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Howard Anglin: The provinces (and conservatives) must take some initiative if they want dental care done right

Commentary

When it comes to health-care policy, the federal Liberals just stole a march on the provinces and on conservatives by committing to provide national low- and middle-income dental care coverage and national pharmacare. But it’s not too late to catch up or even get out ahead of them. 

First things first. It is absurd that our health-care system does not cover most prescription drugs, vision, dental care, and out-patient care. In 2022, these treatments (especially prescription drugs) are part of essential medical care, but they remain arbitrarily excluded based on what was considered important half a century ago. That was always going to have to change as political reality caught up with the technology. What is most surprising about last week’s announcement is that it took so long.

Canada’s lack of prescription drug coverage and public dental care is symptomatic of a bigger problem with our health-care system. When it comes to health-care policy, most Canadian politicians and commentators can’t see beyond the United States (perhaps they could use the vision coverage that our system also fails to provide). They satisfy themselves with the knowledge that, at least when it comes to affordability and some forms of access, we do better than the Americans, but they never bother to lift their eyes to see what is happening in Europe or Australia and New Zealand. If they did, they would see what has been obvious for more than a decade: Canada is badly out of step with most of our peer countries.“The U.S. ranks #11 — last. Exhibit 2 shows the extent to which the U.S. is an outlier: its performance falls well below the average of the other countries and far below the two countries ranked directly above it, Switzerland and Canada.” https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly#equity  

Ironically, this means the same smug incuriosity that has kept us the only developed country with a government monopoly over most health care has also kept us complacent about our lack of coverage for things that are commonly covered in other countries. This could only go on for so long. At some point, our public health-care system was going to expand to include decades of medical advancements. It was just a question of when, how, and who would do it. After last week’s agreement, it looks like we have a tentative answer to the first part of that question—sometime around 2025—but the “how” and maybe even the “who” are still up for grabs. 

I have believed for some time that Canadian conservatives should accept the inevitability of health care expansion and that, following Ralph Klein’s adage that politicians should see which way the parade is heading and jump out in front of it, they should beat the NDP and the Liberals to it. This would have two advantages: first, it would be consistent with the kind of working-class and middle-class populism that is conservatives’ best bet to win modern elections; and second, it would mean the policy could be done right. 

If we were designing the Canadian health-care system from scratch, no one would come up with the frayed patchwork we have today, where hip replacements can take two years or more and our equity in access—the one thing you’d think a state monopoly would be good at—ranks second last among developed countries.“Compared to the other countries, the United States and Canada had larger income-related inequities in patient reported experiences.” https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly#equity Instead, we would probably look at how public health care is paid for and delivered in places like Norway or Switzerland or Australia and learn from them. It may be too late for most of our health-care system, but it is not too late to get pharmacare, dental care, and long-term care coverage right. Or at least it wasn’t too late until last week. Now, with the NDP dictating federal policy and federal conservatives shut out of the process, the last hope will be for provincial conservatives to act—either alone or together. 

Quebec, which among Canadian provinces has the closest thing to a full-blown pharmacare program, provides one model for what a province can do on its own. A mostly positive 2019 evaluation of the Quebec system by the CD Howe Institute estimated that expanding Quebec’s system to the rest of the provinces would cost $2.2B (in 2020 dollars).“One advantage of the public drug insurance model in Quebec – currently the only province with universal prescription drug insurance – is that it includes a funding mechanism: enrollees pay an annual premium. Adopting a prescription drug insurance model that includes a funding mechanism would reduce the potential for short-term strain on government budgets.” https://www.cdhowe.org/sites/default/files/attachments/research_papers/mixed/Commentary_544.pdf This means that it would cost about $45m for a province like New Brunswick or about $320m for a province like Alberta. Adding dental care and any other expanded coverage would raise the cost further, but it is not a prohibitively crazy price tag, especially if the federal government is now bringing funding to the table (or if provinces taxed employer-provided health care benefits to defray the cost for those without existing coverage).

Not every province would have to follow the Quebec model, of course. In a federal system, each government should be able to choose how it wants to design its programs to direct relief to those who need it most. This could include, for example, applying different forms of means testing, refundable tax credits, deductibles, or co-pays. A 2016 Macdonald-Laurier Institute paper suggested some promising options. One obvious choice would be to build on the established existing private insurance market and emulate insurance-based health-care systems used successfully in Switzerland and the Netherlands. This would make the design easier and faster to implement.

