Alberta Politics & Government Thread 3.0

[opendoor]

Originally Posted by CliffFletcher

Do you have the source for that? All of the sources I have show Canada spending as much or more per capita on health care as northern European countries, but they don’t break down the private vs public.

While you and I might support increased taxes to boost health care spending, most Canadians don’t. Certainly not the 20-25 sales tax and across-the-board higher income taxes which European countries can rely on. No Canadian politicians who want to get elected are proposing anything along those lines - even the NDP in Alberta vow they wouldn’t impose a PST.

Which means increased health care spending is coming from two sources: diversion from the other big budget item of education, and higher public deficits. The latter has been particularly attractive for the last couple decades. But with higher interest rates here to stay, we can’t rely on ever-growing deficits anymore. So we can expect health care budgets to continue to consume other public spending priorities - especially education.

OECD data. Most of the top health systems spend more than Canada overall, and almost all of them (other than places with much cheaper labor) have more government funding.

So if we're going to compare to places like Germany, Norway, Sweden, Denmark, Netherlands, etc., it's not private funding driving the difference; it's a combination of more public/compulsory investment and/or lower labor costs. Unfortunately, we can only do so much about the latter. We could take steps to try to increase efficiency and I do wonder whether more decentralized hospital systems with some run by non-profits would help with that. But then, virtually all primary care and most specialists in Canada are run privately, and I don't think we're necessarily seeing huge efficiencies there.

And at the same time, we have inherent inefficiencies given our spread out population. The per capita health spending in the Northwest Territories is about 3-4x the Canadian average, for instance. That's something that most European countries don't have to account for.

So yeah, it is relatively simple that we need to introduce more money into the system. But if we're relying on real-world evidence, I don't really see the case that private funding that would allow people to jump ahead for treatment is the panacea.

If I had to make a somewhat educated guess on where the money should come from, it'd be through increased corporate funding/employment taxes. In places like Germany, businesses cover 50% of their employees' compulsory health insurance; so effectively, they're paying 7-8% of their gross labor cost in additional health premiums. And that's on top of the ~9% they have to contribute for pension and 3-4% for other things. So mandatory payroll taxes in Germany are over 20% of gross pay. In Canada, it's more like 8-9%.

And in the US it's similar, though obviously more money is paid privately. They have slightly higher payroll taxes than Canada, and then private health insurance is a massive cost for businesses on top of that. In Canada, we're kind of taking the worst of both worlds. We have relatively low corporate taxes, low payroll taxes, and yet our health care is funded through tax revenue. So businesses don't seem to be funding health care the way they do in most comparable countries.

I’ve found when I point out that Canadian doctors and nurses are among the highest-paid in the developed world, people tend to lose their ####. I’ll bookmark this comment for the future.

Our expensive and lengthy training plays a part there. Canadian and American doctors are required to have two four-year degrees, while European countries require a single 5 or 6-year degree to practice medicine. Whether that excessive training is due to tuition-hungry universities, or professional bodies trying to keep the number of practitioners low, it should be addressed as part of health care reforms.

That's true to some extent, but even specialists (who presumably have similar levels of training) are generally paid more in Canada. We have to compete more directly with the US (same language, similar training requirements, etc.) so that's kind of just the reality.

But that is something that's probably worth addressing. And I know some places (BC is one) are integrating more Nurse Practitioners into the system, which in the long term should save some money.

But we can see from the U.S. that private health care does increase the health resources in a country. The U.S. has more doctors per capita, more hospitals beds, and shorter wait times than Canada. Those assets are distributed unevenly, but the average American typically has better access to care than the average Canadian - it’s the poorest third of Americans who get worse care. Basically, Americans collectively spend more on health care than Canadians and get better care.

I’m not advocating for Canada adopting that system, just pointing out that private dollars can increase capacity. As you noted yourself, Canada has to pay high salaries to medical professionals in order to compete with the U.S., because the big dollars in the system down there attracts resources (ie labour).

