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Ash Navabi: To end lockdown excuses, allow private hospitals

Commentary


Ontario Premier Doug Ford has announced another round of measures in yet another attempt to control the spread of COVID.  

In his press conference to justify this new round of the same old measures that Ontarians have been put through two times before, Ford stressed the real reason behind them: “we must do everything in our power to protect our hospitals.” 

Protecting the health care sector was the impetus for every single previous round of lockdowns as well. In a province where the number of hospitals is fixed, this is a logical policy to follow. But after two years of the same excuse being trotted out to close businesses and tell people who they can and can’t invite into their own homes, it’s time to rethink the system of a government monopoly on hospitals. 

Breaking this circuit won’t be a quick and easy fix. But a good place to start would be permitting private hospitals. 

New private hospitals have been banned in Ontario since the early 1970s, with the Private Hospitals Act. Yet attempts to repeal this act would not be unprecedented. As recently as 2018, Kathleen Wynne’s Liberal government tabled an omnibus health bill, which included a schedule to overturn the ban immediately. Intense lobbying, including by public sector unions and their allies in government-run health care, ultimately erased that provision. As a result, the same problems of hospital overcrowding persisted, and are now being used to justify Ford’s fourth lockdown in less than two years. 

While initially promised as a kind of bionic panacea to providing medical care for all, over the decades the government-owned and operated hospital sector has developed to be more like a gangrenous limb in need of amputation. 

Immediately allowing a free market in hospital construction and operation would be just the hatchet to do the trick. 

Very little attention has been paid to the fact that Ontario’s health care system, especially in Toronto, has been overwhelmed for many years before the pandemic. In fact, one can find articles for nearly every year before 2020 talking about our hospitals being overwhelmed by the seasonal flu: 

When the government owns the means of production and systematically under-prices its services, shortages are bound to develop as services get overused. This is the case with “free” health care in Ontario. Government decisions are not made based on profit and loss of market prices. Rather, they are made based on political expediency. 

Hospital construction should be just as easy (if not easier) as building a mall, a condo, or a factory. We can’t afford the lives and livelihoods lost otherwise. Whether they run it for profit or not, or how close they are to other existing government hospitals, or even what kind of doctors they hire, should be entirely left up to the entrepreneur taking the risk of competing with the government. We’ve tried central planning these decisions for the past 50 years, and look where it’s gotten us. 

Ontario has only built one net new hospital (not counting replacement buildings etc.) for its population in 30 years, despite 5 million new residents. During the same period, government spending on hospitals has skyrocketed, from $6.6 billion in 1990 (about $12 billion in today’s dollars) to $22.4 billion in 2019. 

Compare these stats with developments in breast augmentation, laser eye surgery, and other cosmetic procedures fulfilled by the private sector. They have drastically fallen in price while becoming more available. Perhaps those responsible for health policy should take a closer look at the market for mammoplasty for inspiration. 

Repealing the Private Hospitals Act will invite many attacks by those vested in the current system. It will require political courage. That’s why the Liberals should be commended for even trying to overturn this disastrous policy. The first step Doug Ford will have to take is to be as courageous as Kathleen Wynne. 

Too sick; too frail. That’s the Ontario government-run health care system in a nutshell. The only prescription is a radical diet of free markets: private hospitals, private accreditation standards, and the end of lockdowns. 

Taylor Jackson: China’s continued ascendance is not guaranteed—and this makes the coming decade more dangerous

Commentary

China’s rise as a global power has been rapid and awe-inspiring. Since 1980, China has seen an 80-fold expansion in the size of its economy, and in the past decade, as its military might has strengthened, it has taken an increasingly assertive role in the Asia-Pacific region.

Together, China’s rise and the relative decline of the United States have led to a resurgence of what some have termed “great power competition,” where the world’s most powerful states increasingly compete to shape global security dynamics, international trade and investment flows, and the very norms and orders that govern state behaviour.

This new period may mark the end of American unipolarity and the coming of a more bipolar, or perhaps even a multipolar world. In this era, revisionist states like China, and to a lesser degree, a revanchist Russia, will increasingly challenge the U.S.-led liberal international order.

However, often laden within such views is an implicit assumption that China will continue to rise. But what if China’s ascendance doesn’t continue, and what if China’s rise begins to dramatically slow or stall altogether?

This potential reality is not given enough attention in current strategic thinking. Yet, the results could be just as dangerous as a world where the expansion of Chinese power continues, further contesting U.S. dominance.

