Mark Stabile
Today, Canada 2020 will launch a book called “The Canada We Want in 2020: A Strategic Policy Roadmap for the Federal Government.” The publication highlights some key challenges for Canada over the next decade, and provides strategic policy advice specifically for the federal government on how to tackle them. A series of five chapters on productivity, Asia, carbon, income disparities, and health care provides some clear policy advice for a majority federal government that is now in a position to provide strong leadership for the country and aims to raise the level of public debate around these key issues. If the federal government is going to act boldly, regardless of its majority standing, it will need the public to understand and support its actions. Each topic is supported by pieces from various authors, and I was privileged to write one of the chapters on health care.
First, some disclosure: I’m on the Board of Canada 2020 so it should be no surprise that I think they are doing great work and I’m encouraged by the release of this book. That said, I really do think that the editors picked the right areas for the federal government to tackle. We know that Canada, for all its strengths, has a productivity problem that if addressed, could enhance our ability to do many other things we as Canadians would like to do. It could improve the quality of lives for our citizens, make our businesses more competitive, and enhance our ability to help people in need around the world. We also know that the rise of Asia’s growing economies presents lots of opportunity for Canada. Despite strong immigration from many Asian countries, and therefore ready-made networks that are entry points to these growing economies, Canada has yet to fully capitalize on these new potential partners.
In addition, we know that dealing with carbon emissions is one of the great world challenges of our time. Canada has lagged in reducing carbon emissions as part of the our daily lives, and we have the additional challenge of being a major producer of fossil fuel energy. Finally, while the Occupy movement hadn’t begun when the editors set income disparities as a theme for the book, we know that growing income inequality, characterized by strong increases in the wealth of the very top and declines in real income among the least well off, threatens our social cohesion and conflicts in some important ways. Thus, it seems clear to me that these four areas should be major areas of policy debate and attention as Canada moves towards 2020.
This leaves health care, the fifth priority area as designated by Canada 2020. Is health care one of the major issues Canada faces over the next decade? On the one hand we have made tremendous progress. We can do all kinds of things for people that we couldn’t do a generation or two ago. And as a result, people are living longer, healthier lives and diseases that used to be death sentences are now managed effectively. It’s worth remembering this context of how far we’ve come when we think about whether our health care system is ‘working.’ But, of course, we have to pay for all this progress. And health care costs have been growing faster than GDP for most of the last few decades. So what do we do? And what is the role for the federal government? First off, it is worth noting that we are not alone in this context. Most countries in the OECD, and all the countries that we like to compare ourselves to have the same problem of constantly growing health care costs. So this isn’t a problem with our Canadian Medicare system specifically. Countries with more government involvement and with less government involvement all have the same financing problem. But while it may be reassuring that many countries face the same challenge, it is also quite daunting. Every country in the world is working to make health care delivery more efficient, more effective, and of higher quality. And none, so far, have managed to get health care costs to growth more slowly than GDP.
There is lots we need to do to make the system more efficient: incorporate more market mechanisms into our public delivery system, improve incentives, rationalize where and how we deliver care, pay less for more when technology reduces costs, and scrutinize when expensive new technology is worth our public money and when it is not. All of this need to be done and many provinces are making strong progress in some or all of these areas. (And there are some great ideas out there about how to do things better – I hope our provincial governments take them seriously). But let’s be realistic about what we’ve seen around the world so far: rich nations are spending more and more on health care. Given this reality, and coupled with the nature of our federal-provincial arrangements over who pays for care in Canada, it seems clear that the federal government is going to have to continue to be involved in securing a high quality, effective health care system in Canada well beyond 2020. How the federal government can continue to support this goal, recognizing all the important work on the delivery side that the provinces need to do, is the subject of my contribution to this exciting project.
Mark Stabile is the founding Director of the University of Toronto’s School of Public Policy & Governance and a Professor at the Rotman School of Management.
**What is the Canada you want in 2020?**
Leave a comment in the response box below.
All respondents will be entered in a draw for a copy of “The Canada We Want in 2020.”
PP+G REVIEW 
I think you’ve rightly identified the key challenges that are impeding Canada’s economic growth and denying Canadians an even greater quality of life (productivity, Asia, carbon, income disparities, and health care).
I hope the book outlines tangible health care policy options for the federal government, without resorting to tired platitudes, like “the federal government should work cooperatively with the provinces to ensure more effective and efficient delivery of health care”. Now is the time for real solutions, not empty rhetoric.
Let’s talk about how to emulate the best health care systems in the world. Let’s talk about alternative service delivery mechanisms. Let’s talk about the implementation of effective – though probably unpopular – health promotion tools.
The economic and political contexts in which we find ourselves should serve as an impetus for making tough decisions. Let’s not squander the tremendous opportunity before us.
I was surprised to learn that none of Canada 2020’s five priorities dealt directly with our changing labour force, though one might argue that if we Venn (*not a verb, but let’s pretend) “productivity” and “income inequality,” we might get there.
The ever-elusive productivity goal connotes a more efficient (and effective) workforce. Everyone digs this aspiration, but does it come at a cost? What proportion of our labour force (persons as innovators, but mostly at the firm level) *really* stand to make significant gains through the productivity margin (*I don’t know)?
But what about the characteristics of the workforce itself — what will we do about that? What do we want the dominant characteristics of “work” to look like in 2020? And do we want our writers to use less question marks?
