An Ounce Of Prevention is Worth a Pound of Cure- Healthcare Cracks

Last year, my daughter, Hannah, 11 months old at the time suffered through a respiratory illness, commonly known as the common cold, but dangerous to those under the age of one. It was likely contracted from her two older school aged brothers. This illness, Respiratory syncytial virus, forced her into a general hospital, an hour and a half away from our rural home, for a week, and the week before Christmas, no less. We were discharged on December 23rd. The best Christmas gift, was her health mostly returned.

Luckily, she was old enough to not have sustained any lasting damage, but she did require oxygen for a period of time in hospital, along with high doses of inhalant, puffer-like drugs designed to open up the bronchioles. Another friend of ours with a younger son, though recovered from the RSV, hasn’t been as fortunate as us with respect to the longer term respiratory problems associated with RSV. 😦

What is more distressing, as I learned from one of the nurses at the hospital, is that there IS a vaccination available in Ontario, but it is expensive (about $1000). The government will cover it for premature children, but no other exceptions.

Just a thought, but maybe they should extend that to babies under the year of one with other school aged children in the home, at absolute minimum.

Even better, how can we conscionably deny our youngest and most vulnerable children protection from a common disease like this that can potentially harm their basic respiratory function for the rest of their lives? Most adults get the disease 1-2 times per year. It isn’t like it is hiding under the rug.

According to this webpage, there are about 140’000 babies born in Ontario, each year, so this vaccination effort would initially cost the Ontario government $140 million, if costs don’t drop with increased demand.

My daughter was in a private room (due to risk of infection) for a week at the hospital. Maybe I’m out to lunch, but I imagine that if her disease had been prevented by vaccination this would have saved, at minimum, the cost of the vaccine.

Younger children are often hospitalized for longer periods, and often require recurrent care afterwards. If they suffer from long term respiratory damage, the healthcare costs could be huge. And don’t we have an obligation to prevent this, since we can?

I really don’t think decisions like this for our youngest and newest children should rely on being able to prove that mass vaccination will lower costs enough that the balance sheet will look better. On this issue, however, it seems like the initial cost will pay itself off through reduced healthcare costs.

So the real question isn’t “should we do this?” but why aren’t we doing this?”

GST, Deficit and Revenue

Stephen Harper has always been a man of strategy. In an attempt to further the conservative agenda, and to make the case for austerity, part of this strategy seems to have been to rob the government of revenue (through tax reductions), so that new spending promises will require tax increases or deficit spending. One of the least beneficial tax reductions was the lowering of the GST rate from 7% to 5%.

Canadian’s aren’t stupid. Let’s make the case to them.

Returning the GST rate to 7% would result in about $11 billion in additional tax revenue, without discouraging business because GST is paid by the end user, not business. It is true that business is responsible for the collection and reporting of GST, but a change in the rate makes little difference to them. The administration involved is the same regardless of the rate.

Liberals have previously argued the case for increased taxes on corporations, but this is ultimately paid by consumers too, and can actually have detrimental effects on the economy and revenue, more than a GST hike would. We do want to convince multinational corporations to report their profits in Canada, not overseas.

Think about it though: If corporations are paying tax on profits, and those profits are earned by selling consumers goods and services, then it is really consumers that are paying the tax at the end of the day, not the corporation. It is just diverted away from the consumers immediate attention. If the corporation feels that it isn’t making the profit it should because of the corporate taxes it pays, then the corporate may increase prices for consumers, and how would that increase  be any different than a GST hike?

Luckily, with GST, we have credits already available for lower income families that can offset the costs of an increased GST rate so that it doesn’t hurt those already struggling to make ends meet. If we increase corporate taxes, however, and corporations raise costs on consumers, then we are limited in what we can do. The increase in corporate tax rates could actually hurt those that need our help.

Consumption taxes end up being a tax on the rich because those that spend more will pay more. It is also something that isn’t forced as a consumer can choose to spend less in order to pay less. The $11 billion or so in revenue that we could gain from an increase could help slashing our deficit, and could be applied to our debt so that the nation is in a more secure financial position. Once the fundamentals are solid, we will be in a better position to expand our social programs.

The Time for Progress: Dentacare, Pharmacare

Let us assume that we have created an economic climate of growth and employment, where there are more people working than ever before. Deficits have been eliminated, and we have a plan to eliminate the debt (which is also important. All it takes is a few economic downturns before the debt burden becomes too great on the nation. This in turn will discourage business and the country will end up digging a deeper and deeper hole trying to stimulate the economy with little success. We need to make sure we have the room to endure downturns.) Things are looking good, and current expenditures are sustainable. It is time for progress.