Consider six internal and external factors that might abate China’s ascendance in the coming years:

  1. China’s economic growth in the last 30 years has no doubt been impressive. But the tendency to focus on the topline GDP numbers can mask how far behind China is compared to the United States in other important economic measures. While the overall size of China’s economy is now larger than the United States by some estimates, when comparing living standards (GDP per capita), the two countries are not even close. In 2020, the United States had a per capita GDP of over $60,000 (in 2017 international dollars). On the other hand, China’s was a little over $16,000 in the same year, which is less than that of Mexico. At the same time, Chinese economic growth is, in fact, slowing, dropping from over 10 percent in 2010 to less than 6 percent in 2019. These growth rates may still be higher than in the United States, but the downward trajectory should raise serious questions about just how much China’s economic heft will continue to expand in the near future.
  1. This leads to the second factor working against China’s continued ascendence. That is, China’s turn towards an even heavier hand of government in directing the economy. The story of China’s economic miracle is one of unleashing the power of markets and expanding global trade. Yet, under President Xi Jinping, China is heading in the opposite direction. In recent years, the Chinese state has brought in several new regulations on private firms and entrepreneurs, increasingly restrained the ability of Chinese firms to attract capital, and expanded the role of state-owned enterprises, all to assert further political control over the economy. This will not bode well for China’s future economic growth potential.
  1. A third internal force working against China is the continued and, in many cases, worsening state repression of the Chinese people—be that against the Uyghurs in Xinjiang, the people of Hong Kong, or countless others. The Chinese state appears to be maintaining control for now. But it is unclear how much the Chinese people will tolerate such repression in the future and what effect this may have on China’s internal stability.
  1. Switching to the external environment, another factor working against China’s rise is the fact that the U.S. still maintains a preponderance of military power over China. The United States continues to spend more on defence than the next 11 countries combined, and it remains unmatched in its ability to project power at sea, in the air, or in its ability to “command the commons.”
  1. Before China can become a genuinely dominant global power, it will first seek to become dominant in the Indo-Pacific region. This will be no easy task. China is surrounded on three sides by other great powers, namely India, Japan, and Russia. Each of these countries has its own strategic interests in the region, which will increasingly clash with China’s expansion. Japan, for example, has actively indicated that Taiwan’s stability is in its own security interests, and just this past week, Japan and Australia signed a new defence pact. India and China have also recently clashed over disputed territory along their Himalayan border, resulting in casualties on both sides. Since then, China and India have increasingly militarized the region, and the dispute remains unsettled. China will have its hands full managing great power politics within its own region before expanding its power too far abroad.
  1. Finally, as China seeks to compete with the United States, it will be hard to do so unilaterally. The U.S. has a robust alliance network that President Biden is working to repair after the damage caused by the Trump presidency. Yet as analysts Ali Wyne and Ryan Hass make clear in a recent article, “China’s diplomacy is limiting its own ambitions.” Indeed, Xi Jinping’s “Wolf Warrior Diplomacy” and its tone of more assertive Chinese nationalism is not engendering China with allies. Canadians know this well, having experienced China’s “hostage diplomacy” in the case of the two Michaels.

If the above forces stunt China’s ascendance, we would be remiss in thinking that such a world is immediately safer than one where China continues to contest American dominance, although one would hope.

Internally, suppose the reality of Chinese power doesn’t match its expected role of regional or global dominance. In that case, this could prompt China to become more aggressive economically and militarily, recognizing that its time to be dominant may be running out.

Externally, there is a risk that the United States overestimates the threat from China by responding more aggressively to its rise than is necessary to secure its interests. Overly aggressive action by the United States that China perceives as threatening its security and survival could, in turn, provoke a military confrontation.

This recognition of the threat from overestimation should not be taken as a suggestion that China’s rise poses no threat to the security, economic standing, and liberal values of the United States, Canada, and their allies. The threat is real and well documented, and it’s one that the Canadian government appears to have not yet come to terms with.

But policymakers should be skeptical of the most hawkish hawks and the most dovish doves when thinking through how to respond to China’s rise and increasing assertiveness. In international politics, overreaction to threats can be just as deadly as underreaction.

At the very least, policymakers need to be increasingly cognizant that China’s continued ascendence is not guaranteed. When paired with the ongoing dynamics of great power competition, this reality means that the coming decade will likely be turbulent, and unlike anything seen in a very long time.