The US actually has slightly fewer doctors per capita. But I agree, they have significantly more resources in terms of beds, nurses, etc. But again, it's not necessarily a private vs. public thing. If you take out every single dollar of private money from the US health system, they're still spending somewhere in the neighborhood of $6,700 per person. Canada's total spending (including public and private) is only $5,905 USD. So we'd need to bump up our total spending by almost 15% just to match the US's public spending. And if we wanted our public spending to match the US's, we'd have to increase it by almost 55%. Again, that completely ignores every single dollar of private health spending in the US. So talking about more private money doesn't make a whole lot of sense when we're comparing ourselves to a country that spends 55% more public money than we do.

[Major Major]

Originally Posted by pepper24

Or maybe rural voters just not interested in voting for an Edmonton strong union heavy big city political party. UCP does a better job identifying with them.

Identity politics is highly influential in the rural parts of the province, there is little doubt in that.

[bizaro86]

Originally Posted by GioforPM

And why would RCMP officers who quit to join the APP keep their RCMP pensions?

Presumably they'd be able to transfer their defined benefit pension credits accrued from the federal pension plan to the pension plan for the APP. That seems especially likely given there is already a process and an agreement in place for pension service credit transfers from the Federal public service to the Alberta public service, so no new agreement would required.

https://www.canada.ca/en/treasury-bo...ce.html#toc3-2

[MoneyGuy]

Originally Posted by Wormius

Which municipalities in Alberta have complained about poor service from the RCMP?

I’m aware that some rural municipalities have complained because of slow response time to outlying areas but none that I know of want to replace the RCMP.

[Major Major]

Originally Posted by Fuzz

https://twitter.com/user/status/1663668000006852608


It's OK though, I've been told disinformation isn't a threat to our democracy and people can figure things out themselves. Sorry, but some people are just too dumb. We need to put a stop to this rot, starting with Rebel and WS. Shut them down already. Unless you really admire what is happening in Florida.

I think that 'dumb' is a bit of a misnomer. Some of these people are successful at what they do and may be intelligent in other areas. But there is an evident inability or distain for critical thought when it comes to these things. If your political schema starts with, this is the party I like and this is the party I hate, then you have already admitted you don't want to think about things too much.

My hope is that it is getting better. In the last 10 years, other parties have made gains and other ideas are forming. The sensible goal is to have multiple strong parties that can bring strong policy to the table and have more competition for our provincial legislature. That would lead to the conservative party staying on the rails a little better. I have hope but I could see it going both ways. Alberta is certainly changing politically, there is no doubt about that.

[Ford Prefect]

Originally Posted by MoneyGuy

I’m aware that some rural municipalities have complained because of slow response time to outlying areas but none that I know of want to replace the RCMP.

As a rural Albertan with connections to rural areas across the province it’s true that rural areas are very underserved by policing. I don’t see that changing with a provincial police force funded by the UCP though. If anything it will get worse. UCP has shown their MO is to underfund vote poor rural areas to channel funding into vote rich urban areas. If anything I expect rural policing will get worse under a UCP funded provincial police force. There’s also the question of talent. Who will staff a rural police force and what level of competency will they have? You also have to know that the best talent will end up in urban areas. The same thing that has happened in education and health care will happen with policing. The best talent will end up in urban centres and the rural areas will be staffed by deadwood paycheque earners and new recruits who leave for urban jobs as soon as they can.

[looooob]

Originally Posted by calgarygeologist

Why would the governments care about over supply though? Would they benefit from increased supply and competition in the physician market? I'm not speaking in race to the bottom scenario for wages but moreso a benefit in terms of selecting candidates for their hiring.

maybe not sure I understand, most physicians are small business owners and not hired by government- I agree I suppose for some of the complex hospital based specialists you could argue more 'competition' ensures the 'best' get hired but that would be a pretty rough scheme to train a bunch of doctors with a plan not to hire some of them (especially given the cost to train them) sorry if I missed your point I think I might have

[PsYcNeT]

Originally Posted by Ford Prefect

As a rural Albertan with connections to rural areas across the province it’s true that rural areas are very underserved by policing. I don’t see that changing with a provincial police force funded by the UCP though. If anything it will get worse. UCP has shown their MO is to underfund vote poor rural areas to channel funding into vote rich urban areas. If anything I expect rural policing will get worse under a UCP funded provincial police force. There’s also the question of talent. Who will staff a rural police force and what level of competency will they have? You also have to know that the best talent will end up in urban areas. The same thing that has happened in education and health care will happen with policing. The best talent will end up in urban centres and the rural areas will be staffed by deadwood paycheque earners and new recruits who leave for urban jobs as soon as they can.

