The National To-Do List III: Not Health Care, Demographics


A quick note before we begin: Macleans recently had an article that asked whether people who smoke or eat too much really deserve health care, since they were burdening the system. I guess it’s a fair question, but consider this:

If you saw somebody who’d been hit by a car, would you lend assistance? Of course you would. Now, if this individual stupidly ran into traffic and got hit by a car, would you still lend assistance? I think you still would. Even if the person ran into traffic deliberately, it would still be the right thing to lend medical assistance, because denying medical treatment and allowing somebody to die is simply an inhuman thing to do. So why should smokers and obese individuals be any different? Dealing with their costs is what consumption taxes are for.

Anyway, on with the meat of the article.

Soon after the 2004 election, the newly elected prime minister Paul Martin held a highly photogenic first ministers’ conference in order to hammer out a deal that would “fix health care for a generation”. True to form, it was only after the first ministers shoved the cameras into the lobby and locked the meeting room doors that anything actually got done, although whether or not health care has been fixed for a generation is up for debate. In this session of parliament, newly elected prime minister Stephen Harper promises action on reducing waiting lists.

As the Constitution was for the 1980s, Health Care appears to have become Canada’s national toothache.

I don’t mind that our politicians are worried about the state of our health care system. I worry about it too. I want there to be a system available should I fall ill or have an accident. I want to be able to count on receiving prompt and quality medical assistance that won’t bankrupt myself and my family. And I’m altruistic enough to believe that everybody in Canada deserves similarly good treatment.

But successive governments, federal and provincial, are looking at the numbers with increasing alarm. In the provincial budget unveiled late last March by the McGuinty government, it was revealed that health care spending now swallows half of Queen’s Park’s revenues. Health care costs have been steadily increasing for years, and there seems little that we can do to stop this trend. To prevent health care from becoming a crushing burden on taxpayers, a number of people have advocated taking the health care system out of the hands of the public, bringing in private for-profit care, or encouraging the use of user fees.

The frustrating thing about this is that these advocates have a point. Health care is dominating our budget the same way that military spending is dominating the American budget. I like public health care. I also like debt reduction and spending on education and public transit. But the problem with the advocates’ solution is that it won’t work. Public and private health-care advocates are merely rearranging the deck chairs of the Titanic. It’s not that our public health care system is any less efficient than a private for-profit system. The problem is, we’re just getting too old.

In 2010, our first baby boomers will reach retirement age. This means that more and more of our workers, some of whom pay the highest tax rates in the country and spend oodles of dollars, will take their productivity out of the workforce, cash in their RRSPs, pay fewer taxes, spend less and invest less.

Just ten years later, our first baby boomers will be reaching the age of average life expectancy. They will begin to die of natural causes. In Canada today, 250,000 people die from natural causes each year. By 2025, you can expect that number to double. Imagine what 250,000 additional deaths per year will do to this country. The SARS outbreak in 2003 highlighted the limitations of our hospitals, and don’t forget that many of these 250,000 people will need palliative care in the months and years leading up to their passing. Who foots the bill for that?

Health care is not, typically, a voluntary expense. What little voluntary health care does exist (such as elective surgery) is usually not funded by our health care or private insurance systems. If you are hit by a car or you contract a disease, your choices are to get help, or die. The expense is not one you can avoid. All you can do is try to plan ahead and share the risk, spreading out the cost among as many days as possible when you are healthy, or among as many people as possible who won’t need the service, either by funding a universal public health care system out of the tax base, or by taking out private insurance.

But whether you have a tax supported system or rely on private insurance, the cost of health care remains. If it goes up thanks to the changing demographics of our society, the cost impacts upon the economy. Moving it off the tax base onto the backs of private insurers simply shifts the burden. And more than just health care costs, consider the cost of millions of baby boomers cashing in their RRSPs, working less and spending less.

The automotive industry is not one I would invest in at the moment, unless the company was selling most of its cars to the burgeoning (and younger) overseas market. If I wanted to keep my cash in Canada, a growth industry that I’d look at is retirement centres and funeral homes.

