannot expect the market to build below market housing, social housing for Canadians living in tents needs to be a Government responsibility.

References

Dent, G. (2023, February 2). The global money pool that soaked Canada's hope of affordable housing ⋆ The Breach. The Breach. Retrieved February 4, 2024, from https://breachmedia.ca/the-global-money-pool-that-soaked-canadas-hope-of-affordable-housing/? 

Kershaw, P., & Urback, R. (2024, February 2). Pushing to 'Axe the Tax' is unfair to our kids. The Globe and Mail. Retrieved February 4, 2024, from https://www.theglobeandmail.com/investing/personal-finance/young-money/article-pushing-to-axe-the-tax-is-unfair-to-our-kids/ 

Tombe, T., & Winter, J. (n.d.). ENERGY & ENVIRONMENTAL EMISSIONS PRICING AND AFFORDABILITY: LESSONS FROM BRITISH COLUMBIA. The School of Public Policy. Retrieved February 4, 2024, from https://www.policyschool.ca/wp-content/uploads/2023/12/EE-Trends-DEC.pdf 

Wherry, A. (2024, February 3). Trudeau and Poilievre have very different theories of change. CBC. Retrieved February 4, 2024, from https://www.cbc.ca/news/politics/trudeau-poilievre-election-1.7103710? 

Health Homes and Climate

The relationships between health services, housing needs, and the climate crisis are many. The tension between market based action and government control in these areas compels us to carefully analyze trends and progress.

Health and Housing in Climate Crisis

The Ottawa Citizen reports on privatization of orthopedic surgery that may be impacting staffing for hospital health care. Elizabeth Payne reports:

“We are not able to provide the service we want for oncology patients because nurses are working in a higher paid environment,” said the unnamed source. “My view is that this is confirming the concerns that we are limited in terms of the service we can provide in the public system because nurses are obviously being poached by this private clinic.” (Payne, 2023)

Nicole Munro, at Saltwire, contributes an article on West End Mall redevelopment in Halifax.

By the time the master plan is finished, Coun. Shawn Cleary (Halifax West Armdale) said, the inclusionary zoning bylaw should be in place at about the same time, giving HRM the power to ensure there is a percentage of affordable units included.

While Cleary suspects most of the units will be market-based rents, he said the inclusionary zoning bylaw would allow some affordable units.

“We’ll have the power to actually say, ‘No, no, you don’t have a choice. You’re going to have this per cent of those units that have to be affordable.’” (Halifax's West End Mall Redevelopment Will Go on Despite Pushback, Councillor Says, 2023)

Matt McGrath, environment correspondent for BBC News, contributes an article about fossil fuel emissions falling in worldwide electricity generation.

One significant player impacting the overall trend is China. Around 50% of the global addition of wind power came from China and about 40% of the world's new solar came from from the country that's also the world's biggest use of coal power.

"There is a chance that at the rate that China is building wind and solar and all types of clean generation, that they achieve that peak in coal generation earlier than 2025, which would be significant," said Mr Jones.

Energy experts acknowledge that curbing fossil fuels in power generation could well be a "turning point", but much more remains to be done. (McGrath, 2023)

We monitor important trends as we ponder the best economic approach to address these serious concerns that impact the common good.

References

Halifax's West End Mall redevelopment will go on despite pushback, councillor says. (2023, April 12). SaltWire. Retrieved April 14, 2023, from https://www.saltwire.com/nova-scotia/business/halifaxs-west-end-mall-redevelopment-will-go-on-despite-pushback-councillor-says-100843479/ 

McGrath, M. (2023, April 11). Climate change: Fossil fuel emissions from electricity set to fall - report. BBC. Retrieved April 14, 2023, from https://www.bbc.com/news/science-environment-65240094 

Payne, E. (2023, March 21). Surgeries at for-profit orthopedic clinic already impacting hospital staffing, some insiders say. Ottawa Citizen. Retrieved April 14, 2023, from https://ottawacitizen.com/news/surgeries-at-for-profit-orthopedic-clinic-already-impacting-hospital-staffing-some-insiders-say 

Help for Health Housing Here

Government budgets have recently provided some attention to the crisis in health and housing that we are experiencing across Canada.

Housing Options in HRM

The challenge of providing primary health care to Nova Scotians is evidenced by over 100,000 people who have no family physician.

Doctor Parking Empty

Some Governments have promised bonus payments to health care professionals to retain them in positions that are becoming increasingly challenging as workload increases.