Based on the UCPs desire to emulate the US, I would guess they will try to institute a Vote In The Sheriff type system, but I don't not know that squares legally

[calgarygeologist]

Originally Posted by looooob

maybe not sure I understand, most physicians are small business owners and not hired by government- I agree I suppose for some of the complex hospital based specialists you could argue more 'competition' ensures the 'best' get hired but that would be a pretty rough scheme to train a bunch of doctors with a plan not to hire some of them (especially given the cost to train them) sorry if I missed your point I think I might have

I just don't see why governments would be concerned about over supply of physicians. If there is a high demand for medical school spots the governments/universities should aim to match the demand because they will get the tuition revenue so I don't see that as a cost concern. I also don't see the concern for the clinical business or the labour market for physicians in an over supply situation. Some of the grads will fill vacancies, some of the grads might have to go to international markets and some grads might sit on their degrees and have to consider a different field but this isn't a concern for the government.

[Fuzz]

Originally Posted by calgarygeologist

I just don't see why governments would be concerned about over supply of physicians. If there is a high demand for medical school spots the governments/universities should aim to match the demand because they will get the tuition revenue so I don't see that as a cost concern. I also don't see the concern for the clinical business or the labour market for physicians in an over supply situation. Some of the grads will fill vacancies, some of the grads might have to go to international markets and some grads might sit on their degrees and have to consider a different field but this isn't a concern for the government.

Tuition doesn't cover the full costs though(no idea the %), so every additional student is another taxpayer cost. Which is fine if they stay here, but if 1 in 4 leave because they can't find work in Alberta, it makes sense to cut 25% of spaces.

[opendoor]

Originally Posted by calgarygeologist

I just don't see why governments would be concerned about over supply of physicians. If there is a high demand for medical school spots the governments/universities should aim to match the demand because they will get the tuition revenue so I don't see that as a cost concern. I also don't see the concern for the clinical business or the labour market for physicians in an over supply situation. Some of the grads will fill vacancies, some of the grads might have to go to international markets and some grads might sit on their degrees and have to consider a different field but this isn't a concern for the government.

Post-secondary education is heavily subsidized, so more people paying tuition is a liability, not extra revenue.

And there are a few reasons why having more doctors could lead to a rise in costs:

-induced demand; there's strong evidence that more doctors in an area leads to more visits and more billing. So if that happens with no positive increase in health outcomes, it might be seen as wasted money.

-it could lead to more physicians working fewer hours. 10 doctors working 40hrs a week is going to be more cost effective than 13 working ~30 hrs a week.


And that report came at a time when governments were seeing massive debt servicing costs and huge deficits and the economy was in a recession. So they were basically looking for any way to could cut spending without significantly impacting services, and that was seen as a way to do it. And doctors per capita are up about 20% since then, so it's not like it reduced the number of doctors.

[Goriders]

Originally Posted by Ford Prefect

As a rural Albertan with connections to rural areas across the province it’s true that rural areas are very underserved by policing. I don’t see that changing with a provincial police force funded by the UCP though. If anything it will get worse. UCP has shown their MO is to underfund vote poor rural areas to channel funding into vote rich urban areas. If anything I expect rural policing will get worse under a UCP funded provincial police force. There’s also the question of talent. Who will staff a rural police force and what level of competency will they have? You also have to know that the best talent will end up in urban areas. The same thing that has happened in education and health care will happen with policing. The best talent will end up in urban centres and the rural areas will be staffed by deadwood paycheque earners and new recruits who leave for urban jobs as soon as they can.