Using an insurance-based approach would also allow provinces to introduce a model of health care that improves on the current government monopoly system, but is not especially threatening because: (a) it would be a new benefit and (b) it would align with how most people who already have coverage for these services get it. New programs could extend the kind of benefits most public and private employees receive to those who don’t already have it and can’t afford it. An ambitious and far-sighted province could also lay the groundwork for expanding private insurance to cover regular health-care treatments where waitlists currently make public options an empty promise.“Specialist physicians surveyed report a median waiting time of 25.6 weeks between referral from a general practitioner and receipt of treatment—longer than the wait of 22.6 weeks reported in 2020. This year’s wait time is the longest wait time recorded in this survey’s history and is 175% longer than in 1993, when it was just 9.3 weeks.” https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2021

Although the idea of a significant new entitlement program will set off alarm bells among many fiscal conservatives and libertarians, I would ask them to put their skepticism on hold and consider three things. First, it is not radical to think that, if we are going to have public health care (and we are), it should include the things that are necessary to care for our health in 2022. Second, relief for unavoidable life costs would be very popular among families experiencing an acute cost of living crunch and is consistent with a common good conservatism. Third, and most importantly, it is happening whether you like it or not. If you want input in how it happens, now is the time.

If provinces can beat the federal government’s announced timelines to implement their own policies (which shouldn’t be hard, given the pace at which the wheels of the federal bureaucracy turn), they will have a better chance to earn some credit for the benefits provided and to insist, as Quebec will almost certainly do, on being able to apply new federal funding to the systems they have already set up on their own terms. Federally, conservatives could then support expanding health care coverage in principle while remaining faithful to the Harper government’s commitment to constitutional federalism and defending the right of the provinces to design their own systems without meddling from federal politicians.

I began by saying that what surprised me most about last week’s agreement between the Liberals and the NDP is that it took so long. For three years, Trudeau has been governing with the open support of the NDP, which means the new confidence and supply agreement is really just a formalization of the status quo. You can think of it like a couple that has been living in sin for years finally deciding to tie the knot. Sticking with that analogy, if conservatives want to have a say in the future of Canadian health-care policy, they should speak now or forever hold their peace.

Aiden Muscovitch: I know the value of debate and we need that in our schools

Commentary

Editor’s note: We are delighted at The Hub to be the venue for Aiden Muscovitch’s first-ever published piece of analysis, which we expect will be the first of many. Aiden joined us as a co-op student because he enjoyed the analysis and debate at The Hub and he quickly realized that this spirit was lacking in his high school. Please enjoy Aiden’s engaging plea for a broader and more inclusive debate for our young people.

One morning, as I checked my phone, I got a Facebook notification. “6 Years Ago-With Zak Muscovitch.” I opened the notification and saw this photo of me and my dad outside of Roy Thomson Hall attending a Munk Debates event. It sparked so many memories.

This was not a regular debate; this was the 2015 Federal Election Debate on Canadian foreign policy. Incumbent Prime Minister Stephen Harper, former NDP Leader Thomas Mulcair, and then up-and-coming Liberal Leader Justin Trudeau were battling it out. Even as a ten-year-old kid, barely grasping the Canadian electoral system or foreign policy, I loved it.

When the debate wrapped up, my Dad and I walked out of the auditorium and into the lobby. An audience member came up to us and said, “I would never bring a kid to something like this,” in a harsh, disapproving voice and walked away. I was upset because I thought that I embarrassed my Dad in front of all these people, and I felt disappointed in myself for coming to the debate in the first place.

The thought that young people should not be exposed to certain topics because it’s deemed to be too “problematic” is becoming a widespread ideology. That audience member felt that I did not belong, that I should not have been in a space where such robust debate was taking place. She did not want me to hear these ideas and she did not want me to develop my own opinions. School boards all over Canada are following the same regressive path, with even steeper consequences for the students. 

Diversity of thought can only be achieved by example. Youth all over Canada are being hidden from points of view that others think they may not comprehend. This is shown recently as Marie Henein’s book was not allowedMarie Henein speaks out about ‘outrageous’ disinvitations. https://thehub.ca/2021-11-16/marie-henein-speaks-out-about-outrageous-disinvitation/ to be read in the A Room of Your Own Book Club, which holds its events in schools belonging to multiple school boards, while teachers and principals promote them. This book club is meant for teenage girls to hear from female authors. Tanya Lee, the organizer of the A Room of Your Own Book Club, reported that a TDSB Superintendent told her that Henein’s event would not be promoted in TDSB schools because Henein defended Jian Ghomeshi, asking “how do you explain that to little girls?”Toronto school board rejects Marie Henein book club event. https://www.theglobeandmail.com/canada/article-tdsb-students-wont-be-attending-marie-henein-book-club-event-amid/

Nobel Peace Prize Laureate Nadia Murad had an uncannily similar issue with the TDSB. Murad was invited to speak at the same book club as Henein. The TDSB Superintendent also told Lee that students would not be allowed to participate in an event with Murad. Lee said she was told Murad’s book, The Last Girl: My Story of Captivity, and My Fight Against the Islamic State, would promote IslamophobiaCanadian schools ban a Nobel Laureate to avoid looking ‘Islamophobic.’ https://nationalpost.com/news/canada/first-reading-canadian-schools-ban-a-nobel-laureate-to-avoid-looking-islamophobic. Not only does this stop students from hearing another side to an incredibly complex story, but it sets a precedent for all students to not speak up about any form of injustice from their perspective.

