April 4th, 2023
Written by Dominic Cardy
Justin Trudeau is the magpie of modern Canadian politics. Every year there’s something new and shiny that to be picked up, played with, displayed for everyone to see, before being abandoned in pursuit of the next big thing. It’s been that way since the beginning: Marijuana! Democratic reform! Deliverology! Child care! Dentists!
Not surprising for a Prime Minister who is – like him or not – an incredible political communicator. Not surprising for someone born to privilege, who grew up watching his father move political mountains without ever having to be in the departmental offices or on the doorsteps where political dreams and policy reality collide. Announcements are always more exciting than the implementation.
The Prime Minister is a leader for our times. Our collective average attention span has dropped by more than a third since 2000. Our media is equally flighty, resource-starved and with little of the deep analysis that used to offer a view of the world most people agreed was based on truth, even if we disagreed on interpretations.
I write this as someone who supports government programs when evidence, or research that’s based on evidence, suggests the public sector can offer programs at a lower cost, or more efficiently, than the private or voluntary sector. The two-hundred-year argument about whether the government should run everything, or nothing, is over. Over everywhere, except in the world of partisan politics, where posturing about being for or against big government, or privatization, continues to widen the gulf between politicians and citizens.
But agreeing government has a role to play doesn’t mean it should play that role. Building a government program requires a commitment to the sort of long-term planning that is increasingly unpopular. It requires a focus on the strength and sustainability of new programs.
The Canada Wide Agreement on Early Learning and Child Care is a great example of how this problem hurts Canadians. Investments in affordable, high quality early childhood education are proven to open economic opportunities for parents, especially women, and to improve outcomes for children. We have the data. What we don’t have? Sufficient resources.
Until last year I was New Brunswick’s minister for education and early childhood development. I was proud of the deal we negotiated with federal colleagues to open up thousands of early childhood education spaces for families that need them. I was equally concerned about the federal government living up to its promises to support its own flagship program.
Two years on and the program faces enormous pressures precisely because of its popularity. The federal government is covering most of the costs, for now, but this year’s budget will not meet the public need. That means the provinces will be left to carry the can, meaning they will have to add funds or face public backlash when some families cannot access the affordable care they were promised.
This disconnection is not an isolated problem. In this year’s budget, to placate the NDP, the federal government announced a broad dentalcare plan. Billions of dollars to start a plan that will be run out of Ottawa, without regard to different dentalcare plans already in place at the provincial level, and without sufficient funds to make the program universal.
When the next election comes there will be people saying, with honestly, that they are grateful for the access to childcare and dentalcare they didn’t have before. Their lives will be changed because of it. Others will say, equally honestly, that they can’t access any early childhood education spaces for their children, or at least not any affordable ones, and the same will go with people who need dental care. They will be more frustrated than they were before.
Poorly resourced programs make great headlines when they’re launched but end up contributing to divisions that last beyond the latest smile-filled press conference. That frustration undermines support for social programs, in those paying for them who can’t access them, and among taxpayers who hear familiar rhetoric but see an increasingly-familiar lack of results. Hearing the feds and the provinces complain about how neither are paying their fair share doesn’t help.
Similarly, the inconsistencies between programs drives public frustration. While Ottawa pushed provinces to embrace a not-for-profit model for early childhood education, they created an unnecessary division between those centres and those run for often minimal profit. You can debate the politics behind this, but it was bizarre that, in another corner of the Trudeau government, millions of dollars were invested in “social enterprises” – organizations that are nominally businesses but exist only to meet a social need. There was no effort made to designate for-profit centres as social enterprises. Why? Poor planning. The consequence? An already overstretched early childhood education system that is now divided based on competing business models.
Over in healthcare, it’s the same thing. Doctors are mainly private businesspeople, running offices, hiring and firing staff, paying rent. They run businesses, but all their revenue comes from the government. Which is fine, and now we see a similar plan being established where existing businesses – dentists – will be able to submit bills to the government too. This is being hailed as a huge and progressive move, and I don’t doubt that it will help many Canadians.
So, if doctors always have been and dentists are now going to be part of the border-zone between the public and private sector, surely the same approach could be used for surgeries, for medical clinics providing services of all sorts, using the same model of competition for services, under a single payer model? No. The government says that is unacceptable privatization.
There is a lack of joined-up thinking, here. So long as healthcare is free on point of delivery, competition in service delivery should be encouraged: there is no conflict between a public system and competition between providers. Competition increases quality and lowers costs. When the foundations of our healthcare system are cracked, the only responsible action is to make sure that we have already built is repaired, before expanding into new areas.
Instead of a political deal to create a patchwork dentistry program: invest in the primary care system Canadians are already paying for, but in too many cases not receiving. When every Canadian can access to primary care, ideally as part of a collaborative care network where all medical professions can work to the full scope of their practise, then we can talk of expansion.
It’s time politicians focused on results. For now, Canada remains a wealthy and stable country. As the world becomes more dangerous and complicated, we will become more worried about where our money is going. For politicians like me who believe in the power of the collective to solve some of our problems, the current approach is just making things worse. Let’s do less, and do it well. That’s the foundation for real progress, reflected in high quality services Canadians should once more be proud of.
Dominic Cardy is a Director of Centre Ice Canadians and Co-Chair of the Advisory Council