I know a lot of Liberals and NDPers would like to progress faster than this, but I believe that progress at too fast of rate is self-defeating. Everything ultimately ties back to GDP and the economy. Progress too fast, and the programs will be unsustainable and the case for cuts will be made. To progress without careful consideration of the economy is like borrowing money to buy a new vehicle without having any job security. The case for certain programs (especially those that better help people provide for themselves, or help those that are unable to) can be made all the time, but the “nice to haves” need to wait until we can afford it.

The first “nice to haves” I would like to see implemented are Dentacare and Pharmacare. These types of programs would benefit almost everyone, and not just a select few. It would be nice to know that getting sick and needing prescriptions, or needing to fix aching teeth, wouldn’t mean less disposable income. This could also give Canada an additional competitive edge to employers.

Progress is good, but we have to make sure that it can be sustained. Otherwise we become our own worst enemy.

Empowering workers: Unemployment and Jobs

The best social policy is one that helps someone provide for themselves through employment. People need jobs, but they need good paying jobs. Trying to convince private sector employers to pay good wages if they don’t feel the need to is almost impossible, but there is a way to do it.

We need to strive to obtain a low unemployment rate by creating private sector jobs. To create these jobs, the private sector needs the confidence to invest in Canada. When big businesses are making decisions, the accountant takes all costs into account (except, of course, Conservative accountants) before they determine where they intend to set up shop.  Hydro rates, taxes, labour prices, social programs (as benefits that they might have to provide employees otherwise, such as healthcare), and the job market all come into play. Businesses that are already set up  in Canada (factories for instance) might be willing to absorb higher costs to avoid start up costs elsewhere, but those that are planning their start up aren’t going to invest in Canada if they see it as being more affordable somewhere else. This is an undeniable fact in the way many businesses make decisions. Everything is a number. To attract more employers to Canada, there has to be some kind of competitive advantage. Right now, some of Canada’s advantage is the fact that our banks are solid, but working to foster job creation to reduce unemployment will best empower workers.

By fostering job creation, unemployment rates drop. As there are more employers looking to hire than there are people looking for work, employers will have to pay higher wages and more benefits to attract employees. It makes sense though, doesn’t it? If you really need milk but there’s only one store that sells it, they could charge you more because the market would favour the retailer. We want to create a job market that favours workers.

The second component to this is to anticipate for skill shortages and take measures to accommodate for that, at least to a degree. An inefficient job market will have more positions to fill than there are people to fill them, but the skills of the unemployed won’t match the jobs that are available. Liberals can help by supporting training programs that will help meet demand. In many respects, lower unemployment will make it so more employers will be willing to (or forced to) advance and train employees because it will be harder to find people to hire with the skills needed.

Taking measures to support job creation and reduce unemployment is the best way to guarantee prosperity. With new business in Canada and more people employed, government revenues will go up, deficits will go down. Once we have finances in order, we will be able to implement social programs  and won’t face as much criticism in doing so.

 

Ed Broadbent’s study and a new question

The recent study by the Broadbent Institute shows that Canadian’s are willing to pay slightly higher taxes if that’s what it would take to save social programs. If that’s what it would take, sure, no problem, but maybe we don’t all think that’s what it would take. Maybe cuts to middle management are what it would take. Maybe cutting spending from a low priority area and shuffling the savings to a higher priority area is what it would take. Maybe higher taxes would make the problem worse by decreasing revenues.

Personally, I think a tax bracket for higher income earners may be needed, and government priorities should be better set. We can’t be everything to everyone. Corporate taxes are tricky, because businesses might make choices that we don’t want if we raise their taxes too much. This could lead to greater unemployment, higher prices or decreased corporate tax revenue. Hard to say.

So what do people think? If social programs were being threatened, what should government do to save them?

Political Shift: Progressive Conservatives and Blue Liberals Struggle to find a home

The 2011 election gave rise to the NDP in a way that nobody could have predicted. It left Liberals wandering the political wilderness. Our strategy in 2011, as it often has been was to attract NDP voters to the Liberals to stop Harper. With the NDP rise in Quebec, NDP votes went where they belonged. With the NDP.

What is interesting, is that it provided Harper with a new strategy that may have well contributed to him gaining his much sought after majority.  Traditionally Liberals have claimed that a vote for the NDP is a vote for the conservatives, and that progressives should unite by voting Liberal. As the political tides changed, the new argument for the Conservatives was that blue Liberals and Progressive Conservatives that aren’t comfortable with the economic position of the NDP should unite by voting Conservative because a vote for the Liberals is a vote for the NDP. As a blue Liberal, or Progressive Conservative myself, it was a good argument.