So, it’s your choice. As the number of our country’s healthy workers drops and the number of retirees requiring health care increases, the economic burden will increase, and eventually it could hit intolerable levels. If we let the marketplace handle it, private insurers will find themselves unable to maintain their profits without raising premiums and cutting people off insurance rolls. If we let the taxpayers handle it, health care costs will raise taxes through the roof and push out other government programs. Under private care, I expect we will leave people to die uninsured and in poverty, and that some will kill themselves in order to spare their children the burden. Under the government, I predict that at least one MP in the next twenty-five years will stand up and suggest a mandatory euthanasia program to ease the suffering.

Pick your poison.

The problem, clearly, is demographics. The solution is to change the demographics of the nation. We need to make Canada, as a whole, younger and healthier. We need more workers to support our new retirees.

We could try raising the retirement age and ending mandatory retirement, but that would only delay the inevitable. And let’s give these people a break: they’ve been working for forty years or more; they deserve time to enjoy their golden years.

We could try encouraging people to breed, but I doubt that would help. Quebec tried this in the late 1980s, and it didn’t work. Moreover, by the time the first children born in a new “get paid to get laid” strategy reach the age where they join the workforce, the worker shortage would already have been in place for almost a decade, and let us not forget the cost of providing these young workers with the education they will need to be productive. Besides, it seems unethical to encourage indiscriminate breeding when the rest of the world is so severely overpopulated.

Which leaves immigration.

Erin is a recent immigrant to Canada. The lovestruck woman left her home in Omaha, Nebraska to come to Canada to be with me and make a family (I still can hardly believe how lucky I am). It took two years and $1475 in fees in order to set her status as a landed immigrant in this country. For this reason, I am always shocked and a little angered to hear people go on about how it’s too easy for immigrants to get into Canada. That sentiment has more than a tinge of ignorance and racism about it.

The only reason Erin is in Canada today is because we signed statements to Immigration Canada that we would marry no less than 180 days after Erin’s landing. Due to delays, we’d already been married a year by the time the paperwork finally arrived. Erin is a particle physicist, with a Bachelor’s Degree, and experience gleaned at the CERN particle accelerator facility in Geneva, Switzerland.

Think about that: she’s a nuclear freakin’ physicist and yet she was unable to cross into this country on her own merits.

Our points system requires that people have work experience linked to their education experience, which eliminates recent college graduates from contention. Immigration Canada does have a list of job titles that it believes this nation is short on, but if you’re job is not on the list, you are out of luck. Erin was actually recruited in a nationwide search by the Canadian Space Agency to coordinate scientific experiments that could be performed by schools and taken up on the American space shuttle program. She was told that she was the best candidate in the country. Unfortunately, since “coordinator of outer-space experiments” is not exactly on Immigration Canada’s list, they vetoed the Canadian Space Agency’s decision and told them to pick a qualified Canadian candidate that didn’t exist. All told, given the time and money and frustration, we were left wondering if Canada wants immigrants at all.

We already have a shortage of doctors, but laws prevent immigrants trained outside of the United States and the United Kingdom from practising, and these people end up driving taxis. We have a shortage of skilled workers, and yet we are deporting illegal immigrants from Portugal who know how to use their tools. We still do not accept recent college graduates unless they consent to marry Canadians. The Conservative government, to its credit, has committed to lowering the immigrant head tax, but won’t eliminate it completely. And meanwhile, the demographic time bomb is ticking.

A shortage of workers will probably raise average pay rates. I have no doubt that skilled workers who come to this country will find employment, as long as we make it easier for them, and give them the services they need to function in this country. In some ways, we find ourselves where we were at the end of the 19th century, with a whole lot of territory to cover, and a desperate need for labour to open up the last best west. This time, the territory we need to open up is time itself. We have people outside our borders who can lend this country so much, and make a paraphrase of Wilfrid Laurier’s famous quote, “the twenty-first century belongs to Canada” a reality.

We just need the courage to open up our doors and put out the welcome mats.

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