Not sure how you avoid that unless you financially inventivize people to staff rural areas. Or hire locals.

[Faust]

Max Fawcett

As Premier, Danielle Smith's biggest opponent isn't Rachel Notley or Justin Trudeau -- it's the future. And the faster the energy transition moves, the further behind Alberta is going to be left. #ableg #cdnpoli

https://twitter.com/maxfawcett/statu...960928257?s=21


Markham Hislop @politicalham

This. All of this.

@ABdaniellesmith's job as premier is to fight battles for her junior and intermediate oil company backers as they figure out how to survive the energy transition or, more likely, how to exit without paying for their $300 billion of environmental liabilities.

https://twitter.com/politicalham/sta...713652225?s=21

[Faust]

The Breakdown @TheBreakdownAB

Here’s the thread that @ZiadFazel referenced last night on our show that spells out just how badly #yyc taxpayers seem to be getting taken to the cleaners on the arena deal!

#abpoli #ableg #cdnpoli

https://twitter.com/thebreakdownab/s...644106754?s=21

[calgarygeologist]

Originally Posted by Faust

The Breakdown @TheBreakdownAB

Here’s the thread that @ZiadFazel referenced last night on our show that spells out just how badly #yyc taxpayers seem to be getting taken to the cleaners on the arena deal!

#abpoli #ableg #cdnpoli

https://twitter.com/thebreakdownab/s...644106754?s=21

Shouldn't this be in the municipal thread so that we can lay the blame for this deal at the feet of our council?

[Wastedyouth]

Originally Posted by GioforPM

You said you lived in Ottawa and that gave you some sort of insight into how badly “Ottawa” runs things. So what does living in Ottawa have to do with it?

Whoops, quoted wrong post

[GioforPM]

Originally Posted by calgarygeologist

Here is an article on federal judge vacancies and issues:
https://www.cbc.ca/news/politics/sup...cies-1.6836145

The federal government is not the only player in Canada's justice system. Wagner also criticized the "chronic underfunding [of the courts] on the part of the provinces and territories."

The feds appoint judges. But they can only appoint what the provinces pay for and how much they make. A lot of lawyers have to take a pay cut to be a judge. The funding is the issue there. And criminal law is 75% in provincial courts anyway. Family court is 50-50.

The federal competence issue for managing judges is not how many - it's who.

[para transit fellow]

Originally Posted by Doctorfever

Where do you find what doctors compensations? Is it listed by province?

https://www.albertadoctors.org/fee-navigator

[CliffFletcher]

Originally Posted by opendoor

And that report came at a time when governments were seeing massive debt servicing costs and huge deficits and the economy was in a recession. So they were basically looking for any way to could cut spending without significantly impacting services, and that was seen as a way to do it. And doctors per capita are up about 20% since then, so it's not like it reduced the number of doctors.

But doctors today work fewer hours over their career than doctors in the past. Half of medical school graduates are women, who often take several years off to raise children, and reduce their hours when they do return. And both men and women in medicine (and other professional fields) work fewer hours per month than in the past, take more vacation, etc. Doctors also retire earlier than they did 30 years ago, when it wasn’t uncommon for them to continue working into their 70s. My own family doctor just turned 60 and has announced he’s retiring.

So we need to graduate more doctors per capita now just to provide the same hours of work as in the past.

[Table 5]

Originally Posted by opendoor

-it could lead to more physicians working fewer hours. 10 doctors working 40hrs a week is going to be more cost effective than 13 working ~30 hrs a week.

This wouldn't be the worst thing in the world. Having some more flexibility would result in less stress for doctors and probably better health care for the patient. My last doctor retired early because she was totally burnt out from the long hours and having to cram in as many patients as possible into her day. My brother is a specialist, and the guy can't ever seem to take a vacation as there's nobody to replace him if he does. I'm pretty sure if you asked him, he'd rather make a little less money, but have more time for his patients and himself.