Bonus for long hours with short staff

The path to timely resolution of these challenges to our assumption that Canada is a wealthy progressive society that can take care of the needs of it’s residents may require us to decide in which ballpark we can expect to find help.

Consider Health and Housing as Human Right

In healthcare, jurisdictions across Canada have sought the help of entrepreneurial enterprises who have provided resources for virtual access to primary care and supplemental diagnostic testing and surgery services. The principals of these organizations use the language of “target market” and “customer” in describing their operations. 

Health and Housing is a Right Here

A nation of 11 Million that is a very popular sun destination for Canadians, the Republic of Cuba, has defined health care and housing as rights for it’s citizens in its constitution. During the Obama administration, the loosening of the US Embargo on Cuba saw the flourishing of a small market economy and increased tourist and economic involvement with the United States. The Trump administration reversed the Obama policy and took aggressive action to severely inhibit economic activity between the US and Cuba.

Canada has a much better relationship with Cuba and many Canadian visitors have encountered well educated Cubans working in the resort industry. Surprisingly, the largest source of government income in Cuba is not from tourism but from export of medical services to countries in the Global South.

Canadians encounter well educated Cubans

The government's responsibility to maintain health and housing as a right for residents in Cuba has necessitated maintaining a high quality education system that supports health and economic development in the country.

On the road to Havana

Health and housing are too essential to the success of a society to be left to the market that best serves profit and short term gain for shareholders rather than community needs that are long term. Healthy, educated people with housing are essential to maintain our health, education, and business infrastructure. 

Canadians can learn from Cuba that government support to create health care and housing as a right for people is a wise investment in creating the healthy educated community that is required to build the infrastructure that is now required in Canada as we prepare to address the transitions required to respond to the climate crisis and the worldwide migration emergency.

Report on Healthcare Policy in August Articles

As people and governments struggle to find a strategy to fix a broken healthcare system, we might consider some of the articles published in August 2022 that have addressed this issue.

Some topics from August

Eesha Affan of CBC News reports about an activist who says private clinics will pull health professionals away from publicly funded care and a co-founder of a private health care service who believes Canada’s strained system can’t meet the needs of citizens.

Alexandra Rose, the The Nova Scotia Health Coalition's provincial coordinator, says while private care might provide a temporary solution, it makes the shortfalls in Canada's public health care system even worse.

Doctor Parking Spaces

"Every time a private clinic opens, doctors leave the public sector, doctors, nurses, nurse practitioners. That's less staff working in the public sector, which is only going to exacerbate the extreme staffing crisis that we're already facing," Rose said.

Dr. Adam Hofmann, co-founder of Algomed, says he's a strong advocate for public health care but Canada's strained system can't meet the needs of citizens.

"What public health care does badly is adapt to the times. It doesn't innovate. It cannot innovate. It is too big a battleship to turn around," said Hofmann.

Rose says the responsibility to solve systemic issues lands on the shoulders of the government. She says she's worried private care will dissuade the government from finding long-term solutions on their own. (Affan & Donaldson, 2022)

Ali Amad, writing for Macleans magazine, in a discussion with Dr. Andrew Boozary dissects proposed solutions like privatization and prescribes a new approach to delivering health care across Canada.

Traditionally, our health care system is structured around hospitals and doctors working on their own in an urban neighbourhood or rural community. To modernize health care delivery, we must shift from this archaic and rigid structure to a more dynamic team-based approach. Instead of forcing patients to deal with our siloed health care system, which splits services into different locations or departments, each with their own procedures and red tape, teams of primary care physicians, nurses, specialists and social workers could work together in one setting or travel together as mobile units to underserved communities. Health care can then be collaboratively delivered in a much more time- and cost-efficient approach that benefits providers and patients.

An integral part of this team-based approach is an investment in more community health workers. Typically trained and employed by community health centres, community health workers tend to be locals with shared lived experiences who can act as guides and advocates for their community members. For my immigrant single-mom patient, a community health worker who speaks the same language would be an ally who can help enrol her with a family doctor and ease some of her daily life burdens. (Amad, 2022)

Danielle Edwards of CBC News notes that Premier Houston says his goal is to get Nova Scotians good health care quicker.

Nova Scotia NDP Leader Claudia Chender said on Wednesday the possibility of a private system overtaking the public one is always present.