Liberals have to move away from the old strategy and recognize that votes from the NDP will now belong to the NDP. We have been in power, had the chance to implement policies that would woo NDP leaning voters, and didn’t. NDP economics are not responsible and are likely to do more harm than good, so I’m happy we didn’t implement NDP-lite policy, but it means that in the new political climate, NDP votes will go to the NDP. Liberals need to seize the votes of those that are more fiscally prudent.

To do this it is important to be conscious of what they believe in. Progressive Conservative has often been thought to be an oxymoron, but it isn’t. They, like blue liberals are fiscally conservative but socially liberal, but what does that mean? At the core I think it means to be fiscally prudent while keeping an open mind, but I will try to elaborate further.

On the fiscal side it is a strong belief in maintaining balanced budgets, paying down debt, keeping the economy strong, and planning for the future. It means working to keep a low unemployment rate, because this will give the most bargaining power to employees so that they can earn better wages and benefits. It means limits on the roll of government, and setting priorities on what’s important, what’s not. Cut are sometimes supported if it’s believed that the wrong priorities have been made. Sometimes these cuts are so that other priorities can be made. It means taxation needs to be responsible, especially on the corporate side. Charge too much in the way of corporate taxes, and revenues will go down. Charge too little, and you get more of the same. The rate should be at that which yields the most revenue (measured against the economic climate), while being fair.

On the socially liberal side, it is a belief in social policy that leads to greater equality of opportunity, without ignoring individual responsibility. It also needs to be done in the best possible way, that keeps costs down so that it is sustainable. One issue that is a good example is post secondary education. I tend to believe in the need to ensure that everyone that  gets the grades gets to go, but also think that this needs to be structured in the shape of a loan. This is so that those that go think carefully about their decisions and don’t drain the system by training to be a social worker, then a paramedic, then an accountant. Individual responsibility is important. They also recognize that some things are just necessary to the health and well being of citizens, like health care that ensures that everyone can have access regardless of ability to pay. They also believe that it does no good to expect those less fortunate (on welfare, perhaps) to find a job if we refuse to do anything, or do very little to help them gain marketable skills. Sure, they can end up off the rolls for a few months with a low wage job, but it is only a matter of time before they are back on the rolls because of job loss and having the same set of skills they had to begin with. Sometimes people need helped into a position where they can better contribute to society.

Really, how many would choose to live in poverty if they had the opportunity not to?

National Daycare: A Fair and Sustainable Strategy

It is getting harder and harder for families to make ends meet, and most two parent families require that both mom and dad work.  Given the cost of daycare, it is understandable that government assistance is required. I think the goal should be to open opportunities for parents by helping them to offset the cost of childcare.

Sweden is one of the countries that is referenced frequently in the case for national daycare. The preschool portion of their system (which is basically what the NDP and Liberals had agreed to back in the day. Preschool daycare only.) costs the government about $10,500 Canadian per child per year according to the OECD. This doesn`t seem unreasonable, however, it is important to remember that this is what the existing Swedish system costs, as the preschools are already in place. In Canada, our costs would likely run considerably higher initially because of start up and implementation costs to build the system. Numbers have been thrown around up to and sometimes even higher than $30’000 per child per year.

As I see it, the problem with the subsidized daycare approach is that Preschool funding is limited in who it helps. It also could present similar problems to what we sometimes see in other public systems, where services are diminished while costs keep rising so access maybe denied and would-be users are wait-listed. We want a strategy that is efficient, works and doesn’t leave people out that need the help.

I think that a strategy that provides geared to income benefits to parents to assist with the cost of childcare is the right approach to take. Many parents that need assistance make childcare choices that won’t fit the subsidized spaces model.  Many parents use another family member (in my case we often use my retired mother), or tailor work schedules between mom, dad & babysitters so that daycare isn’t needed very often. Many homes have one parent that stays at home due to unemployment, while the other works. When children are under a year it is very difficult to find providers that want to care for that age group. This can force one parent to stay at home, and single parents face even greater challenges. The need for assistance is undeniable in many situations that don’t fit the shape of subsidized daycare. If we give a direct benefit to parents, we do have to be careful that it doesn’t discourage employment. I think it is unlikely to occur in most cases, but not impossible.

Obviously, the benefit I propose will not address a shortage in spaces, but if parents want more spaces, the private sector will likely respond. If it is known that this childcare benefit will be put into action, it is very possible that entrepreneurs may see it as a business opportunity and create spaces in advance. No matter what is done, parents will always find a way to make sure that their children are cared for, whether in a daycare setting or not. Government should help with the costs of childcare so that opportunities are available to more families, but government isn’t needed to provide the spaces too, anymore than it is needed to put children to bed.