Restrained Healthcare Spending Anchors Ontario’s Balanced Budget


On April 27 the Ontario government presented a balanced budget for the 2017-18 fiscal year, a projection made credible by last year’s estimated deficit of $1.5 billion. The return to balance marks an important milestone in the fiscal journey from deficits of $19.3 and $14 billion for 2009-10 and 2010-11 respectively. How did they do it?

One perspective is to analyze how the story played out relative to the projections and recommendations of the 2012 report of the Commission on the Reform of Ontario’s Public Finances. The Commission was established in 2011 to advise how to return to balance by 2017-18. Its plan was based on spending restraint coupled with almost no policy-based revenue enhancement. Continue Reading »

Post-Mortem on the Commission on the Reform of Ontario’s Public Services: Discipline in Health Spending the Anchor to Returning to Budget Balance


The Ontario Government struck the Commission on the Reform of Ontario’s Public Services (the Commission) in 2011 with the singular mandate of advising on how to balance Ontario’s budget by 2017-18. The Commission reported in early 2012 with a plan to balance the budget in 2017-18 on the basis of restraint in spending and almost no policy enhancement to revenues. The Commission used what it felt was modest, but realistic economic assumptions.

The Commission was created in the context of an Ontario deficit of $19.3 billion in 2009-10 and $14.0 billion in 2010-11. There was little confidence from analysts, the media and likely the public at the time that the deficit would be reined in and considerable skepticism that the Government would limit spending as severely as the Commission recommended. Yet on April 27, 2017 the Ontario Government released a budget showing a balanced budget for 2017-18. Continue Reading »

A Vision of Healthcare in the 21st Century


(This is a condensed version of our Publication “Wanted: Leadership for Healthcare”, C.D. Howe Institute Verbatim, June 8, 2016)

Canada needs both ‘top-down’ and ‘bottom-up’ leadership to create a genuine system to meet our 21st century needs for health and healthcare services at a cost each province, territory and the country can afford. Governments need to step up to governing, of re-vamping the ‘delivery system’; doctors, nurses and other providers have to find better ways of working together.

Leaders would start afresh by envisioning a reinvented healthcare system. It would provide equitably the range of high-quality services needed to optimize the health of the population; its elements would be affordable, informed, and smoothly connected.

Their first step would be to create the new system’s apolitical governance, answerable ideally to the federal and provincial/territorial governments working together[1]. Continue Reading »

Trump’s impulsive missile strikes against Syria have changed nothing and could ultimately prove counterproductive.


This op-ed first appeared in Policy Options on April 11, 2017.

On the evening of April 6, Trump took a break from hosting Chinese President Xi Jinping at the Mar-a-Lago residence to launch air strikes in Syria, targeting the Shayrat airbase. The strikes were punitive, ordered after US intelligence indicated that Bashar al-Assad had once again gassed his own people, killing more than 80 men, women and children. The US strikes were also futile, the knee-jerk reaction of a president who has not planned his next move, let alone thought through a strategy to end the Syrian conflict.

The night Trump called for those strikes, US allies, Canada included, were not consulted, they were notified. According to reports, Trump called Prime Minister Justin Trudeau one hour before the missiles were launched and asked for political support. Continue Reading »

Why is Transformation of Healthcare so Hard?


The need for change in healthcare has been obvious for years. Many studies have been conducted and recommendations made on what’s needed to meet optimally the needs of the population in the current and coming decades. But change itself has been very scarce.

One reason is that none of our 14 provincial/territorial/federal healthcare delivery ‘systems’ has a single governance; the place where the ‘buck stops’ with respect to what each does and does not accomplish and how well or poorly. It is only by default that Canadians hold their governments accountable for how well their hospitals, physicians, pharmacists, and other providers meet their changing needs for healthcare services. On the other hand that there are 14 ‘systems’ could be an advantage as it was when Saskatchewan’s pioneering introduction of Medicare was copied by other jurisdictions.

That there is no governance of healthcare’s delivery rests on David Naylor’s phrase “public payment for private practice”. Continue Reading »