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?**
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