It’s been an eventful week or so in the world of Canadian public policy and current affairs including the ongoing protests and rallies in response to the Israel-Hamas war, the Trudeau government’s intra-debate about its position on the war, and a growing scandal in Ontario over the Ford government’s greenbelt policy. The Hub’s editor-at-large Sean Speer weighs into these distinct issues below. 

Canadian universities have lost their social license

The Canadian Left introduced the notion of “social licence” into our policy and political lexicon during the Harper era to describe the expectation that oil and gas companies act, consult, and operate in ways that secured public buy-in for individual projects and the sector as a whole. 

Conservatives were mostly critical of the concept at the time. It seemed elusive, woolly, and conceived of to block projects rather than ultimately enable them. I’ve wondered in recent weeks, however, if in hindsight it has utility for thinking and talking about the place of institutions in a democratic society. 

In particular, Canadian universities should ask themselves hard questions about their own social licence. The growing gap between the culture and ideas on campus and the rest of the population ought to be a major cause for concern. Universities’ alienation from the society in which they inhabit represents a threat to their social licence. 

The shocking reaction of many university faculty members and students to Hamas’s terrorist attacks against Israel has exposed this gap for the rest of us to see. One gets the sense (as others such as Tyler Harper have noted) that the consequences will be lasting. The incentives for politicians to seriously take on universities have changed. 

Academic freedom isn’t a get-out-of-jail-free card from democratic accountability—particularly in Canada where we still heavily rely on public dollars (even if the relative share has fallen) to finance universities. Scholars don’t have a positive right to publicly-subsidized employment or research funding. Universities don’t have a positive right to their current funding levels. 

There’s nothing stopping provincial governments, for instance, from cutting core institutional funding (especially in a zero-sum world in which health care is consuming roughly half of program spending) or even reducing public subsidies for particular fields or disciplines (which might come in the form of policy reforms that require universities to charge the full cost of certain programs). 

The upshot: if you’re a university president, you need to stop spending so much time and attention on managing your internal politics and start dedicating more to your external politics. Placating the most radical voices on your campus isn’t worth it if the cost is the public’s support for your institution’s basic mission. In fact, the opposite is true: a firm stand against radicalism is arguably the best means to protect your institution’s long-run interests.

What if there had never been a Ford government in Ontario?

A common criticism of the Harper government from the Right is that it didn’t do enough to advance proactive conservative reforms. It left too much of the liberal state and its underlying assumptions in place. The CBC is a prime example. 

This critique is fair enough. It ultimately comes down to a debate about prudence, risk, and trade-offs. 

It also neglects that successful centre-right governance is in large part the unseen. The stuff that would have otherwise happened if conservatives had not been in power. Counterfactuals are hard to prove, but it is fair to think that were it not for the Harper government, federal taxes as a share of GDP would have been higher, the fiscal response to the global financial crisis would have been larger and longer, and federal spending would be higher more generally, we would have had another top-down health accord with the provinces, a weaker foreign policy, and identity politics would have found earlier expression in federal policy. 

Try the same counterfactual exercise for the Ford government. What would have changed if it hadn’t been elected in 2018? Not much I’d argue. Would Ontario’s fiscal position be much different? Maybe on the margins. Would the government have spent less on corporate subsidies? It’s hard to imagine. Would the government’s COVID response have been more restrictive? I doubt it. Would the province’s curriculum be more woke? I don’t know how. Would there be less progress on market-driven health-care reform? Maybe a bit. The list goes on. 

The most damning critique of the Ford government from the Right isn’t that it hasn’t done enough to move the province in a conservative direction. It’s that the government’s record is by and large indistinguishable from what would have happened if it had never been elected.

Support for Israel should be a CPC requirement

The Liberal Party’s mix of free memberships, open nominations, and diaspora politics has enabled a small number of MPs and their supporters to essentially hijack the party’s principled position on the Middle East. 

It’s a reminder that political parties shouldn’t be treated as mounds of clay that can be molded and remolded based on the passing preferences of one leader or well-organized yet non-representative political minorities. 

Political parties should instead understand themselves as institutions with their own long-run interests and values that must transcend a single election cycle or single-issue campaign. 

There’s a balancing act to be struck here. Parties don’t want to be dogmatic or static either. But the lesson of Donald Trump’s takeover of the Republican Party and the Liberal Party’s obfuscation on the Israel-Hamas war is that the current bias is tilted too far in the direction of weak parties. 

There’s a strong case in my mind that political parties should insist that prospective candidates affirm statements of core principles and values. Such statements would have to be narrowly conceived so as to not significantly constrain intra-party debate about policy and priorities. But parties should be able to settle on their core principles and values that aren’t up for debate—even if there’s plenty of scope for debate on how to apply them to new and emerging issues. 

For the Conservative Party, I’d argue that support for Israel ought to be among those core principles and values. That’s in large part because support for Israel is a good proxy for a set of principles and values—including a basic commitment to liberal democratic capitalism—that ought to define modern conservatism. 

The Conservatives should seriously consider adopting such a statement as a condition for being a party candidate. It would be a key step towards strengthening their party as its own institution and protecting against the type of silent takeover that has befallen the Liberal Party.