"To indicate that there is no slide toward private health care is to willingly ignore the evidence," Chender said.

"When we say that we're concerned about a slip into private health care, what we're talking about is all of the existing ways in which people are right now paying to access health care," she added, pointing to the private, subscription-based clinic that recently opened in Dartmouth as an example.

"That includes the private clinic that's opened in Dartmouth, telemedicine and other ways in which Nova Scotians now, if they have the means, can pay for health care that others can't," she said. "That remains a concern for us."

Liberal Leader Zach Churchill said he was not assured by Houston's comments.

"One of the biggest issues we're having in health care right now is a labour shortage, so if you create a private health care delivery system, undoubtedly I believe that is going to siphon more staff out of our public health care system and make the labour shortage worse in health care," Churchill said. "I think you're creating a very big risk." (Edwards, 2022)

Healthcare political opinions

Yasmine Ghania reporting for CBC News interviewed Steven Lewis, a health policy consultant formerly based in Saskatchewan and adjunct professor of health policy at Simon Fraser University in British Columbia, who says the government should be building up the public system instead of turning to the private sector.

"If there is some advantage in having a stand-alone surgical clinic that does nothing but these kinds of day procedures, it would be just as efficient to build them and operate them in the public system," Lewis said in an interview with CBC News. (Ghania, 2022)

Jacques Poitras of CBC News writes that things are going to change in New Brunswick according to Premier Higgs.

The two opposition parties quickly denounced his comments.

"This is deeply concerning," said Liberal Leader Susan Holt.

"Our health-care system is falling apart, with ERs closing, waiting lists exploding, and health-care professionals pushed past their limits, and this government, sitting on a surplus, wants to make room for profits from the system?"

Holt vowed to "do everything I can to prevent this." 

Green Party MLA Kevin Arseneau called any privatization "a race to the bottom" that would weaken the system further and make it inaccessible to working class people.

The province ran surpluses of $408 million in 2020-21 and $487.8 million in 2021-22. A surplus of $35.2 million is projected this year. (Higgs Sees More Private-Sector Delivery of Health Care as an Option, 2022)

An article in the Economist explores how friendships across classes are important aids to social mobility for young Americans.

One measure seemed especially important. What the researchers called “economic connectedness”—the extent of friendships across social classes—was strongly associated with increased rates of high-school completion, reduced rates of teenage pregnancy and increased income for those born poorer. Moving from a place where friendships across social strata are relatively uncommon (a one-in-four chance of a friendship between someone in the bottom half of the class distribution and someone in the top) to one where it was relatively standard (a one-in-two chance) translated into an 8.2 percentile increase in future earnings, the researchers found. (A New Study Shows How Much Social Capital Matters, 2022)

The delays that patients endure in seeking health care has renewed interest in the question of the value of outsourcing procedures like surgeries to independent service providers. For the National Health Service in the UK outsourcing of NHS services to the independent sector is not a new phenomenon. The BMA is concerned that the Government's pandemic response and newly published elective recovery plan heavily reflect its commitment to further embedding the independent sector into the fabric of health services delivery. In February 2022, The BMA surveyed members to better understand their views on the outsourcing arrangements in place with ISP hospitals, and the potential trade-offs or implications this may have on doctors, patients, and the NHS more broadly. Many of the concerns of the BMA members are relevant in our circumstances as conservative governments consider offering more health services to private service providers.

Our research found that doctors are largely divided as to whether purchasing additional capacity from the independent sector would improve the ability to manage pressures on NHS hospitals. Two in five doctors (39%) feel that ISP contracting will significantly worsen the ability to manage NHS pressures, compared to just 29% who believe it would improve. (NHS Outsourcing, 2022)

Andre Picard, writing in the Globe and Mail, about the Canadian healthcare system comments that we have the worst of both worlds: a largely unaccountable public system, and an almost-not-regulated private system.

Public and private service improvement

In Canada, on the other hand, we have the worst of both worlds: a largely unaccountable public system, and an almost-not-regulated private system.

Worse yet, we pretend that simplistic approaches such as “more private delivery” or “more public funding” will magically solve everything when the real problem in Canada is that the health system isn’t a system, but rather a series of unconnected services that often work at cross purposes, and with an almost total lack of oversight and planning.

The current crisis – grave staffing shortages – is a case in point. We’ve known for years, if not decades, that this problem was coming, given the demographics of the aging work force.

