Letter to the Edmonton Journal, Friday, November 2, 2019 (In Response to the October 24 Budget)

We have just one generation left in which to convert the Alberta Advantage (in non-renewable resource revenue) into a New Advantage built upon renewable and sustainable energy and human resources.

It is probably already too late to ever build the Heritage Trust Fund into what it should have been. But by sticking its head in the oilsands and deliberately ignoring the real problem (i.e. government’s continuing reliance upon the  energy-revenue roller-coaster, against the global backdrop of ecologically induced shifting demand and technologically induced over-supply), and ideologically pretending that the solution is simply one of cutting taxes and expenditures, this government risks squandering the few opportunities we have left to get our transition to the low-carbon economy right.

As a result, we may ultimately find ourselves no better placed to face the conditions of the mid-21st century than our neighbours in Saskatchewan and Manitoba. And that would be no “Advantage” at all.

Isn't it Ironic?

By any measure, the victory of Jason Kenney and the United Conservative Party (UCP) over Rachel Notley and the NDP in the April 16 Alberta provincial election was impressive: 63 seats versus 24 for the NDP, with 54.8% of the popular vote  versus 32.7% for the NDP, on a  71% turnout.  The UCP tapped into the economic insecurity of Albertans caused by a sluggish oil economy and growing frustration with the lack of pipelines. Conservative candidates promised to “stand up to Justin Trudeau” , and “get tough” with opponents in British Columbia and Quebec. Listening to Kenney and his supporters in the right-wing media, you would think that the problem was that Notley played too nice with the Feds and those “foreign-financed” environmentalists and Native peoples, and that all that was needed was to replace the carrot with the stick. In truth, the exact opposite was true: if the government of Alberta had simply tried to force BC and the Feds to allow the pipelines by threatening to “turn off the taps”, the likelihood of regulatory and judicial approval would have been even smaller.

Thus the campaign waged by the Alberta Conservatives was fundamentally ironic.    It was the federal Conservatives between 2011 and 2015, including Mr. Kenney, who discredited the National Energy Board and sparked the Idle No More protests---and ensured defeat in court over Northern Gateway. And, if the Trans-Mountain is finally approved this spring, it will be because governments and TMX have finally met the high standards of environmental protection and First Nations consultation that the law now requires.  This is the biggest irony that I have seen in federal politics since the Harper Conservatives took credit for avoiding the worst of the financial crisis, after promoting the use of sub-prime mortgages in their first budget in 2006.

As for the supposed failure of "social licence", were conservatives suggesting that a truth-based energy and climate policy is only warranted if it gets a pipeline built in under 4 years?  The irony is that our most enlightened oil companies have more in common with Ms Notley on this point than they do with Mr. Kenney: the CEOs  of Suncor,Shell and Cenovus all favour the carbon tax.   Furthermore, the NDP’s farsighted industrial diversification policy was better than anything Alberta  had seen since the days of Peter Lougheed.

All this from  the first gender-equal government in Canadian history, a government whose entire caucus had fewer scandals than any new government that I can remember. Support for pipelines outside of Alberta rose from 40% to 70% thanks primarily to the efforts of Rachel Notley, Canada’s finest premier. Can Jason Kenney really do better? It seems  more likely that he will benefit from a pipeline that was enabled by Notley’s salesmanship and paid for by the Canadian taxpayer. As Alanis Morrissette might  say, that’s more than a little ironic.

Canadian Healthcare at a Crossroads

Canadians generally like their heathcare system, and rightly so. It guarantees basic physician care and hospital care (insofar as such things can be practicably guaranteed, given our geography  and diversity), so that we can get on with our lives, and cope with catastrophic illness when that happens, without having to also worry that it will wipe out our savings or saddle us with huge debts. Most of the world’s leading health economists and health policy experts generally approve of universal care and single payer not just on the grounds of equity and general health outcomes,  but on the grounds of efficiency and cost containment as well: it pools risk, spreads cost, and provides patients generally with bargaining power vis a vis health care providers and drug companies.  From a comparative perspective, the cost  of Canada’s health care system is best described as middle of the pack-- in 2017 we spent about 10.5% of our GDP on health care (7.4% publicly and 3.1% privately), compared to an average among the ten most comparable OECD countries of  10.6%, (7.9% publicly and 2.7% privately),  #11 in spending in the OECD. (The United States, at about 17.3% of GDP,  is far and away the biggest spender.)  The problem is that many of these countries include a broader basket of health  services on a universal basis than we do. 

Canadian medicare coverage has been described as being stuck in a rut that is "deep but narrow". The narrowness comes from our difficulty imagining our dentists, home care workers, pharmacists,  optometrists and physiotherapists, etc. billing the government like our doctors and hospitals do. It also comes from our difficulty imagining a doubling of transfer payments from the federal government to the provinces in order to help pay for the expansion of coverage. Notice that the problem does NOT stem from our single-payer model per se, but from how it articulates with fee-for-service private payment schemes  and our system of fiscal federalism.

Alberta's practice of allowing a small number of visits to physiotherapists to be paid for under Alberta Health (I believe the number is six visits), has a general preventive benefit in terms of encouraging early treatment, as well as enabling workers to gauge the value of physio in managing pain, etc so that they can make an  informed decision about whether to pay for further treatment.  Similar benefits on a larger scale  could be expected from having a basic public dental plan.  I have never studied the economics of dental care specifically, but it seems to me that basic dental care (annual check up and treatment up to $1000, for example) would not only catch many problems early and thereby improve the general health and productivity of the population, but would also act as a payroll tax cut--since our company plans (such as my own) would no longer have to pay for the basic care. In other words, it should not be regarded as a deadweight loss of $1000 to the treasury, or to the economy as a whole. And just think of all the nursing costs and drug costs that could be reduced if we could just remove them from the aegis of hospital and physician care, viz. the most expensive venues imaginable.  A lot of seniors have been housed (at enormous expense) in hospitals because of the lack of space in seniors centres, or the lack of publicly-funded home care. Or kept in a hospital so that their drugs could be paid for. These practices are humane and quintessentially Canadian; but they are also wasteful.If people could access drug treatments and senior care outside of hospitals, we could help more people for the same amount of money.

So the issue is whether we can introduce a broader range of services into our provincial health plans, while still remaining a median country in terms of overall health expenditure.  In Canada , we  probably spend too much of our health care budget  in areas (physician and hospital acute care) that are expensive, and made more expensive than necessary by the fee-for -service system .  We should therefore focus on reducing and modifying fee-for-service, improving the blurred accountability created by federal transfers, and confining any experiments in "new" models of co-payment to the presently uncovered areas of homecare, pharmacare and eye and dental care. In other words,  let’s try not to throw out the single-payer baby with the bath-water.