In the post-pandemic world, health spending in Canada continues to be marked by the paradox of simultaneous feast and famine, according to the Canadian Institute for Health Information (CIHI) release of the National Health Expenditure Trends 2023.

Total health spending in Canada for 2023 is projected at $343.8 billion, up 2.8 percent from 2022. The lingering effects of the pandemic contributed to growth in hospital expenditures of 11 percent in 2022 and 4 percent in 2023. Meanwhile, physician spending grew almost 10 percent in 2022 and nearly 7 percent in 2023. As a share of GDP, health spending’s projected share of GDP in 2023 is approximately the same as the previous year, at about 12 percent which is still above the pre-pandemic figure of 11 percent.

However, despite what seems to be robust overall growth numbers, once one factors in population growth as well as inflation, it turns out that real per capita health spending in Canada is expected to be down for the second year in a row. Indeed, for 2023, the change in real total health spending per capita is -0.5 percent which comes after a nearly 2 percent decline the previous year. However, it remains that real per capita spending is still substantially higher than it was going into the pandemic.

Figure 1 provides some historical perspective on the long ascent of real per capita health spending in Canada providing a plot not only of total spending but also provincial government and private sector health spending. The pre-pandemic period saw a slowdown in the growth rate of real per capita spending, which was more pronounced at the provincial government level.

From 2010 to 2019, the average annual growth rate for total real per capita spending was 1.2 percent, but provincial government spending grew at 1.1 percent while private spending grew at 1.6 percent. By way of comparison, during the heyday of the federal transfer escalator, the 2000 to 2010 period saw average annual growth in real per capita total health spending of 3.2 percent—3.3 percent for provincial government and 3.1 percent for private.

The pandemic, fueled by emergency federal health transfers, saw real per capita public sector health spending surge, but also a decline in private sector. Figure 2 dramatically illustrates the 2020 surges in real per capita health spending for total and provincial government health, which each clocked in at about 8 percent respectively, but this was accompanied by a nearly 8 percent drop in private spending. The next year, provincial government spending grew at a slower but still robust rate at 4.7 percent, but real per capita private health spending rebounded at 8 percent and total health spending at 4.9 percent. For the subsequent two years however, decline sets in for real per capita total health spending at -3.9 and -0.5 percent driven mainly by declining provincial government spending at -2.2 and -0.5 percent given that private spending rose at 1.8 and 2.2 percent. However, this decline in per capita spending was partly driven by the wind-up of COVID-19 supports as well as other public health spending.

It should be noted that for 2023, real per capita provincial government health spending is projected at $5,723. If after 2019 spending had continued to increase at the same average rate from 2010 to 2019, then 2023 would clock in at approximately $5,450 which means that real per capita health spending in 2023 is still projected at several hundred dollars above what the previous trends might have placed it at. Indeed, compared to 2019, real per capita provincial government health spending in Canada is 10 percent higher. Overall, despite the recent declines due to both a winding up of pandemic-specific health spending as well as robust population growth, it would appear that there has been an enrichment of per-person health spending.

However, performance varies across health spending categories. In the case of provincial government health spending, for 2023 the largest components are hospitals (36 percent), physicians (20 percent), other institutional care including LTC homes (14 percent), and provincial drug plan spending (7 percent). If one looks at a comparison of real per capita provincial government spending between 2019 and 2023 for these key categories, hospital spending is up 6 percent, other institutions is up 25 percent, physicians is up 1.3 percent, but drugs is down nearly 2 percent. As for some of the other categories, real per capita provincial government public health over the same period is up 29 percent, other professionals at 10 percent, administration is up 9 percent, and home care/community care is up 14 percent.

So, what is one to make of all this in the current context of waiting lists and health care shortages that continue to plague health systems across Canada? Despite the post-pandemic decline in emergency health spending and the resulting slowdown in real per capita health spending growth for 2022 and 2023, it remains that real per capita health spending is up substantially. But two areas still lag the others: physician spending and drugs. Drug spending by provincial drug plans is linked to physician spending: if people cannot access physicians because of shortages in family doctors, then they are also going to find it more difficult to fill their prescriptions.

Of course, the Canadian health spending paradox of more spending and yet growing issues of access and timely service delivery is not a new one. It has, however, entered a more concerning phase given that physicians are the primary gatekeepers when it comes to health care access. If large proportions of provincial populations are not able to access physician services and get in line for care, how exactly are all these spending increases going to meet the health-care needs of Canadians?

For the time being, provincial health-care systems appear to be dealing with access issues by changing the access rules to some health services. Take the case of Ontario. Pharmacists in Ontario can now prescribe treatments for nineteen health services including diaper rashes, canker sores, and yeast infections. And most recently, Ontario has expanded the ability to self-refer for screening tests by lowering the age for women’s breast screening without a doctor’s referral to 40. One expects that eventually you may be able to self-refer for other routine screening tests in order to free up scarce physician time.

While such measures are a way of dealing with current physician shortages by reducing some of their gatekeeping requirements, it remains that they are short-term stop-gap measures. Eventually, once results from self-referred tests come back and short-term pharmacy treatments are exhausted, people will still need to see a doctor. Expect to see within a year or two complaints that despite a test result requiring follow-up, people cannot get in to see a physician. The next health-care accessibility crisis is already taking shape.