In the post-Fordist economy, the rise of non-standard work has meant more under-employment and multiple job holders with less benefits and increasingly rare pension opportunities. Coupled with disparaging labour force mismatch, and you’ve got yourself an Occupy movement.
The Canada I want in 2020 is one where most people have “good” jobs, where “good” is not a synonym for union representation, but just a quality opportunity that matches their skills, training, and interest while providing full time hours and (at least!) modest benefits. Ultimately, I think satisfaction and pleasure should be derived from the work we do in and for Canada, and that people have to feel secure in their employment to achieve that. Maybe we’d realize productivity gains if all boats were floating, dig?
This is a fantastic idea! In a political climate where short-term solutions are the options more likely to be viable, it is pleasing to see that there are still some people that are thinking long-term.
I have one main item on my wish list: transportation. We simply are not moving fast enough (pun intended) on this issue.
Is it too much to dream about being able to travel from Toronto to Calgary in, say 2 hours, by way of high speed train within the next few years? How about faster linkages to Quebec or Newfound Land? Canada is the only G8 country that does not have high-speed rail, and this issue is bound to become even more apparent in the years to come. Moreover, there is also something to be said about the economic gains that can be reaped by taking a regional approach to developing rapid linkages with US cities such as New York or Boston. The good news is that we do not have to invent the technology, we could simply model our approach to what Europe has done for instance. Making it easy and affordable for people to move regionally could help improve issues linked to frictional unemployment, tourism, social cohesion, and other business-related challenges. Ottawa is the level of government that is best positioned to take leadership on this initiative.
Since thinking long-term is the goal of this project, one policy area that is both long overdue and intertwined with two ideas already listed in the book (carbon and Asia) is energy.
Just like in the area of transportation, Canada remains one of the few OECD countries without a coordinated national energy framework. Having ten siloed energy policy agendas have not worked in our favour. We have no countrywide energy electricity transmission system. The same goes for crude oil. While the West exports, the East has to import. Our reluctance to bridge this gap has benefited the US for the most part.
Nationwide energy projects have been successful in the past. Foreign ownership of energy projects decreased thanks to Trudeau’s National Energy Program in the 1980s. Natural gas flow from Alberta to Ontario thanks to the Trans-Canada Pipeline built after WWII.
Clearly our current challenges go beyond heating our homes and fearing economic colonization. Canada’s 2020 national energy strategy must balance our environmental commitments with regional economic needs. Although this balance may seem a daunting task, the good news is that now more than ever the federal government is a unique position to design a national energy strategy because of three factors:
– majority in Parliament allows the ruling Conservatives to introduce policies/plans with long-term impact without fearing losing the confidence of the House of Commons – sinister, I know, but it’s been done in the past (i.e. GST, NAFTA, so on);
– Ontario, the confederation’s largest economy, is fully committed to developing alternative sources of energy, hence no arm-twisting is needed to get it on board;
– and, perhaps most importantly, Alberta’s new premier Alison Redford is exploring for options to develop a comprehensive energy plan for the province, including expanding development of renewable sources of energy.
The status quo is no longer viable. Conventional oil supply is dwindling and global demand for energy is unlikely to decline with Brazil, India and China rising, which means that Alberta’s oilsands are not shutting down anytime soon. The Canada in 2020 that I want will have an energy strategy that knows how to reap the economic benefits from its fossil fuel energy sector to develop renewable energy. The ideas are there, all that’s needed is political leadership.
There is no doubt that the five areas of focus in Canada 2020’s upcoming book are critical policy areas. However, it is useful to pick through some of the other policy issues that ended up on the editorial chopping block for perspective. (Perhaps the author can provide further insight into the decision making process that whittled down Canada 2020’s agenda.)
Having not read the book yet, I can only suppose that one of the criteria used was relevance to Canadians. In this sense, the policy issues that impact more Canadians are of greater salience and worthy of visionary thought. Healthcare, productivity, income disparities – are prevalent. The latter two, Asia and carbon, are arguably less tangible to Canadians, but feed into general economic and environmental well being of the nation. All are very forward looking to greater prosperity for all.
However, personally some of the policy issues that have most preoccupied my mind as of late have had more to do with hindsight than foresight.
Twenty-two years ago to this month, the House of Commons adopted an all-party resolution to end child poverty in Canada by the year 2000. Yet the most recent report card on child poverty by Campaign 2000 (here) notes that 639,000 children still are in poverty today.
Equally as troubling is our Aboriginal people’s quality of living – particularly on reserves. Canadians shouldn’t have to pressure government to react to a state of emergency on a reserve like Attawapiskat First Nation in Northern Ontario. In fact, things shouldn’t get as bad as a state of emergency to begin with.
Thus when asked where I would like to see Canada in 2020, I would be happy if these outstanding policy issues were resolved. Arguably, Canada 2020’s focus on income inequality encapsulates both, but by using a broader label, the spotlight shifts away just enough to obscure the priority status that I feel child poverty and Aboriginal peoples’ deserve.
Canada is a nation of cyberspace. Despite the vastness of our land, Canadians from sea to sea are more connected than ever, thanks to the Internet, which has created a digital agora.
Unfortunately, this digital agora is under threat. Just like climate change and our planet, our global communications environment is facing destruction. Canada must do something.
In 2020, I’ll like to see Canada as a world leader and champion in the fight to protect the Internet as a global commons, and human rights. Just as Canadians fought valiantly to get the International Treaty to Ban Landmines off the ground, so can a new generation of Canadians fight to save the Internet.
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