After hearing the stories of Marie Henein and Nadia Murad, I understand that without debate and the freedom to discuss big, new, unconventional ideas and current issues, whole generations would be kept from other viewpoints that may differ from their own, and it is happening to our students now. This act of withholding information from our students will lead them to become sheep, following the wicked crook of their close-minded shepherd. In both Marie Henein and Nadia Murad’s cases, the shepherd is the TDSB. 

Students have been guided by our teacher’s own worldview, and at times, ignorance with the stick instead of the carrot. As students, we feel as if we cannot object to the teacher’s point of view. The power imbalance is so vast that when we try to push back on the teacher’s assertions with our own thoughts and/or life experiences, we are ignored. We are forced to bite our tongues and keep our hands down, and if we choose not to, we are ostracized.

In Henein’s Dialogue with The Hub, she stated, “First of all, it infantilizes everybody. We aren’t triggered constantly; we aren’t falling or passing out every time someone says something that we don’t agree with. We can sustain conversation and we can withstand opposite views.” The flawed ideology of sheltering students from opinions the administrators of school boards may find dangerous or problematic will be detrimental to future generations. Both the TDSB Superintendent and the audience member at the Munk Debates have participated in the growing indoctrination that silencing students and preventing them from hearing bold opinions, perspectives, ideas, and schools of thought is beneficial for their students. It most certainly is not.

A recent Intelligent study that interviewed conservative, liberal, and moderate university students, asked the students how frequently they withhold their opinions or perspectives in the classroom and what are the fears behind the decisions to withhold their point of view. The top three fears among conservative students are losing their professors’ respect (40 percent), losing their classmates’ respect (40 percent), and jeopardizing their grades (39 percent). For liberal students, their top three concerns are losing their classmates’ respect (37 percent), being ridiculed or confronted (37 percent), and putting their physical safety at risk (35 percent). The top three concerns among moderate students are losing their classmates’ respect (37 percent), being ridiculed or confronted (37 percent), and jeopardizing their grades (35 percent).

Fifty-five percent of conservative students, 52 percent of moderate students, and 49 percent of liberal students say they “always” or “often” refrain from speaking up about political or social issues in the classroom out of concern for potential consequences. Withholding speech is becoming an epidemic that affects all students, no matter their political affiliation“Many students simply have no idea how to disagree constructively, or even if constructive disagreement is possible,” said James Patterson, Associate Professor of Politics at Ave Maria University. https://universitybusiness.com/the-3-reasons-why-students-dont-want-to-share-political-views-in-class/.

Teachers tell their students that the classroom is an open environment to express themselves freely. They will not mention that if they do, they face a plethora of both discrete punishments and not-so-discrete public humiliation, done by the teacher, of course. Most of the argumentative scenarios I have seen are not amongst students; the teacher starts and finishes the tensest dialogues in the classroom. I assure you that they are not playing the Devil’s Advocate. They really, truly mean what they are saying and are more than happy to strike down any conflicting opinions.

I have had teachers give hour-long lectures on why being uncomfortable in the classroom is beneficial. Yet in those very same lectures, if one brave soul decides to speak up, the teacher becomes absolutely perplexed by the idea that somebody might actually disagree with them.

Of course, not all teachers are like this. I have had some teachers that promote free speech and implement it in their classes. But, I feel that it is a rarity. It has been an extremely infrequent occurrence in my high school career where the teacher has told their students the facts on any given subject and allowed them to formulate their own opinions.

We have a brilliant but silent minority of students from all walks of life that possess different viewpoints and experiences and who look into these issues for themselves. They will dive deep into these social problems and establish an opinion.

The reason why this is a minority of students rather than a majority is that students are generally too timid to break the mould. We grow up idolizing our teachers, valuing what they have to say. That never stops until students identify what they may or may not disagree with. Lots of students are not at the point when they can make that distinction for themselves so they follow what the teacher says. Instead, teachers should be encouraging their students to look for themselves to develop their own opinions.

To remedy this issue, there are a few viable options. We must have teachers that do not project their opinions but give their students unbiased information to make their own. This calls for total educational reform involving student-teacher-administration transparency policies and a refreshed curriculum that allows all students to speak freely and not be docked grade points for doing so. There should be reviews by the administration on how teachers prepare their lesson plans and how they acquire the information to prepare them. There must be policy changes within school boards and private institutions that would enable students to feel comfortable in expressing their views freely. We need to convert our concern into action before future generations turn into mindless lemmings.

With that being said, nothing in life is neutral. The classroom should be fueled with discussions about all sorts of controversial topics, but all voices need to be valued or at least heard. There are going to be ill-advised opinions, offensive ones. Still, when they do come up, teachers should use this as a teachable moment to address why it may be ill-advised or offensive but not crucify their students due to their ignorance. A teacher’s job is to educate, not humiliate. In a democratic society and in a classroom that moulds the brains of the inhabitants of such a society, open discussion on various topics is crucial, especially to students today who will be tomorrow’s adults.