Yet, there is no health human-resource plan. Provinces simply pilfer workers from each other, and then, when they’ve exhausted that approach, look to countries like the Philippines for workers.

That constant lurching from crisis to crisis with no plan, and no vision, is the real problem we need to address in Canadian health care.

The so-called private-public “debate” is the least of our worries. Rather, it’s a tiresome and costly distraction from the real problems that need to be addressed. (Picard, 2022)

The improvement in access to health care and the reduction of wait time for treatment and procedures will require increased funding that will raise the per capita cost of care for Canadians.  Dr. Katharine Smart, past president of the Canadian Medical Association, says, on the surface, it might seem privatization would increase capacity and take weight off the public system, but “that's not really what happens.”

“What starts to happen, of course, is differential access to care,” Smart said in an interview Thursday. “So people with more resources have more access, shorter wait times, and people who don’t, do not. “

Smart says, if Canadians want equity in accessing the health-care system, it needs more resources and investments to make it “successful.” (Privatizing Health Care Would Cause Inequity: CMA President, 2022)

A report on a survey counting those experiencing homelessness in Eastern Nova Scotia recommends treating housing as a human right. Housing security is one of the social determinants of health.

Source: Adapted by the article author from Gibson et al. 2011, Sandel et al. 2018, Maqbool et al. 2015, and Braveman et al. 2011.

Treating housing as a human right is an additional recommendation from this report, and a rights-based approach to housing, formalized through

provincial legislation, urgently needs to be implemented in Nova Scotia. T (Service-Based Homelessness Count 2021, n.d.)

Discussion on the best approach to restore timely access, affordability, and quality to our health care system requires consideration of the appropriate role of government and the private sector.

Focus suggested by Picard

Ideological pressure to abandon government involvement or to banish private sector suppliers needs to be avoided as we attempt to synthesize the structure and regulations to improve access, equity, value for money, and quality of service.

References

Affan, E., & Donaldson, J. (2022, August 13). Owner of private medical clinic says it will ease burden on N.S. health-care system. CBC. Retrieved August 13, 2022, from https://www.cbc.ca/news/canada/nova-scotia/private-ns-medical-clinic-says-ease-health-care-system-1.6549725 

Amad, A. (2022, August 15). How to fix our broken health care system. Macleans.ca. Retrieved August 17, 2022, from https://www.macleans.ca/society/how-to-fix-our-broken-healthcare-system/ 

Edwards, D. (2022, August 24). N.S. premier says 'fear-mongering' misplaced over privatization of health care. CBC. Retrieved August 25, 2022, from https://www.cbc.ca/news/canada/nova-scotia/tim-houston-private-healthcare-concerns-1.6561206?cmp=rss 

Ghania, Y. (2022, July 29). Turning to private sector to reduce surgical wait times in Sask. a bad idea: critics. CBC. Retrieved August 2, 2022, from https://www.cbc.ca/news/canada/saskatchewan/surgical-backlog-private-sector-plan-critics-1.6536788 

Higgs sees more private-sector delivery of health care as an option. (2022, August 22). CBC. Retrieved August 23, 2022, from https://www.cbc.ca/news/canada/new-brunswick/premier-blaine-higgs-private-sector-healthcare-1.6558677?cmp=rss 

A new study shows how much social capital matters. (2022, August 1). The Economist. Retrieved August 17, 2022, from https://www.economist.com/graphic-detail/2022/08/01/a-new-study-shows-how-much-social-capital-matters 

NHS outsourcing. (2022, March 15). British Medical Association. Retrieved August 18, 2022, from https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/commissioning/nhs-outsourcing 

Picard, A. (2022, August 22). Opinion: The private-public debate is a distraction from health care's real problems. The Globe and Mail. Retrieved August 25, 2022, from https://www.theglobeandmail.com/opinion/article-the-private-public-debate-is-a-distraction-from-health-cares-real/ 

Privatizing health care would cause inequity: CMA president. (2022, August 12). CTV News Atlantic. Retrieved August 30, 2022, from https://atlantic.ctvnews.ca/privatizing-health-care-results-in-worse-access-for-less-fortunate-cma-president-1.6025038 

Service-Based Homelessness Count 2021. (n.d.). End Homelessness Today. Retrieved August 3, 2022, from https://www.endhomelessnesstoday.ca/images/Report_-_Service-Based_Homelessness_Count_for_Eastern_Nova_Scotia_2021.pdf